Highlights
- •Maternal Overweight/Obesity and risk of GHP, macrosomia andLGA were mediated by gestational diabetes mellitus.
- •Maternal underweight is associated with the LBW and SGA.
- •21.0 kg/m2 maybe the appropriate tipping point pre-pregnancy BMI among Chinese women.
Abstract
Aims
We explored the complex relationships between pre-pregnancy body mass index (pBMI)
and maternal or infant complications and the mediating role of gestational diabetes
mellitus (GDM) in these relationships.
Methods
Pregnant women from 24 hospitals in 15 different provinces of China were enrolled
in 2017 and followed through 2018. Propensity score–based inverse probability of treatment
weighting, logistic regression, restricted cubic spline models, and causal mediation
analysis were utilized. In addition, the E-value method was used to evaluate unmeasured
confounding factors.
Results
A total of 6174 pregnant women were finally included. Compared to women with a normal
pBMI, obese women had a higher risk for gestational hypertension (odds ratio [OR] = 5.38,
95% confidence interval [CI]: 3.48–8.34), macrosomia (OR = 2.65, 95% CI: 1.83–3.84),
and large for gestational age (OR = 2.05, 95% CI: 1.45–2.88); 4.73% (95% CI: 0.57%-8.88%),
4.61% (95% CI: 0.51%-9.74%), and 5.02% (95% CI: 0.13%-10.18%) of the associations,
respectively, were mediated by GDM. Underweight women had a high risk for low birth
weight (OR = 1.42, 95% CI: 1.15–2.08) and small for gestational age (OR = 1.62, 95%
CI: 1.23–2.11). Dose–response analyses indicated that 21.0 kg/m2 may be the appropriate tipping point pBMI for risk for maternal or infant complications
in Chinese women.
Conclusion
A high or low pBMI is associated with the risk for maternal or infant complications
and partly mediated by GDM. A lower pBMI cutoff of 21 kg/m2 may be appropriate for risk for maternal or infant complications in pregnant Chinese
women.
Keywords
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Article info
Publication history
Published online: March 09, 2023
Accepted:
March 6,
2023
Received in revised form:
February 3,
2023
Received:
June 1,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
