Background: Both prepregnancy obesity and gestational diabetes mellitus (GDM) have been linked to adverse neonatal birth weight. However, the mediating role of GDM between prepregnancy obesity and neonatal birth weight is unclear.
Method: The cohort study included 17 260 singleton pregnant women and their newborns. Participants' demographic characteristics, disease history, family history of the disease, and the perinatal outcomes were recorded. The association between maternal prepregnancy body mass index (BMI) status and small for gestational age (SGA) or large for gestational age (LGA) neonates was analyzed using logistic regressions, before and after adjusting for covariates and GDM. The potential mediation of GDM on the association between prepregnancy BMI and adverse birth weight was examined.
Result: Multivariate logistic regression demonstrated that prepregnancy underweight women were more likely to deliver SGA neonates compared to those who had normal weights, whereas prepregnancy obese pregnant women were more likely to have LGA neonates. The RMediation analyses illustrated that the mediation effect of GDM on the maternal prepregnancy BMI (continuous variable) and the risk of SGA was not significant, whereas the association between prepregnancy BMI and LGA was statistically mediated by GDM (95%CI of a*b: 0.009-0.051). The Iacobacci (2012) method indicated that the impact of maternal prepregnancy overweight (Zmediation = 2.418, P = .015) and obesity (Zmediation = 2.165, P = .030) on LGA was partially mediated by GDM, with an indirect effect of 16.3% and 13.1%, respectively.
Conclusion: Prepregnancy BMI was observed to be associated with SGA and LGA. The association of prepregnancy overweight and obesity with LGA was found to be partially mediated by GDM.
背景: 妊娠前肥胖和妊娠糖尿病(GDM)都与新生儿出生体重不良有关。然而, GDM在孕前肥胖和新生儿出生体重之间的作用尚不清楚。 方法: 采用队列研究方法, 对17260名单胎孕妇及其新生儿进行调查。记录患者的人口学特征、病史、家族史及围产期结局。在校正协变量和GDM之前和之后, 采用logistic回归分析孕妇孕前BMI状态与小胎龄(SGA)和大胎龄(LGA)新生儿之间的关系。研究GDM在孕前BMI和不良出生体重之间的潜在作用。 结果: 多因素logistic回归显示, 孕前体重偏轻的孕妇比正常体重的孕妇更容易分娩SGA新生儿, 而孕前肥胖孕妇更容易分娩LGA新生儿。RMediation分析显示, GDM对孕产妇孕前BMI和SGA风险的调节作用不显著, 而孕前BMI与LGA之间的关联是由GDM介导的(a*b的95%CI: 0.009-0.051)。Iacobacci's(2012)方法表明, 孕产妇孕前超重(Zmediation= 2.418, p=0.015)和肥胖(Zmediation= 2.165, p=0.030)对LGA的影响部分由GDM介导, 间接影响分别为16.3%和13.1%。 结论: 孕前BMI与SGA、LGA相关。妊娠前超重和肥胖与LGA的关系部分由GDM介导。.
Keywords: adverse birth weight; gestational diabetes mellitus; obesity before pregnancy; 出生体重不良; 妊娠期糖尿病; 孕前肥胖.
© 2021 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai JiaoTong University School of Medicine and John Wiley & Sons Australia, Ltd.