Maternal Obesity and Neonatal Cardiac Remodeling Among Cesarean Deliveries: The Predictive Role of Maternal Lipid Profiles and Pre-Pregnancy BMI Based on Echocardiographic Assessment

Aims/Background: Maternal obesity has been recognized as a critical factor influencing fetal cardiovascular development. Metabolic disturbances during pregnancy potentially affect neonatal cardiac structure and function. Cesarean section, which is more frequently performed among obese pregnant women, may further influence neonatal adaptation after birth. This study aimed to investigate the association between maternal pre-pregnancy obesity and neonatal left ventricular (LV) structure and function in a cohort of cesarean deliveries and to analyze the associations between maternal gestational weight, lipid profile, and neonatal cardiac function parameters. Methods: This retrospective cohort study was conducted at Yongkang Women and Children’s Health Hospital between January 2021 and August 2024. Initially, 231 pregnant women were screened, of whom 161 mother-infant pairs met the predetermined inclusion criteria. Pregnant women undergoing cesarean delivery were assigned to a non-obese group and an obese group. Maternal demographic data, lipid profiles during pregnancy (total cholesterol [TC], triglycerides [TG], low-density lipoprotein cholesterol [LDL-C], and high-density lipoprotein cholesterol [HDL-C]), and neonatal echocardiographic parameters (interventricular septal thickness in diastole [IVSd], left ventricular posterior wall thickness in diastole [LVPWd], IVSd/LVPWd ratio, left ventricular ejection fraction [LVEF], mitral annular plane systolic excursion [MAPSE], tricuspid annular plane systolic excursion [TAPSE], right ventricular fractional area change [RVFAC], left ventricular deceleration time [LV DCT], Tei index, and E/e’) were collected. Correlation and multivariate regression analyses were conducted to evaluate the effects of maternal obesity and lipid levels on neonatal cardiac function. Results: Pre-pregnancy body mass index (BMI) and neonatal birth weight were significantly higher in the obese group compared to the non-obese group (p < 0.05). Neonates in the obese group had significantly increased IVSd, LVPWd, and LV DCT, while IVSd/LVPWd ratio and TAPSE were significantly lower than those in the non-obese group (p < 0.05). IVSd/LVPWd ratio was positively correlated with neonatal birth weight and maternal TG levels in late pregnancy. Furthermore, TAPSE showed a positive correlation with maternal HDL-C levels and a negative correlation with maternal pre-pregnancy TG and BMI, while LV DCT demonstrated a positive correlation with neonatal birth weight, pre-pregnancy BMI, and maternal TC, TG, and LDL-C levels in late pregnancy. Multivariate regression analysis identified neonatal birth weight, pre-pregnancy BMI, and maternal TC and LDL-C levels as independent predictors of LV DCT (p < 0.05). Conclusion: Maternal pre-pregnancy BMI and lipid levels during pregnancy significantly affect neonatal LV structure and function. These findings suggest that maternal obesity and metabolic disturbances may adversely influence neonatal cardiac development.