Maternal metabolic risk factors and their association with birthweight
and cord blood insulin
Abstract
Objective To quantify the inter-dependency between maternal metabolic
risk factors and their association with birthweight and cord blood
insulin (CBI) level. Design Prospective cohort study. Setting Guangzhou
Women and Children’s Medical Centre (GWCMC). Population Pregnant women
with a singleton pregnancy who delivered at GWCMC between Jan 2015 and
Jun 2016 and had umbilical cord blood retained (total 1522). Methods
Multivariable linear regression and Additive Bayesian Network analysis
were used to investigate the association between maternal metabolic risk
factors (pre-pregnancy body mass index [BMI], fasting glucose, lipid
profiles, and early gestational weight gain [GWG]) and their
interdependency in predicting birthweight and CBI concentrations. Main
outcome measures Birthweight and cord blood insulin. Results High
maternal pre-pregnancy BMI was strongly associated with neonatal
birthweight (standardized adjusted regression coefficient [βstd] =
0.27, 95%CI 0.22-0.32) directly; and with CBI indirectly. Maternal
fasting glucose was positively associated with increased CBI (βstd=0.12,
95%CI 0.07-0.17). Maternal GWG was positively associated with increased
birthweight, but not with CBI. None of the maternal lipids profile was
independently associated with birthweight or CBI. Conclusions Maternal
pre-pregnancy overweight/obesity is the most influential upstream
metabolic risk factor for both maternal and neonatal metabolic health,
therefore weight management should be addressed from the preconception
period. Maternal dyslipidaemia appears to be secondary to maternal
metabolic dysfunction with no clear causality relationship with
metabolic adverse outcomes in neonates.