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BMC Medicine
Published in: BMC Medicine 1/2024

Open Access 01-12-2024 | Pre-Eclampsia | Research article

Integrating multiple lines of evidence to assess the effects of maternal BMI on pregnancy and perinatal outcomes

Authors: Maria Carolina Borges, Gemma L. Clayton, Rachel M. Freathy, Janine F. Felix, Alba Fernández-Sanlés, Ana Gonçalves Soares, Fanny Kilpi, Qian Yang, Rosemary R. C. McEachan, Rebecca C. Richmond, Xueping Liu, Line Skotte, Amaia Irizar, Andrew T. Hattersley, Barbara Bodinier, Denise M. Scholtens, Ellen A. Nohr, Tom A. Bond, M. Geoffrey Hayes, Jane West, Jessica Tyrrell, John Wright, Luigi Bouchard, Mario Murcia, Mariona Bustamante, Marc Chadeau-Hyam, Marjo-Riitta Jarvelin, Martine Vrijheid, Patrice Perron, Per Magnus, Romy Gaillard, Vincent W. V. Jaddoe, William L. Lowe Jr, Bjarke Feenstra, Marie-France Hivert, Thorkild I. A. Sørensen, Siri E. Håberg, Sylvain Serbert, Maria Magnus, Deborah A. Lawlor

Published in: BMC Medicine | Issue 1/2024

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Abstract

Background

Higher maternal pre-pregnancy body mass index (BMI) is associated with adverse pregnancy and perinatal outcomes. However, whether these associations are causal remains unclear.

Methods

We explored the relation of maternal pre-/early-pregnancy BMI with 20 pregnancy and perinatal outcomes by integrating evidence from three different approaches (i.e. multivariable regression, Mendelian randomisation, and paternal negative control analyses), including data from over 400,000 women.

Results

All three analytical approaches supported associations of higher maternal BMI with lower odds of maternal anaemia, delivering a small-for-gestational-age baby and initiating breastfeeding, but higher odds of hypertensive disorders of pregnancy, gestational hypertension, preeclampsia, gestational diabetes, pre-labour membrane rupture, induction of labour, caesarean section, large-for-gestational age, high birthweight, low Apgar score at 1 min, and neonatal intensive care unit admission. For example, higher maternal BMI was associated with higher risk of gestational hypertension in multivariable regression (OR = 1.67; 95% CI = 1.63, 1.70 per standard unit in BMI) and Mendelian randomisation (OR = 1.59; 95% CI = 1.38, 1.83), which was not seen for paternal BMI (OR = 1.01; 95% CI = 0.98, 1.04). Findings did not support a relation between maternal BMI and perinatal depression. For other outcomes, evidence was inconclusive due to inconsistencies across the applied approaches or substantial imprecision in effect estimates from Mendelian randomisation.

Conclusions

Our findings support a causal role for maternal pre-/early-pregnancy BMI on 14 out of 20 adverse pregnancy and perinatal outcomes. Pre-conception interventions to support women maintaining a healthy BMI may reduce the burden of obstetric and neonatal complications.

Funding

Medical Research Council, British Heart Foundation, European Research Council, National Institutes of Health, National Institute for Health Research, Research Council of Norway, Wellcome Trust.
Appendix
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Metadata
Title
Integrating multiple lines of evidence to assess the effects of maternal BMI on pregnancy and perinatal outcomes
Authors
Maria Carolina Borges
Gemma L. Clayton
Rachel M. Freathy
Janine F. Felix
Alba Fernández-Sanlés
Ana Gonçalves Soares
Fanny Kilpi
Qian Yang
Rosemary R. C. McEachan
Rebecca C. Richmond
Xueping Liu
Line Skotte
Amaia Irizar
Andrew T. Hattersley
Barbara Bodinier
Denise M. Scholtens
Ellen A. Nohr
Tom A. Bond
M. Geoffrey Hayes
Jane West
Jessica Tyrrell
John Wright
Luigi Bouchard
Mario Murcia
Mariona Bustamante
Marc Chadeau-Hyam
Marjo-Riitta Jarvelin
Martine Vrijheid
Patrice Perron
Per Magnus
Romy Gaillard
Vincent W. V. Jaddoe
William L. Lowe Jr
Bjarke Feenstra
Marie-France Hivert
Thorkild I. A. Sørensen
Siri E. Håberg
Sylvain Serbert
Maria Magnus
Deborah A. Lawlor
Publication date
01-12-2024
Publisher
BioMed Central
Keyword
Pre-Eclampsia
Published in
BMC Medicine / Issue 1/2024
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-023-03167-0

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