Association between gestational weight gain and metabolic and inflammatory biomarkers in the ETCHED cohort

Gestational weight gain (GWG) is a critical determinant of maternal and neonatal health, with both excess (EGWG) and inadequate GWG (IGWG) linked to adverse pregnancy outcomes and metabolic risk. We investigated the association between maternal prenatal demographic, clinical, and metabolic biomarkers at baseline, and GWG in singleton pregnancies from the Early Tracking of Childhood Health Determinants (ETCHED) life-course cohort. GWG, defined as the difference between pregestational and pre-delivery weight, was the primary outcome. Among 120 eligible mothers, 79.2% self-identified as Hispanic and 16.0% as American Indian/Alaska Native. The cohort represented socioeconomically disadvantaged populations: 75% had a high school education or less, 31% were single mothers, and 52.5% reported an annual household income < $25,000. Compared with mothers with normal GWG, those with EGWG had significantly higher leptin and lower IL-8 levels (P < 0.05). A multivariate multinomial logistic regression identified leptin to be strongly associated with EGWG (OR/1 SD: 11.09; 95%CI 3.18–38.67; P = 0.001), followed by FGF21, IL8, and pregestational BMI. Higher cortisol levels were associated with increased risk of IGWG (OR/1 SD: 2.59; 95%CI 1.07–6.29; P = 0.03). EGWG was associated with higher rates of cesarean delivery and prematurity. These findings highlight distinct metabolic and inflammatory biomarkers associated with GWG in an understudied population.