Obesity is a common, serious, and costly disease Centers for Disease Control and Prevention2022, updated May 17 2022. Available from: https://www.cdc.gov/obesity/data/adult.html.

Obesity in pregnancy. ACOG Practice Bulletin, Number 230. Obstet Gynecol. 2021;137(6):e128–44.

Article  Google Scholar 

Birth defects are common, costly, and critical Centers for Disease Control and Prevention, updated December 5 2019. Available from: https://www.cdc.gov/ncbddd/birthdefects/infographic.html#:~:text=Birth%20defects%20affect%201%20in,the%20United%20States%20each%20year.

Persson M, Cnattingius S, Villamor E, Söderling J, Pasternak B, Stephansson O, et al. Risk of major congenital malformations in relation to maternal overweight and obesity severity: cohort study of 1.2 million singletons. Bmj. 2017;357:j2563.

Stothard KJ, Tennant PW, Bell R, Rankin J. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA. 2009;301(6):636–50.

Article  CAS  PubMed  Google Scholar 

van de Putte R, de Walle HEK, van Hooijdonk KJM, de Blaauw I, Marcelis CLM, van Heijst A, et al. Maternal risk associated with the VACTERL association: a case-control study. Birth Defects Res. 2020;112(18):1495–504.

Article  PubMed  PubMed Central  Google Scholar 

Reller MD, Strickland MJ, Riehle-Colarusso T, Mahle WT, Correa A. Prevalence of congenital heart defects in metropolitan Atlanta, 1998–2005. J Pediatr. 2008;153(6):807–13.

Article  PubMed  PubMed Central  Google Scholar 

Egbe A, Uppu S, Stroustrup A, Lee S, Ho D, Srivastava S. Incidences and sociodemographics of specific congenital heart diseases in the United States of America: an evaluation of hospital discharge diagnoses. Pediatr Cardiol. 2014;35(6):975–82.

Article  PubMed  Google Scholar 

Watkins ML, Rasmussen SA, Honein MA, Botto LD, Moore CA. Maternal obesity and risk for birth defects. Pediatrics. 2003;111(5 Pt 2):1152–8.

Article  PubMed  Google Scholar 

Waller DK, Shaw GM, Rasmussen SA, Hobbs CA, Canfield MA, Siega-Riz AM, et al. Prepregnancy obesity as a risk factor for structural birth defects. Arch Pediatr Adolesc Med. 2007;161(8):745–50.

Article  PubMed  Google Scholar 

Brite J, Laughon SK, Troendle J, Mills J. Maternal overweight and obesity and risk of congenital heart defects in offspring. Int J Obes (Lond). 2014;38(6):878–82.

Article  CAS  PubMed  Google Scholar 

Persson M, Razaz N, Edstedt Bonamy AK, Villamor E, Cnattingius S. Maternal overweight and obesity and risk of congenital heart defects. J Am Coll Cardiol. 2019;73(1):44–53.

Article  PubMed  Google Scholar 

Engineer A, Saiyin T, Greco ER, Feng Q. Say NO to ROS: their roles in embryonic heart development and pathogenesis of congenital heart defects in maternal diabetes. Antioxidants (Basel). 2019;8(10).

Jarvie E, Hauguel-de-Mouzon S, Nelson SM, Sattar N, Catalano PM, Freeman DJ. Lipotoxicity in obese pregnancy and its potential role in adverse pregnancy outcome and obesity in the offspring. Clin Sci (Lond). 2010;119(3):123–9.

Article  CAS  PubMed  Google Scholar 

He X, Hong X, Zeng F, Kang F, Li L, Sun Q. Zinc antagonizes homocysteine-induced fetal heart defects in rats. Cardiovasc Toxicol. 2009;9(3):151–9.

Article  CAS  PubMed  Google Scholar 

Kumar SD, Vijaya M, Samy RP, Dheen ST, Ren M, Watt F, et al. Zinc supplementation prevents cardiomyocyte apoptosis and congenital heart defects in embryos of diabetic mice. Free Radic Biol Med. 2012;53(8):1595–606.

Article  CAS  PubMed  Google Scholar 

Yang J, Kang Y, Chang Q, Zhang B, Liu X, Zeng L, et al. Maternal zinc, copper, and selenium intakes during pregnancy and congenital heart defects. Nutrients. 2022;14(5).

Maffoni S, De Giuseppe R, Stanford FC, Cena H. Folate status in women of childbearing age with obesity: a review. Nutr Res Rev. 2017;30(2):265–71.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Bird JK, Murphy RA, Ciappio ED, McBurney MI. Risk of deficiency in multiple concurrent micronutrients in children and adults in the United States. Nutrients. 2017;9(7).

Folic acid & neural tube defects: data & statistics Centers for Disease Control and Prevention2022, updated November 9, 2017. Available from: https://www.cdc.gov/ncbddd/birthdefectscount/data.html#:~:text=In%20the%20United%20States%2C%203%2C000,defects%20every%20year%20(1).

Rasmussen SA, Chu SY, Kim SY, Schmid CH, Lau J. Maternal obesity and risk of neural tube defects: a metaanalysis. Am J Obstet Gynecol. 2008;198(6):611–9.

Article  PubMed  Google Scholar 

Benjamin RH, Ethen MK, Canfield MA, Hua F, Mitchell LE. Association of interpregnancy change in body mass index and spina bifida. Birth Defects Res. 2019;111(18):1389–98.

Article  CAS  PubMed  Google Scholar 

Arbuzova S, Nikolenko M, Cuckle H. Maternal weight as an additional first trimester spina bifida screening marker. J Matern Fetal Neonatal Med. 2022;35(17):3353–8.

