Maternal obesity and metabolic disorders associate with congenital heart defects in the offspring: A systematic review
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Abstract
Background: Congenital heart defects (CHDs) are the most common congenital malformations. The aetiology of CHDs is complex. Large cohort studies and systematic reviews and meta-analyses based on these have reported an association between higher risk of CHDs in the offspring and individual maternal metabolic disorders such as obesity, diabetes, hypertension, and preeclampsia, all conditions that can be related to insulin resistance or hyperglycaemia. However, the clinical reality is that these conditions often occur simultaneously. The aim of this review is, in consequence, both to evaluate the existing evidence on the association between maternal metabolic disorders, defined as obesity, diabetes, hypertension, preeclampsia, dyslipidaemia and CHDs in the offspring, as well as the significance of combinations, such as metabolic syndrome, as risk factors. Methods: A systematic literature search of papers published between January 1, 1990 and January 14, 2021 was conducted using PubMed and Embase. Studies were eligible if they were published in English and were case-control or cohort studies. The exposures of interest were maternal overweight or obesity, hypertension, preeclampsia, diabetes, dyslipidaemia, and/or metabolic syndrome, and the outcome of interest was CHDs in the offspring. Furthermore, the studies were included according to a quality assessment score. Results: Of the 2,250 identified studies, 32 qualified for inclusion. All but one study investigated only the individual metabolic disorders. Some disorders (obesity, gestational diabetes, and hypertension) increased risk of CHDs marginally whereas pre-gestational diabetes and early-onset preeclampsia were strongly associated with CHDs, without consistent differences between CHD subtypes. A single study suggested a possible additive effect of maternal obesity and gestational diabetes. Conclusions: Future studies of the role of aberrations of the glucose-insulin homeostasis in the common aetiology and mechanisms of metabolic disorders, present during pregnancy, and their association, both as single conditions and–particularly–in combination, with CHDs are needed.
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Gestational diabetes increases the risk of congenital heart defects.
“GDM increases the risk of congenital heart defects. 74”
From Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review (2022) · cites this paper as [74]
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- Authors
- Hedermann, G., Hedley, P. L., Thagaard, I. N., Krebs, L., Ekelund, C. K., Sørensen, T. I. A., & Christiansen, M.
- Affiliations
- Statens Serum Institut (DK)
- University of Copenhagen (DK)
- Corresponding author
- Hedermann, Gitte
- ORCID
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2021-05-27
- Volume
- 16
- Issue
- 5
- Pages
- e0252343
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC8158948
- OpenAlex
- W3165047476
- Cited by
- 48
- References
- 94
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 11 · 2023: 7 · 2022: 7 · 2021: 3
- FWCI
- 1.29
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- medRxiv (acceptedVersion)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- The Danish Children Heart Foundation (18-R109-A5193-26043)
- The A.P. Moller Foundation (19-L-0096)
- Aase og Ejnar Danielsens Fond (19-10-0493)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Congenital heart defects research
- Keywords
- congenital heart disease, maternal obesity, maternal metabolic disorders, gestational diabetes mellitus, preeclampsia, hypertension in pregnancy, dyslipidemia, metabolic syndrome, pregestational diabetes, insulin resistance, hyperglycemia, glucose-insulin homeostasis
- MeSH terms
- Obesity, Maternal, Pregnancy in Obesity, Female, Heart Defects, Congenital, Humans, Pregnancy, Risk Factors, Diabetes, Gestational, Hypertension, Pregnancy-Induced, Overweight
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