Association between prepregnancy body mass index and risk of congenital heart defects in offspring: an ambispective observational study in China

Yuan, Xuelian; Liu, Zhen; Zhu, Jun; Yu, Ping; Deng, Ying; Chen, Xinlin; Li, Nana; Li, Shengli; Yang, Shuihua; Li, Jun; Liu, Hanmin; Li, Xiaohong

doi:10.1186/s12884-020-03100-w

Cited by 8 publications

(11 citation statements)

References 29 publications

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“…A total of 32 publications were included in the review ( Table 1 and S3 Table ). Among these, 17 dealt with maternal overweight or obesity [ 14 , 15 , 19 , 29 – 42 ], 10 dealt with pre-gestational diabetes (PGDM) [ 16 – 18 , 40 , 41 , 43 – 47 ], four dealt with DM1 [ 13 , 19 , 48 , 49 ], two dealt with DM2 [ 19 , 48 ], eight dealt with GDM [ 16 – 18 , 39 – 41 , 46 , 49 ], four dealt with hypertension [ 19 , 20 , 43 , 48 ], three dealt with PE [ 21 , 22 , 50 ], and none were about dyslipidaemia or MetS (as a diagnostic category). Except for the combination of PGDM and GDM, six studies investigated more than one maternal metabolic disorder (but not in combination) [ 19 , 39 – 41 , 43 , 48 ], and one study assessed a combination of two conditions (obesity and GDM) and the risk of CHDs [ 31 ].…”

Section: Resultsmentioning

confidence: 99%

“…Characteristics of the 32 studies are presented in Table 1 and S3 Table . Three examined populations of non-European descent (Taiwan and China) [ 39 , 42 , 48 ]. Half of the studies reported results from livebirths only; eight studies had populations including both singleton and multiple births; and 11 studies did not state whether they included only singleton or multiple births.…”

Section: Resultsmentioning

confidence: 99%

“…Several studies have investigated the association between maternal overweight or obesity and any CHDs [ 14 , 15 , 19 , 31 , 33 , 37 , 39 , 41 , 42 ]. In Fig 2 , five out of eight studies found a significant association between maternal obesity (BMI ≥ 30 kg/m 2 ) and any CHDs.…”

Section: Resultsmentioning

confidence: 99%

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Maternal obesity and metabolic disorders associate with congenital heart defects in the offspring: A systematic review

et al. 2021

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Background Congenital heart defects (CHDs) are the most common congenital malformations. The aetiology of CHDs is complex. Large cohort studies and systematic reviews and meta-analyses based on these have reported an association between higher risk of CHDs in the offspring and individual maternal metabolic disorders such as obesity, diabetes, hypertension, and preeclampsia, all conditions that can be related to insulin resistance or hyperglycaemia. However, the clinical reality is that these conditions often occur simultaneously. The aim of this review is, in consequence, both to evaluate the existing evidence on the association between maternal metabolic disorders, defined as obesity, diabetes, hypertension, preeclampsia, dyslipidaemia and CHDs in the offspring, as well as the significance of combinations, such as metabolic syndrome, as risk factors. Methods A systematic literature search of papers published between January 1, 1990 and January 14, 2021 was conducted using PubMed and Embase. Studies were eligible if they were published in English and were case-control or cohort studies. The exposures of interest were maternal overweight or obesity, hypertension, preeclampsia, diabetes, dyslipidaemia, and/or metabolic syndrome, and the outcome of interest was CHDs in the offspring. Furthermore, the studies were included according to a quality assessment score. Results Of the 2,250 identified studies, 32 qualified for inclusion. All but one study investigated only the individual metabolic disorders. Some disorders (obesity, gestational diabetes, and hypertension) increased risk of CHDs marginally whereas pre-gestational diabetes and early-onset preeclampsia were strongly associated with CHDs, without consistent differences between CHD subtypes. A single study suggested a possible additive effect of maternal obesity and gestational diabetes. Conclusions Future studies of the role of aberrations of the glucose-insulin homeostasis in the common aetiology and mechanisms of metabolic disorders, present during pregnancy, and their association, both as single conditions and–particularly–in combination, with CHDs are needed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Maternal obesity and metabolic disorders associate with congenital heart defects in the offspring: A systematic review

et al. 2021

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“…However, this nding contrasts with previous studies in China. Xuelian [21] et al reported that the risk of CHDs was signi cantly higher among mothers with prepregnancy underweight and low-average BMI, and they failed to observe any signi cant relationships between prepregnancy overweight or obesity and the risk of CHDs in offspring, even when using different cut-off values to de ne reference groups. This difference may be due to the relatively small number of overweight women in their study.…”

