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Maternal factors during pregnancy influencing maternal, fetal and childhood outcomes

Guest edited by: Dr Louis Muglia, Professor Stephen Tong, Professor Susan Ozanne and Professor Katrien Benhalima.

maternal factors (1)

A myriad of maternal factors (including pre-existing conditions, environmental exposures, and genetic predisposition) are known to influence pregnancy, childbirth, and the health of both the mother and her child during pregnancy and long after birth. Collectively, these issues represent a serious and growing burden on expectant mothers and their children; for example, in the United States, gestational diabetes is thought to affect between 2 and 10% of mothers each year (Centers for Disease Control and Prevention), and around 1 in 160 babies are stillborn (Centers for Disease Control and Prevention).

Understanding how these factors can influence outcomes for both mother and child, as well as identifying novel factors that mediate these effects, is crucial in addressing this global problem. BMC Medicine is pleased to launch a Collection titled ‘Maternal factors during pregnancy influencing maternal, fetal and childhood outcomes’, that welcomes outstanding contributions in these fields. We are particularly interested in papers that fall under the following topics:

Maternal factors

  • Pre-existing medical conditions (for example polycystic ovary syndrome, diabetes and endometriosis)
  • Maternal stress and mental health (including socio-economic factors, stigmas)
  • Environmental exposures (for example smoking, alcohol and pollution)
  • Obesity/high BMI
  • Microbiota
  • Breastfeeding
  • Genetics/epigenetics
  • Nutrition (including macronutrients and essential micronutrients)


  • Fetal outcomes in pregnancy (for example stillbirth, preterm birth, normal and disordered fetal growth and cognitive development)
  • Childhood outcomes following fetal and maternal complications during pregnancy (for example childhood obesity, cardiovascular disease risk, congenital disorders and cognitive development)
  • Maternal outcomes in pregnancy (pre-eclampsia, gestational diabetes, blood pressure and maternal hemorrhage)
  • Maternal and offspring benefits of breastfeeding
  • Maternal risk of developing diseases in later life (for example type 2 diabetes, hypertension and gestational diabetes risk in subsequent pregnancies)
  • How pregnancy can affect maternal pre-existing/co-existing medical conditions

BMC Medicine encourages submissions of front matter articles and original research including randomised clinical trials (phase I, I/II, II and III as well as positive or negative trials), epidemiological studies (retrospective or prospective), systematic and umbrella reviews, medical imaging, medical genomics studies, biomarkers and translational research. We also welcome outstanding mechanistic laboratory studies that provide translational insights.

Please note that we do not consider case reports.

  1. Higher maternal pre-pregnancy body mass index (BMI) is associated with adverse pregnancy and perinatal outcomes. However, whether these associations are causal remains unclear.

    Authors: Maria Carolina Borges, Gemma L. Clayton, Rachel M. Freathy, Janine F. Felix, Alba Fernández-Sanlés, Ana Gonçalves Soares, Fanny Kilpi, Qian Yang, Rosemary R. C. McEachan, Rebecca C. Richmond, Xueping Liu, Line Skotte, Amaia Irizar, Andrew T. Hattersley, Barbara Bodinier, Denise M. Scholtens…
    Citation: BMC Medicine 2024 22:32
  2. Preterm birth (PTB) is a leading cause of child morbidity and mortality. Evidence suggests an increased risk with both maternal underweight and obesity, with some studies suggesting underweight might be a grea...

    Authors: R. P. Cornish, M. C. Magnus, S. K. Urhoj, G. Santorelli, L. G. Smithers, D. Odd, A. Fraser, S. E. Håberg, A. M. Nybo Andersen, K. Birnie, J. W. Lynch, K. Tilling and D. A. Lawlor
    Citation: BMC Medicine 2024 22:10
  3. Increasing maternal glycaemia across the continuum during pregnancy may predispose offspring to subsequent cardiometabolic risk later in life. However, evidence of long-term impacts of maternal glycemic status...

    Authors: Mengjiao Liu, Shiao-Yng Chan, Johan G. Eriksson, Yap Seng Chong, Yung Seng Lee, Fabian Yap, Mary Foong-Fong Chong, Mya Thway Tint, Jiaxi Yang, David Burgner, Cuilin Zhang and Ling-Jun Li
    Citation: BMC Medicine 2023 21:472
  4. Breastfeeding has long been associated with numerous benefits for both mothers and infants. While some observational studies have explored the relationship between breastfeeding and mental health outcomes in m...

