Zhang Bin, Zhan Zhaolong, Xi Sijie, Zhang Yinglu, Yuan Xiaosong
Department of Medical Genetics, Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China.
J Epidemiol Glob Health. 2025 May 8;15(1):70. doi: 10.1007/s44197-025-00414-w.
Serum creatinine to body weight ratio (CBWR) is closely associated with non-alcoholic fatty liver disease, diabetes, and all-cause mortality. This study aimed to assess the impact of CBWR in late pregnancy on incident small and large for gestational age (SGA/LGA) deliveries.
This observational study included 11,734 pregnant women with hospital-based hepatic/renal data (2016-2017). Demographic characteristics were compared between CBWR quintiles using appropriate parametric or nonparametric tests. Relationship between CBWR and clinical/laboratory parameters was assessed using Spearman's correlation. Linear regression was employed to evaluate the association of CBWR with fetal birth length/weight, while logistic regression was used to calculate adjusted odds ratios (ORs) for SGA/LGA, with both models adjusting for maternal age, parity, blood pressure, gestational week, assisted reproduction, neonatal sex, and laboratory results. Sensitivity analyses and subgroup stratifications confirmed these associations. Non-linear trends were explored using smooth curve fitting techniques.
Among these newborns, 1033 (8.80%) were classified as SGA and 1,827 (15.57%) as LGA. CBWR was associated with smaller birth length (β = -0.21 cm; 95% CI: -0.28, -0.15) and lower birth weight (β = -0.29 kg; 95% CI: -0.31, -0.27) in the highest versus lowest quintile. The multivariate-adjusted ORs of SGA in higher quintiles versus the lowest quintile of CBWR were 1.63 (95% CI: 1.21, 2.21), 2.16 (95% CI: 1.61, 2.89), 2.99 (95% CI: 2.25, 3.97), and 5.24 (95% CI: 3.97, 6.92), respectively; those for LGA were 0.60 (95% CI: 0.52, 0.70), 0.53 (95% CI: 0.46, 0.62), 0.39 (95% CI: 0.32, 0.46), and 0.23 (95% CI: 0.19, 0.29), respectively. Per standard deviation (SD) increase in CBWR was accompanied by a 1.63-fold increase in SGA risk (OR = 1.63, 95% CI: 1.52, 1.75) and a 42% decrease in LGA risk (OR = 0.58, 95% CI: 0.55, 0.63). Sensitivity analysis confirmed the consistence of these findings. Subgroup analysis demonstrated that CBWR was strongly associated with SGA risk in women with CBWR > 0.98 umol/L/kg complicated by preeclampsia or preterm birth, while in those complicated by gestational diabetes mellitus, the association was attenuated.
Our findings suggest that elevated CBWR in late pregnancy may be associated with decreased LGA risk and increased SGA risk. While CBWR represents an easily measurable and cost-effective potential indicator, these observational results require validation in prospective, population-based studies before considering clinical application.
血清肌酐与体重比（CBWR）与非酒精性脂肪性肝病、糖尿病及全因死亡率密切相关。本研究旨在评估孕晚期CBWR对小于胎龄儿（SGA）和大于胎龄儿（LGA）分娩发生率的影响。
这项观察性研究纳入了11734例有医院肝脏/肾脏数据的孕妇（2016 - 2017年）。使用适当的参数或非参数检验比较CBWR五分位数之间的人口统计学特征。使用Spearman相关性评估CBWR与临床/实验室参数之间的关系。采用线性回归评估CBWR与胎儿出生身长/体重的关联，同时采用逻辑回归计算SGA/LGA的调整优势比（OR），两个模型均对产妇年龄、产次、血压、孕周、辅助生殖、新生儿性别和实验室结果进行了调整。敏感性分析和亚组分层证实了这些关联。使用平滑曲线拟合技术探索非线性趋势。
在这些新生儿中，1033例（8.80%）被分类为SGA，1827例（15.57%）被分类为LGA。最高五分位数与最低五分位数相比，CBWR与较小的出生身长（β = -0.21 cm；95%CI：-0.28，-0.15）和较低的出生体重（β = -0.29 kg；95%CI：-0.31，-0.27）相关。CBWR较高五分位数与最低五分位数相比，SGA的多变量调整OR分别为1.63（95%CI：1.21，2.21）、2.16（95%CI：1.61，2.89）、2.99（95%CI：2.25，3.97）和5.24（95%CI：3.97，6.92）；LGA的分别为0.60（95%CI：0.52，0.70）、0.53（95%CI：0.46，0.62）、0.39（95%CI：0.32，0.46）和0.23（95%CI：0.19，0.29）。CBWR每增加一个标准差（SD），SGA风险增加1.63倍（OR = 1.63，95%CI：1.52，1.75），LGA风险降低42%（OR = 0.58，95%CI：0.55，0.63）。敏感性分析证实了这些发现的一致性。亚组分析表明，CBWR>0.98 umol/L/kg且并发子痫前期或早产的女性中，CBWR与SGA风险密切相关，而在并发妊娠期糖尿病的女性中，这种关联减弱。
我们的研究结果表明，孕晚期CBWR升高可能与LGA风险降低和SGA风险增加有关。虽然CBWR是一个易于测量且具有成本效益的潜在指标，但在考虑临床应用之前，这些观察结果需要在前瞻性、基于人群 的研究中进行验证。
