Periconceptional maternal body mass index and the impact on post-implantation (sex-specific) embryonic growth and morphological development

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Scopus)


Objective: Women with obesity have an increased risk of pregnancy complications. Although complications generally present in the second and third trimester of pregnancy, most of them develop in the periconception period. Moreover, fetal sex also impacts pregnancy course and outcome. Therefore, our aim is to study (sex-specific) associations between periconceptional maternal body mass index (BMI) and embryonic growth and morphological development. Methods: A total of 884 women with singleton pregnancies were selected from the Rotterdam Periconception Cohort, comprising 15 women with underweight, 483 with normal weight, 231 with overweight and 155 with obesity. Longitudinal three-dimensional ultrasound examinations were performed at 7, 9, and 11 weeks of gestation for offline measurements of crown-rump length (CRL), embryonic volume (EV), and Carnegie stages. Analyses were adjusted for maternal age, parity, ethnicity, education, and periconceptional lifestyle. Results: A negative trend was observed for embryos of women with obesity (βEV −0.03, p = 0.086), whereas embryonic growth and developmental trajectories in women with overweight were comparable to those with normal weight. Maternal underweight was associated with faster morphological development (βCarnegie 0.78, p = 0.004). After stratification for fetal sex, it was demonstrated that female embryos of underweight women grow and morphologically develop faster than those of normal weight women (βEV 0.13, p = 0.008; βCarnegie 1.39, p < 0.001), whereas female embryos of women with obesity grow slower (βEV −0.05, p = 0.027). Conclusion: We found that periconceptional maternal underweight is associated with faster embryonic growth, especially in females. In contrast, female embryos of women with obesity grow slower than female embryos of women with normal weight. This may be the result of altered female adaptation to the postnatal environment. Future research should focus on strategies for optimizing preconceptional maternal weight, to reduce BMI-related pregnancy complications and improve the health of future generations.

Original languageEnglish
Pages (from-to)2369-2376
Number of pages8
JournalInternational Journal of Obesity
Issue number11
Early online date21 Jul 2021
Publication statusPublished - Nov 2021

Bibliographical note

Funding Information:
JL reports grants and personal fees from Ferring and Titus Healthcare, grants and personal fees from Ansh Labs, grants from NIH, the Dutch Heart Association, and ZonMW, outside the submitted work. None of the other authors have a conflict of interest to disclose.

Funding Information:
The authors thank the Rotterdam Periconception Cohort team for data acquisition and the participating couples and gynecologists for their contributions. We also thank Dr. Anton Koning for his contributions by assisting in the acquisition and accessibility of VR data and Mitch Vleghert for his support in data analyses. This research was funded by the Erasmus MC Medical Research Advisor Committee’s ‘Health Care Efficiency Research’ program and the department of Obstetrics and Gynaecology of the Erasmus University Medical Center, Rotterdam, The Netherlands.

Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Nature Limited.


Dive into the research topics of 'Periconceptional maternal body mass index and the impact on post-implantation (sex-specific) embryonic growth and morphological development'. Together they form a unique fingerprint.

Cite this