Association between maternal adiposity measures and adverse maternal outcomes of pregnancy: Systematic review and meta-analysis

Abstract

Maternal obesity increases pregnancy-related risks. Women with a body mass index (BMI) ≥ 30 kg/m² are considered to be at risk and should receive additional care, although approximately half will have uncomplicated pregnancies. This systematic review aimed to identify early pregnancy measures of adiposity associated with adverse maternal health outcomes. Searches included six databases, reference lists, citations, and contacting authors. Screening and quality assessment were carried out by two authors independently. Random effects meta-analysis and narrative synthesis were conducted. Seventy studies were included with a pooled sample of 89,588 women. Meta-analysis showed significantly increased odds of gestational diabetes mellitus (GDM) with higher waist circumference (WC) categories (1.40, 95% confidence interval [CI] 1.04, 1.88) and per unit increase in WC (1.31, 95% CI 1.03, 1.67). Women with GDM had higher WC than controls (mean difference [MD] 6.18 cm, 95% CI 3.92, 8.44). WC was significantly associated with hypertensive disorders, delivery-related outcomes, metabolic syndrome, and composite pregnancy outcomes. Waist to hip ratio was significantly associated with GDM, hypertensive disorders, and delivery-related outcomes. Fat mass, neck circumference, skinfolds, and visceral fat were significantly associated with adverse outcomes, although limited data were available. Our findings identify the need to explore how useful adiposity measures are at predicting risk in pregnancy, compared with BMI, to direct care to women with the greatest need.

Keywords: adiposity; maternal; obesity; pregnancy.

FIGURE 1

Meta‐analysis of the association between waist circumference categories and gestational diabetes mellitus. Categories of high waist circumference reported by the included studies were >80 cm (Popova et al., Gao et al., Ebrahimi‐Mameghani et al., Zhu et al., and Campbell et al. ⁴⁶ ), >84.5 cm (Hancerliogullari et al. ⁵⁸ ), >78.5 cm (Han et al. ⁵⁷ ), and not defined (He et al. ⁶⁰ ). CI, confidence interval; OR, odds ratio; RE, random effect

FIGURE 2

Meta‐analysis of the association between waist circumference as a continuous measure and gestational diabetes mellitus. *Data restricted to women with a body mass index ≥ 30 kg/m². Units of measurement for increase in waist circumference reported by the included studies: 1 standard deviation (Sina et al., Han et al., and Harville et al. ⁵⁹ ) and 1 cm (White et al. ⁹⁷ ). CI, confidence interval; OR, odds ratio; RE, random effect

FIGURE 3

Meta‐analysis of the association between waist circumference (mean differences) and gestational diabetes mellitus. *Data restricted to women with a body mass index ≥ 30 kg/m². **Data restricted to women with a body mass index ≥ 25 kg/m². Dakshnamurthy et al. excluded women with obesity (for control). CI, confidence interval; MD, mean difference in cm; RE, random effect

FIGURE 4

Meta‐analysis of the association between waist circumference categories and hypertensive disorders. Waist circumference categories reported by the studies were ≥80 cm (Ebrahimi‐Mameghani et al. and Sattar et al. ²¹ ) and ≥65 cm (Wen et al. ¹⁰⁴ ). Data marked as ⁽²⁾ were for preeclampsia; other data were pregnancy‐induced hypertension. CI, confidence interval; OR, odds ratio; RE, random effect

FIGURE 5

Meta‐analysis of the association between waist circumference (mean differences) and hypertensive disorders. Kausar et al. and Sina et al. reported combined category of preeclampsia or gestational hypertension; Sween et al. and Taebi et al. reported preeclampsia. CI, confidence interval; MD, mean difference (cm); RE, random effect