Maternal adiposity and perinatal and offspring outcomes: an umbrella review

ABSTRACT Maternal adiposity deleteriously affects obstetrical health and has been associated with long-term adverse consequences in offspring. Here we conducted an umbrella review

encompassing 194 observational meta-analyses, 10 Mendelian randomization studies and 748 interventional meta-analyses to appraise the published evidence on the associations between maternal

adiposity and perinatal and offspring outcomes. Evidence grading suggested that 17 (8.8%) observational meta-analyses were supported by convincing evidence for 12 outcomes: maternal

adiposity was associated with an increased risk of caesarean delivery following labour induction, infant mortality, Apgar score <7 at 1 min, antenatal depression, offspring overweight and

obesity, early timing of puberty onset in daughters, attention deficit hyperactivity disorder, cerebral palsy, congenital heart disease and spina bifida (OR/RR ranging from 1.14 to 2.31),

as well as increased offspring body fat percent and fat mass (SMD 0.31 and 0.35, respectively). Among these outcomes, interventional meta-analyses supported that maternal weight loss

interventions significantly reduced the risk of antenatal depression but not low Apgar scores; these interventions also could not reduce offspring fat mass or body fat percent. Evidence from

Mendelian randomization studies supported a causal relationship between maternal adiposity and gestational diabetes mellitus, preeclampsia, birth size and offspring adiposity. Our findings

highlight that while observational meta-analyses reveal associations between maternal adiposity and various adverse perinatal and offspring outcomes, convincing, unbiased evidence or support

from Mendelian randomization studies is limited. Maternal pre-conceptional and prenatal weight loss interventions can reduce some, but not all, of these adverse effects. Access through your

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OTHERS THE IMPACT OF MATERNAL OBESITY ON CHILDHOOD NEURODEVELOPMENT Article 28 November 2020 MATERNAL OBESITY AND OFFSPRING CARDIOVASCULAR REMODELLING — THE EFFECT OF PRECONCEPTION AND

ANTENATAL LIFESTYLE INTERVENTIONS: A SYSTEMATIC REVIEW Article Open access 19 June 2024 MODE OF DELIVERY, TYPE OF LABOR, AND MEASURES OF ADIPOSITY FROM CHILDHOOD TO TEENAGE: PROJECT VIVA

Article 16 November 2020 DATA AVAILABILITY The data used to support the findings of this study are collected from already published studies. Data collection form is available at the Open

Science Framework (https://doi.org/10.17605/OSF.IO/97BCS). CODE AVAILABILITY Code is available with open access at the following GitHub repository:

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Program of China (2021YFC2700400 (H.Z.) and 2021YFC2700701 (S.Z.)), the Basic Science Center Program of NSFC (31988101) (Z.-J.C.), the National Natural Science Foundation of China (32370916

(S.Z.), 82071606 (S.Z.), 82101707 (X.G.) and 82192874 (H.Z.)), the CAMS Innovation Fund for Medical Sciences (2021-I2M-5-001) (Z.-J.C.), the Shandong Provincial Key Research and Development

Program (2020ZLYS02) (Z.-J.C.), the Natural Science Foundation of Shandong Province for Excellent Youth Scholars (ZR2023YQ061) (S.Z.), the Program for Chang Jiang Scholars (Q2022144)

(S.Z.), the Taishan Scholars Program of Shandong Province (ts20190988) (H.Z.), the Innovative Research Team of High-level Local Universities in Shanghai (SHSMU-ZLCX20210200) (Z.-J.C.) and

the Fundamental Research Funds of Shandong University (2023QNTD004) (S.Z.). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the

paper. AUTHOR INFORMATION Author notes * These authors contributed equally: Ziyi Yang, Gengchen Feng, Xueying Gao. AUTHORS AND AFFILIATIONS * State Key Laboratory of Reproductive Medicine

and Offspring Health, Center for Reproductive Medicine, Institute of Women, Children and Reproductive Health, Shandong University, Jinan, China Ziyi Yang, Gengchen Feng, Xueqi Yan, Yimeng

Li, Yuteng Wang, Yonghui Jiang, Shigang Zhao, Han Zhao & Zi-Jiang Chen * National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University,

Jinan, China Xueying Gao, Shumin Li, Shigang Zhao, Han Zhao & Zi-Jiang Chen * Department of Reproductive Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine,

Shanghai, China Xueying Gao, Shumin Li & Zi-Jiang Chen * Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China Xueying Gao, Shumin Li & 

Zi-Jiang Chen * Key Laboratory of Reproductive Endocrinology (Shandong University), Ministry of Education, Jinan, China Shigang Zhao, Han Zhao & Zi-Jiang Chen * Shandong Technology

Innovation Center for Reproductive Health, Jinan, China Shigang Zhao, Han Zhao & Zi-Jiang Chen * Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, China

Shigang Zhao, Han Zhao & Zi-Jiang Chen * Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China

Shigang Zhao, Han Zhao & Zi-Jiang Chen * Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences, Jinan, China Shigang Zhao, Han Zhao & 

Zi-Jiang Chen Authors * Ziyi Yang View author publications You can also search for this author inPubMed Google Scholar * Gengchen Feng View author publications You can also search for this

author inPubMed Google Scholar * Xueying Gao View author publications You can also search for this author inPubMed Google Scholar * Xueqi Yan View author publications You can also search for

this author inPubMed Google Scholar * Yimeng Li View author publications You can also search for this author inPubMed Google Scholar * Yuteng Wang View author publications You can also

search for this author inPubMed Google Scholar * Shumin Li View author publications You can also search for this author inPubMed Google Scholar * Yonghui Jiang View author publications You

can also search for this author inPubMed Google Scholar * Shigang Zhao View author publications You can also search for this author inPubMed Google Scholar * Han Zhao View author

publications You can also search for this author inPubMed Google Scholar * Zi-Jiang Chen View author publications You can also search for this author inPubMed Google Scholar CONTRIBUTIONS

Z.Y., S.Z., H.Z. and Z.-J.C. were involved in the original conceptualization. Z.Y., G.F., X.G., S.Z., H.Z. and Z.-J.C. were responsible for developing the study methodology. Z.Y., G.F. and

X.G. did the literature search. Z.Y., G.F., X.G., X.Y., Y.L., Y.W., Y.J. and S.L. were responsible for data curation. Z.Y., G.F. and X.G. did the formal statistical analysis. Z.Y., G.F. and

X.G. wrote the original draft. All authors edited and reviewed the paper. CORRESPONDING AUTHORS Correspondence to Shigang Zhao, Han Zhao or Zi-Jiang Chen. ETHICS DECLARATIONS COMPETING

INTERESTS The authors declare no competing interests. PEER REVIEW PEER REVIEW INFORMATION _Nature Human Behaviour_ thanks Ilkka Kalliala, Mai-Lei Woo Kinshella and the other, anonymous,

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and applicable law. Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Yang, Z., Feng, G., Gao, X. _et al._ Maternal adiposity and perinatal and offspring outcomes: an umbrella

review. _Nat Hum Behav_ 8, 2406–2422 (2024). https://doi.org/10.1038/s41562-024-01994-6 Download citation * Received: 25 March 2024 * Accepted: 30 August 2024 * Published: 11 October 2024 *

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