Metabolic obesity phenotypes and adverse pregnancy outcomes: a National Cross-Sectional study

To evaluate the association between metabolic obesity phenotypes and adverse pregnancy outcomes.

This was a population-based cross-sectional study utilizing data from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) from 2016 to 2018, including 2,065,701 delivery hospitalizations. Women were categorized into four metabolic obesity phenotypes based on obesity status and the metabolic abnormalities (hypertension, hyperlipidemia, and hyperglycemia/type 2 diabetes): metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUNO) and metabolically unhealthy obese (MUO). Multivariable logistic regression was used to assess the relationship between metabolic obesity phenotypes and adverse pregnancy outcomes.

Compared to the MHNO group, both MUNO and MUO women had significantly higher odds of adverse maternal outcomes (including postpartum hemorrhage, hypertensive complications, cesarean delivery, and hysterectomy) and adverse neonatal outcomes (including preterm birth, fetal growth restriction, large for gestational age, fetal death, and congenital anomalies). An increasing number of metabolic abnormalities was associated with progressively higher odds of adverse maternal and neonatal outcomes, independent of obesity status.

The presence of metabolic abnormalities, with or without obesity, was associated with higher odds of adverse pregnancy outcomes. Our study highlights the importance of early metabolic screening and tailored interventions in routine prenatal care to improve pregnancy outcomes.