Maternal anthropometry, trimester-specific metabolic profiles, and placental morphometry as determinants of neonatal growth: a prospective maternal–placental–fetal cohort study
Dalia Rafat, Mohsina Zahera Majeedi, Tabassum Nawab, Hamid AshrafAbstract
Objectives
To examine the interrelationships between maternal anthropometry, trimester-specific metabolic biomarkers, placental morphometry, and neonatal anthropometric outcomes in a South Asian population.
Methods
In this prospective longitudinal cohort (January 2023–December 2024), 250 eligible singleton pregnancies were recruited at <12 weeks’ gestation from a tertiary-care center. Maternal anthropometry, glucose metabolism (OGTT), insulin resistance (HOMA-IR), and lipid profile (TC, LDL-C, HDL-C, triglycerides) were assessed across all trimesters. Placental morphometry was measured immediately postpartum. Neonatal anthropometry was assessed within 24–48 h of birth. Associations were analyzed using correlation matrices, regression modelling, and trimester-stratified analyses.
Results
Despite a relatively lean maternal profile (mean BMI 23.4 kg/m 2 ), metabolic abnormalities were highly prevalent (GDM: 30–48 %; IR: 72–77 %). Lipid parameters showed trimester specific alterations. Gestational weight gain correlated modestly with birthweight ( ρ =0.226). Placental weight and thickness showed strong associations with birthweight ( ρ =0.523; ρ =0.517) and neonatal fat mass ( ρ =0.423). First-trimester GDM and IR were associated with increased neonatal length, while second-trimester GDM predicted larger head circumference. Across all trimesters, GDM showed inverse associations with neonatal skinfold thickness. Third-trimester LDL-C, triglycerides, and total cholesterol were the strongest predictors of neonatal adiposity, with minimal influence on skeletal growth.
Conclusions
Maternal metabolic perturbations exert trimester-specific influences on placental structure and neonatal anthropometry, with late-pregnancy lipids showing the strongest association with neonatal adiposity. Placental morphometry functions as a key mediator of maternal–fetal metabolic interactions. These findings support comprehensive metabolic screening in pregnancy and provide population-specific evidence to guide targeted antenatal interventions in South Asian settings.