Association of maternal pre-pregnancy low or increased body mass index with adverse pregnancy outcomes

�� 2021 The Authors. Published by Springer. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher���s website: https://doi.org/10.1038/s41598-021-82064-zThis study investigated the association between pre-pregnancy body mass index (BMI) and adverse pregnancy outcomes among women participated in the National Free Preconception Health Examination Project in Guangdong Province, China, and explored these associations according to maternal age. Pre-pregnancy BMI was classified into underweight (BMI < 18.5��kg/m2), healthy weight (18.5���23.9��kg/m2), overweight (24.0���27.9��kg/m2), and obesity (��� 28.0��kg/m2) according to Chinese criteria. Outcomes were preterm birth (PTB, delivery before 37��weeks of gestation), large for gestational age (LGA, birthweight above the 90th percentile for gestational age by infants��� sex), small for gestational age (SGA, birthweight below the 10th percentile for gestational age by infants��� sex), primary caesarean delivery, shoulder dystocia or birth injury, and stillbirth. Adjusted incidence risk ratios (aIRR) were calculated for underweight, overweight and obesity, respectively. Compared with healthy weight, underweight was associated with increased risk of PTB (aIRR 1.06, 95%CI 1.04���1.09) and SGA (1.23, 1.22���1.26) but inversely associated with LGA (0.83, 0.82���0.85), primary caesarean delivery (0.88, 0.87���0.90) and stillbirth (0.73, 0.53���0.99). Overweight was associated with increased risk of LGA (1.17, 1.14���1.19), primary caesarean delivery (1.18, 1.16���1.20) and stillbirth (1.44, 1.03���2.06), but inversely associated with SGA (0.92, 0.90���0.95) and shoulder dystocia or birth injury (0.86, 0.79���0.93). Obesity was associated with increased risk of PTB (1.12, 1.05���1.20), LGA (1.32, 1.27���1.37), primary caesarean delivery (1.45, 1.40���1.50), but inversely associated with SGA (0.92, 0.87���0.97). The aIRRs for underweight, overweight and obesity in relation to these adverse pregnancy outcomes ranged from 0.65 to 1.52 according to maternal age. In Chinese population, maternal pre-pregnancy BMI was significantly associated with the risk of adverse pregnancy outcomes and the risk differs according to maternal age. Further investigation is warranted to determine whether and how counselling and interventions for women with low or increased BMI before pregnancy can reduce the risk of adverse pregnancy outcomes.Published versio