    Authors: Polina Bugaeva, Inna Arkusha, Rinat Bikaev, Igor Kamenskiy, Aleksandra Pokrovskaya, Yasmin El-Taravi, Valeria Caso, Alla Avedisova, Derek K. Chu, Jon Genuneit, Gabriel Torbahn, Timothy R. Nicholson, Dina Baimukhambetova, Aigun Mursalova, Anastasia Kolotilina, Svetlana Gadetskaya…
    Citation: BMC Medicine 2023 21:393
  5. Deoxynivalenol (DON), one of the most prevalent mycotoxins, has been found to cause fetal growth retardation in animals. However, limited evidence exists regarding its effects on pregnant women.

    Authors: Tianqi Tan, Tingting Chen, Wenwen Zhu, Lin Gong, Yizhong Yan, Qian Li, Li Chen, Yiling Li, Jialin Liu, Yanan Li, Xuefeng Yang, Liping Hao, Huaiji Wang, Nianhong Yang and Sheng Wei
    Citation: BMC Medicine 2023 21:328
  6. Prenatal alcohol exposure (PAE) is a worldwide public health concern. While PAE is known to be associated with low birth weight, little is known about timing and quantity of PAE on fetal growth. This study inv...

    Authors: Marin Pielage, Hanan El Marroun, Hein J. Odendaal, Sten P. Willemsen, Manon H. J. Hillegers, Eric A. P. Steegers and Melek Rousian
    Citation: BMC Medicine 2023 21:318
  7. Gestational diabetes mellitus (GDM) is associated with both short- and long-term risks, although it is unknown if risks vary by severity, timing, and duration of gestational hyperglycemia. We aimed to identify...

    Authors: Shuyun Chen, Margareta Persson, Rui Wang, Christina Dalman, Brian K. Lee, Håkan Karlsson and Renee M. Gardner
    Citation: BMC Medicine 2023 21:260
  8. Although many conventional healthcare services to prevent postpartum depression are provided face-to-face, physical and psychosocial barriers remain. These barriers may be overcome by using mobile health servi...

    Authors: Yuki Arakawa, Maho Haseda, Kosuke Inoue, Daisuke Nishioka, Shiho Kino, Daisuke Nishi, Hideki Hashimoto and Naoki Kondo
    Citation: BMC Medicine 2023 21:221
  9. Early iron deficiency (ID) is a common risk factor for poorer neurodevelopment, limiting children’s potential and contributing to global burden. However, it is unclear how early ID alters the substrate of brai...

    Authors: Mengdi Hua, Donglin Shi, Wenwen Xu, Liuyan Zhu, Xiaoxin Hao, Bingquan Zhu, Qiang Shu, Betsy Lozoff, Fengji Geng and Jie Shao
    Citation: BMC Medicine 2023 21:167
  10. Diabetes has reached epidemic proportions in recent years with serious health ramifications. The aim of this study was to evaluate the strength and validity of associations between diabetes and anti-diabetic i...

    Authors: Anita Semertzidou, Harriet Grout-Smith, Ilkka Kalliala, Akanksha Garg, Vasso Terzidou, Julian Marchesi, David MacIntyre, Phillip Bennett, Konstantinos Tsilidis and Maria Kyrgiou
    Citation: BMC Medicine 2023 21:152
  11. Liver plays an important role in maintaining glucose homeostasis. We aimed to examine the associations of liver enzymes and hepatic steatosis index (HSI, a reliable biomarker for non-alcoholic fatty liver dis...

    Authors: Ping Wu, Yi Wang, Yi Ye, Xue Yang, Yichao Huang, Yixiang Ye, Yuwei Lai, Jing Ouyang, Linjing Wu, Jianguo Xu, Jiaying Yuan, Yayi Hu, Yi-Xin Wang, Gang Liu, Da Chen, An Pan…
    Citation: BMC Medicine 2023 21:150
  12. Obesity and neurodevelopmental delay are complex traits that often co-occur and differ between boys and girls. Prenatal exposures are believed to influence children’s obesity, but it is unknown whether exposur...

