Metabolic syndrome during pregnancy and adverse pregnancy outcomes: A systematic review and meta-analysis

Metabolic syndrome (MetS), a cluster of cardiometabolic risk factors, is increasingly prevalent among women of reproductive age. Pregnancy involves substantial metabolic and cardiovascular adaptations, and the presence of MetS may increase susceptibility to adverse pregnancy outcomes. This systematic review and meta-analysis aimed to evaluate whether MetS during pregnancy is associated with higher odds of adverse pregnancy outcomes, including preeclampsia, small for gestational age, preterm birth, and gestational diabetes mellitus. We searched PubMed, EMBASE, CINAHL, Web of Science, and Scopus databases. We registered the review protocol with PROSPERO (CRD42024568396). We conducted study selection, data extraction, and analyses in accordance with the MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. We estimated pooled odds ratios (ORs) for adverse pregnancy outcomes using a DerSimonian and Laird random-effects model in JBI SUMARI software. We assessed study quality using the JBI critical appraisal checklist for cohort studies. We defined MetS according to IDF (International Diabetes Federation), NCEP ATP III (National Cholesterol Education Program Adult Treatment Panel III), WHO (World Health Organization), or the Harmonizing the Metabolic Syndrome criteria. Seven studies met the inclusion criteria and included data on 3,677 pregnant women with MetS and 44,166 pregnant women without MetS. Women with MetS during pregnancy had higher odds of adverse pregnancy outcomes than women without MetS (OR 2.72, 95 percent CI 1.77-4.17, I² = 92). Leave-one-out sensitivity analyses showed consistent findings. MetS during pregnancy is associated with increased odds of adverse pregnancy outcomes.