Cardiometabolic Markers Associated With Altered Fetal Growth in Mediterranean Cohort

Cardiometabolic disturbances in pregnancy appear to be associated with inappropriate fetal growth, but evidence from uncomplicated pregnancies is still scarce and, due to varied findings, inconclusive. Moreover, most studies focus on specific markers, often measured at a single gestational time-point. We aimed to assess the associations between maternal cardiometabolic markers, measured in early and late pregnancy, and neonatal size in a Mediterranean cohort of healthy women. Longitudinally, we analyzed 264 mother-neonate pairs. Maternal metabolic markers (glucose, insulin resistance, triglycerides, total cholesterol, HDL-c, LDL-c, and blood pressure (BP)) were assessed in the first (T1) and third (T3) trimesters. Birthweight (g) and head circumference (HC, cm) were assessed in the newborns. Small (SGA, < 10th percentile) and large (LGA, > 90th percentile) for-gestational-age were the primary outcomes. Multivariable-adjusted linear and logistic regressions were performed. Overall, based on weight and HC at birth, there were 10.5% and 6.4% SGA infants, while 8.1% and 16.7% were LGA, respectively. After adjustments for confounders, maternal T1 triglycerides were positively associated with birthweight (β:74.81 g per 1-SD increment, p = 0.006), and higher T1 LDL-c levels increased the risk of LGA newborns (OR:1.64 g per 1-SD increment, p = 0.046). T3 diastolic-BP was inversely associated with birthweight (β:-86.19 g per 1-SD increment; p = 0.010) and HC (β:-0.30 g per 1-SD increment; p = 0.008). High diastolic-BP (≥ 75th percentile, 77 mmHg) was also linked to a higher risk of SGA newborns for both weight (OR:3.54, p = 0.022) and HC (OR:2.56 g per 1-SD increment, p = 0.025). In conclusions, elevated maternal lipids in early pregnancy and diastolic BP in late pregnancy adversely impact offspring birth size, highlighting the importance of incorporating metabolic monitoring into routine prenatal care.