    Authors: Alejandro Cáceres, Natàlia Carreras-Gallo, Sandra Andrusaityte, Mariona Bustamante, Ángel Carracedo, Leda Chatzi, Varun B. Dwaraka, Regina Grazuleviciene, Kristine Bjerve Gutzkow, Johanna Lepeule, Léa Maitre, Tavis L. Mendez, Mark Nieuwenhuijsen, Remy Slama, Ryan Smith, Nikos Stratakis…
    Citation: BMC Medicine 2023 21:142
  13. Systemic corticosteroids are often used to treat inflammatory bowel disease (IBD) flares during pregnancy as maintenance of disease remission is crucial to optimize pregnancy outcomes. However, there is little...

    Authors: Line Riis Jølving, Jan Nielsen, Mette Louise Andersen, Sonia Friedman and Bente Mertz Nørgård
    Citation: BMC Medicine 2023 21:140
  14. Guidance to improve fertility includes reducing alcohol and caffeine consumption, achieving healthy weight-range and stopping smoking. Advice is informed by observational evidence, which is often biased by con...

    Authors: Robyn E. Wootton, Rebecca B. Lawn, Maria C. Magnus, Jorien L. Treur, Elizabeth C. Corfield, Pål R. Njølstad, Ole A. Andreassen, Deborah A. Lawlor, Marcus R. Munafò, Siri E. Håberg, George Davey Smith, Ted Reichborn-Kjennerud, Per Magnus and Alexandra Havdahl
    Citation: BMC Medicine 2023 21:125
  15. There is limited evidence on how the classification of maternal metabolic syndrome during pregnancy affects children’s developmental outcomes and the possible mediators of this association. This study uses a c...

    Authors: Janell Kwok, Lydia Gabriela Speyer, Georgia Soursou, Aja Louise Murray, Kostas A. Fanti and Bonnie Auyeung
    Citation: BMC Medicine 2023 21:124
  16. Previous studies have suggested that gestational weight gain (GWG) outside an optimal range increases the risks of neurodevelopmental disorders (NDDs) in offspring including autism spectrum disorder (ASD), int...

    Authors: Shuyun Chen, Mengyu Fan, Brian K. Lee, Christina Dalman, Håkan Karlsson and Renee M. Gardner
    Citation: BMC Medicine 2023 21:108
  17. Current evidence relating birthweight and gestational age to cardiovascular risk is conflicting. Whether these factors have independent or interactive impacts on cardiovascular parameters during early childhoo...

    Authors: Bowen Du, Hualin Wang, Yujian Wu, Zhuoyan Li, Yiwei Niu, Qianchuo Wang, Lin Zhang, Sun Chen, Yurong Wu, Jihong Huang, Kun Sun and Jian Wang
    Citation: BMC Medicine 2023 21:103
  18. Metabolomic changes during pregnancy have been suggested to underlie the etiology of gestational diabetes mellitus (GDM). However, research on metabolites during preconception is lacking. Therefore, this study...

    Authors: Ling-Jun Li, Ximeng Wang, Yap Seng Chong, Jerry Kok Yen Chan, Kok Hian Tan, Johan G. Eriksson, Zhongwei Huang, Mohammad L. Rahman, Liang Cui and Cuilin Zhang
    Citation: BMC Medicine 2023 21:99
  19. Preterm premature rupture of membranes (PPROM), which is associated with vaginal dysbiosis, is responsible for up to one-third of all preterm births. Consecutive ascending colonization, infection, and inflamma...

    Authors: Luiz Gustavo dos Anjos Borges, Jana Pastuschek, Yvonne Heimann, Kristin Dawczynski, Ekkehard Schleußner, Dietmar H. Pieper and Janine Zöllkau
    Citation: BMC Medicine 2023 21:92
  20. Maternal hypertensive disorders during pregnancy (HDP) have been suggested to contribute to the development of offspring cardiovascular disease later in life, but empirical evidence remains inconsistent. This ...

    Authors: Liu Yang, Chen Huang, Min Zhao, Priscilla M. Y. Lee, Cheng Zhang, Yongfu Yu, Bo Xi and Jiong Li
    Citation: BMC Medicine 2023 21:59
  21. It is now understood that it is the quality rather than the absolute amount of adipose tissue that confers risk for obesity-associated disease. Adipose-derived stem cells give rise to adipocytes during the dev...

