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Background Preeclampsia is a major pregnancy complication associated with long-term maternal cardiometabolic disease. Research generally is focused on metabolic and pathophysiological changes during pregnancy; however, there is much less focus on the early postpartum period in subjects who suffered preeclampsia. The aim of this study was to (1) characterize energy intake and expenditure 6 months following normotensive and preeclamptic pregnancies and (2) examine associations between energy balance, body composition, insulin resistance measures (HOMA-IR), and clinical characteristics. Design A cross-sectional study 6 months following normotensive (n = 75) and preeclamptic (n = 22) pregnancies was performed. Metabolic measurements included anthropometrics measures, body composition via bioelectrical impedance analysis, 24-h energy expenditure via SenseWear Armbands, energy intake via a 3-day food diary, and serum metabolic parameters. Results Six months following preeclampsia, women had a significantly higher weight (77.3 ± 20.9 kg vs 64.5 ± 11.4 kg, P = 0.01), fat mass percentage (FM%; 40.7 ± 7.4% vs 34.9 ± 8.1%, P = 0.004), and insulin resistance (HOMA-IR 2.2 ± 1.5 vs 1.0 ± 0.7, P = 0.003), as well as reduced HDL levels (1.5 ± 0.4 mmol/L vs 1.8 ± 0.4 mmol/L, P = 0.01) compared to normotensive women. Women post-preeclampsia had lower activity-related energy expenditure (P = 0.02) but a decreased total energy intake (P = 0.02), leading to a more negative energy balance compared to their normotensive counterparts (−1942 kJ/24 h vs −480 kJ/24 h, P = 0.02). Conclusion Increases in insulin resistance and FM%, reduced high-density lipoprotein, and more sedentary lifestyles characterize the postpartum period following preeclamptic compared with normotensive pregnancies. Early post-preeclampsia interventions, such as lifestyle behavior change, should be implemented and assessed to determine whether they reduce long-term cardiometabolic risk in women who experienced preeclampsia during pregnancy.

Introduction Hypertensive disorders and poor dietary quality are associated with increased long-term risk of cardiovascular and metabolic disease. Energy intake patterns after hypertensive (HP) versus normotensive pregnancy (NP) may provide insight into these risk associations and their mechanisms. Objective/hypothesis Assess diet quality as measured by micronutrient and macronutrient intake six months after NP versus HP (either preeclampsia or gestational hypertension). Methods Prospective sub-study of the P4 (Postpartum, Physiology, Psychology and Paediatrics) study. Women were studied 6 months after NP versus HP. Energy intake (EI) was measured using a self-reported, three-day food diary and FoodWorksTM to calculate macronutrient and micronutrient intake. Results 74 women (60 NP, 14 HP) had complete, analysable 3-day food diaries 6 months postpartum. Maternal age (32 NP, 31 HP) was similar, however less (4/14; 29%) of the HP group were still breastfeeding (50/60; 83% of NP, p 0.001). Mean BMI was higher postpartum in HP (29 ± 8 versus 24 ± 4, p =0.02). Total average EI was 17% lower in HP (7909kJ versus 9534kJ NP, p = 0.02). Macronutrient intake (carbohydrate, fat and protein) was similar between groups. However, intake of several important micronutrients was significantly lower after HP, even allowing for the lower total EI, including Vitamin A (43% lower), riboflavin (36% lower), magnesium (34%), calcium (29%), iodine (29%) and phosphorus (24%). Women breastfeeding at 6 months (both after NP and HP, n=54) had higher carbohydrate and fat (but not protein) intake compared to women not breastfeeding (n=20), and also increased intake of Vitamin A, riboflavin, magnesium and iron. However, breastfeeding women also had higher EI, with their increased macronutrient and micronutrient intake approximately in proportion to their overall EI versus women not breastfeeding. Discussion Six months postpartum, women with previous HP have significantly lower reported micronutrient intake compared to NP, possibly reflecting poorer diet quality.