Maternal Metabolic Health and Pregnancy Outcomes

Maternal metabolic health encompasses the intricate adaptive processes that regulate energy homoeostasis, endocrine function and vascular integrity during pregnancy. This dynamic interplay affects glucose and lipid metabolism, placental nutrient transport and vascular tone to support foetal growth and maintain maternal well-being. Disruptions in these processes, arising from pre-existing obesity, dysglycaemia or insulin resistance, predispose to complications such as gestational diabetes mellitus (GDM) and pre-eclampsia (PE). Both conditions are characterised by endothelial dysfunction, aberrant angiogenesis and inflammatory activation, which contribute to hypertension, placental insufficiency and adverse neonatal outcomes including preterm birth and intrauterine growth restriction. Long term, affected mothers and offspring bear increased risk of cardiometabolic diseases. Recent investigations have advanced our understanding of biomarker profiles, mechanistic pathways and predictive algorithms, offering new opportunities for early risk stratification and targeted interventions to improve global maternal and child health.

Research from Nature Portfolio

Recent studies have illuminated the balance of anti-angiogenic and pro-angiogenic factors in pregnancies complicated by GDM and PE. Analysis of maternal blood established that the soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1/PlGF) ratio is significantly elevated in women with both GDM and superimposed PE compared to those with uncomplicated GDM or normotensive controls. Parallel examination of placental tissues revealed decreased PlGF gene expression across GDM, PE and combined conditions, while protein levels varied, reflecting complex post-transcriptional regulation. These findings underscore the role of angiogenic imbalance in endothelial dysfunction and suggest that modulation of the sFlt-1/PlGF axis may serve as a therapeutic or prognostic target in high-risk pregnancies.

Maternal Metabolic Health and Pregnancy Outcomes publication trend

The graph below shows the total number of articles in maternal metabolic health and pregnancy outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

Gestational diabetes mellitus (GDM): glucose intolerance first recognised during pregnancy, leading to hyperglycaemia.

Pre-eclampsia (PE): pregnancy-specific syndrome of hypertension and organ dysfunction often associated with proteinuria.

Insulin resistance: reduced responsiveness of cells to insulin, impairing glucose uptake and utilisation.

Endothelial dysfunction: impaired function of the vascular endothelium, affecting vasodilation and barrier properties.

sFlt-1/PlGF ratio: balance between anti-angiogenic soluble fms-like tyrosine kinase-1 and pro-angiogenic placental growth factor, indicative of vascular health.

Angiogenic imbalance: disruption in pro- and anti-angiogenic factors affecting blood vessel formation and function.

References

1. Regulation of MMP-2 by IL-8 in Vascular Endothelial Cells: Probable Mechanism for Endothelial Dysfunction in Women with Preeclampsia. International Journal of Molecular Sciences (2023).
2. Higher daytime systolic BP, prepregnancy BMI and an elevated sFlt-1/PlGF ratio predict the development of hypertension in normotensive pregnant women. Reproductive Biology and Endocrinology (2022).
3. Pre-Eclampsia Biomarkers for Women With Type 1 Diabetes Mellitus: A Comprehensive Review of Recent Literature. Frontiers in Bioengineering and Biotechnology (2022).
4. Mechanisms of Endothelial Dysfunction in Pre-eclampsia and Gestational Diabetes Mellitus: Windows Into Future Cardiometabolic Health?. Frontiers in Endocrinology (2020).
5. Placental and maternal sFlt1/PlGF expression in gestational diabetes mellitus. Scientific Reports (2021).