ArticlemedRxiv : the preprint server for health sciences2025
Placental growth plays a key role in the link between maternal glucose levels in pregnancy and risk of preeclampsia.
Article in medRxiv : the preprint server for health sciences, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Preeclampsia is a serious condition affecting 2-4% of pregnancies globally. However, it is more common in pregnancies with diabetes (e.g. 10-20% in Type 1 diabetes) than in pregnancies without diabetes. In the general population, higher maternal fasting glucose levels are observationally associated with higher risk of preeclampsia, but whether the relationship is causal is unknown. Based on previous research, we hypothesise that higher fasting glucose increases placental weight, likely through fetal insulin mediated growth, and higher placental weight increases the risk of preeclampsia. We used data from published genome-wide association studies on fasting glucose (N=281,416), placental weight (Nfetal=65,405, Nmaternal=61,228) and preeclampsia (Nfetal=377,975, Nmaternal=723,181) and individual level data from the Exeter Family Study of Childhood Health (N=948) and the Avon Longitudinal Study of Parents and Children (N=5,214). We compared observational multivariable regression analysis with Mendelian Randomization (MR), an analytical approach that uses genetic variants to estimate causal effects of exposures (e.g. fasting glucose) on outcomes (e.g. risk of preeclampsia). We found that genetically instrumenting a 1mmol/l higher fasting glucose caused a higher placental weight of 44.16g (95%CI: [29.82,58.49]). Furthermore, we showed that fetal genetic predisposition to higher placental weight increased the risk of preeclampsia (OR=1.99, 95% CI: [1.25, 3.19]). Using the two-step MR method, we estimated that a maternal genetic predisposition to higher fasting glucose increases the risk of preeclampsia through increasing placental weight with an OR of 1.26 (95% CI: [1.05,1.49]). We found evidence for a causal effect of higher maternal fasting glucose levels on risk of preeclampsia, and our results are consistent with this effect being mediated via placental weight. Further well-powered studies are needed to confirm the causal relationship between higher maternal fasting glucose and preeclampsia. If confirmed, our findings suggest research focusing on fetal insulin may help elucidate preeclampsia disease mechanisms.
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