Impact of maternal central adiposity on infant anthropometry and perinatal morbidity: A systematic review

Abstract

Overweight and obesity during pregnancy are risk factors for a large number of perinatal complications, both for the mother and the infant. Risk stratification and early interventions are therefore highly clinically important to minimize future complications. Currently, body mass index (BMI) in early pregnancy is used for risk stratification of pregnant women, but a disadvantage of BMI is that it does not distinguish muscle from fat tissue and central from peripheral adiposity. Maternal fat distribution is suggested to be a better predictor than BMI of obesity-related adverse pregnancy outcomes, with central adiposity posing a greater risk than peripheral subcutaneous fat. With this study, we aimed to systematically review the evidence of what impact maternal central adiposity in early to mid-pregnancy or at most 365 days prior to conception has on infant anthropometry and perinatal morbidity. The databases PubMed/MEDLINE, Web of Science Core Collection, CINAHL, SCOPUS, Clinical Trials, and Open Grey were searched from inception until November 2019. Eligible studies assessed the association between maternal central adiposity, in early to mid-pregnancy or at most 365 days prior to conception, and any of the following infant outcomes: preterm delivery (< 37 weeks of gestation), birthweight, macrosomia, large for gestational age, congenital malformations, hypoglycemia, hyperbilirubinemia, care at neonatal intensive care unit, and death. Two authors independently screened titles and abstracts, read the included full-text studies, and extracted data. The Newcastle-Ottawa Quality Assessment Scale for cohort studies was used to evaluate the quality of and risk of bias in the studies. A total of 720 records were identified, 20 full-text studies assessed for eligibility, and 10 cohort studies included in the review. The results suggest that central adiposity in early to mid-pregnancy or at most 365 days prior to conception may contribute to increased birthweight and increased likelihood of delivery by cesarean section. There is also some evidence of associations between central adiposity and preterm delivery (< 37 weeks of gestation), and admission to neonatal intensive care unit. A meta-analysis was not possible to perform due to substantial heterogeneity among the included studies regarding the exposure, outcome, and statistical methods used. Hence, central adiposity in early to mid-pregnancy or at most 365 days prior to conception could be a possible risk marker in addition to BMI for risk stratification of pregnant women. However, since the topic is only scarcely researched, and the results not unanimous, more studies are needed to further clarify the associations between maternal central adiposity and adverse neonatal complications, before any altered recommendations of guidelines could be made. To enable a future meta-analysis, studies using similar methods for central adiposity assessment,and similar outcome measures, are required.

Association of maternal central adiposity measured by ultrasound in early mid pregnancy with infant birth size

“…Previous studies show associations between maternal central adiposity and infant birth size 12 – 18 , 32 , but the studies use several different methods to assess central adiposity 33 . To our knowledge, only two previous studies report on the association between ultrasound measurement of central adiposity including assessment of visceral fat tissue and infant birth size 15 , 32 , the first including only adolescent mothers 15 , and the second evaluating only 45 women 32 .…”

Gestational potential space hypothesis

“…It is crucial to emphasize the term “non-diseased” human state; in some diseases, such fat diversion is disabled or reversed, such as polycystic ovarian syndrome (PCOS), congenital lipodystrophy and Cushing syndrome, which are characterized by fat distribution to the visceral compartment instead of the gluteofemoral region resulting in a high risk of infertility [ 21 ]. The presence and amount of maternal visceral adipose tissue during the first half of pregnancy has been found to be predictive of gestational [ 22 , 23 ] and neonatal complications [ 24 ]. It is important to point out that infertile women of normal weight, with PCOS and primary amenorrhea, exhibited a high amount of fat tissue, as well as a tendency toward visceral fat distribution [ 25 , 26 ].…”

“…Intra-abdominal visceral fat increases the IAP which may be responsible, fully or in part, for the high risk of complications in pregnancy with visceral adiposity [ 30 ]. Conditions with increased intra-abdominal mass, such as visceral obesity and twin pregnancy, increase the risk of pregnancy complications [ 23 , 24 , 31 ]. Multiple gestation also imposes higher IAP, shorter pregnancy duration, higher maternal and fetal morbidity and mortality [ 31 ].…”

Is overweight associated with periodontitis in pregnant women? Systematic review and meta-analysis

“…Obesity represents a major public health challenge because it is related to comorbidities, such as systemic arterial hypertension, diabetes mellitus, obstructive sleep apnea and cancers [13] . Excessive weight is associated with adverse effects in pregnancy such as arterial hypertension, pre-eclampsia, gestational diabetes mellitus, excessive babies’ size for gestational age, premature delivery, macrosomia, emergency cesarean section and forced delivery with the aid of instruments [8] , [14] .…”