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Maternal obesity in pregnancy and children's cardiac function and structure: A systematic review and meta-analysis of
Tamara den Harink1,2, Manouck J M Roelofs1, Jacqueline Limpens3
1Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
Insights
Maternal obesity during pregnancy is linked to altered fetal and infant heart function and structure. These changes, including reduced left ventricular strain and a thicker interventricular septum, may increase cardiovascular disease risk in offspring.
Area of Science:
- Cardiology
- Obstetrics
- Public Health
Background:
- Rising global obesity rates highlight the need to understand its impact on maternal and child health.
- Experimental studies suggest maternal obesity affects offspring cardiac development, but human evidence is limited.
- Cardiovascular disease (CVD) risk in offspring may be influenced by the intrauterine environment, particularly maternal metabolic status.
Approach:
- A systematic review and meta-analysis was conducted by searching Embase, MEDLINE, and NARCIS databases up to June 29, 2022.
- Included were human studies comparing cardiac structure and function in offspring of women with and without obesity, from fetal life onwards.
- Risk of bias was assessed using a modified Newcastle-Ottawa scale, and results were expressed as standardized mean differences (SMD).
Key Points:
- Offspring of women with obesity exhibited reduced fetal left ventricular strain, indicating impaired systolic function, which persisted into infancy.
- Infants born to mothers with obesity had a significantly thicker interventricular septum compared to controls.
- These cardiac alterations were observed from fetal development through infancy, suggesting early-onset effects.
Conclusions:
- Maternal obesity is associated with significant differences in fetal and infant cardiac structure and function.
- Observed cardiac changes in offspring are consistent with an elevated risk for future cardiovascular disease.
- Further long-term follow-up studies are needed to assess the lifelong impact of maternal obesity on offspring cardiovascular health.
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.
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