Risk Factors for Adverse Pregnancy Outcomes among Zhuang Ethnic Pregnant Women: A Cohort Study in Guangxi, China

Abstract

Risk factors for adverse pregnancy outcomes among Zhuang ethnic pregnant women are unclear. This study analyzed the incidence and risk factors related to preterm birth (PB), low birth weight (LBW) and macrosomia in Zhuang population. We conducted a prospective cohort study of 9965 Zhuang pregnancy women in Guangxi, China. Information on mothers and newborns was obtained by using questionnaires and referring to medical records. Multivariate logistic regression analyses were used to evaluate the association between related factors and adverse pregnancy outcomes. Our results showed that the incidence of PB, LBW and macrosomia in Zhuang people was 5.55%, 5.64% and 2.19%, respectively. Maternal age ≥36 years (OR=2.22, 95% CI: 1.51–3.27) was related to a higher incidence of PB. Those with pre-pregnancy body mass index (BMI) <18.5 kg/m² (OR=1.91, 95% CI: 1.45–2.51), and had a female fetus (OR=1.74, 95% CI: 1.36–2.23) were more likely to have LBW infants. Maternal age between 31 and 35 years (OR=1.76, 95% CI: 1.03–2.99) and pre-pregnancy overweight or obesity (OR=1.79, 95% CI: 1.15–2.80) were associated with a higher risk of macrosomia. The protective factors of macrosomia were maternal pre-pregnancy BMI <18.5 kg/m² (OR=0.30, 95% CI: 0.15–0.60) and female fetus (OR=0.41, 95% CI: 0.28–0.59). Our study provided a reference for maternal and childcare administration among Zhuang population.

Keywords

Zhuang ethnic / cohort study / low birth weight / preterm birth / macrosomia / risk factors

References

[1] BlencoweH, CousensS, OestergaardMZ, et al.. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet, 2012, 379(9832): 2162-2172

[2] VogelJP, ChawanpaiboonS, MollerAB, et al.. The global epidemiology of preterm birth. Best Pract Res Clin Obstet Gynaecol, 2018, 52: 3-12

[3] EvensenKA, SteinshamnS, TjonnaAE, et al.. Effects of preterm birth and fetal growth retardation on cardiovascular risk factors in young adulthood. Early Hum Dev, 2009, 85(4): 239-245

[4] CrumpC, SundquistJ, WinklebyMA, et al.. Gestational age at birth and mortality from infancy into mid-adulthood: a national cohort study. Lancet Child Adolesc Health, 2019, 3(6): 408-417

[5] LiS, XiB. Preterm birth is associated with risk of essential hypertension in later life. Int J Cardiol, 2014, 172(2): e361-363

[6] MalacovaE, ReganA, NassarN, et al.. Risk of stillbirth, preterm delivery, and fetal growth restriction following exposure in a previous birth: systematic review and meta-analysis. BJOG, 2018, 125(2): 183-192

[7] HuangA, JinX, LiuX, et al.. A matched case-control study of preterm birth in one hospital in Beijing, China. Reprod Health, 2015, 12: 1

[8] SimmonsLE, RubensCE, DarmstadtGL, et al.. Preventing preterm birth and neonatal mortality: exploring the epidemiology, causes, and interventions. Semin Perinatol, 2010, 34(6): 408-415

[9] BlencoweH, KrasevecJ, de OnisM, et al.. National, regional, and worldwide estimates of low birth weight in 2015, with trends from 2000: a systematic analysis. Lancet Glob Health, 2019, 7(7): e849-e860

[10] YeJF, TorloniMR, OtaE, et al.. Searching for the definition of macrosomia through an outcome-based approach in low- and middle-income countries: a secondary analysis of the WHO Global Survey in Africa, Asia and Latin America. BMC Pregnancy Childbirth, 2015, 15: 324

[11] Liang X, Xiao L, Luo Y, et al. Prevalence and Risk Factors of Childhood Hypertension in Urban-Rural Areas of China: A Cross-Sectional Study. Int J Hypertens, 2020(5):1–18

[12] PanXF, TangL, LeeAH, et al.. Association between fetal macrosomia and risk of obesity in children under 3 years in Western China: a cohort study. World J Pediatr, 2019, 15(2): 153-160

[13] ChamanR, AmiriM, RaeiM, et al.. Low birth weight and its related risk factors in northeast iran. Iran J Pediatr, 2013, 23(6): 701-704

[14] PhungH, BaumanA, NguyenTV, et al.. Risk factors for low birth weight in a socio-economically disadvantaged population: parity, marital status, ethnicity and cigarette smoking. Eur J Epidemiol, 2003, 18(3): 235-243

[15] ShahPS. Parity and low birth weight and preterm birth: a systematic review and meta-analyses. Acta Obstet Gynecol Scand, 2010, 89(7): 862-875

[16] WangJ, ZengY, NiZM, et al.. Risk Factors for Low Birth Weight and Preterm Birth: A Population-based Case-control Study in Wuhan, China. J Huazhong Univ Sci Technol [Med Sci], 2017, 37(2): 286-292

[17] ShanX, ChenF, WangW, et al.. Secular trends of low birthweight and macrosomia and related maternal factors in Beijing, China: a longitudinal trend analysis. BMC Pregnancy Childbirth, 2014, 14(1): 105

[18] ZhangQ, BaiRH, WangLL, et al.. Incidence of fetal macrosomia among single live birth neonates and influencing factors in Xi’an, 2010–2013. Zhonghua Liuxingbingxue Zazhi (Chinese), 2016, 37(8): 1095-1098

