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BMI modifies the effect of pregnancy complications on risk of small- or large-for-gestational-age newborns

Pediatric Research (2024)Cite this article

Abstract

Background

Maternal physical condition (reflected by maternal body mass index (BMI) at delivery) and pregnancy complications influence neonatal health outcomes. High BMI during pregnancy increases various health problems’ risks, but studies about the synthesized effect of these factors on fetal growth, are scarce.

Methods

The retrospective cohort study was conducted in Zhejiang Province, China from 1 January 2019 to 31 December 2021. The associations between complications and small-for-gestational-age (SGA) and large-for-gestational-age (LGA) were measured by the Fine-Gray model and subgroup analysis. Effect modification and interaction analyses were conducted to explore BMI’s modification effect and complications’ interaction.

Results

Several complications increased the risk for SGA and LGA, some significance varied in different subgroups. There was a positive effect modification of gestational diabetes mellitus (GDM) across BMI strata on LGA (relative excess risk due to interaction (RERI) [95% CI] = 0.57 [0.09,1.04]). Several pairwise complications’ interactions were synergistic (e.g., pregestational diabetes and intraamniotic infection for SGA (ratio of ORs [95% CI] = 8.50 [1.74,41.37]), pregestational diabetes and assisted reproductive technology (ART) for LGA (ratio of ORs [95% CI] = 2.71 [1.11,6.62])), one was antagonistic (placental problems and ART for LGA (ratio of ORs [95% CI] = 0.58 [0.35,0.96])).

Conclusions

High-BMI positively modified the risk of GDM on LGA. Many interactions existed when two specific pregnancy complications occurred simultaneously.

Impact

  • This is the largest retrospective study covering more than 10 pregnancy complications to date in this aspect.

  • High-BMI (BMI > 28 kg/m2) positively modifies the risk of GDM on LGA. Many pregnancy complications influence the risk of SGA and LGA, with several interactions that may create a “syndrome” effect.

  • Pregnant women with different BMIs should consider the additional risks caused by pregnancy complications for their heterogeneous effects on abnormal fetal growth.

  • Measures should be taken to prevent the occurrence of other exposure factors in the “syndrome”. This study may aid in developing a new strategy for improving neonatal outcomes.

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Fig. 1: The inclusion and exclusion criteria of the study population.
Fig. 2: The effects of related complications on the risk of abnormal fetal birth weight were analyzed using the Fine-Gray model according to the stratification of BMI at delivery.
Fig. 3: The disease relationship diagram of pregnancy complications.

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Data availability

Data available on request due to restrictions, e.g., privacy or ethical restrictions. The data presented in this study are available upon request from the corresponding author. The data are not publicly available due to participant privacy.

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Acknowledgements

We thank all participants, coaches, research midwives/nurses, and health professionals who collaborated in the recruitment and procedures. In particular, we would like to thank The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University for their valuable data and sufficient support. We would like to express our gratitude to Springer Nature (https://www.springernature.com) for the expert linguistic services provided.

Funding

This research was partially supported by the Medical Science and Technology Project of Zhejiang Province, China (No. 2023KY149, 2020KY185), and the Public Welfare Science and Technology Plan Project of Wenzhou, China (No. Y20200087). The funders had no role in any aspect of the study beyond funding.

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Author notes

  1. These authors contributed equally: Peng Wang, Zhengchen Yu.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, 325000, China

    Peng Wang & Fan Wang

  2. School of Stomatology, Wenzhou Medical University, Wenzhou City, Zhejiang Province, 325000, China

    Peng Wang & Wangzhi Li

  3. The Second Clinical Medical College, Wenzhou Medical University, Wenzhou City, Zhejiang Province, 325000, China

    Zhengchen Yu, Luxuan Xu, Fangqing Da & Fan Wang

  4. The First Clinical Medical College, Wenzhou Medical University, Wenzhou City, Zhejiang Province, 325000, China

    Yinkai Hu

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Contributions

Conceptualization, F.W., Z.Y., and P.W.; Data curation, W.L.; Formal analysis, P.W. and Y.H.; Funding acquisition, F.W.; Investigation, P.W., Z.Y., W.L.; Methodology, F.W., Z.Y., and P.W.; Project administration, F.W.; Resources, F.W.; Software, Z.Y., P.W., and Y.H.; Supervision, F.W.; Validation, F.W., Z.Y., P.W., W.L.; Visualization, Z.Y., P.W., Y.H., F.D., X.L.; Writing—original draft, F.W., Z.Y., P.W., W.L.; Writing—review & editing, F.W., Z.Y., P.W.

Corresponding author

Correspondence to Fan Wang.

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The authors declare no competing interests.

Ethics approval and consent to participate

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University (2021-K-318-02). This study was granted exemption for ethics approval by the Ethics Committee of The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University (2021-K-318-02). This study did not involve human intervention.

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Wang, P., Yu, Z., Hu, Y. et al. BMI modifies the effect of pregnancy complications on risk of small- or large-for-gestational-age newborns. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03298-x

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