Wang Peng, Yu Zhengchen, Hu Yinkai, Li Wangzhi, Xu Luxuan, Da Fangqing, Wang Fan
Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, 325000, China.
School of Stomatology, Wenzhou Medical University, Wenzhou City, Zhejiang Province, 325000, China.
Pediatr Res. 2025 Jan;97(1):301-310. doi: 10.1038/s41390-024-03298-x. Epub 2024 Jun 13.
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.
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.
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])).
High-BMI positively modified the risk of GDM on LGA. Many interactions existed when two specific pregnancy complications occurred simultaneously.
This is the largest retrospective study covering more than 10 pregnancy complications to date in this aspect. High-BMI (BMI > 28 kg/m) 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.
母亲身体状况（以分娩时的母亲体重指数（BMI）反映）和妊娠并发症会影响新生儿健康结局。孕期高BMI会增加各种健康问题的风险，但关于这些因素对胎儿生长的综合影响的研究较少。
2019年1月1日至2021年12月31日在中国浙江省进行了一项回顾性队列研究。采用Fine-Gray模型和亚组分析来衡量并发症与小于胎龄儿（SGA）和大于胎龄儿（LGA）之间的关联。进行效应修饰和交互分析以探讨BMI的修饰作用和并发症的交互作用。
几种并发症增加了SGA和LGA的风险，在不同亚组中一些显著性有所不同。妊娠糖尿病（GDM）在不同BMI分层中对LGA存在正向效应修饰（交互作用导致的相对超额风险（RERI）[95%置信区间] = 0.57 [0.09,1.04]）。几种并发症之间的两两交互作用是协同的（例如，孕前糖尿病和羊膜腔内感染导致SGA（比值比的比值[95%置信区间] = 8.50 [1.74,41.37]），孕前糖尿病和辅助生殖技术（ART）导致LGA（比值比的比值[95%置信区间] = 2.71 [1.11,6.62]）），一种是拮抗的（胎盘问题和ART导致LGA（比值比的比值[95%置信区间] = 0.58 [0.35,0.96]））。
高BMI正向修饰了GDM对LGA的风险。当两种特定的妊娠并发症同时发生时存在许多交互作用。
这是迄今为止在这方面涵盖超过10种妊娠并发症的最大规模回顾性研究。高BMI（BMI＞28kg/m²）正向修饰了GDM对LGA的风险。许多妊娠并发症影响SGA和LGA的风险，存在几种可能产生“综合征”效应的交互作用。不同BMI的孕妇应考虑妊娠并发症因其对胎儿生长异常的异质性影响而带来的额外风险。应采取措施预防“综合征”中其他暴露因素的发生。本研究可能有助于制定改善新生儿结局的新策略。
