Assessing the relationship between pregravid body mass index and risk of adverse maternal pregnancy and neonatal outcomes: prospective data in Southwest China

Abstract

The relevance of pregestational body mass index (BMI) on adverse pregnancy outcomes remained unclear in Southwest China. This study aimed to investigate the overall and age-category specific association between pre-gestational BMI and gestational diabetes mellitus (GDM), preeclampsia, cesarean delivery, preterm delivery, stillbirth, macrosomia, and small-for-gestational age (SGA) or large-for-gestational age (LGA) neonates in Southwest China. Furthermore, it explores the relative importance of influence of pregravid BMI and maternal age on pregnancy outcomes. 51,125 Chinese singleton pregnant women were recruited as study subjects. Multiple logistic regression models were used to examine the influence of pre-pregnancy BMI on adverse pregnancy outcomes. Gradient boosting machine was used to evaluate the relative importance of influence of pregravid BMI and maternal age on pregnancy outcomes. It is found that women who were overweight or obese before pregnancy are at higher risk of adverse pregnancy outcomes except for SGA neonates, while pre-pregnancy underweight is a protective factor for GDM, preeclampsia, cesarean delivery, macrosomia and LGA, but not SGA. Younger mothers are more susceptible to GDM and macrosomia neonates, while older mothers are more prone to preeclampsia. Pre-pregnancy BMI has more influence on various pregnancy outcomes than maternal age. To improve pregnancy outcomes, normal BMI weight as well as relatively young maternal ages are recommended for women in child-bearing age.

Figure 1

Pre-gestational BMI and risks of maternal pregnancy outcomes stratified by maternal age. Figures (A–C) show the age specific odds ratio and 95% CI for pre-pregnancy BMI on maternal outcomes. Models were adjusted for maternal age, gestational weight gain, parity, gestational age, infant’s sex and marital status, and models in (C) were additional adjusted for GDM and preeclampsia.

Figure 2

Pre-gestational BMI and risks of infant outcomes stratified by maternal age. Figures (A–E) show the age specific odds ratio and 95% confidence intervals for pre-pregnancy BMI on infant outcomes. Models were adjusted for maternal age, gestational weight gain, parity, gestational age, infant’s sex, marital status, GDM, and models in (A,B) were additionally adjusted for preeclampsia.