Preconception leptin level predicts risk for adverse pregnancy outcomes
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Healthy women with a high preconception leptin level are nearly 20 times more likely to develop gestational diabetes when compared with women with a low leptin level, although leptin was not shown to influence risks for pregnancy loss or preterm delivery, according to findings published in Obesity Science & Practice.
“We found that women with higher preconception leptin levels had a higher likelihood of experiencing gestational diabetes and hypertensive disorders of pregnancy, even after accounting for maternal obesity,” Sunni L. Mumford, PhD, Earl Stadtman investigator in the epidemiology branch of the division of intramural population health research at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, told Healio. “Preconception leptin levels were not associated with preterm birth or pregnancy loss.”
In a prospective study, Mumford and colleagues analyzed data from 776 healthy women with one or two prior pregnancy losses recruited for the Effects of Aspirin in Gestation and Reproduction trial (2007-2011), a randomized, placebo-controlled trial assessing the effects of low-dose aspirin on live birth. Women were followed for less than six cycles while trying to conceive and throughout pregnancy. Researchers measured preconception leptin concentrations at baseline (95 fasting blood samples) and stratified women by leptin level tertiles (0.007-11.3 ng/mL, 11.4-26.2 ng/mL, and 26.3-97.4 ng/mL), using the lowest as a reference group. Researchers used weighted log-binomial regression to estimate risk ratios for pregnancy loss, preterm delivery, gestational diabetes and hypertensive disorders in pregnancy, adjusted for age, waist-to-hip ratio and BMI.
Researchers found that mean BMI varied across low-, middle- and high-level leptin tertiles (21 kg/m², 24.8 kg/m² and 31.8 kg/m², respectively), as did mean waist-to-hip ratio (0.78, 0.81 and 0.83, respectively). Women with leptin levels in the highest tertile also had higher blood pressure and lower gestational weight gain.
Compared with women in the lowest leptin level tertile, women in the middle- and high-level groups did not have a greater risk for any pregnancy loss, clinical pregnancy loss or preterm delivery, with results persisting after adjustment for age, waist-to-hip ratio, BMI and fasting status at blood draw. However, women in the highest leptin tertile were nearly 20 times more likely to develop gestational diabetes when compared with the lowest tertile (RR = 18.68; 95% CI, 2.46-141.44), with results persisting after adjustment. Women in the highest tertile were also more likely to develop hypertensive disorders during pregnancy (RR = 2.35; 95% CI, 1.2-4.61); however, the risk did not persist once the model was adjusted for BMI.
“The direct clinical implications are currently unknown, though our findings suggest that leptin may hold promise as a marker to predict adverse pregnancy outcomes independent of central adiposity and warrant further evaluation in other cohorts,” Mumford said. “Further study of the role of preconception leptin levels on pregnancy outcomes to confirm these findings may help to guide counseling and screening, which is particularly relevant in light of the obesity epidemic.” – by Regina Schaffer
For more information:
Sunni L. Mumford, PhD, can be reached at 6710B Rockledge Drive, MSC 7004, Bethesda, MD 20892; email: mumfords@mail.nih.gov.
Disclosures: The authors report no relevant financial disclosures.
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