Yang Ziyi, Feng Gengchen, Gao Xueying, Yan Xueqi, Li Yimeng, Wang Yuteng, Li Shumin, Jiang Yonghui, Zhao Shigang, Zhao Han, Chen Zi-Jiang
State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Reproductive Medicine, Institute of Women, Children and Reproductive Health, Shandong University, Jinan, China.
National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, China.
Nat Hum Behav. 2024 Dec;8(12):2406-2422. doi: 10.1038/s41562-024-01994-6. Epub 2024 Oct 11.
Maternal adiposity deleteriously affects obstetrical health and has been associated with long-term adverse consequences in offspring. Here we conducted an umbrella review encompassing 194 observational meta-analyses, 10 Mendelian randomization studies and 748 interventional meta-analyses to appraise the published evidence on the associations between maternal adiposity and perinatal and offspring outcomes. Evidence grading suggested that 17 (8.8%) observational meta-analyses were supported by convincing evidence for 12 outcomes: maternal adiposity was associated with an increased risk of caesarean delivery following labour induction, infant mortality, Apgar score <7 at 1 min, antenatal depression, offspring overweight and obesity, early timing of puberty onset in daughters, attention deficit hyperactivity disorder, cerebral palsy, congenital heart disease and spina bifida (OR/RR ranging from 1.14 to 2.31), as well as increased offspring body fat percent and fat mass (SMD 0.31 and 0.35, respectively). Among these outcomes, interventional meta-analyses supported that maternal weight loss interventions significantly reduced the risk of antenatal depression but not low Apgar scores; these interventions also could not reduce offspring fat mass or body fat percent. Evidence from Mendelian randomization studies supported a causal relationship between maternal adiposity and gestational diabetes mellitus, preeclampsia, birth size and offspring adiposity. Our findings highlight that while observational meta-analyses reveal associations between maternal adiposity and various adverse perinatal and offspring outcomes, convincing, unbiased evidence or support from Mendelian randomization studies is limited. Maternal pre-conceptional and prenatal weight loss interventions can reduce some, but not all, of these adverse effects.
母亲肥胖会对产科健康产生有害影响，并与后代的长期不良后果相关。在此，我们进行了一项综合性综述，涵盖194项观察性荟萃分析、10项孟德尔随机化研究和748项干预性荟萃分析，以评估已发表的关于母亲肥胖与围产期及后代结局之间关联的证据。证据分级表明，17项（8.8%）观察性荟萃分析为12种结局提供了令人信服的证据：母亲肥胖与引产术后剖宫产风险增加、婴儿死亡率、1分钟时阿氏评分<7、产前抑郁、后代超重和肥胖、女儿青春期提前开始、注意力缺陷多动障碍、脑瘫、先天性心脏病和脊柱裂相关（比值比/风险比范围为1.14至2.31），以及后代体脂百分比和脂肪量增加（标准化均数差分别为0.31和0.35）。在这些结局中，干预性荟萃分析支持母亲体重减轻干预可显著降低产前抑郁风险，但不能降低低阿氏评分风险；这些干预也无法降低后代脂肪量或体脂百分比。孟德尔随机化研究的证据支持母亲肥胖与妊娠期糖尿病、先兆子痫、出生体重和后代肥胖之间存在因果关系。我们的研究结果表明，虽然观察性荟萃分析揭示了母亲肥胖与各种不良围产期及后代结局之间的关联，但来自孟德尔随机化研究的令人信服、无偏倚的证据或支持有限。孕前和孕期母亲体重减轻干预可以减少其中一些，但不是全部，这些不良影响。
