Preconception glucose and BMI jointly associated with pregnancy outcomes

A retrospective cohort study of 8,057,713 women in China found that preconception fasting glucose and BMI were jointly associated with several adverse pregnancy outcomes. Risks differed by outcome, and some outcomes showed additive interaction between hyperglycemia and elevated BMI.

Cohort included more than 8 million women in China.
Obesity plus diabetes was linked to higher risks across several outcomes.
Underweight plus diabetes had the highest observed SGA and birth-defect risks.
Observational findings do not establish that risk modification improves outcomes.

Researchers analyzed data from China’s National Free Preconception Checkup Project for 8,057,713 women aged 26 years at the median, examined between 2013 and 2020. They classified preconception fasting plasma glucose and BMI into four categories each and used robust Poisson regression to assess associations with pregnancy outcomes, including pregnancy loss, preterm birth, fetal growth measures, birth defects and perinatal death.

Compared with women with normal glucose and BMI, women with both obesity and diabetes had higher adjusted risks of medically indicated termination (risk ratio [RR], 1.49), spontaneous abortion (RR, 1.38), preterm birth (RR, 1.39), large-for-gestational-age birth (RR, 1.87) and perinatal death (RR, 2.31). The highest observed risks of small-for-gestational-age birth (RR, 1.41) and birth defects (RR, 2.19) were among underweight women with diabetes. Additive interaction between hyperglycemia and elevated BMI varied by outcome and was not observed for small-for-gestational-age birth, birth defects or perinatal death.

The findings support considering glucose and BMI together when assessing preconception risk, but the study is observational and cannot show that changing either factor improves outcomes. The authors call for prospective interventional studies to test whether modification reduces risks.

In practice

For people planning pregnancy, the study suggests that preconception glucose and BMI considered together may help characterize risk, since the observed associations differed across outcomes and were strongest for some outcomes when diabetes and obesity co-occurred. This is evidence from a large retrospective cohort, not a trial: it does not establish that changing glucose or BMI will prevent adverse outcomes, and it does not demonstrate that a specific assessment or intervention improves pregnancy outcomes. The authors call for prospective interventional studies.

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Source

BMC Public Health: Joint association of preconception fasting plasma glucose and body mass index with adverse pregnancy outcomes: a retrospective cohort study in China ↗

This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.