ArticleBMC pregnancy and childbirth2026
Potential for primary prevention of low birth weight in pregnancies with and without gestational diabetes mellitus: a prospective cohort study in Central China.
Article in BMC pregnancy and childbirth, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLow 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.
methodsThis 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.
resultsFive 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%.
conclusionThis 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.
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