Health of mothers, fetuses, and children are all affected by the maternal environment

A recent editorial published in the journal BMC Medicine examined existing literature for associations between the mother’s and offspring’s health outcomes and a broad range of maternal characteristics related to pregnancy and postnatal phenotypes and complications.

Study: Maternal factors during pregnancy influencing maternal, fetal, and childhood outcomes. Image Credit: Marc Roura / Shutterstock


A large body of research indicates that the immediate and long-term health of the offspring is influenced to a large extent by the genetic, nutritional, physiological, psychological, and immune response characteristics of the maternal environment. Furthermore, pregnancy complications such as preterm birth and preeclampsia are shown to impact the mother’s cardiovascular health.

Studies have also explored correlations between maternal nutrition, maternal weight, and gestational diabetes mellitus to fetal adiposity and early childhood obesity. A comprehensive analysis of existing research will help understand the common mechanisms underlying the diverse maternal and fetal health outcomes.

Preterm birth

The authors examined the underlying mechanisms of preterm birth and evaluated studies on potential biomarkers and preterm birth risk factors, including polycystic ovary syndrome (PCOS).

One of the studies investigated correlations between placental proteins and spontaneous preterm birth and found that the alpha-1 antitrypsin (AAT) messenger ribonucleic acid (mRNA) and protein levels were downregulated in the mother and the fetus in preterm births. They also found that decreased AAT protein levels affected the extracellular matrix and actin cytoskeleton.

Another study from Brazil examined the risk factors associated with preterm birth during the second pregnancy and correlations to preterm births during the first pregnancy. Interestingly, the study found that incident preterm birth during second pregnancy (first pregnancy was carried to term) was associated with socioeconomic conditions such as overcrowding at home, and ethnic and age-related factors, with mixed-race, black, and indigenous mothers and very young mothers (below 19 years of age) having a higher risk of preterm birth. In addition, fewer prenatal visits, stress, smoking behavior, and socioeconomic deprivations were other risk factors identified by the study.

Preterm birth was also seen to be associated with PCOS. Characterized by ovarian cysts, androgen excess, and infrequent or absent menstruation, PCOS is a metabolic disorder that presents a wide range of symptoms and is linked to metabolic conditions such as obesity and diabetes with progressing age.

A study from the United Kingdom examined the link between PCOS and obstetric complications and found an 11% increase in the odds of preterm birth in women with PCOS. However, since the study did not adjust for pregnancy-related complications such as hypertension and gestational diabetes, which are characteristic of preterm birth and PCOS, the authors believe those complications were more likely to cause preterm birth.

Environmental exposures

The editorial also examined studies investigating the effect of obesity, smoking, and the in-utero environment on fetal health. Obesity has serious consequences, such as preeclampsia, gestational diabetes, and cesarian section. Studies have also found that the offspring of obese women have a higher risk of obesity, cardiovascular diseases, and type 2 diabetes, primarily due to non-genetic factors.

A mother-child cohort study reported that children born to obese mothers deviated from healthy weight gain patterns in the first few months after birth and were at high risk of being overweight or obese by age five.

Another study from Singapore explored correlations between the lipid profiles of the mother and the fetus during pregnancy and found that fetal lipid profiles have higher concentrations of lysophospholipids, indicating specific developmental needs. The study also identified lower levels of triacylglycerols, phospholipids, and sphingomyelin in the lipid profiles of obese mothers, highlighting the importance of weight management during pregnancy. The shared adiposity characteristics between mothers and children could also be influenced by diet and similar lifestyles.

Along with obesity, maternal smoking was a strong indicator of abnormal body mass index (BMI) in children during early growth. Surprisingly, a Swedish study that evaluated the type 1 diabetes risk associated with maternal smoking found that maternal smoking was linked to a 22% reduction in the risk of type 1 diabetes in the offspring. However, the mechanistic pathways that could explain this correlation need to be explored.

Various other studies found associations between maternal smoking and shorter telomere length, a biomarker for cellular aging and oxidative damage. Studies also indicated links between smoking, telomere length, and attention-deficit hyperactivity disorder (ADHD).


To summarize, the present editorial explored the association between pregnancy phenotypes and complications and the mother’s and offspring’s long-term health. In addition, the authors discussed various studies that investigated the influence of maternal obesity on early childhood adiposity, as well as risk factors and biomarkers linked to preterm birth.

Studies investigating the association of socioeconomic and demographic factors and PCOS with preterm birth risk were also discussed. Maternal smoking behavior was found to be linked to short telomere length and possible ADHD development in children.

Journal reference:

  • Muglia, L. J., Benhalima, K., Tong, S., & Ozanne, S. (2022). Maternal factors during pregnancy influencing maternal, fetal, and childhood outcomes. BMC Medicine, 20(1).,  

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