Maternal pre-pregnancy body mass index and risk of preterm birth: a collaboration using large routine health datasets.

Autor: Cornish RP; Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Road, Bristol, BS8 2BN, UK. rosie.cornish@bristol.ac.uk.; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK. rosie.cornish@bristol.ac.uk., Magnus MC; Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway., Urhoj SK; Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark., Santorelli G; Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK., Smithers LG; School of Public Health, University of Adelaide, Adelaide, Australia.; School of Health and Society, University of Wollongong, Wollongong, Australia., Odd D; Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK., Fraser A; Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Road, Bristol, BS8 2BN, UK.; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK., Håberg SE; Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway., Nybo Andersen AM; Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark., Birnie K; Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Road, Bristol, BS8 2BN, UK.; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK., Lynch JW; Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Road, Bristol, BS8 2BN, UK.; School of Public Health, University of Adelaide, Adelaide, Australia., Tilling K; Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Road, Bristol, BS8 2BN, UK.; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK., Lawlor DA; Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Road, Bristol, BS8 2BN, UK.; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
Jazyk: angličtina
Zdroj: BMC medicine [BMC Med] 2024 Jan 05; Vol. 22 (1), pp. 10. Date of Electronic Publication: 2024 Jan 05.
DOI: 10.1186/s12916-023-03230-w
Abstrakt: Background: Preterm birth (PTB) is a leading cause of child morbidity and mortality. Evidence suggests an increased risk with both maternal underweight and obesity, with some studies suggesting underweight might be a greater factor in spontaneous PTB (SPTB) and that the relationship might vary by parity. Previous studies have largely explored established body mass index (BMI) categories. Our aim was to compare associations of maternal pre-pregnancy BMI with any PTB, SPTB and medically indicated PTB (MPTB) among nulliparous and parous women across populations with differing characteristics, and to identify the optimal BMI with lowest risk for these outcomes.
Methods: We used three UK datasets, two USA datasets and one each from South Australia, Norway and Denmark, together including just under 29 million pregnancies resulting in a live birth or stillbirth after 24 completed weeks gestation. Fractional polynomial multivariable logistic regression was used to examine the relationship of maternal BMI with any PTB, SPTB and MPTB, among nulliparous and parous women separately. The results were combined using a random effects meta-analysis. The estimated BMI at which risk was lowest was calculated via differentiation and a 95% confidence interval (CI) obtained using bootstrapping.
Results: We found non-linear associations between BMI and all three outcomes, across all datasets. The adjusted risk of any PTB and MPTB was elevated at both low and high BMIs, whereas the risk of SPTB was increased at lower levels of BMI but remained low or increased only slightly with higher BMI. In the meta-analysed data, the lowest risk of any PTB was at a BMI of 22.5 kg/m 2 (95% CI 21.5, 23.5) among nulliparous women and 25.9 kg/m 2 (95% CI 24.1, 31.7) among multiparous women, with values of 20.4 kg/m 2 (20.0, 21.1) and 22.2 kg/m 2 (21.1, 24.3), respectively, for MPTB; for SPTB, the risk remained roughly largely constant above a BMI of around 25-30 kg/m 2 regardless of parity.
Conclusions: Consistency of findings across different populations, despite differences between them in terms of the time period covered, the BMI distribution, missing data and control for key confounders, suggests that severe under- and overweight may play a role in PTB risk.
(© 2023. The Author(s).)
Databáze: MEDLINE
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