Pre-pregnancy body mass index and risk of macrosomia: glycemic status-specific thresholds and subgroup interactions in a prospective cohort

作者：Yuhang Wu, Hanyu Xiao, Lizhang Chen, Jiabi Qin, Tingting Wang · 发表于：Frontiers in Nutrition · 年份：2025 · DOI：10.3389/fnut.2025.1633088 · 被引用次数：3 · 研究领域：Gestational Diabetes Research and Management、Pregnancy and preeclampsia studies、Cancer Risks and Factors

Background Macrosomia, a critical perinatal complication, is closely linked to maternal obesity and gestational diabetes mellitus (GDM). However, the extent to which GDM status modifies the association between pre-pregnancy body mass index (BMI) and macrosomia, particularly across demographic subgroups, remains poorly understood. This study aimed to quantify glycemic status-specific risk thresholds and explore subgroup interactions in a large prospective cohort. Methods In this prospective cohort study, 34,031 women initiating antenatal care before 14 weeks of gestation were enrolled at a tertiary hospital in Central China (2013–2019). Participants were stratified by GDM status and pre-pregnancy BMI categories. Multivariable logistic regression, restricted cubic spline (RCS) models, and interaction analyses evaluated associations between BMI and macrosomia (birth weight ≥ 4,000 g), adjusting for sociodemographic, behavioral, and clinical covariates. Results Macrosomia incidence was markedly higher in GDM (6.2%) vs. non-GDM pregnancies (3.6%). Adjusted models revealed a steeper dose–response gradient in GDM: each 1-unit BMI increase conferred 24% higher odds (aOR: 1.24 [95% CI 1.20, 1.28]) in GDM vs. 13% (aOR: 1.13 [1.11, 1.15]) in non-GDM. Obesity amplified risk 6.80-fold (aOR: 6.80 [4.02, 11.51]) in GDM vs. 4.70-fold (aOR: 4.70 [3.12, 7.10]) in non-GDM. RCS models identified nonlinear trajectories in both GDM and non-GDM pregnancies (reference level: 22.94 kg/m 2 for GDM and...