    Authors: Taylor B. Scheidl, Amy L. Brightwell, Sarah H. Easson and Jennifer A. Thompson
    Citation: BMC Medicine 2023 21:50
  22. Rapid postnatal growth may result from exposure in utero or early life to adverse conditions and has been associated with diseases later in life and, in particular, with childhood obesity. DNA methylation, interf...

    Authors: Rossella Alfano, Daniela Zugna, Henrique Barros, Mariona Bustamante, Leda Chatzi, Akram Ghantous, Zdenko Herceg, Pekka Keski-Rahkonen, Theo M. de Kok, Tim S Nawrot, Caroline L Relton, Oliver Robinson, Theano Roumeliotaki, Augustin Scalbert, Martine Vrijheid, Paolo Vineis…
    Citation: BMC Medicine 2023 21:17
  23. Prenatal alcohol exposure (PAE) affects embryonic development, causing a variable fetal alcohol spectrum disorder (FASD) phenotype with neuronal disorders and birth defects. We hypothesize that early alcohol-i...

    Authors: P. Auvinen, J. Vehviläinen, H. Marjonen, V. Modhukur, J. Sokka, E. Wallén, K. Rämö, L. Ahola, A. Salumets, T. Otonkoski, H. Skottman, M. Ollikainen, R. Trokovic, H. Kahila and N. Kaminen-Ahola
    Citation: BMC Medicine 2022 20:495
  24. Leukocyte telomere length (LTL) is suggested to be a biomarker of biological age and reported to be associated with metabolic diseases such as type 2 diabetes. Glucose metabolic traits including glucose and in...

    Authors: Kwun Kiu Wong, Feifei Cheng, Cadmon K. P. Lim, Claudia H. T. Tam, Greg Tutino, Lai Yuk Yuen, Chi Chiu Wang, Yong Hou, Michael H. M. Chan, Chung Shun Ho, Mugdha V. Joglekar, Anandwardhan A. Hardikar, Alicia J. Jenkins, Boyd E. Metzger, William L. Lowe Jr., Wing Hung Tam…
    Citation: BMC Medicine 2022 20:490
  25. Preterm birth may affect maternal mental health, yet most studies focus on postpartum mental disorders only. We explored the relationship between preterm delivery and the long-term risk of maternal hospitaliza...

    Authors: Gabriel Côté-Corriveau, Gilles Paradis, Thuy Mai Luu, Aimina Ayoub, Marianne Bilodeau-Bertrand and Nathalie Auger
    Citation: BMC Medicine 2022 20:447
  26. Several recent observational studies have reported that gut microbiota composition is associated with preeclampsia. However, the causal effect of gut microbiota on preeclampsia-eclampsia is unknown.

    Authors: Pengsheng Li, Haiyan Wang, Lan Guo, Xiaoyan Gou, Gengdong Chen, Dongxin Lin, Dazhi Fan, Xiaoling Guo and Zhengping Liu
    Citation: BMC Medicine 2022 20:443
  27. The influence of maternal levothyroxine treatment during pregnancy remains unclear. This study aimed to evaluate the associations of maternal levothyroxine treatment during pregnancy with the birth and neurode...

    Authors: Grace Mengqin Ge, Edmund C. L. Cheung, Kenneth K. C. Man, Patrick Ip, Wing Cheong Leung, Gloria H. Y. Li, Annie W. C. Kung, Ching-Lung Cheung and Ian C. K. Wong
    Citation: BMC Medicine 2022 20:390
  28. The Accelerating Innovation for Mothers (AIM) project established a database of candidate medicines in research and development (R&D) between 2000 and 2021 for five pregnancy-related conditions, including pre-...

    Authors: Annie R. A. McDougall, Roxanne Hastie, Maya Goldstein, Andrew Tuttle, Stephen Tong, Anne Ammerdorffer, A. Metin Gülmezoglu and Joshua P. Vogel
    Citation: BMC Medicine 2022 20:393
  29. Gestational age (GA) is associated with later cognition and behavior. However, it is unclear how specific cognitive domains and brain structural development varies with the stepwise change of gestational durat...