Article  PubMed  Google Scholar 

Pace ND, Siega-Riz AM, Olshan AF, Chescheir NC, Cole SR, Desrosiers TA, et al. Survival of infants with spina bifida and the role of maternal prepregnancy body mass index. Birth Defects Res. 2019;111(16):1205–16.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Shaw GM, Velie EM, Schaffer D. Risk of neural tube defect-affected pregnancies among obese women. JAMA. 1996;275(14):1093–6.

Article  CAS  PubMed  Google Scholar 

Zhang L, Zhang Y, Li Z, Ren A, Liu J, Ye R. Maternal periconceptional body mass index and risk for neural tube defects: results from a large cohort study in China. J Matern Fetal Neonatal Med. 2021;34(2):274–80.

Article  PubMed  Google Scholar 

Lupo PJ, Canfield MA, Chapa C, Lu W, Agopian AJ, Mitchell LE, et al. Diabetes and obesity-related genes and the risk of neural tube defects in the national birth defects prevention study. Am J Epidemiol. 2012;176(12):1101–9.

Article  PubMed  PubMed Central  Google Scholar 

Wang M, Wang ZP, Gao LJ, Gong R, Sun XH, Zhao ZT. Maternal body mass index and the association between folic acid supplements and neural tube defects. Acta Paediatr. 2013;102(9):908–13.

Article  CAS  PubMed  Google Scholar 

Parker SE, Yazdy MM, Tinker SC, Mitchell AA, Werler MM. The impact of folic acid intake on the association among diabetes mellitus, obesity, and spina bifida. Am J Obstet Gynecol. 2013;209(3):239.e1-8.

Article  CAS  PubMed  Google Scholar 

da Silva VR, Hausman DB, Kauwell GP, Sokolow A, Tackett RL, Rathbun SL, et al. Obesity affects short-term folate pharmacokinetics in women of childbearing age. Int J Obes (Lond). 2013;37(12):1608–10.

Article  PubMed  Google Scholar 

Tinker SC, Hamner HC, Berry RJ, Bailey LB, Pfeiffer CM. Does obesity modify the association of supplemental folic acid with folate status among nonpregnant women of childbearing age in the United States? Birth Defects Res A Clin Mol Teratol. 2012;94(10):749–55.

Article  CAS  PubMed  Google Scholar 

Giouleka S, Tsakiridis I, Koutsouki G, Kostakis N, Mamopoulos A, Kalogiannidis I, et al. Obesity in pregnancy: a comprehensive review of influential guidelines. Obstet Gynecol Surv. 2023;78(1):50–68.

Article  PubMed  Google Scholar 

Jadresić L, Au H, Woodhouse C, Nitsch D. Pre-pregnancy obesity and risk of congenital abnormalities of the kidney and urinary tract (CAKUT)-systematic review, meta-analysis and ecological study. Pediatr Nephrol. 2021;36(1):119–32.

Article  PubMed  Google Scholar 

Macumber I, Schwartz S, Leca N. Maternal obesity is associated with congenital anomalies of the kidney and urinary tract in offspring. Pediatr Nephrol. 2017;32(4):635–42.

Article  PubMed  Google Scholar 

Arendt LH, Ramlau-Hansen CH, Lindhard MS, Henriksen TB, Olsen J, Yu Y, et al. Maternal overweight and obesity and genital anomalies in male offspring: a population-based Swedish cohort study. Paediatr Perinat Epidemiol. 2017;31(4):317–27.

Article  PubMed  Google Scholar 

Schneuer FJ, Nassar N. Maternal obesity and male genital anomalies: potential role of placental insufficiency and metabolic syndrome. Paediatr Perinat Epidemiol. 2017;31(5):e1–3.

Article  PubMed  Google Scholar 

Lassance L, Haghiac M, Minium J, Catalano P, Hauguel-de MS. Obesity-induced down-regulation of the mitochondrial translocator protein (TSPO) impairs placental steroid production. J Clin Endocrinol Metab. 2015;100(1):E11–8.

Article  PubMed  Google Scholar 

Blanco R, Colombo A, Suazo J. Maternal obesity is a risk factor for orofacial clefts: a meta-analysis. Br J Oral Maxillofac Surg. 2015;53(8):699–704.

Article  CAS  PubMed  Google Scholar 

Aagaard-Tillery KM, Flint Porter T, Malone FD, Nyberg DA, Collins J, Comstock CH, et al. Influence of maternal BMI on genetic sonography in the FaSTER trial. Prenat Diagn. 2010;30(1):14–22.

Article  PubMed  Google Scholar 

Dashe JS, McIntire DD, Twickler DM. Maternal obesity limits the ultrasound evaluation of fetal anatomy. J Ultrasound Med. 2009;28(8):1025–30.

Article  PubMed  Google Scholar 

Gupta VK, Adams JH, Heiser T, Iruretagoyena JI, Hoppe KK, Antony KM. Detailed fetal anatomic ultrasound examination duration and association with body mass index. Obstet Gynecol. 2019;134(4):774–80.

Article  PubMed  Google Scholar 

Yaqub M, Kelly B, Noble JA, Papageorghiou AT. The effect of maternal body mass index on fetal ultrasound image quality. Am J Obstet Gynecol. 2021;225(2):200–2.

Article  PubMed  Google Scholar 

Eastwood KA, Daly C, Hunter A, McCance D, Young I, Holmes V. The impact of maternal obesity on completion of fetal anomaly screening. J Perinat Med. 2017;45(9):1061–7.

Article  PubMed  Google Scholar 

Romary L, Sinkovskaya E, Ali S, Cunningham TD, Marwitz S, Heeze A, et al. The role of early gestation ultrasound in the assessment of fetal anatomy in maternal obesity. J Ultrasound Med. 2017;36(6):1161–8.