The mediating effects of gestational diabetes mellitus and hypertensive disorders of pregnancy between maternal advanced age, previous caesarean section and the risk of small- or large-for-gestational-age newborns: a multicentric prospective cohort study in southern China
2025

Impact of Maternal Age and Previous Caesarean Section on Newborn Size

Sample size: 482458 publication 10 minutes Evidence: high

Author Information

Author(s): Lin Lihua, Sun Bin, Wang Xiaomei, Zhang Ronghua, Lin Juan, Yan Jianying

Primary Institution: Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University

Hypothesis

Does gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) mediate the relationship between maternal advanced age, previous caesarean section, and the risk of small- or large-for-gestational-age newborns?

Conclusion

HDP mediates the impact of maternal advanced age and previous caesarean section on the risk of small-for-gestational-age newborns, while GDM mediates the connection between previous caesarean section and large-for-gestational-age newborns.

Supporting Evidence

  • Maternal advanced age was associated with a higher likelihood of gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP).
  • Previous caesarean section increased the risk of GDM and HDP.
  • GDM was linked to a higher risk of large-for-gestational-age (LGA) infants.
  • HDP was significantly associated with small-for-gestational-age (SGA) infants.
  • HDP mediated 68.96% of the effect of maternal advanced age on SGA risk.
  • GDM mediated 5.62% of the effect of previous caesarean section on LGA risk.

Takeaway

Older moms and those who had a C-section before are more likely to have babies that are either too big or too small, and health issues during pregnancy can make this worse.

Methodology

Data from a prospective multicentre cohort study conducted through China's National Maternal Near-miss Surveillance System from January 2012 to December 2021 was analyzed using logistic regression and mediation analyses.

Potential Biases

Potential bias due to unmeasured confounding factors and the observational nature of the study.

Limitations

Findings may not be generalizable beyond southeastern China, and potential confounding factors like pre-pregnancy BMI and socioeconomic status were not assessed.

Participant Demographics

13.5% of participants were classified as advanced age, 51.4% were multipara, and 16.3% had a history of uterine scarring.

Statistical Information

P-Value

p<0.05

Confidence Interval

95% CI for various odds ratios reported in the study.

Statistical Significance

p<0.05

Digital Object Identifier (DOI)

10.7189/jogh.15.04053

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