    Authors: Qing Ma, Hui Wang, Edmund T. Rolls, Shitong Xiang, Jiong Li, Yuzhu Li, Qiongjie Zhou, Wei Cheng and Fei Li
    Citation: BMC Medicine 2022 20:424
  30. Breastmilk is a dynamic fluid whose initial function is to provide the most adapted nutrition to the neonate. Additional attributes have been recently ascribed to breastmilk, with the evidence of a specific mi...

    Authors: Raúl Piñeiro-Salvador, Eduardo Vazquez-Garza, José Antonio Cruz-Cardenas, Cuauhtémoc Licona-Cassani, Gerardo García-Rivas, Jorge Moreno-Vásquez, Mario René Alcorta-García, Victor Javier Lara-Diaz and Marion E. G. Brunck
    Citation: BMC Medicine 2022 20:388
  31. Maternal blood pressure levels reflect cardiovascular adaptation to pregnancy and proper maternal-fetal exchanges through the placenta and are very sensitive to numerous environmental stressors. Maternal hyper...

    Authors: Lucile Broséus, Daniel Vaiman, Jörg Tost, Camino Ruano San Martin, Milan Jacobi, Joel D. Schwartz, Rémi Béranger, Rémy Slama, Barbara Heude and Johanna Lepeule
    Citation: BMC Medicine 2022 20:397
  32. Cervical insufficiency is one of the underlying causes of late miscarriage and preterm birth. Although many risk factors have been identified, the relative magnitude of their association with risk in nulliparo...

    Authors: Lili Meng, Sara Öberg, Anna Sandström, Chen Wang and Marie Reilly
    Citation: BMC Medicine 2022 20:348
  33. Birth weight is considered not only to undermine future growth, but also to induce lifelong diseases; the aim of this study is to explore the relationship between birth weight and adult bone mass.

    Authors: Jiang-Wei Xia, Lin Zhang, Jin Li, Cheng-Da Yuan, Xiao-Wei Zhu, Yu Qian, Saber Khederzadeh, Jia-Xuan Gu, Lin Xu, Jian-Hua Gao, Ke-Qi Liu, David Karasik, Shu-Yang Xie, Guo-Bo Chen and Hou-Feng Zheng
    Citation: BMC Medicine 2022 20:361
  34. Identifying pregnancies at risk for preterm birth, one of the leading causes of worldwide infant mortality, has the potential to improve prenatal care. However, we lack broadly applicable methods to accurately...

    Authors: Abin Abraham, Brian Le, Idit Kosti, Peter Straub, Digna R. Velez-Edwards, Lea K. Davis, J. M. Newton, Louis J. Muglia, Antonis Rokas, Cosmin A. Bejan, Marina Sirota and John A. Capra
    Citation: BMC Medicine 2022 20:333
  35. Offspring born to women with pregestational type 1 diabetes (T1DM) are exposed to an intrauterine hyperglycemic milieu and has an increased risk of metabolic disease later in life. In this present study, we hy...

    Authors: Sine Knorr, Anne Skakkebæk, Jesper Just, Emma B. Johannsen, Christian Trolle, Søren Vang, Zuzana Lohse, Birgitte Bytoft, Peter Damm, Kurt Højlund, Dorte M. Jensen and Claus H. Gravholt
    Citation: BMC Medicine 2022 20:338
  36. The type 2 diabetes risk after gestational diabetes mellitus (GDM) is twice as high in South Asian compared to European women. Current guidelines differ regarding which test to use as a screening-tool post-GDM...

    Authors: Archana Sharma, Ingrid Nermoen, Elisabeth Qvigstad, Anh T. Tran, Christine Sommer, Naveed Sattar, Jason M. R. Gill, Hanne L. Gulseth, Stina T. Sollid and Kåre I. Birkeland
    Citation: BMC Medicine 2022 20:318
  37. Gestational diabetes (GDM) is prevalent and benefits from timely and effective treatment, given the short window to impact glycemic control. Clinicians face major barriers to choosing effectively among treatme...

    Authors: Lauren D. Liao, Assiamira Ferrara, Mara B. Greenberg, Amanda L. Ngo, Juanran Feng, Zhenhua Zhang, Patrick T. Bradshaw, Alan E. Hubbard and Yeyi Zhu
    Citation: BMC Medicine 2022 20:307
  38. Preeclampsia (PE) is a multisystemic maternal syndrome with substantial maternal and fetal morbidity and mortality. Currently, there is no clinically viable non-invasive biomarker assay for early detection, th...

