Background/Objectives: Maternal obesity is a known risk factor for pregnancy complications. Obesity is commonly associated with metabolic disturbances, however the obese phenotype may exist in the absence of these. The impact of maternal metabolic health, as a clustering of metabolic abnormalities, and that is independent of obesity, on pregnancy outcomes, has not been investigated. The aim was to determine whether metabolic phenotype, with or without obesity, associates with adverse pregnancy outcomes (spontaneous preterm delivery, small- and large for gestational age (SGA, LGA), intrauterine growth restriction (IUGR), macrosomia, preeclampsia (PE) and gestational diabetes (GDM)).
Subjects/Methods: Participants with complete data from the large multi-centre Screening for Pregnancy Endpoints Study (SCOPE) were included (n=5488). Metabolic phenotype was determined according to modified criteria used for metabolic syndrome (<4 abnormalities vs ≥4 out of 8 abnormalities: glucose, mean arterial pressure, lipids, waist circumference, CRP at 15 weeks gestation), and additionally categorized for obesity (BMI ≥30 kg/m2 vs <30 kg/m2). Multivariable models were used to assess the relationships between metabolic phenotype and pregnancy outcomes.
Results: Compared to metabolically healthy and not obese, being metabolically unhealthy and not obese increased risk for GDM (OR 4.85; 95% CI: 2.56, 9.19) and PE (OR 2.31; 95% CI: 1.51, 3.52), and being metabolically unhealthy and obese increased risk for GDM (OR 4.85; 95% CI: 2.56, 9.19), PE (OR 2.31; 95% CI: 1.51, 3.52), SGA (OR 1.59; 95% CI: 1.10, 2.29) and IUGR (OR 1.87; 95% CI: 1.18, 2.95).
Conclusions: The combination of poor metabolic health and obesity increased risk for aberrant fetal growth, while poor metabolic health, significantly increased risk for GDM in lean women. In lean and obese women, assessment of metabolic profile is warranted early pregnancy, if not before, so that targeted interventions to improve maternal metabolic health and pregnancy outcomes can be achieved.