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Metabolic syndrome in pregnancy and risk for adverse pregnancy outcomes: A prospective cohort of nulliparous women
Open accessAbstract
BACKGROUND: Obesity increases the risk for developing gestational diabetes mellitus (GDM) and preeclampsia (PE), which both associate with increased risk for type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) in women in later life. In the general population, metabolic syndrome (MetS) associates with T2DM and CVD. The impact of maternal MetS on pregnancy outcomes, in nulliparous pregnant women, has not been investigated. METHODS AND FINDINGS: Low-risk, nulliparous women were recruited to the multi-centre, international prospective Screening for Pregnancy Endpoints (SCOPE) cohort between 11 November 2004 and 28 February 2011. Women were assessed for a range of demographic, lifestyle, and metabolic health variables at 15 ± 1 weeks' gestation. MetS was defined according to International Diabetes Federation (IDF) criteria for adults: waist circumference ≥80 cm, along with any 2 of the following: raised trigycerides (≥1.70 mmol/l [≥150 mg/dl]), reduced high-density lipoprotein cholesterol (<1.29 mmol/l [<50 mg/dl]), raised blood pressure (BP) (i.e., systolic BP ≥130 mm Hg or diastolic BP ≥85 mm Hg), or raised plasma glucose (≥5.6 mmol/l). Log-binomial regression analyses were used to examine the risk for each pregnancy outcome (GDM, PE, large for gestational age [LGA], small for gestational age [SGA], and spontaneous preterm birth [sPTB]) with each of the 5 individual components for MetS and as a composite measure (i.e., MetS, as defined by the IDF). The relative risks, adjusted for maternal BMI, age, study centre, ethnicity, socioeconomic index, physical activity, smoking status, depression status, and fetal sex, are reported. A total of 5,530 women were included, and 12.3% (n = 684) had MetS. Women with MetS were at an increased risk for PE by a factor of 1.63 (95% CI 1.23 to 2.15) and for GDM by 3.71 (95% CI 2.42 to 5.67). In absolute terms, for PE, women with MetS had an adjusted excess risk of 2.52% (95% CI 1.51% to 4.11%) and, for GDM, had an adjusted excess risk of 8.66% (95% CI 5.38% to 13.94%). Diagnosis of MetS was not associated with increased risk for LGA, SGA, or sPTB. Increasing BMI in combination with MetS increased the estimated probability for GDM and decreased the probability of an uncomplicated pregnancy. Limitations of this study are that there are several different definitions for MetS in the adult population, and as there are none for pregnancy, we cannot be sure that the IDF criteria are the most appropriate definition for pregnancy. Furthermore, MetS was assessed in the first trimester and may not reflect pre-pregnancy metabolic health status. CONCLUSIONS: We did not compare the impact of individual metabolic components with that of MetS as a composite, and therefore cannot conclude that MetS is better at identifying women at risk. However, more than half of the women who had MetS in early pregnancy developed a pregnancy complication compared with just over a third of women who did not have MetS. Furthermore, while increasing BMI increases the probability of GDM, the addition of MetS exacerbates this probability. Further studies are required to determine if individual MetS components act synergistically or independently.
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“Pregnancy is a metabolically dynamic condition, and an inappropriate nutritional status may contribute to metabolic alterations, making the person susceptible to metabolic disorders and poor pregnancy outcomes (1, 2).”
From Maternal nutritional status and the risk of metabolic syndrome in pregnancy: implications for public health nutrition (2026) · cites this paper as [1]
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“Pregnancy is a metabolically dynamic condition, and an inappropriate nutritional status may contribute to metabolic alterations, making the person susceptible to metabolic disorders and poor pregnancy outcomes (1, 2).”
From Maternal nutritional status and the risk of metabolic syndrome in pregnancy: implications for public health nutrition (2026) · cites this paper as [1]
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Metadata
- Authors
- Grieger, J. A., Bianco-Miotto, T., Grzeskowiak, L. E., Leemaqz, S. Y., Poston, L., McCowan, L. M., Kenny, L. C., Myers, J. E., Walker, J. J., Dekker, G. A., & Roberts, C. T.
- Affiliations
- The University of Adelaide (AU)
- St Thomas' Hospital (GB)
- University of Auckland (NZ)
- University of Liverpool (GB)
- University of Manchester (GB)
- University of Leeds (GB)
- Corresponding author
- Grieger, Jessica A.
- Grzeskowiak, Luke E.
- Leemaqz, Shalem Y.
- Poston, Lucilla
- McCowan, Lesley M.
- Kenny, Louise C.
- Myers, Jenny E.
- Walker, James J.
- Roberts, Claire T.
- ORCID
- Venue
- PLOS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2018-12-04
- Volume
- 15
- Issue
- 12
- Pages
- e1002710
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC6279018
- OpenAlex
- W2902051656
- Cited by
- 182
- References
- 61
- Citations by year
- 2026: 18 · 2025: 18 · 2024: 25 · 2023: 39 · 2022: 30 · 2021: 22 · 2020: 21 · 2019: 9
- FWCI
- 14.60
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, cc-by)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Funders
- Health Research Board (12/RC/2272, CSA/2007/2)
- Government of South Australia
- Auckland District Health Board
- Australian Government
- National Institute for Health and Care Research (NIHR-CS-011-020)
- King's College London
- University of Leeds
- Science Foundation Ireland (12/RC/2272, 12/RC/)
- Cerebra
- Tommy's
- Directorate for Biological Sciences
- Medical Research Council
- National Health and Medical Research Council (1099422, 1020749, 1070421)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- metabolic syndrome, pregnancy, nulliparous women, gestational diabetes mellitus, preeclampsia, adverse pregnancy outcomes, large for gestational age, small for gestational age, preterm birth, type 2 diabetes risk, cardiovascular risk, maternal obesity, waist circumference, hypertriglyceridemia, low HDL cholesterol, hypertension in pregnancy
- MeSH terms
- Adult, Australia, Female, United Kingdom, Humans, Ireland, New Zealand, Parity, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Prospective Studies, Risk Factors, Cohort Studies, Metabolic Syndrome, Internationality
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