Excessive Pregestational Weight and Maternal Obstetric Complications: The Role of Adipokines

Abstract

There is a high frequency of overweight and obesity in women of reproductive age. Women who start pregnancy with overweight or obesity have an increased risk of developing maternal obstetric complications such as gestational hypertension, pre-eclampsia, gestational diabetes mellitus, postpartum hemorrhage, and requiring C-section to resolve the pregnancy with a higher risk of C-section surgical site infection. Excessive weight in pregnancy is characterized by dysregulation of adipokines, the functions of which partly explain the predisposition of pregnant women with overweight or obesity to these maternal obstetric complications. This review compiles, organizes, and analyzes the most recent studies on adipokines in pregnant women with excess weight and the potential pathophysiological mechanisms favoring the development of maternal pregnancy complications.

Keywords: adipokines; cytokines; maternal obesity; pregnancy complications.

Figure 1

Prevalence of excessive weight in women. Prevalence data are shown only for member countries of the Organization for Economic Cooperation and Development. Women aged 18 to 44 were included in most countries (Supplementary Table S1). Data are from the Global Obesity Observatory [5].

Figure 2

Risk of maternal obstetric complications in pregestational excess-weight women. All odds ratios (ORs) and relative risks (RRs) were compared to normal-weight pregnant women [8,9,10,11,12,13,14,15,16,17,18,19,20,21]. a: adjusted; PE: pre-eclampsia; mPE: mild pre-eclampsia; sPE: severe pre-eclampsia; SW: Swedish women; CW: Chinese women; GDM: gestational diabetes mellitus; ¹: GDM that required only dietary modifications; ²: GDM that required insulin therapy; PPH: postpartum hemorrhage; C1O: class 1 obesity; C2O: class 2 obesity; C3O: class 3 obesity; and CSSI: C-section surgical site infection.

Figure 3

Potential pathophysiological mechanisms of hyperleptinemia in women with obesity favoring the development of maternal obstetric complications. The arrowhead lines indicate stimulation, and the T-shaped lines indicate inhibition. GH: gestational hypertension; PE: pre-eclampsia; MR: mineralocorticoid receptor; GDM: gestational diabetes mellitus; IRS1: insulin receptor substrate 1; PEG2: prostaglandin E2; FL: failed labor; PPH: postpartum hemorrhage; and CSSI: C-section surgical site infection.

Figure 4

Potential pathophysiological consequences of hypoadiponectinemia in women with obesity promoting the development of maternal obstetric complications. The arrowhead lines indicate stimulation, and the T-shaped lines indicate inhibition. GH: gestational hypertension; PE: pre-eclampsia; NF-κB: nuclear factor kappa B; eNOS: endothelial nitric oxide synthase; and GDM: gestational diabetes mellitus.