Pre-pregnancy body mass index, gestational diabetes mellitus, and gestational weight gain: individual and combined effects on fetal growth

Yanyu Lyu; Mingming Cui; Lingling Zhang; Guang Zheng; Hanxiao Zuo; Qingyong Xiu; Prakesh S Shah

doi:10.3389/fpubh.2024.1354355

Pre-pregnancy body mass index, gestational diabetes mellitus, and gestational weight gain: individual and combined effects on fetal growth

Front Public Health. 2024 Mar 11:12:1354355. doi: 10.3389/fpubh.2024.1354355. eCollection 2024.

Authors

Yanyu Lyu¹, Mingming Cui², Lingling Zhang³, Guang Zheng⁴, Hanxiao Zuo⁵, Qingyong Xiu⁶, Prakesh S Shah⁷

Affiliations

¹ Experiment Center, Capital Institute of Pediatrics, Beijing, China.
² Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, China.
³ Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, United States.
⁴ School of Information Science and Engineering, Lanzhou University, Lanzhou, China.
⁵ School of Public Health, University of Alberta, Edmonton, AB, Canada.
⁶ Department of Pediatrics, Beijing Daxing Maternal and Child Care Hospital, Beijing, China.
⁷ Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada.

Abstract

Background: Pre-pregnancy body mass index (BMI), gestational diabetes mellitus (GDM), and gestational weight gain (GWG) are interlinked and may play a complex role in fetal growth. We aimed to examine the relationship between pre-pregnancy BMI, GDM, GWG, and fetal growth outcomes and explore the contribution of GDM and GWG to the relationship between Pre-pregnancy obesity/overweight and large-for-gestational-age (LGA) in a prospective cohort.

Methods: We prospectively recruited women in the first trimester and having one-step GDM screened with a 75-g oral glucose tolerance test between 24 and 28 weeks of gestation (n = 802). Outcomes included LGA, small-for-gestational-age (SGA), and preterm birth. To assess the individual and cumulative associations between pre-pregnancy BMI, GDM, GWG, and these outcomes, we used multivariate logistic regression analysis. Furthermore, we employed structural equation modeling (SEM) to investigate the mediating role of GDM and excessive GWG in the correlation between pre-pregnancy overweight/obesity and LGA.

Results: Pre-pregnancy obesity, GDM, and excessive GWG were all independently associated with increased odds of LGA. Inadequate GWG was associated with higher odds of preterm birth. Compared with women unexposed to pre-pregnancy overweight/obesity, GDM, or excessive GWG, women exposed any two conditions had higher odds for LGA (AOR 3.18, 95% CI 1.25-8.11) and women with coexistence of all had the highest odds for LGA (AOR 8.09, 95% CI 2.18-29.97). The mediation analysis showed that GDM explained 18.60% (p < 0.05) of the total effect of pre-pregnancy overweight/obesity on LGA, and GWG explained 17.44% (p < 0.05) of the total effect.

Conclusion: Pre-pregnancy obesity/overweight, GDM, and excessive GWG are associated with higher odds of fetal growth disturbances as individual factors and when they co-exist. The effect of pre-pregnancy overweight/obesity on LGA is partially achieved through GDM and excessive GWG.

Keywords: birth cohort; gestational diabetes mellitus; gestational weight gain; large-for-gestational-age; mediation analysis; pre-pregnancy body mass index; preterm birth.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Body Mass Index
Diabetes, Gestational* / epidemiology
Female
Fetal Development
Gestational Weight Gain*
Humans
Infant, Newborn
Obesity / complications
Overweight / epidemiology
Pregnancy
Pregnancy Outcome
Premature Birth*
Prospective Studies
Weight Gain

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work was supported by Research Foundation of Capital Institute of Pediatrics (JHYJ-2023-07 and FX-15-04).