Maternal adiposity deleteriously affects obstetrical health and has been associated with long-term adverse consequences in offspring. Here we conducted an umbrella review encompassing 194 observational meta-analyses, 10 Mendelian randomization studies and 748 interventional meta-analyses to appraise the published evidence on the associations between maternal adiposity and perinatal and offspring outcomes. Evidence grading suggested that 17 (8.8%) observational meta-analyses were supported by convincing evidence for 12 outcomes: maternal adiposity was associated with an increased risk of caesarean delivery following labour induction, infant mortality, Apgar score <7 at 1 min, antenatal depression, offspring overweight and obesity, early timing of puberty onset in daughters, attention deficit hyperactivity disorder, cerebral palsy, congenital heart disease and spina bifida (OR/RR ranging from 1.14 to 2.31), as well as increased offspring body fat percent and fat mass (SMD 0.31 and 0.35, respectively). Among these outcomes, interventional meta-analyses supported that maternal weight loss interventions significantly reduced the risk of antenatal depression but not low Apgar scores; these interventions also could not reduce offspring fat mass or body fat percent. Evidence from Mendelian randomization studies supported a causal relationship between maternal adiposity and gestational diabetes mellitus, preeclampsia, birth size and offspring adiposity. Our findings highlight that while observational meta-analyses reveal associations between maternal adiposity and various adverse perinatal and offspring outcomes, convincing, unbiased evidence or support from Mendelian randomization studies is limited. Maternal pre-conceptional and prenatal weight loss interventions can reduce some, but not all, of these adverse effects.

母亲肥胖对产科健康有害，并与后代的长期不良后果有关。在这里，我们进行了一项总括性综述，包括 194 项观察性荟萃分析、10 项孟德尔随机化研究和 748 项介入性荟萃分析，以评估已发表的关于孕产妇肥胖与围产期和后代结局之间关联的证据。证据分级表明，17 项 （8.8%） 观察性荟萃分析有 12 项结局的令人信服的证据支持： 产妇肥胖与引产后剖宫产风险增加、婴儿死亡率、1 分钟 Apgar 评分 <7、产前抑郁、后代超重和肥胖、女儿青春期开始时间早、注意力缺陷多动障碍、脑瘫、 先天性心脏病和脊柱裂 （OR/RR 范围为 1.14 至 2.31），以及后代体脂百分比和脂肪量增加 （SMD 分别为 0.31 和 0.35）。在这些结局中，干预性荟萃分析支持产妇减肥干预显著降低产前抑郁的风险，但不降低 Apgar 评分;这些干预措施也不能减少后代脂肪量或体脂百分比。来自孟德尔随机化研究的证据支持母体肥胖与妊娠糖尿病、子痫前期、出生大小和后代肥胖之间存在因果关系。我们的研究结果强调，虽然观察性荟萃分析揭示了孕产妇肥胖与各种不良围产期和后代结局之间的关联，但来自孟德尔随机化研究的令人信服、公正的证据或支持是有限的。 孕产妇孕前和产前减肥干预可以减少部分（但不是全部）这些不良反应。