The Interactive Effect of Prepregnancy Overweight/Obesity and Isolated Maternal Hypothyroxinemia on Macrosomia

Liu, Yindi; Guo, Fei; Zhou, Yulai; Yang, Xi; Zhang, Yong; Fan, Jianxia

doi:10.1210/clinem/dgab171

Cited by 10 publications

(14 citation statements)

References 34 publications

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“…Advanced peripheral deionization to decrease plasma FT4 levels has been reported in obese individuals [ 6 , 24 ]. Contrary to our study, 2 Chinese cohorts [ 20 , 21 ] and a Caucasian cohort from the United States [ 19 ] suggested an increased risk of macrosomia in isolated hypothyroxinemia during the first trimester. In these reports, maternal BMI and the prevalence of overweight/obesity were much higher than our study.…”

Section: Discussioncontrasting

confidence: 99%

Association of Isolated Hypothyroxinemia and Subclinical Hypothyroidism With Birthweight: A Cohort Study in Japan

Sankoda

Arata

Sato

et al. 2023

Journal of the Endocrine Society

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Context Isolated hypothyroxinemia (low maternal free thyroxine [FT4] in the absence of thyroid stimulating hormone [TSH] elevation) and subclinical hypothyroidism (high TSH in the absence of FT4 elevation) during early pregnancy are common. However, there is limited data regarding pregnancy outcomes, particularly their association with birthweight. Objective We assessed the association between isolated hypothyroxinemia and subclinical hypothyroidism during the first trimester and birthweight. Methods Analyses were conducted using a database of pregnant women (n = 1,105; median age, 35 years) who delivered at the National Center for Child Health and Development, a tertiary hospital in Tokyo. The primary outcomes included the rates of small for gestational age (SGA), large for gestational age (LGA), and low birth weight. Results Of the 1,105 pregnant women, 981 were classified into the euthyroidism group, 25 into the isolated hypothyroxinemia group, and 26 into the subclinical hypothyroidism group during the first trimester. The prevalence of SGA was significantly higher in isolated hypothyroxinemia and subclinical hypothyroidism groups compared to the euthyroidism group (28.0% and 19.2%, respectively, vs. 5.7%; p < .01). The odds ratio with 95% confidence interval for SGA was 12.51 (4.41-35.53) for isolated hypothyroxinemia and 4.44 (1.57-12.56) for subclinical hypothyroidism in a multivariable adjustment model. Isolated hypothyroxinemia and subclinical hypothyroidism were not significantly associated with LGA and low birth weight. Conclusion Pregnant women with isolated hypothyroxinemia and subclinical hypothyroidism in the first trimester have an increased likelihood of SGA. Screening and careful perinatal checkups for isolated hypothyroxinemia and subclinical hypothyroidism may help identify pregnant women at high risk for SGA.

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Section: Discussioncontrasting

confidence: 99%

Association of Isolated Hypothyroxinemia and Subclinical Hypothyroidism With Birthweight: A Cohort Study in Japan

Sankoda

Arata

Sato

et al. 2023

Journal of the Endocrine Society

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“…A previous study of 19,622 singleton pregnancies suggested that maternal GDM status increased the risk of macrosomia independently and synergistically with pre-pregnancy overweight ( 9 ). Despite widespread screening and management of GDM, the prevalence of macrosomia remains relatively high among pregnant women without GDM, which indicates that some other factors may also influence the incidence of macrosomia ( 10 ). It is reported that advanced maternal age ( 11 ), male fetuses ( 12 ), higher parity ( 13 ), and certain season of delivery ( 14 ) were also associated with increased odds for fetal macrosomia.…”

Section: Introductionmentioning

confidence: 99%

Protective Effect of Maternal First-Trimester Low Body Mass Index Against Macrosomia: A 10-Year Cross-Sectional Study

