Role of Adipokines in Maternal Cardiac Function of Pregnancies Following Metabolic Bariatric Surgery

OBJECTIVE: Maternal metabolic bariatric surgery is associated with improved maternal cardiovascular function and an altered adipokine (adiponectin and leptin) levels. The aim of this study was to investigate whether adipokine levels mediate the improvement in maternal cardiovascular function reported in pregnant women with previous metabolic bariatric surgery. METHODS: The study included 41 pregnant women with previous metabolic bariatric surgery and 41 pregnant women without metabolic bariatric surgery but with similar early pregnancy body mass index (BMI). All participants underwent cardiac function assessment using two-dimensional echocardiography, at 11-14, 20-24 and 30-32 weeks of gestation. Maternal blood, collected at these three visits, was used for measurement of maternal adiponectin and leptin. Mixed-effects model analysis was used to assess the differences in adiponectin and leptin between groups, after adjustment for time, maternal age, ethnic group, parity, method of conception, BMI, smoking, gestational age at measurement and development of gestational diabetes mellitus. Pearson's correlation was used to assess the correlation of maternal adiponectin and leptin levels with cardiac indices. RESULTS: Overall, maternal adiponectin levels were higher in the post-metabolic bariatric surgery group, compared to the no surgery group (p = 0.008). However, leptin levels did not differ between groups (p = 0.76). Adiponectin levels were not associated with indices of maternal cardiac function including haemodynamics, cardiac geometry, diastolic, systolic and longitudinal function (p > 0.05). In contrast, maternal leptin levels positively correlated with maternal cardiac output in both the no surgery and post-metabolic bariatric surgery groups (p < 0.01 and p = 0.02, respectively). CONCLUSIONS: Although pre-pregnancy maternal metabolic bariatric surgery is associated with an improvement in maternal cardiac function, maternal adiponectin and leptin levels alone are unlikely to contribute to this improvement.