Relationship between maternal obesity, birth weight, and fetal adiponectin/leptin ratio: a potential early biomarker of cardiometabolic risk

Adiponectin and leptin are key adipokines that play crucial roles in metabolic regulation and in fetal and neonatal growth. In adults, lower adiponectin/leptin ratio (AdipoQ/Lep) has been suggested as a potential biomarker for metabolic risk. This study aimed to investigate whether the AdipoQ/Lep ratio in fetal blood correlates with the maternal and neonatal phenotypes and whether it holds predictive value for the cardiometabolic risk of the offspring in early life. Umbilical cord blood (UCB) samples were collected at birth, and the concentrations of adiponectin and leptin levels were measured using ELISA kits. Infants were evaluated echocardiographically at 5 ± 2 mo old (range: 1-12 mo), and these parameters were correlated with the AdipoQ/Lep levels. Results show that fetal AdipoQ/Lep ratio was lower in infants born to mothers with prepregnancy obesity. Both prepregnancy weight and maternal weight at the end of the gestation correlated with the AdipoQ/Lep ratio in UCB, whereas gestational weight gain showed no such association. In addition, birth weight, birth length, and body mass index (BMI)-for-age <i>Z</i>-score were negatively correlated with the AdipoQ/Lep ratio. Notably, lower levels of this adipokine-based biomarker were associated with reduced <i>Z</i>-score of left ventricular end-diastolic diameter. However, multiple linear regression analysis showed that maternal obesity and somatometry at birth influence infants' cardiac function and structure, independent of UCB AdipoQ/Lep ratio, adiponectin, or leptin alone. To our knowledge, this is the first investigation to explore the relationship between fetal AdipoQ/Lep levels, maternal-neonatal weight, and early cardiac alterations, highlighting the biomarker's potential predictive value for early-life cardiometabolic risk.<b>NEW & NOTEWORTHY</b> This study is the first to explore the association between fetal adiponectin/leptin (AdipoQ/Lep) ratio and maternal and neonatal anthropometrics and early alterations in cardiac structure. Although maternal and neonatal weight metrics impact infant heart development, this occurs independently of the AdipoQ/Lep. However, lower levels of AdipoQ/Lep ratio were associated with reduced <i>Z</i>-score of left ventricular end-diastolic diameter, offering insights into fetal programming mechanisms linked to maternal metabolic status during pregnancy.