Maternal Birth Weight and the Risk of Pregnancy Complications: An Epidemiologic Review

This review aims to synthesize current evidence on maternal birth weight (MBW) as a determinant of reproductive health and pregnancy outcomes, examining biological mechanisms and potential intergenerational effects within the Developmental Origins of Health and Disease (DOHaD) framework. Evidence from large-scale cohort studies, systematic reviews, and experimental research examining the association between MBW and pregnancy-related outcomes, including hypertensive disorders of pregnancy, gestational diabetes mellitus, preterm birth, offspring birth weight, and selected congenital malformations, is summarized. Findings are interpreted within a DOHaD framework, with attention to methodological heterogeneity, population differences, and potential confounding by shared familial socioeconomic and lifestyle factors. Recent large-scale cohort studies, including those conducted in Japan, further indicate that MBW is associated with pregnancy complications, offspring birth weight, and specific congenital malformations, suggesting potential intergenerational pathways involving genetic, epigenetic, and placental processes. Despite accumulating evidence, substantial heterogeneity persists across populations, and the underlying causal pathways remain incompletely understood. Interpretation is further complicated by family-level factors, such as socioeconomic disadvantage, nutritional patterns, and shared lifestyle behaviors, which may partially influence both MBW and subsequent pregnancy outcomes. Nevertheless, MBW is a simple and widely available metric that may enhance preconception risk assessment, improve risk stratification for pregnancy complications, and contribute to individualized perinatal care. Overall, current epidemiological evidence is consistent with biological mechanisms linking MBW to pregnancy and offspring outcomes. Research priorities are outlined to clarify causal pathways and inform DOHaD-based interventions.