Background/Objectives: Metabolic syndrome (MetS) is a complex, multifaceted disorder with significant socioeconomic and public health consequences, increasingly acknowledged as a global epidemic. Fibroblast growth factor 21 (FGF-21) is known to play a vital role in metabolic regulation; however, the precise roles and interactions of free fatty acids (FFAs) and insulin in influencing FGF-21 activity under both normal and pathological conditions are not yet fully understood. Meteorin-like protein (Metrnl) is a newly identified adipokine that appears to have the potential to regulate metabolic inflammation, which is a critical pathological factor in obesity and insulin resistance. Additionally, nesfatin-1, which is widely expressed in both central and peripheral tissues, is thought to be involved in various physiological functions beyond appetite control, such as glucose homeostasis, stress response, and cardiovascular health. Recent studies have indicated that sortilin may play a role in the pathophysiology of several metabolic disorders, including type 2 diabetes mellitus. Methods: This investigation was a cross-sectional study involving 200 individuals with obesity, which included both metabolically healthy obese participants and those experiencing obesity along with glycemic disorders. Serum levels of FGF-21, sortilin, Metrnl, and nesfatin-1 were measured using standardized enzyme-linked immunosorbent assay (ELISA) techniques. Results: The results indicated that FGF-21 levels were significantly elevated in patients with metabolic syndrome (p < 0.001), as well as those with insulin resistance (p = 0.009) and dyslipidemia (p = 0.03). Serum Metrnl levels were notably elevated in individuals meeting the criteria for insulin resistance, with a statistical significance of p < 0.001. Additionally, patients experiencing carbohydrate metabolism disorders exhibited significantly higher serum sortilin levels compared to those with normal blood glucose levels, with a p-value of 0.003. Conclusions: This research highlights FGF-21, Metrnl, nesfatin-1, and sortilin as potential biomarkers involved in the development of critical aspects of metabolic syndrome.

Background: Maternal overweight, obesity, and inappropriate gestational weight gain (GWG) are increasingly recognized as major contributors to adverse pregnancy outcomes worldwide. Elevated pre-pregnancy body mass index (BMI) is associated with gestational diabetes mellitus (GDM), hypertensive disorders, cesarean delivery, fetal overgrowth, and long-term cardiometabolic risks for both mother and child. Regional contemporary data from Bulgaria remain limited. Objective: To evaluate trends in maternal obesity and gestational weight gain among pregnant women in Southeastern Bulgaria between 2021 and 2025, using a regional cohort from Burgas, and to assess associations with maternal and neonatal outcomes. Methods: This retrospective cohort study included 1,176 singleton pregnancies registered for antenatal follow-up at MC Prime Clinic – Dr. Kirovakov Ltd., Burgas, Bulgaria, between January 2021 and December 2025. Women were classified according to World Health Organization BMI categories as underweight, normal weight, overweight, and obese. Gestational weight gain was categorized as below, within, or above Institute of Medicine recommendations. Maternal and neonatal outcomes were analyzed using comparative statistics and multivariable logistic regression. Results: The mean maternal age was 30.8 ± 5.4 years, and the mean pre-pregnancy BMI was 25.1 ± 4.8 kg/m². BMI distribution was: underweight 7.6%, normal weight 49.8%, overweight 27.9%, and obesity 14.7%. Overall, 42.6% of women entered pregnancy overweight or obese. Mean total GWG was 13.2 ± 5.6 kg. Excessive GWG occurred in 39.0% of women, while only 39.6% remained within recommended ranges. Excessive GWG was significantly more common among obese women (52.8%) than among women with normal BMI (34.7%, p<0.001). Compared with women of normal BMI, obese women had significantly higher rates of gestational diabetes mellitus (16.7% vs 5.8%), hypertensive disorders (12.9% vs 4.2%), preeclampsia (8.4% vs 2.1%), cesarean delivery (47.4% vs 28.6%), macrosomia (14.5% vs 6.1%), and preterm birth (10.7% vs 6.9%) (all p<0.05). In multivariable analysis, maternal obesity independently predicted GDM (aOR 2.94, 95% CI 1.82-4.73), preeclampsia (aOR 3.18, 95% CI 1.87-5.39), cesarean delivery (aOR 2.11, 95% CI 1.42-3.14), macrosomia (aOR 2.46, 95% CI 1.51-4.01), and preterm birth (aOR 1.67, 95% CI 1.02-2.74). Conclusions: Maternal obesity and excessive gestational weight gain were highly prevalent among pregnant women in Southeastern Bulgaria during 2021-2025 and were strongly associated with adverse maternal and neonatal outcomes. These findings support the need for preconception counseling, individualized antenatal weight management, and targeted regional public health strategies.

