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Epidemiology and Population Health

Role of maternal glucose metabolism in the association between maternal BMI and neonatal size and adiposity

International Journal of Obesity volume 45, pages 515–524 (2021)Cite this article

Subjects

Abstract

Background/Objective

One potential mechanism by which maternal obesity impacts fetal growth is through hyperglycemia below the threshold for gestational diabetes. Data regarding which measures of maternal glucose metabolism mediate this association is sparse. The objectives of this study were to (i) quantify the associations of maternal pre-pregnancy body mass index (BMI) with neonatal size and adiposity and (ii) examine the role of markers of maternal glucose metabolism as mediators in these associations.

Subjects/Methods

This is a secondary analysis of 6,379 mother-infant dyads from the Hyperglycemia and Adverse Pregnancy Outcome cohort. Markers of glucose metabolism, including plasma glucose and c-peptide values, Stumvoll first-phase estimate, modified Matsuda index, and oral disposition index were measured and calculated from an oral glucose tolerance test (OGTT) between 24- and 32-weeks’ gestation. We calculated the direct effect of maternal BMI category, measured at the time of the OGTT and regressed to estimate pre-pregnancy BMI, on neonatal (1) birth weight (BW), (2) fat mass (FM), (3) % body fat (BF%), and (4) sum of skinfold thickness (sSFT). We then calculated the indirect effect of BMI category on these measures through markers of glucose metabolism.

Results

Maternal BMI category was positively associated with neonatal BW, FM, BF%, and sSFT. Additionally, mothers who were overweight or obese had higher odds of delivering an infant with BW, FM, BF%, or sSFT >90th percentile. Fasting glucose and c-peptide values were the strongest mediators in the linear associations between maternal BMI category and neonatal size and adiposity.

Conclusions

Maternal overweight and obesity were associated with higher odds of neonatal BW and adiposity >90th percentile. Fasting measures of glucose metabolism were the strongest mediators of these associations, suggesting that future studies should investigate whether incorporation of these markers in pregnant women with obesity may improve prediction of neonatal size and adiposity.

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Fig. 1: Correlation* matrix of potential mediators in the associations between maternal BMI category and infant size and adiposity.
Fig. 2: Adjusted odds ratios of infant BW, FM, BF%, and sSFT > 90th percentile by maternal BMI category at OGTT*.
Fig. 3: Directed acyclic diagram of significant mediators of the associations between maternal BMI category and neonatal size and adiposity.

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Author information

Authors and Affiliations

  1. Department of Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Chloe Andrews, Carmen Monthé-Drèze & Sarbattama Sen

  2. Harvard Medical School, Boston, MA, USA

    Carmen Monthé-Drèze & Sarbattama Sen

  3. Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA

    David A. Sacks

  4. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China

    Ronald C. W. Ma

  5. Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China

    Ronald C. W. Ma

  6. Chinese University of Hong Kong-Shanghai Jiao Tong University Joint Research Centre in Diabetes Genomics and Precision Medicine, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, China

    Ronald C. W. Ma

  7. Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, China

    Wing Hung Tam

  8. Mater Health and The University of Queensland, South Brisbane, QLD, Australia

    H. David McIntyre

  9. University of Newcastle, Callaghan, NSW, Australia

    Julia Lowe

  10. Mother Infant Research Institute, Tufts Medical Center, Boston, MA, USA

    Patrick Catalano

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Andrews, C., Monthé-Drèze, C., Sacks, D.A. et al. Role of maternal glucose metabolism in the association between maternal BMI and neonatal size and adiposity. Int J Obes 45, 515–524 (2021). https://doi.org/10.1038/s41366-020-00705-1

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