Kaiting Yang, Hong Yang, Chuanfeng Li
Background Maternal obesity is increasingly prevalent worldwide and has been associated with adverse neonatal outcomes. However, the association between maternal obesity and the risk of neonatal sepsis remains uncertain. This meta-analysis aimed to evaluate the association between maternal obesity before or during early pregnancy and the risk of neonatal sepsis in offspring. Methods PubMed, Embase, and Web of Science were searched for observational studies evaluating the association between maternal obesity and neonatal sepsis. Maternal obesity was generally defined as prepregnancy or early-pregnancy body mass index (BMI) ≥30 kg/m 2 . Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled using a random-effects model accounting for potential heterogeneity. Results Nine observational studies involving 2,146,883 women were included. Pooled analysis showed that maternal obesity was associated with a significantly increased risk of neonatal sepsis (RR: 1.46, 95% CI: 1.15–1.85, p = 0.002; I 2 = 58%). Stratified analyses according to maternal obesity severity showed progressively increased RRs for neonatal sepsis among women with BMI values of 30–34.9, 35–39.9, and ≥40 kg/m 2 (RRs: 1.34, 1.87, and 2.26, respectively; p for subgroup difference = 0.12). The association was significant in general obstetric populations but not in studies restricted to preterm delivery. Stronger associations were observed in studies reporting early-onset sepsis than overall neonatal sepsis. Meta-regression analysis showed that mean gestational age at delivery and neonatal birthweight significantly influenced the pooled effect size. Conclusions Maternal obesity before or during early pregnancy is associated with an increased risk of neonatal sepsis in offspring. Systematic Review Registration PROSPERO: CRD420261400345.