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Background <p>Low birth weight (LBW) remains a critical global health challenge, yet the differential contributions of risk factors in pregnancies with and without gestational diabetes mellitus (GDM) are poorly characterized. This study aimed to identify modifiable first-trimester risk factors for LBW in GDM and non-GDM subpopulations within a Chinese context, and quantify the preventable LBW burden by population attributable fraction (PAF) estimation adjusted for risk factor interdependence.</p> Methods <p>This prospective cohort study enrolled 34,031 pregnant women from Central China (2013–2019), stratified by GDM (<i>n</i> = 5414) and non-GDM (<i>n</i> = 28,617) groups. Early-pregnancy exposures included advanced maternal age, passive smoking, alcohol intake, no folic acid used, low education, and pre-pregnancy underweight. Multivariable logistic regression and principal component analysis-adjusted PAFs were used to quantify preventable LBW burdens while accounting for risk factor overlap.</p> Results <p>Five risk factors were identified in both GDM (advanced maternal age, passive smoking, underweight, no folic acid used, and low education) and non-GDM (advanced maternal age, alcohol intake, underweight, no folic acid used, and low education) pregnancies. It was found that 18.4% and 33.4% of LBW cases could be theoretically prevented through these five identified risk factors in both GDM and non-GDM cohorts, respectively. Among four shared contributors, low education emerged as the primary modifiable risk factor (adjusted PAF: 9.3% in GDM; 20.1% in non-GDM), followed by underweight (adjusted PAF: 3.7% in GDM; 5.8% in non-GDM), advanced maternal age (adjusted PAF: 3.3% in GDM; 4.8% in non-GDM), no folic acid used (adjusted PAF: 0.9% in GDM; 2.2% in non-GDM). Passive smoking and alcohol intake are specific risk factors for pregnant women with GDM and non-GDM, respectively, with adjusted PAF of 1.1% and 0.5%.</p> Conclusion <p>This study significantly contributes to the advancement of precision public health approaches by elucidating modifiable risk profiles associated with LBW in both GDM and non-GDM populations. These findings highlight population-specific heterogeneity in preventable disease burdens, revealing that a significant proportion of LBW cases could be reduced through targeted antenatal interventions.</p>

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Potential for primary prevention of low birth weight in pregnancies with and without gestational diabetes mellitus: a prospective cohort study in Central China

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月27日

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  • Yuhang Wu,
  • Hanyu Xiao,
  • Lizhang Chen,
  • Jiabi Qin,
  • Tingting Wang

摘要

Background

Low birth weight (LBW) remains a critical global health challenge, yet the differential contributions of risk factors in pregnancies with and without gestational diabetes mellitus (GDM) are poorly characterized. This study aimed to identify modifiable first-trimester risk factors for LBW in GDM and non-GDM subpopulations within a Chinese context, and quantify the preventable LBW burden by population attributable fraction (PAF) estimation adjusted for risk factor interdependence.

Methods

This prospective cohort study enrolled 34,031 pregnant women from Central China (2013–2019), stratified by GDM (n = 5414) and non-GDM (n = 28,617) groups. Early-pregnancy exposures included advanced maternal age, passive smoking, alcohol intake, no folic acid used, low education, and pre-pregnancy underweight. Multivariable logistic regression and principal component analysis-adjusted PAFs were used to quantify preventable LBW burdens while accounting for risk factor overlap.

Results

Five risk factors were identified in both GDM (advanced maternal age, passive smoking, underweight, no folic acid used, and low education) and non-GDM (advanced maternal age, alcohol intake, underweight, no folic acid used, and low education) pregnancies. It was found that 18.4% and 33.4% of LBW cases could be theoretically prevented through these five identified risk factors in both GDM and non-GDM cohorts, respectively. Among four shared contributors, low education emerged as the primary modifiable risk factor (adjusted PAF: 9.3% in GDM; 20.1% in non-GDM), followed by underweight (adjusted PAF: 3.7% in GDM; 5.8% in non-GDM), advanced maternal age (adjusted PAF: 3.3% in GDM; 4.8% in non-GDM), no folic acid used (adjusted PAF: 0.9% in GDM; 2.2% in non-GDM). Passive smoking and alcohol intake are specific risk factors for pregnant women with GDM and non-GDM, respectively, with adjusted PAF of 1.1% and 0.5%.

Conclusion

This study significantly contributes to the advancement of precision public health approaches by elucidating modifiable risk profiles associated with LBW in both GDM and non-GDM populations. These findings highlight population-specific heterogeneity in preventable disease burdens, revealing that a significant proportion of LBW cases could be reduced through targeted antenatal interventions.