Preperitoneal Subcutaneous Fat and Adverse Pregnancy Outcomes: A Comprehensive Cohort Study and Literature Integration

Maternal adipose tissue remodeling during pregnancy is a critical physiological process, but excessive fat accumulation—particularly in specific depots—may elevate metabolic and gestational risks. This study aimed to investigate the association between preperitoneal subcutaneous fat (PSF) thickness across pregnancy trimesters and adverse pregnancy outcomes (APO), while integrating existing evidence on maternal adiposity and pregnancy health. A prospective cohort study was conducted at the Murialdo Teaching Health Center in Porto Alegre, Brazil, enrolling 210 pregnant women between October 2016 and December 2017. PSF thickness was measured via ultrasound, and APO was defined as the occurrence of gestational diabetes mellitus, hypertensive disorders of pregnancy, abnormal fetal growth, preterm delivery, or preterm premature rupture of membranes. Statistical analyses included Mann–Whitney tests, chi-squared/Fisher’s exact tests, and logistic regression models (unadjusted and multivariate-adjusted). Results showed a total APO prevalence of 25.2% (53/210), with a significantly higher prevalence in women with PSF ≥24.7 mm (73.9%, 17/23) compared to those with PSF <24.7 mm (19.3%, 36/187; p<0.001). Multivariate regression confirmed PSF as a strong independent predictor of APO (adjusted OR=18.28, 95% CI=4.87–68.62, p<0.001). Subgroup analyses revealed associations between elevated PSF and maternal hypertension, white ethnicity, and overweight/obesity. Integration with existing literature highlighted that PSF, like visceral fat, correlates more strongly with metabolic risk factors and APO than traditional BMI, supporting its utility as a non-invasive predictive marker. Conclusion: Elevated preperitoneal subcutaneous fat during pregnancy is independently associated with adverse pregnancy outcomes. Ultrasound measurement of PSF offers a simple, accessible tool for identifying high-risk pregnancies, enabling targeted interventions to improve maternal and fetal health.