Maternal obesity in pregnancy and children’s cardiac function and structure: A systematic review and meta-analysis of evidence from human studies

Abstract

The prevalence of obesity is increasing worldwide. Experimental animal studies demonstrate that maternal obesity during pregnancy directly affects cardiac structure and function in their offspring, which could contribute to their increased cardiovascular disease (CVD) risk. Currently, a systematic overview of the available evidence regarding maternal obesity and alterations in cardiac structure and function in human offspring is lacking. We systematically searched the electronic databases Embase, MEDLINE and NARCIS from inception to June 29, 2022 including human studies comparing cardiac structure and function from fetal life onwards in offspring of women with and without obesity. The review protocol was registered with PROSPERO International Prospective Register of Systematic Reviews (identifier: CRD42019125071). Risk of bias was assessed using a modified Newcastle-Ottawa scale. Results were expressed using standardized mean differences (SMD). The search yielded 1589 unique publications, of which thirteen articles were included. Compared to offspring of women without obesity, fetuses of women with obesity had lower left ventricular strain, indicative of reduced systolic function, that persisted in infancy (SMD -2.4, 95% confidence interval (CI) -4.4 standard deviation (SD) to -0.4 SD during fetal life and SMD -1.0, 95% CI -1.6 SD to -0.3 SD in infancy). Furthermore, infants born to women with obesity had a thicker interventricular septum (SMD 0.6 SD, 95% CI 0.0 to 1.2 SD) than children born to women without obesity. In conclusion, cardiac structure and function differs between fetuses and children of women with and without obesity. Some of these differences were present in fetal life, persisted in childhood and are consistent with increased CVD risk. Long-term follow-up research is warranted, as studies in offspring of older age are lacking.

Maternal Diabetes and Overweight and Congenital Heart Defects in Offspring

“…Interestingly, our results indicated a lower risk for VSD in offspring of mothers with overweight, while previous reports have shown no association 8 or an increased risk. 7 Maternal obesity has been shown to be associated with increased birth weight in offspring 21 , 22 and increased left ventricle 23 and interventricular septum 24 thickness during infancy. Thus, one explanation could be that increased septum thickness in these infants may contribute to the closure of small muscular defects before they are diagnosed.…”

Maternal diabetes and overweight as risk factors for congenital heart defects in offspring - A nationwide register study from Finland

“…Interestingly, our data indicated a lower risk for VSD in offspring of overweight mothers while previous reports have shown no association 8 or increased risk 7 . Maternal obesity has been shown to be associated with increased birth weight in the offspring 26,27 , and increased left ventricle 28 and interventricular septum 29 thickness during infancy. Thus, one explanation could be that the increased septum thickness in these infants might contribute to the closure of small muscular defects before they are diagnosed.…”

Apelin and Visfatin Expression in Placental Tissue in Women With Preeclampsia and Overweight/Obesity

“…The role of apelin and visfatin in PE is still poorly understood, especially in obese women. Evidence points to obesity as an important factor associated with unfavorable maternal-fetal outcomes (den Harink et al, 2022; D’Souza et al, 2019; Patro Golab et al, 2018; Sanchez et al, 2018). The increase in body adiposity predisposes the individual to alterations in the production and release of adipokines by the white adipose tissue, mediating various local and systemic pathophysiological processes (Phipps et al, 2019; Zorena et al, 2020).…”