Section: Discussionmentioning

confidence: 99%

“…A meta-analysis involving 99,205 CHDs cases among 6,467,422 participants reported that increased maternal BMI was associated with the risk of developing CHDs in offspring [20] . However, some failed to observe any signi cant relationships between prepregnancy obesity and the risk of CHDs [21] .…”

Section: Introductionmentioning

confidence: 99%

Maternal Obesity and the Risk of Congenital Heart Defects: the Mediation Effect of Pregestational Diabetes

Huang

et al. 2021

Preprint

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Background Congenital heart defects (CHDs) are the most common birth defects worldwide. Maternal obesity has been proposed as a risk factor for CHDs, but the results are controversial and inconclusive. Pregestational diabetes (PGDM) is well known as a risk factor for CHDs and is closely related to obesity. However, the effect of PGDM on the association between maternal obesity and CHDs has not been investigated.Objectives We aimed to explore the association between maternal obesity and CHDs and to further evaluate the mediation effect of PGDM on this association.Methods We involved 53708 mother-infant pairs with deliveries between 2017 and 2019 from the Birth Cohort in Shenzhen (BiCoS). Mothers were categorized into four groups: the underweight group (BMI < 18.5), normal weight group (18.5 ≤ BMI < 24), overweight group (24 ≤ BMI < 28) and obesity group (BMI ≥ 28). To evaluate the association between BMI and CHDs, we fit multivariable logistic regression models, adjusting for maternal age, maternal education level, mode of conception, parity, GDM and offspring sex. Mediation analysis was used to confirm the mediation effect of PGDM on the association between maternal obesity and CHDs.Results The proportion of obese individuals in the BiCoS was 2.11%. Overall, 372 (0.69%) infants were diagnosed with CHDs. The prevalence of CHDs in underweight, normal weight, overweight and obese individuals was 0.64%, 0.68%, 0.72% and 1.24%, respectively. Maternal obesity was associated with an increased risk of CHDs (OR=1.97, 95% CI 1.14–3.41). The offspring of women with PGDM were 6.88 times (95% CI 4.11–11.53) more likely to have CHDs than the offspring of mothers without PGDM. The mediation effect of PGDM on the association between maternal obesity and CHDs was significant (OR=1.18, 95% CI 1.06–1.32). The estimated mediation proportion was 24.83%.Conclusion Our findings suggested that maternal obesity was associated with CHDs and that PGDM partially mediated the association between maternal obesity and CHDs.

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Preconception underweight and the risk of offspring congenital heart diseases in young pregnant women: Evidence from the China Birth Cohort Study

Yan,

Liu,

Peng

et al. 2024

Intl J Gynecology & Obste

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ObjectiveMaternal obesity is a highly suggestive risk factor of offspring congenital heart diseases (CHD). However, the risk of offspring CHD associated with maternal underweight has rarely been mentioned. Therefore, this study aimed to explore the effect of preconception underweight on offspring CHD.MethodsFrom November 2017 to August 2021, 132 386 pregnant women were enrolled in a birth cohort study in China in early pregnancy, and completed follow‐up until delivery (or miscarriage/termination). Offspring CHD was diagnosed by prenatal ultrasound examination in both live births and stillbirths. Log‐binomial regression and restricted cubic spline were used to estimate the risk of offspring CHD associated with preconception body mass index (BMI). A generalized additive model was used to explore the modification effect of maternal age on the association between preconception BMI and offspring CHD.ResultsA total of 129 096 pregnant women were included in the analysis. The incidence of CHD in the underweight, normal weight, overweight, and obesity groups were 117/17 313 (0.68%), 556/85 695 (0.65%), 128/19 936 (0.64%), 47/6152 (0.76%), respectively. Both underweight and obesity before pregnancy marginally increased the risk of offspring CHD. The association between preconception BMI and offspring CHD varied by maternal age, with low preconception BMI associated with a significantly higher risk of offspring CHD in women <24 years (RR 2.32, 95% CI: 1.07–5.01 for 17 vs 21 kg/m2).ConclusionPreconception underweight was associated with an increased risk of offspring CHD in young pregnant women. Therefore, weight gain is important to prevent offspring CHD, especially for young women with low preconception BMI.

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Association between prepregnancy body mass index and risk of congenital heart defects in offspring: an ambispective observational study in China

Cited by 8 publications

References 29 publications

Maternal obesity and metabolic disorders associate with congenital heart defects in the offspring: A systematic review

Maternal obesity and metabolic disorders associate with congenital heart defects in the offspring: A systematic review

Maternal Obesity and the Risk of Congenital Heart Defects: the Mediation Effect of Pregestational Diabetes

Preconception underweight and the risk of offspring congenital heart diseases in young pregnant women: Evidence from the China Birth Cohort Study

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