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Gestational Diabetes Research and Management / Adipokines, Inflammation, and Metabolic Diseases · Journal article
Frontiers in Endocrinology · September 9, 2026
Encouraging direction, but not yet definitive.
This prospective stratified cohort study identified distinct maternal and fetal adipokine signatures across obesity severity groups, with fetal adipsin and RBP-4 showing differential associations with neonatal macrosomia and NICU requirement respectively in exploratory adjusted models. The findings suggest fetal metabolic remodeling in response to maternal obesity, but the authors acknowledge these results are exploratory and require validation in larger independent cohorts.
Prospective observational cohort study with stratified groups. Singleton pregnancies stratified by maternal BMI: normal-weight, class I obesity (BMI 30–34.9), and class II–III obesity (BMI ≥35). Setting and full eligibility criteria not specified in abstract.. Intervention: Maternal obesity stratification (class I vs. class II–III vs. normal-weight) with measurement of maternal and fetal adipokine profiles at delivery.. Compared with: Normal-weight pregnancies (control reference group).. n = 126.
Fetal adipsin showed highest discrimination for macrosomia with AUC=0.951 Fetal RBP-4 showed highest discrimination for NICU requirement with AUC=0.781 In adjusted analyses, fetal adipsin remained associated with macrosomia (adjusted OR=5.43, 95% CI 2.14–13.77)
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If validated, fetal adipsin and RBP-4 could serve as novel biomarkers to identify pregnancies at risk for neonatal macrosomia and NICU admission in the context of maternal obesity. However, clinicians should await larger independent validation before considering these biomarkers for clinical decision-making.
A well-designed prospective cohort study with balanced stratification identifying novel fetal biomarker associations with clinically relevant neonatal outcomes, but limited by modest sample size, surrogate endpoints for clinical severity, and exploratory analytical approach requiring validation.
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If validated, fetal adipsin and RBP-4 could serve as novel biomarkers to identify pregnancies at risk for neonatal macrosomia and NICU admission in the context of maternal obesity. However, clinicians should await larger independent validation before considering these biomarkers for clinical decision-making.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Introduction Maternal obesity is associated with altered maternal–fetal adipokine profiles and adverse early neonatal outcomes. This study aimed to characterize maternal and fetal adipokine patterns across obesity severity groups and to evaluate their associations with macrosomia and neonatal intensive care unit (NICU) requirement. Methods In this prospective study, 126 singleton pregnancies were stratified into normal-weight, class I obesity, and class II–III obesity groups (n=42 each). Maternal venous and fetal cord blood adiponectin, leptin, asprosin, fetuin-A, retinol-binding protein-4 (RBP-4), adipsin, and glucose transporter-1 (GLUT-1) were assessed at delivery. Macrosomia and NICU requirement were evaluated using group comparisons, receiver operating characteristic (ROC) analyses, and multivariable logistic regression models. Results Maternal and fetal adipokine profiles differed significantly across obesity severity groups. Maternal fetuin-A, RBP-4, and adipsin levels, along with fetal leptin, fetuin-A, RBP-4, adipsin, and GLUT-1 levels, increased significantly with increasing obesity severity. In ROC analyses, fetal adipsin showed the highest discrimination for macrosomia (AUC=0.951), whereas fetal RBP-4 showed the highest discrimination for NICU requirement (AUC=0.781). In exploratory adjusted analyses, fetal adipsin remained associated with macrosomia (adjusted OR=5.43, 95% CI 2.14–13.77), whereas fetal RBP-4 remained statistically associated with NICU requirement (adjusted OR=3.31, 95% CI 1.87–5.86). Discussion Maternal obesity is accompanied by distinct maternal and fetal adipokine remodeling at delivery, with fetal adipsin and RBP-4 showing outcome-specific associations with neonatal macrosomia and NICU requirement, respectively. The compartment-specific biomarker patterns further suggest that the fetal metabolic response to increasing maternal adiposity is not simply a reflection of maternal circulating profiles. These exploratory findings warrant validation in larger, independent cohorts.
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