et al. 2022

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ObjectiveWe aimed to assess whether maternal first-trimester low body mass index (BMI) has a protective effect against macrosomia.MethodsThis was a cross-sectional study from January 1, 2011, to June 30, 2021, and 84,900 participants were included. The predictive performance of maternal first-trimester and parental pre-pregnancy BMI for macrosomia was assessed using the area under the receiver-operating characteristics curve (AUC). Multivariate logistic regression analyses were performed to evaluate the independent effect of maternal first-trimester low BMI on macrosomia. Interactions were investigated to evaluate the potential variation of the effect of first-trimester low BMI across different groups. Furthermore, interactions were also examined across groups determined by multiple factors jointly: a) gestational diabetes mellitus (GDM)/GDM history status, parity, and maternal age; and b) GDM/GDM history status, fetal sex, and season of delivery.ResultsThe proportion of macrosomia was 6.14% (5,215 of 84,900). Maternal first-trimester BMI showed the best discrimination of macrosomia (all Delong tests: P < 0.001). The protective effect of maternal first-trimester low BMI against macrosomia remained significant after adjusting for all confounders of this study [adjusted odds ratios (aOR) = 0.37, 95% CI: 0.32–0.43]. Maternal first-trimester low BMI was inversely associated with macrosomia, irrespective of parity, fetal sex, season of delivery, maternal age, and GDM/GDM history status. The protective effect was most pronounced among pregnant women without GDM/GDM history aged 25 to 29 years old, irrespective of parity (multipara: aOR = 0.32, 95% CI: 0.22–0.47; nullipara: aOR = 0.32, 95% CI: 0.24–0.43). In multipara with GDM/GDM history, the protective effect of low BMI was only observed in the 30- to 34-year-old group (aOR = 0.12, 95% CI: 0.02–0.86). For pregnant women without GDM/GDM history, the protective effect of maternal first-trimester low BMI against macrosomia was the weakest in infants born in winter, irrespective of fetal sex (female: aOR = 0.45, 95% CI: 0.29–0.69; male: aOR = 0.39, 95% CI: 0.28–0.55).ConclusionMaternal first-trimester low BMI was inversely associated with macrosomia, and the protective effect was most pronounced among 25- to 29-year-old pregnant women without GDM/GDM history and was only found among 30- to 34-year-old multipara with GDM/GDM history. The protective effect of maternal first-trimester low BMI against macrosomia was the weakest in winter among mothers without GDM/GDM history.

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“…Maternal overweight/obesity is closely related to the birth weight of newborns. 23,24 However, pre-BMI stratification was not included in the LASSO regression analysis in our logistic regression model. We speculate that it might be related to the obesity character of the GDMresistance subtype, which leads to the limited importance of pre-BMI in the logistic regression model.…”

Section: Discussionmentioning

confidence: 99%

“…Maternal overweight/obesity is closely related to the birth weight of newborns 23,24 . However, pre‐BMI stratification was not included in the LASSO regression analysis in our logistic regression model.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of risk prediction models for large for gestational age infants using logistic regression and two machine learning algorithms

Wang

Guo

Jing

et al. 2023

Journal of Diabetes

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Background Large for gestational age (LGA) is one of the adverse outcomes during pregnancy that endangers the life and health of mothers and offspring. We aimed to establish prediction models for LGA at late pregnancy. Methods Data were obtained from an established Chinese pregnant women cohort of 1285 pregnant women. LGA was diagnosed as >90th percentile of birth weight distribution of Chinese corresponding to gestational age of the same‐sex newborns. Women with gestational diabetes mellitus (GDM) were classified into three subtypes according to the indexes of insulin sensitivity and insulin secretion. Models were established by logistic regression and decision tree/random forest algorithms, and validated by the data. Results A total of 139 newborns were diagnosed as LGA after birth. The area under the curve (AUC) for the training set is 0.760 (95% confidence interval [CI] 0.706–0.815), and 0.748 (95% CI 0.659–0.837) for the internal validation set of the logistic regression model, which consisted of eight commonly used clinical indicators (including lipid profile) and GDM subtypes. For the prediction models established by the two machine learning algorithms, which included all the variables, the training set and the internal validation set had AUCs of 0.813 (95% CI 0.786–0.839) and 0.779 (95% CI 0.735–0.824) for the decision tree model, and 0.854 (95% CI 0.831–0.877) and 0.808 (95% CI 0.766–0.850) for the random forest model. Conclusion We established and validated three LGA risk prediction models to screen out the pregnant women with high risk of LGA at the early stage of the third trimester, which showed good prediction power and could guide early prevention strategies.

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The Interactive Effect of Prepregnancy Overweight/Obesity and Isolated Maternal Hypothyroxinemia on Macrosomia

Cited by 10 publications

References 34 publications

Association of Isolated Hypothyroxinemia and Subclinical Hypothyroidism With Birthweight: A Cohort Study in Japan

Association of Isolated Hypothyroxinemia and Subclinical Hypothyroidism With Birthweight: A Cohort Study in Japan

Protective Effect of Maternal First-Trimester Low Body Mass Index Against Macrosomia: A 10-Year Cross-Sectional Study

Development and validation of risk prediction models for large for gestational age infants using logistic regression and two machine learning algorithms

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