Skip to main content

Advertisement

SpringerLink
Log in

Congenital Anomalies in Women with Obesity

  • REVIEW
  • Published:
Current Obstetrics and Gynecology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

In addition to a general overview of congenital anomalies in pregnant people with obesity as well as new data on the topic, this review aims to discuss the challenges in antenatal diagnosis of anomalies via sonogram.

Recent Findings

Obesity is associated with a dose-dependent increase in risk of certain congenital anomalies including cardiac malformations. The risk reduction of neural tube defects with folic acid supplementation is not as significant in offspring of patients with obesity compared to their normal weight counterparts. The addition of an early anatomy scan at 13 to15 weeks in addition to the traditionally timed anatomy scan may improve completion of the scan and increase identification of anomalies.

Summary

The overall risk of congenital anomalies is 3–5%. This risk increases with maternal obesity. Pregnant people with obesity are at higher risk of multiple types of anomalies in various organ systems, including cardiovascular, renal, and neurologic systems. Several of these are associated with a dose-dependent risk such that the risk is greater with increasing BMI. Along with the increased risk of anomalies, maternal obesity is also associated with lower quality sonogram images and poorer rates of completion of anatomy scans at initial attempt.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Obesity is a common, serious, and costly disease Centers for Disease Control and Prevention2022, updated May 17 2022. Available from: https://www.cdc.gov/obesity/data/adult.html.

  2. Obesity in pregnancy. ACOG Practice Bulletin, Number 230. Obstet Gynecol. 2021;137(6):e128–44.

    Article  Google Scholar 

  3. Birth defects are common, costly, and critical Centers for Disease Control and Prevention, updated December 5 2019. Available from: https://www.cdc.gov/ncbddd/birthdefects/infographic.html#:~:text=Birth%20defects%20affect%201%20in,the%20United%20States%20each%20year.

  4. Persson M, Cnattingius S, Villamor E, Söderling J, Pasternak B, Stephansson O, et al. Risk of major congenital malformations in relation to maternal overweight and obesity severity: cohort study of 1.2 million singletons. Bmj. 2017;357:j2563.

  5. Stothard KJ, Tennant PW, Bell R, Rankin J. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA. 2009;301(6):636–50.

    Article  CAS  PubMed  Google Scholar 

  6. van de Putte R, de Walle HEK, van Hooijdonk KJM, de Blaauw I, Marcelis CLM, van Heijst A, et al. Maternal risk associated with the VACTERL association: a case-control study. Birth Defects Res. 2020;112(18):1495–504.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Reller MD, Strickland MJ, Riehle-Colarusso T, Mahle WT, Correa A. Prevalence of congenital heart defects in metropolitan Atlanta, 1998–2005. J Pediatr. 2008;153(6):807–13.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Egbe A, Uppu S, Stroustrup A, Lee S, Ho D, Srivastava S. Incidences and sociodemographics of specific congenital heart diseases in the United States of America: an evaluation of hospital discharge diagnoses. Pediatr Cardiol. 2014;35(6):975–82.

    Article  PubMed  Google Scholar 

  9. Watkins ML, Rasmussen SA, Honein MA, Botto LD, Moore CA. Maternal obesity and risk for birth defects. Pediatrics. 2003;111(5 Pt 2):1152–8.

    Article  PubMed  Google Scholar 

  10. Waller DK, Shaw GM, Rasmussen SA, Hobbs CA, Canfield MA, Siega-Riz AM, et al. Prepregnancy obesity as a risk factor for structural birth defects. Arch Pediatr Adolesc Med. 2007;161(8):745–50.

    Article  PubMed  Google Scholar 

  11. Brite J, Laughon SK, Troendle J, Mills J. Maternal overweight and obesity and risk of congenital heart defects in offspring. Int J Obes (Lond). 2014;38(6):878–82.

    Article  CAS  PubMed  Google Scholar 

  12. Persson M, Razaz N, Edstedt Bonamy AK, Villamor E, Cnattingius S. Maternal overweight and obesity and risk of congenital heart defects. J Am Coll Cardiol. 2019;73(1):44–53.

    Article  PubMed  Google Scholar 

  13. Engineer A, Saiyin T, Greco ER, Feng Q. Say NO to ROS: their roles in embryonic heart development and pathogenesis of congenital heart defects in maternal diabetes. Antioxidants (Basel). 2019;8(10).

  14. Jarvie E, Hauguel-de-Mouzon S, Nelson SM, Sattar N, Catalano PM, Freeman DJ. Lipotoxicity in obese pregnancy and its potential role in adverse pregnancy outcome and obesity in the offspring. Clin Sci (Lond). 2010;119(3):123–9.

    Article  CAS  PubMed  Google Scholar 

  15. He X, Hong X, Zeng F, Kang F, Li L, Sun Q. Zinc antagonizes homocysteine-induced fetal heart defects in rats. Cardiovasc Toxicol. 2009;9(3):151–9.

    Article  CAS  PubMed  Google Scholar 

  16. Kumar SD, Vijaya M, Samy RP, Dheen ST, Ren M, Watt F, et al. Zinc supplementation prevents cardiomyocyte apoptosis and congenital heart defects in embryos of diabetic mice. Free Radic Biol Med. 2012;53(8):1595–606.

