Sex-specific mediating effect of gestational weight gain between pre-pregnancy body mass index and gestational diabetes mellitus

Shuang Zhang; Jingyu Wang; Fang Xu; Juhong Yang; Yongzhang Qin; Junhong Leng; Nan Li; Jia Guo; Xiaochen Li; Zhong'ai Gao; Xiaofang Shen; Hui Gao; Baocheng Chang; Hong Zhu

doi:10.1038/s41387-022-00203-5

Sex-specific mediating effect of gestational weight gain between pre-pregnancy body mass index and gestational diabetes mellitus

Nutr Diabetes. 2022 Apr 25;12(1):25. doi: 10.1038/s41387-022-00203-5.

Authors

Shuang Zhang^#^{1

2}, Jingyu Wang^#¹, Fang Xu^#^{1

3}, Juhong Yang¹, Yongzhang Qin^{1

4}, Junhong Leng², Nan Li², Jia Guo², Xiaochen Li¹, Zhong'ai Gao¹, Xiaofang Shen¹, Hui Gao⁵, Baocheng Chang⁶, Hong Zhu⁷

Affiliations

¹ NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China.
² Tianjin Women's and Children's Health Center, Tianjin, China.
³ Department of Endocrinology, Inner Mongolia Baogang Hospital, Inner Mongolia Autonomous Region, Baotou, China.
⁴ Department of Endocrinology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China.
⁵ Department of Obstetrics and Gynaecology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁶ NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China. changbc1970@126.com.
⁷ Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, China. zhuhong@tmu.edu.cn.

^# Contributed equally.

Abstract

Background: Inappropriate weight gain may increase the risk of gestational diabetes mellitus (GDM). However, the relationship between pre-pregnancy body mass index (BMI), weight gain, and GDM has not been precisely quantified. This study aimed to explore whether gestational weight gain played a mediating role between pre-pregnancy BMI and GDM and whether the mediating effect was sex specific.

Methods: This study established a population-based observational cohort to assess weight gain in pregnant women. Mediation analyses were performed to quantify whether weight gain mediated the association between pre-pregnancy BMI and GDM.

Results: A total of 67,777 pregnant women were included in the final analysis, among whom 6751 (10.0%) were diagnosed with GDM. We verified that both pre-pregnancy BMI and weight gain were associated with GDM, and that BMI negatively contributed to weight gain. We also found that weight gain had a significant mediating effect on the relationship between pre-pregnancy BMI and GDM (Z_a × Z_b confidence intervals [CIs] 0.00234-0.00618). Furthermore, the effect was sex-specific, in that it was only significant in overweight women carrying female fetuses (Z_a × Z_b CIs 0.00422-0.01977), but not male fetuses (Z_a × Z_b CIs -0.00085 to 0.01236).

Conclusions: Weight gain during pregnancy had a fetal sex-specific mediating effect between pre-pregnancy BMI and GDM.

Publication types

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

MeSH terms

Body Mass Index
Diabetes, Gestational*
Female
Gestational Weight Gain*
Humans
Male
Overweight / complications
Pregnancy
Weight Gain