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Cited by 30Pregnancy and preeclampsia studiesGestational Diabetes Research and ManagementBirth, Development, and Health

Independent influences of maternal obesity and fetal sex on maternal cardiovascular adaptation to pregnancy: a prospective cohort study

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Teulings, Noor E. W. D., Wood, Angela M., Sovio, Ulla, Ozanne, Susan E., Smith, Gordon C. S., Aiken, Catherine E.·2020·International Journal of Obesity
DOI 10.1038/s41366-020-0627-2PMC PMC7577853
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Abstract

Background/Objectives: Successful pregnancy requires the de novo creation of low-resistance utero-placental and feto-placental circulations and incomplete remodeling of this vasculature can lead to maternal or fetal compromise. Maternal BMI and fetal sex are known to influence vascular compliance and placental development, but it is unknown if these are independent or synergistic effects. Here we aim to investigate the impact of maternal obesity, fetal sex, and any interaction thereof on maternal cardiovascular adaptation to pregnancy, by assessing the physiological drop of uterine artery doppler pulsatility (UtA-PI) and umbilical artery doppler pulsatility index (UA-PI) over gestation. Subjects/Methods: Nulliparous women with a singleton pregnancy participating in a prospective cohort study (n = 4212) underwent serial UtA-PI and UA-PI measurements at 20-, 28- and 36-weeks gestation. Linear mixed regression models were employed to investigate the influence of maternal BMI, fetal sex and interactions thereof on the magnitude of change in UtA-PI and UA-PI. Results: Throughout gestation, UtA-PI was higher for male fetuses and UA-PI was higher for female fetuses. The physiological drop of UtA-PI was significantly smaller in overweight (change −24.3% [95%CI −22.3, −26.2]) and obese women (change −21.3% [−18.3, −24.3]), compared to normal-weight women (change −25.7% [−24.3, −27.0]) but did not differ by fetal sex. The physiological drop in UA-PI was greater for female than male fetuses (–32.5% [−31.5, −33.5] vs. −30.7% [−29.8, −31.7]) but did not differ by maternal BMI. No interactions between maternal BMI and fetal sex were found. Conclusions: Maternal cardiovascular adaptation to pregnancy is independently associated with maternal BMI and fetal sex. Our results imply sexual dimorphism in both maternal cardiovascular adaptation and feto-placental resistance.

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  • The higher vulnerability in males and improved outcomes in females when the intrauterine milieu changes and becomes less hospitable is most likely explained by sex differences in fetal growth strategy and reserve capacity.

    “This most likely explains the higher vulnera­ bility in males and the improved outcomes in females seen when the intrauterine milieu changes and become less hospitable (Meakin et al., 2021; Teulings et al., 2020).”

    From Pregnancy-related maternal physiological adaptations and fetal chemical exposure (2023) · cites this paper as Teulings et al., 2020

    The Conclusions (page unavailable) report a higher incidence of placenta-mediated pathologies in pregnancies with male rather than female fetuses, supporting the male-vulnerability part. The Discussion and Conclusions do not establish improved female outcomes when the intrauterine environment becomes less hospitable or explain the difference through fetal growth strategy and reserve capacity; the Discussion says the mechanism underlying the observed sex difference is unknown. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Fetuses of different sexes respond differently to changes in the intrauterine milieu: male fetuses prioritize growth, whereas female fetuses show increased adaptability and higher reserve capacity.

    “In addition, fetuses of different sexes respond differently; while male fetuses prioritize growth, the females show increased adaptability and higher reserve capacity.”

    From Pregnancy-related maternal physiological adaptations and fetal chemical exposure (2023) · cites this paper as Teulings et al., 2020

    The Introduction and Discussion (Main findings; page numbers unavailable) describe sex differences in placental development and vascular resistance, supporting the general point that fetal sex matters. They do not say that males prioritize growth or that females have greater adaptability or reserve capacity; the reference title about growth and survival does not establish those specific claims. (LLM, conf=0.86)

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Cited by

Sorted by citations

Authors
Teulings, N. E. W. D., Wood, A. M., Sovio, U., Ozanne, S. E., Smith, G. C. S., & Aiken, C. E.
Affiliations
University of Cambridge (GB)
Corresponding author
Teulings, Noor E. W. D.
ORCID
Venue
International Journal of Obesity
Publisher
Springer Science and Business Media LLC
Published
2020-06-15
Volume
44
Issue
11
Pages
2246-2255
ISSN
  • 0307-0565 (ISSN-L)
  • 1476-5497
DOI
10.1038/s41366-020-0627-2
PMC
PMC7577853
OpenAlex
W3035001697
Cited by
30
References
2
Citations by year
2026: 7 · 2025: 4 · 2024: 5 · 2023: 2 · 2022: 4 · 2021: 8
FWCI
2.14
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Obesity (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Apollo (University of Cambridge) (submittedVersion, cc-by)
  • Apollo (cc-by)
  • Apollo
Funders
  • National Institute for Health and Care Research (RG/13/13/30194)
  • British Heart Foundation (RG/18/13/33946, FS/16/53/32729, RG/17/12/33167, RG/13/13/30194)
  • Department of Health and Social Care
  • University of Cambridge
  • Cambridge University Hospitals
  • Medical Research Council (RG/13/13/30194, MR/L003120/1, MR/L003120)
  • NIHR Cambridge Biomedical Research Centre (MR/L003120/1)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
Keywords
maternal obesity, fetal sex, uterine artery pulsatility index, umbilical artery pulsatility index, fetoplacental circulation, maternal body mass index, sexual dimorphism
MeSH terms
Obesity, Maternal, Pregnancy in Obesity, Adaptation, Physiological, Adult, Female, Humans, Male, Placenta, Pregnancy, Prospective Studies, Pulsatile Flow, Sex Factors, Umbilical Arteries, Vascular Resistance, Body Mass Index, Ultrasonography, Doppler, Young Adult, Uterine Artery

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