    Article  CAS  PubMed  Google Scholar 

  17. Yang J, Kang Y, Chang Q, Zhang B, Liu X, Zeng L, et al. Maternal zinc, copper, and selenium intakes during pregnancy and congenital heart defects. Nutrients. 2022;14(5).

  18. Maffoni S, De Giuseppe R, Stanford FC, Cena H. Folate status in women of childbearing age with obesity: a review. Nutr Res Rev. 2017;30(2):265–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Bird JK, Murphy RA, Ciappio ED, McBurney MI. Risk of deficiency in multiple concurrent micronutrients in children and adults in the United States. Nutrients. 2017;9(7).

  20. Folic acid & neural tube defects: data & statistics Centers for Disease Control and Prevention2022, updated November 9, 2017. Available from: https://www.cdc.gov/ncbddd/birthdefectscount/data.html#:~:text=In%20the%20United%20States%2C%203%2C000,defects%20every%20year%20(1).

  21. Rasmussen SA, Chu SY, Kim SY, Schmid CH, Lau J. Maternal obesity and risk of neural tube defects: a metaanalysis. Am J Obstet Gynecol. 2008;198(6):611–9.

    Article  PubMed  Google Scholar 

  22. Benjamin RH, Ethen MK, Canfield MA, Hua F, Mitchell LE. Association of interpregnancy change in body mass index and spina bifida. Birth Defects Res. 2019;111(18):1389–98.

    Article  CAS  PubMed  Google Scholar 

  23. Arbuzova S, Nikolenko M, Cuckle H. Maternal weight as an additional first trimester spina bifida screening marker. J Matern Fetal Neonatal Med. 2022;35(17):3353–8.

    Article  PubMed  Google Scholar 

  24. Pace ND, Siega-Riz AM, Olshan AF, Chescheir NC, Cole SR, Desrosiers TA, et al. Survival of infants with spina bifida and the role of maternal prepregnancy body mass index. Birth Defects Res. 2019;111(16):1205–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Shaw GM, Velie EM, Schaffer D. Risk of neural tube defect-affected pregnancies among obese women. JAMA. 1996;275(14):1093–6.

    Article  CAS  PubMed  Google Scholar 

  26. Zhang L, Zhang Y, Li Z, Ren A, Liu J, Ye R. Maternal periconceptional body mass index and risk for neural tube defects: results from a large cohort study in China. J Matern Fetal Neonatal Med. 2021;34(2):274–80.

    Article  PubMed  Google Scholar 

  27. Lupo PJ, Canfield MA, Chapa C, Lu W, Agopian AJ, Mitchell LE, et al. Diabetes and obesity-related genes and the risk of neural tube defects in the national birth defects prevention study. Am J Epidemiol. 2012;176(12):1101–9.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wang M, Wang ZP, Gao LJ, Gong R, Sun XH, Zhao ZT. Maternal body mass index and the association between folic acid supplements and neural tube defects. Acta Paediatr. 2013;102(9):908–13.

    Article  CAS  PubMed  Google Scholar 

  29. Parker SE, Yazdy MM, Tinker SC, Mitchell AA, Werler MM. The impact of folic acid intake on the association among diabetes mellitus, obesity, and spina bifida. Am J Obstet Gynecol. 2013;209(3):239.e1-8.

    Article  CAS  PubMed  Google Scholar 

  30. da Silva VR, Hausman DB, Kauwell GP, Sokolow A, Tackett RL, Rathbun SL, et al. Obesity affects short-term folate pharmacokinetics in women of childbearing age. Int J Obes (Lond). 2013;37(12):1608–10.

    Article  PubMed  Google Scholar 

  31. Tinker SC, Hamner HC, Berry RJ, Bailey LB, Pfeiffer CM. Does obesity modify the association of supplemental folic acid with folate status among nonpregnant women of childbearing age in the United States? Birth Defects Res A Clin Mol Teratol. 2012;94(10):749–55.

    Article  CAS  PubMed  Google Scholar 

  32. Giouleka S, Tsakiridis I, Koutsouki G, Kostakis N, Mamopoulos A, Kalogiannidis I, et al. Obesity in pregnancy: a comprehensive review of influential guidelines. Obstet Gynecol Surv. 2023;78(1):50–68.

    Article  PubMed  Google Scholar 

  33. Jadresić L, Au H, Woodhouse C, Nitsch D. Pre-pregnancy obesity and risk of congenital abnormalities of the kidney and urinary tract (CAKUT)-systematic review, meta-analysis and ecological study. Pediatr Nephrol. 2021;36(1):119–32.

    Article  PubMed  Google Scholar 

  34. Macumber I, Schwartz S, Leca N. Maternal obesity is associated with congenital anomalies of the kidney and urinary tract in offspring. Pediatr Nephrol. 2017;32(4):635–42.