Background: Maternal overweight, obesity, and inappropriate gestational weight gain (GWG) are increasingly recognized as major contributors to adverse pregnancy outcomes worldwide. Elevated pre-pregnancy body mass index (BMI) is associated with gestational diabetes mellitus (GDM), hypertensive disorders, cesarean delivery, fetal overgrowth, and long-term cardiometabolic risks for both mother and child. Regional contemporary data from Bulgaria remain limited. Objective: The objective of this study was to evaluate trends in maternal obesity and gestational weight gain among pregnant women in Southeastern Bulgaria between 2021 and 2025, using a regional cohort from Burgas, and to assess associations with maternal and neonatal outcomes. Methods: This retrospective cohort study included 1176 singleton pregnancies registered for antenatal follow-up at MC Prime Clinic–Dr. Kirovakov Ltd., Burgas, Bulgaria, between January 2021 and December 2025. Women were classified according to World Health Organization BMI categories as underweight, normal weight, overweight, and obese. Gestational weight gain was categorized as below, within, or above Institute of Medicine recommendations. Maternal and neonatal outcomes were analyzed using comparative statistics and multivariable logistic regression. Results: The mean maternal age was 30.8 ± 5.4 years, and the mean pre-pregnancy BMI was 25.1 ± 4.8 kg/m². BMI distribution was: underweight 7.6%, normal weight 49.8%, overweight 27.9%, and obesity 14.7%. Overall, 42.6% of women entered pregnancy overweight or obese. Mean total GWG was 13.2 ± 5.6 kg. Excessive GWG occurred in 39.0% of women, while only 39.6% remained within recommended ranges. Excessive GWG was significantly more common among obese women (52.8%) than among women with normal BMI (34.7%, p < 0.001). Compared with women of normal BMI, obese women had significantly higher rates of gestational diabetes mellitus (16.7% vs. 5.8%), hypertensive disorders (12.9% vs. 4.2%), preeclampsia (8.4% vs. 2.1%), cesarean delivery (47.4% vs. 28.6%), macrosomia (14.5% vs. 6.1%), and preterm birth (10.7% vs. 6.9%) (all p < 0.05). In multivariable analysis, maternal obesity independently predicted GDM (aOR 2.94, 95% CI 1.82–4.73), preeclampsia (aOR 3.18, 95% CI 1.87–5.39), cesarean delivery (aOR 2.11, 95% CI 1.42–3.14), macrosomia (aOR 2.46, 95% CI 1.51–4.01), and preterm birth (aOR 1.67, 95% CI 1.02–2.74). Conclusions: Maternal obesity and excessive gestational weight gain were highly prevalent among pregnant women in Southeastern Bulgaria during 2021–2025 and were strongly associated with adverse maternal and neonatal outcomes. These findings support the need for preconception counseling, individualized antenatal weight management, and targeted regional public health strategies.

Background: Maternal undernutrition is associated with impaired fetal growth and adverse pregnancy outcomes, but the effects of food-based nutritional interventions during pregnancy remain uncertain. This systematic review and meta-analysis evaluated their effects on maternal and neonatal outcomes using evidence exclusively from randomized controlled trials (RCTs). Methods: PubMed, Embase, Scopus, and the Cochrane Library were searched from inception to 15 July 2026 for RCTs comparing food-based nutritional interventions with standard care, no supplementation, micronutrient supplementation, or an alternative nutritional intervention. Risk ratios (RRs) for binary outcomes were pooled using the Mantel–Haenszel method, while mean differences (MDs) for continuous outcomes were pooled using the inverse-variance method. Restricted maximum-likelihood random-effects models were applied, and heterogeneity was assessed using I² and Cochran’s Q test. The protocol was registered in PROSPERO (CRD420261465279). Results: Six RCTs comprising 6245 participants were included, of whom 3150 (50%) received a nutritional intervention. Nutritional interventions increased birth weight (MD 51.49 g; 95% CI 22.87–80.11; I² = 42.7%; p < 0.01) and birth length (MD 0.29 cm; 95% CI 0.14–0.45; I² = 21.6%; p < 0.01). No significant effects were observed on birth head circumference (MD −0.14 cm; 95% CI −0.62 to 0.34; I² = 73.9%; p = 0.57), low birth weight (RR 0.76; 95% CI 0.35–1.68; I² = 64.2%; p = 0.28), stillbirth (RR 0.96; 95% CI 0.78–1.19; I² = 0%; p = 0.61), or miscarriage (RR 0.83; 95% CI 0.35–1.97; I² = 0%; p = 0.45). Conclusions: Food-based nutritional intervention strategies were associated with small statistically significant increases in birth weight and birth length; however, the clinical importance of differences of approximately 51 g and 0.29 cm remains uncertain. Evidence was inconclusive for low birth weight, head circumference, stillbirth, and miscarriage.