    Authors: Siqi Bao, Tong Zhou, Congcong Yan, Jiale Bao, Fan Yang, Shan Chao, Meng Zhou and Zhangye Xu
    Citation: BMC Medicine 2022 20:303
  39. Polycystic ovary syndrome (PCOS) affects up to one in five women of childbearing age. Observational studies assessing the association between maternal PCOS and adverse obstetric outcomes have reported varying ...

    Authors: Anuradhaa Subramanian, Siang Ing Lee, Katherine Phillips, Konstantinos A. Toulis, Punith Kempegowda, Michael W. O’Reilly, Nicola J. Adderley, Shakila Thangaratinam, Wiebke Arlt and Krishnarajah Nirantharakumar
    Citation: BMC Medicine 2022 20:298
  40. Maternal smoking during pregnancy was reported to be associated with a reduced risk of type 1 diabetes in the offspring. We investigated whether this association is consistent with a causal interpretation by a...

    Authors: Yuxia Wei, Tomas Andersson, Jessica Edstorp, Josefin E. Löfvenborg, Mats Talbäck, Maria Feychting and Sofia Carlsson
    Citation: BMC Medicine 2022 20:240

    The Commentary to this article has been published in BMC Medicine 2022 20:296

  41. Lipids play a vital role in health and disease, but changes to their circulating levels and the link with obesity remain poorly characterized in expecting mothers and their offspring in early childhood.

    Authors: Sartaj Ahmad Mir, Li Chen, Satvika Burugupalli, Bo Burla, Shanshan Ji, Adam Alexander T. Smith, Kothandaraman Narasimhan, Adaikalavan Ramasamy, Karen Mei-Ling Tan, Kevin Huynh, Corey Giles, Ding Mei, Gerard Wong, Fabian Yap, Kok Hian Tan, Fiona Collier…
    Citation: BMC Medicine 2022 20:242
  42. Prenatal maternal tobacco smoking is a predictor of child attention-deficit/hyperactivity disorder (ADHD) and is associated with offspring telomere length (TL). In this study, we examine the relationship betwe...

    Authors: Meghan P. Howell, Christopher W. Jones, Cade A. Herman, Celia V. Mayne, Camilo Fernandez, Katherine P. Theall, Kyle C. Esteves and Stacy S. Drury
    Citation: BMC Medicine 2022 20:153
  43. Preterm birth is defined as live birth before 37 completed weeks of pregnancy, and it is a major problem worldwide. The molecular mechanisms that lead to onset of spontaneous preterm birth are incompletely und...

    Authors: Heli Tiensuu, Antti M. Haapalainen, Pinja Tissarinen, Anu Pasanen, Tomi A. Määttä, Johanna M. Huusko, Steffen Ohlmeier, Ulrich Bergmann, Marja Ojaniemi, Louis J. Muglia, Mikko Hallman and Mika Rämet
    Citation: BMC Medicine 2022 20:141
  44. Obesity in pregnancy and related early-life factors place the offspring at the highest risk of being overweight. Despite convincing evidence on these associations, there is an unmet public health need to ident...

    Authors: Delphina Gomes, Lien Le, Sarah Perschbacher, Nikolaus A. Haas, Heinrich Netz, Uwe Hasbargen, Maria Delius, Kristin Lange, Uta Nennstiel, Adelbert A. Roscher, Ulrich Mansmann and Regina Ensenauer
    Citation: BMC Medicine 2022 20:156
  45. Preterm birth (PTB) is a syndrome resulting from a complex list of underlying causes and factors, and whether these risk factors differ in the context of prior PTB history is less understood. The aim of this s...

    Authors: Aline S. Rocha, Rita de Cássia Ribeiro-Silva, Rosemeire L. Fiaccone, Enny S. Paixao, Ila R. Falcão, Flavia Jôse O. Alves, Natanael J. Silva, Naiá Ortelan, Laura C. Rodrigues, Maria Yury Ichihara, Marcia F. de Almeida and Mauricio L. Barreto
    Citation: BMC Medicine 2022 20:111