Maternal Pre-conception Body Mass Index and Fasting Plasma Glucose With the Risk of Pre-term Birth: A Cohort Study Including 4.9 Million Chinese Women

Abstract

Background: To evaluate the associations of pre-conception body mass index (BMI), fasting plasma glucose (FPG) alone and their combination with pre-term birth (PTB) risk. Methods: We conducted a population-based retrospective cohort study with 4,987,129 reproductive-aged women, who participated in National Free Pre-Pregnancy Checkups Project in 2013-2016 and had a singleton delivery before December 2017 in China. All data analyses were conducted in 2018-2021. Results: A total of 339,662 (6.81%) women had pre-term deliveries. Compared with women with normal weight and normal glucose, underweight and normal weight were associated with PTB among hypoglycemia women, the adjusted odd ratios (aORs) were 1.24 (95% CI: 1.05-1.48) and 1.16 (95% CI: 1.07-1.25), respectively; underweight, overweight and obesity were associated with PTB among women with normal glucose, the aORs were 1.09 (95% CI: 1.08-1.10), 1.06 (95% CI: 1.05-1.07) and 1.08 (95% CI: 1.05-1.12), respectively; all the BMI groups were significantly associated with PTB among women with pre-diabetes or diabetes (P < 0.05). The dose-response relationships of BMI with PTB varied in different FPG level, with U-shaped curve in normal glucose and pre-diabetes women, J-shaped in diabetes women, L-shaped in hypoglycemia women. For FPG with PTB, the dose-response relationships were U-shaped in normal weight, overweight, and obesity women, and L-shaped in underweight women. Conclusion: We found that the associations of PTB with BMI varied with levels of FPG, and associations of PTB with FPG varied with levels of BMI. There was a synergistic effect on PTB risk due to abnormal weight and glycemia besides a conventional main effect derived from either of them. Achieving desirable weight and glucose control before conception should be advised.

Keywords: body mass index; cohort study; fasting plasma glucose; pre-conception; pre-term birth.

Figure 1

Flowchart of the study participants. NFPCP, National Free Pre-Pregnancy Checkups Project.

Figure 2

The exposure-response relationship of pre-conception BMI with PTB, stratified by FPG. BMI, body mass index; FPG, fasting plasma glucose; PTB, (pre-term birth, 28 to <37 weeks). (A) Hypoglycemia; (B) Normal glucose; (C) Pre-diabetes; (D) Diabetes. In the graph, black lines, and shaded gray areas represent predicted ORs and 95% CIs, respectively. The models were adjusted for characteristics of women (age, education, ethnic, occupation), parity, smoking and alcohol drinking before or during early pregnancy, history of adverse pregnancy outcomes, history of hypertension, thyroid dysfunction, anemia, infectious disease, and sex of child.

Figure 3

The exposure-response relationship of pre-conception FPG with PTB, stratified by BMI. BMI, body mass index; FPG, fasting plasma glucose; PTB, (pre-term birth, 28 to <37 weeks). (A) Underweight; (B) Normal weight; (C) Overweight; (D) Obesity. In the graph, black lines and shaded gray areas represent predicted ORs and 95% CIs, respectively. The models were adjusted for characteristics of women (age, education, ethnic, occupation), parity, smoking and alcohol drinking before or during early pregnancy, history of adverse pregnancy outcomes, history of hypertension, thyroid dysfunction, anemia, infectious disease, and sex of child.