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Maternal adipose tissue expansion, a missing link in the prediction of birth weight centile.

CONTEXT
Maternal body mass index (BMI) is associated with increased birth weight but does not explain all the variance in fetal adiposity.


OBJECTIVE
To assess the contribution of maternal body fat distribution to offspring birth weight and adiposity.


DESIGN
Longitudinal study throughout gestation and at delivery.


SETTING
Women recruited at 12 weeks of gestation and followed up at 26 and 36 weeks. Cord blood was collected at delivery.


PATIENTS
Pregnant women (n=45) with BMI 18.0-46.3 kg/m2 and healthy pregnancy outcome.


METHODS
Maternal first trimester abdominal subcutaneous and visceral adipose tissue thickness (SAT and VAT) was assessed by ultrasound.


RESULTS
VAT was the only anthropometric measure independently associated with birth weight centile (r2 adjusted 15.8%, P=0.002). BMI was associated with trimester 2 and trimester 1 - 3 area under the curve (AUC) glucose and insulin resistance (HOMA). SAT alone predicted trimester 2 lipoprotein lipase (LPL) mass (a marker of adipocyte insulin sensitivity) (11.3%, P=0.017). VAT was associated with fetal triglyceride (9.3%, P=0.047). Placental weight was the only independent predictor of fetal adiposity (48%, P<0.001). Maternal trimester 2 and AUC LPL were inversely associated with fetal adiposity (r=-0.69, P=0.001 and r=-0.58, P=0.006 respectively).


CONCLUSIONS
Maternal VAT provides additional information to BMI for prediction of birth weight. VAT may be a marker of reduced SAT expansion and increased availability of maternal fatty acids for placental transport.