[19] LeiF, ZhangL, ShenY, et al.. Association between parity and macrosomia in Shaanxi Province of Northwest China. Ital J Pediatr, 2020, 46(1): 24

[20] VinturacheAE, ChaputKH, ToughSC. Pre-pregnancy body mass index (BMI) and macrosomia in a Canadian birth cohort. J Matern Fetal Neonatal Med, 2017, 30(1): 109-116

[21] KoyanagiA, ZhangJ, DagvadorjA, et al.. Macrosomia in 23 developing countries: an analysis of a multicountry, facility-based, cross-sectional survey. Lancet, 2013, 381(9865): 476-483

[22] DiabelkováJ, RimárováK, UrdzíkP, et al.. Risk factors of preterm birth and low birth weight neonates among roma and non-roma mothers. Cent Eur J Public Health, 2018, 26: S25-S31 Suppl

[23] ZhengS, ChangW, LinWY, et al.. An analysis of status of birth weight among different ethnic groups in Qapqal. Zhongguo Fuyou Baojian (Chinese), 2004, 19(23): 86-87

[24] SpongCY. Defining “term” pregnancy: recommendations from the Defining “Term” Pregnancy Workgroup. JAMA, 2013, 309(23): 2445-2446

[25] Zhang J, Tian Y, Wang W, et al. Cohort profile: The Shanghai Birth Cohort. Int J Epidemiol, 2019(1):21–21G

[26] GeX, TaoF, HuangK, et al.. Maternal Snoring May Predict Adverse Pregnancy Outcomes: A Cohort Study in China. PLoS One, 2016, 11(2): e0148732

[27] SongL, ShenL, LiH, et al.. Afternoon napping during pregnancy and low birth weight: the Healthy Baby Cohort study. Sleep Med Clin, 2018, 48: 35-41

[28] QiuX, LuJH, HeJR, et al.. The Born in Guangzhou Cohort Study (BIGCS). Eur J Epidemiol, 2017, 32(4): 337-346

[29] YangY, HeY, LiQ, et al.. Preconception blood pressure and risk of preterm birth: a large historical cohort study in a Chinese rural population. Fertil Steril, 2015, 104(1): 124-130

[30] LiuAP, ZhangR, LiZP, et al.. Incidence of low birth weight among single live birth neonates and influencing factors in Shaanxi. Zhonghua Liuxingbingxue Zazhi (Chinese), 2015, 36(11): 1244-1248

[31] ArgerichMI, DavidRA, BocchiniA. GDM—Impact of BMI in Maternal Bioquimical-Metabolic Variables and Its Association with Macrosomia. Diabetes, 2018, 67(Supplement 1): 2347-PUB

[32] LiuP, XuL, WangY, et al.. Association between perinatal outcomes and maternal pre-pregnancy body mass index. Obes Rev, 2016, 17(11): 1091-1102

[33] WangX, WangX, ChenQ, et al.. Urinary bisphenol a concentration and gestational diabetes mellitus in chinese women. Epidemiology, 2017, 28: S41-S47

[34] AndersonI, RobsonB, ConnollyM, et al.. Indigenous and tribal peoples’ health (The Lancet-Lowitja Institute Global Collaboration): a population study. Lancet, 2016, 388: 131-157

[35] StephensC, NettletonC, PorterJ, et al.. Indigenous peoples’ health—why are they behind everyone, everywhere?. Lancet, 2005, 366: 10-11

[36] HuangY, ShallcrossD, PiL, et al.. Ethnicity and maternal and child health outcomes and service coverage in western china: a systematic review and meta-analysis. Lancet Glob Health, 2018, 6(1): e39-e56

[37] Wong-TaylorLA, LawrenceA, CowenS, et al.. Maternal and neonatal outcomes of spontaneously conceived pregnancies in mothers over 45 years: a review of the literature. Arch Gynecol Obstet, 2012, 285(4): 1161-1166

[38] WangC, WangXY, YangHX. Effect of maternal age on pregnancy outcomes in Beijing. Zhonghua Fuchanke Zazhi (Chinese), 2017, 52(8): 514-520

[39] FitzpatrickKE, TuffnellD, KurinczukJJ, et al.. Pregnancy at very advanced maternal age: a UK population-based cohort study. BJOG, 2017, 124(7): 1097-1106

[40] KhanJR, IslamMM, AwanN, et al.. Analysis of low birth weight and its co-variants in Bangladesh based on a sub-sample from nationally representative survey. BMC Pediatr, 2018, 18(1): 100

[41] NeggersY, GoldenbergRL. Some thoughts on body mass index, micronutrient intakes and pregnancy outcome. J Nutr, 2003, 133(5suppl): 1737S-1740S

[42] CogswellME, YipR. The influence of fetal and maternal factors on the distribution of birthweight. Semin Perinatol, 1995, 19(3): 222-240

[43] KcK, ShakyaS, ZhangH. Gestational diabetes mellitus and macrosomia: a literature review. Ann Nutr Metab, 2015, 66(Suppl 2(2)): 14-20

[44] KennyLC, LavenderT, McNameeR, et al.. Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort. PLoS One, 2013, 8(2): e56583

[45] ChiefariE, ArcidiaconoB, FotiD, et al.. Gestational diabetes mellitus: an updated overview. J Endocrinol Invest, 2017, 40(9): 899-909