    Article  PubMed  Google Scholar 

  35. Arendt LH, Ramlau-Hansen CH, Lindhard MS, Henriksen TB, Olsen J, Yu Y, et al. Maternal overweight and obesity and genital anomalies in male offspring: a population-based Swedish cohort study. Paediatr Perinat Epidemiol. 2017;31(4):317–27.

    Article  PubMed  Google Scholar 

  36. Schneuer FJ, Nassar N. Maternal obesity and male genital anomalies: potential role of placental insufficiency and metabolic syndrome. Paediatr Perinat Epidemiol. 2017;31(5):e1–3.

    Article  PubMed  Google Scholar 

  37. Lassance L, Haghiac M, Minium J, Catalano P, Hauguel-de MS. Obesity-induced down-regulation of the mitochondrial translocator protein (TSPO) impairs placental steroid production. J Clin Endocrinol Metab. 2015;100(1):E11–8.

    Article  PubMed  Google Scholar 

  38. Blanco R, Colombo A, Suazo J. Maternal obesity is a risk factor for orofacial clefts: a meta-analysis. Br J Oral Maxillofac Surg. 2015;53(8):699–704.

    Article  CAS  PubMed  Google Scholar 

  39. Aagaard-Tillery KM, Flint Porter T, Malone FD, Nyberg DA, Collins J, Comstock CH, et al. Influence of maternal BMI on genetic sonography in the FaSTER trial. Prenat Diagn. 2010;30(1):14–22.

    Article  PubMed  Google Scholar 

  40. Dashe JS, McIntire DD, Twickler DM. Maternal obesity limits the ultrasound evaluation of fetal anatomy. J Ultrasound Med. 2009;28(8):1025–30.

    Article  PubMed  Google Scholar 

  41. Gupta VK, Adams JH, Heiser T, Iruretagoyena JI, Hoppe KK, Antony KM. Detailed fetal anatomic ultrasound examination duration and association with body mass index. Obstet Gynecol. 2019;134(4):774–80.

    Article  PubMed  Google Scholar 

  42. Yaqub M, Kelly B, Noble JA, Papageorghiou AT. The effect of maternal body mass index on fetal ultrasound image quality. Am J Obstet Gynecol. 2021;225(2):200–2.

    Article  PubMed  Google Scholar 

  43. Eastwood KA, Daly C, Hunter A, McCance D, Young I, Holmes V. The impact of maternal obesity on completion of fetal anomaly screening. J Perinat Med. 2017;45(9):1061–7.

    Article  PubMed  Google Scholar 

  44. Romary L, Sinkovskaya E, Ali S, Cunningham TD, Marwitz S, Heeze A, et al. The role of early gestation ultrasound in the assessment of fetal anatomy in maternal obesity. J Ultrasound Med. 2017;36(6):1161–8.

    Article  PubMed  Google Scholar 

  45. Majeed A, Abuhamad A, Romary L, Sinkovskaya E. Can ultrasound in early gestation improve visualization of fetal cardiac structures in obese pregnant women? J Ultrasound Med. 2019;38(8):2057–63.

    Article  PubMed  Google Scholar 

  46. Weatherborn M, McGuinness B, Ogamba MI, Leung K, Leftwich HK. Optimal timing of the second trimester fetal ultrasound in the obese gravida. J Matern Fetal Neonatal Med. 2022;35(14):2703–7.

    Article  PubMed  Google Scholar 

  47. Paladini D. Sonography in obese and overweight pregnant women: clinical, medicolegal and technical issues. Ultrasound Obstet Gynecol. 2009;33(6):720–9.

    Article  CAS  PubMed  Google Scholar 

  48. Abuhamad A. Ultrasound in obstetrics and gynecology: a practical approach 2014.

  49. Bak GS, Shaffer BL, Madriago E, Allen A, Kelly B, Caughey AB, et al. Impact of maternal obesity on fetal cardiac screening: which follow-up strategy is cost-effective? Ultrasound Obstet Gynecol. 2020;56(5):705–16.

    Article  CAS  PubMed  Google Scholar 

  50. Uhden M, Knippel AJ, Stressig R, Hammer R, Siegmann H, Froehlich S, et al. Impact of maternal obesity and maternal overweight on the detection rate of fetal heart defects and the image quality of prenatal echocardiography. Ultraschall Med. 2011;32(Suppl 2):E108–14.

    Article  PubMed  Google Scholar 

  51. Maxwell C, Glanc P. Imaging and obesity: a perspective during pregnancy. AJR Am J Roentgenol. 2011;196(2):311–9.

    Article  PubMed  Google Scholar 

  52. Garel C. Imaging the fetus: when does MRI really help? Pediatr Radiol. 2008;38(Suppl 3):S467–70.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of South Florida, 2 Tampa General Circle, Tampa, FL, 33606, USA

    Katherine Pressman & Sarah Običan

Authors
  1. Katherine Pressman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarah Običan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sarah Običan.

Ethics declarations

Conflict of Interest

The authors have no disclosures and no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pressman, K., Običan, S. Congenital Anomalies in Women with Obesity. Curr Obstet Gynecol Rep 12, 117–121 (2023). https://doi.org/10.1007/s13669-023-00352-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13669-023-00352-z

Keywords

Search

Navigation