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. 2022 Feb 10:13:805636.
doi: 10.3389/fendo.2022.805636. eCollection 2022.

Protective Effect of Maternal First-Trimester Low Body Mass Index Against Macrosomia: A 10-Year Cross-Sectional Study

Yongqing Sun  1   2 , Man Zhang  2   3 , Ruixia Liu  2   3 , Jingjing Wang  2   4 , Kai Yang  1   2 , Qingqing Wu  2   4 , Wentao Yue  2   3 , Chenghong Yin  1   2
Affiliations

Protective Effect of Maternal First-Trimester Low Body Mass Index Against Macrosomia: A 10-Year Cross-Sectional Study

Yongqing Sun et al. Front Endocrinol (Lausanne). .

Abstract

Objective: We aimed to assess whether maternal first-trimester low body mass index (BMI) has a protective effect against macrosomia.

Methods: This was a cross-sectional study from January 1, 2011, to June 30, 2021, and 84,900 participants were included. The predictive performance of maternal first-trimester and parental pre-pregnancy BMI for macrosomia was assessed using the area under the receiver-operating characteristics curve (AUC). Multivariate logistic regression analyses were performed to evaluate the independent effect of maternal first-trimester low BMI on macrosomia. Interactions were investigated to evaluate the potential variation of the effect of first-trimester low BMI across different groups. Furthermore, interactions were also examined across groups determined by multiple factors jointly: a) gestational diabetes mellitus (GDM)/GDM history status, parity, and maternal age; and b) GDM/GDM history status, fetal sex, and season of delivery.

Results: The proportion of macrosomia was 6.14% (5,215 of 84,900). Maternal first-trimester BMI showed the best discrimination of macrosomia (all Delong tests: P < 0.001). The protective effect of maternal first-trimester low BMI against macrosomia remained significant after adjusting for all confounders of this study [adjusted odds ratios (aOR) = 0.37, 95% CI: 0.32-0.43]. Maternal first-trimester low BMI was inversely associated with macrosomia, irrespective of parity, fetal sex, season of delivery, maternal age, and GDM/GDM history status. The protective effect was most pronounced among pregnant women without GDM/GDM history aged 25 to 29 years old, irrespective of parity (multipara: aOR = 0.32, 95% CI: 0.22-0.47; nullipara: aOR = 0.32, 95% CI: 0.24-0.43). In multipara with GDM/GDM history, the protective effect of low BMI was only observed in the 30- to 34-year-old group (aOR = 0.12, 95% CI: 0.02-0.86). For pregnant women without GDM/GDM history, the protective effect of maternal first-trimester low BMI against macrosomia was the weakest in infants born in winter, irrespective of fetal sex (female: aOR = 0.45, 95% CI: 0.29-0.69; male: aOR = 0.39, 95% CI: 0.28-0.55).

Conclusion: Maternal first-trimester low BMI was inversely associated with macrosomia, and the protective effect was most pronounced among 25- to 29-year-old pregnant women without GDM/GDM history and was only found among 30- to 34-year-old multipara with GDM/GDM history. The protective effect of maternal first-trimester low BMI against macrosomia was the weakest in winter among mothers without GDM/GDM history.

Keywords: body mass index; fetal sex; gestational diabetes mellitus; macrosomia; maternal age; parity; season of delivery.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the selection of study participants. GDM, gestational diabetes mellitus.
Figure 2
Figure 2
Receiver-operating characteristic curves for the prediction of macrosomia by maternal pre-pregnancy BMI (BMI1), maternal first-trimester BMI (BMI2), and paternal pre-pregnancy BMI (BMI3). BMI, body mass index; AUC, area under the receiver-operating characteristic curve; CI, confidence intervals.
Figure 3
Figure 3
Interactive analyses of the association between maternal first-trimester BMI and macrosomia (each stratification adjusted for all the factors except for the stratification factor itself). All the factors included maternal age, parental ethnicity, parental educational level, parental occupational physical activity, maternal income, parental smoking, maternal secondhand smoke exposure, parental drinking before or during pregnancy, parity, mode of conception, folic acid and multivitamin supplementation, preterm birth, fetal sex, season of delivery, GDM/GDM history, hypertension/hypertension history, and thyroid disease/thyroid disease history. BMI, body mass index; GDM, gestational diabetes mellitus.
Figure 4
Figure 4
Association between maternal first-trimester BMI and macrosomia stratified by GDM/GDM history status, parity, and maternal age. The association between maternal first-trimester BMI and macrosomia in multipara without GDM/GDM history (A), multipara with GDM/GDM history (B), nullipara without GDM/GDM history (C) and nullipara with GDM/GDM history (D). BMI, body mass index; GDM, gestational diabetes mellitus.
Figure 5
Figure 5
Association between maternal first-trimester BMI and macrosomia stratified by GDM/GDM history status, fetal sex, and season of delivery. The association between maternal first-trimester BMI and macrosomia in female fetuses whose mothers without GDM/GDM history (A), female fetuses whose mothers with GDM/GDM history (B), male fetuses whose mothers without GDM/GDM history (C) and male fetuses whose mothers with GDM/GDM history (D). BMI, body mass index; GDM, gestational diabetes mellitus.
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