Maternal Adipose Tissue Expansion, A Missing Link in the Prediction of Birth Weight Centile

Abstract

Context Maternal body mass index (BMI) is associated with increased birth weight but does not explain all the variance in fetal adiposity. Objective To assess the contribution of maternal body fat distribution to offspring birth weight and adiposity. Design Longitudinal study throughout gestation and at delivery. Setting Women recruited at 12 weeks of gestation and followed up at 26 and 36 weeks. Cord blood was collected at delivery. Patients Pregnant women (n = 45) with BMI 18.0 to 46.3 kg/m2 and healthy pregnancy outcome. Methods Maternal first trimester abdominal subcutaneous and visceral adipose tissue thickness (SAT and VAT) was assessed by ultrasound. Main Outcome Measures Maternal body fat distribution, maternal and cord plasma glucose and lipid concentrations, placental weight, birth weight, and fetal adiposity assessed by cord blood leptin. Results VAT was the only anthropometric measure independently associated with birth weight centile (r2 adjusted 15.8%, P = .002). BMI was associated with trimester 2 and trimesters 1 through 3 area under the curve (AUC) glucose and insulin resistance (Homeostatic Model Assessment). SAT alone predicted trimester 2 lipoprotein lipase (LPL) mass (a marker of adipocyte insulin sensitivity) (11.3%, P = .017). VAT was associated with fetal triglyceride (9.3%, P = .047). Placental weight was the only independent predictor of fetal adiposity (48%, P < .001). Maternal trimester 2 and AUC LPL were inversely associated with fetal adiposity (r = -0.69, P = .001 and r = -0.58, P = .006, respectively). Conclusions Maternal VAT provides additional information to BMI for prediction of birth weight. VAT may be a marker of reduced SAT expansion and increased availability of maternal fatty acids for placental transport.

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

“…Our findings are in agreement with a similar, but smaller, study by Jarvie et al 32 , where abdominal subcutaneous and visceral adipose tissue thickness were measured by ultrasound at mean 12.4 weeks of gestation in 45 pregnant women. The study shows that first trimester visceral adipose tissue thickness, but not abdominal subcutaneous adipose tissue thickness or first trimester BMI, is associated with birthweight centile.…”

“…Besides, the authors report an association between first trimester visceral adipose tissue thickness and fetal cord plasma triglyceride at delivery. Of note, fetal cord blood was available from only 23 of the pregnancies 32 . In non-pregnant individuals, fat accumulation in visceral fat tissue and other organs is proposed to occur when the adipocytes in the subcutaneous fat tissue are unable to store triglycerides 48 .…”

“…In non-pregnant individuals, fat accumulation in visceral fat tissue and other organs is proposed to occur when the adipocytes in the subcutaneous fat tissue are unable to store triglycerides 48 . Jarvie et al hypothesize that in pregnant women with visceral fat accumulation, the fatty acids are transported to the fetus by the placenta, instead of being accumulated in ectopic organs, subsequently leading to higher birthweight 32 .…”

Early Appearance of Epicardial Adipose Tissue through Human Development

“…On the other hand, maternal diet quality (assessed by the Healthy Eating Index-2015) during pregnancy and lactation was positively associated with infant percent body fat (%BF) and fat mass (in kg, by air displacement plethysmography, ADP) at 6 months of age [ 50 ]. Specifically, VAT thickness (measured by ultrasound) in the first trimester explained the variations in the newborn birth weight centile to the greatest extent compared to subcutaneous adipose tissue and BMI [ 51 ].…”

Adipose Tissue Development and Expansion from the Womb to Adolescence: An Overview

“…Findings from a large study including 1173 mother–child pairs (mostly Caucasians) demonstrated that maternal obesity during early pregnancy was associated with a 0.63 standard deviation increase in body mass index (BMI) z-score ( p = 0.006) and a 11.5% increase in sum of skinfold thickness ( p < 0.001) in children at 6 years old (adjusted analysis for maternal covariates) [ 34 ]. More specifically, VAT thickness (measured by ultrasound) in the first trimester explained the variations in newborn birth weight centile to the greatest extent compared to SAT and BMI (R 2 = 15.8%, p = 0.002) [ 35 ]. Interestingly, maternal diet quality (assessed by the Healthy Eating Index—2015) during pregnancy and lactation was positively associated with infant percent body fat (%BF) and FM (in kg, by air-displacement plethysmography (ADP)) at 6 months of age [ 36 ].…”