Peer Review #1 of "Association of pre-pregnancy body mass index with adverse pregnancy outcome among first-time mothers (v0.2)"

Abstract

Background: Studies have reported an increased risk of adverse pregnancy outcome associated with pre-pregnancy body mass index (BMI). However, the data on such associations in urban areas of southern Chinese women is limited, which drive us to clarify the associations of pre-pregnancy BMI and the risks of adverse pregnancy outcomes (preterm birth (PTB) and low birth weight (LBW)) and maternal health outcomes (gestational hypertension and cesarean delivery). Methods: We performed a hospitalbased case-control study including 3,864 Southern Chinese women who gave first birth to a live singleton infant from January 2015 to December 2015. PTB was stratified into three subgroups according to gestational age (extremely PTB, very PTB and moderate PTB). Besides, we combined birth weight and gestational age to dichotomise as being small for gestational age (SGA, less than the tenth percentile of weight for gestation) and non-small for gestational age (NSGA, large than the tenth percentile of weight for gestation), gestational week was also classified into categories of term, 34-36 week and below 34 week.. We then divided newborns into six groups: (1) term and NSGA; (2) 34-36 week gestation and NSGA; (3) below 34 week gestation and NSGA; (4) term and SAG; (5) 34-36 week gestation and SAG; (6) below 34 week gestation and SAG. Adjusted logistic regression models was used to estimate the odds ratios of adverse outcomes. Results: Underweight women were more likely to give LBW (AOR=1.44, 95% CI 1.11 to 1.89), the similar result was seen in term and SAG as compare with term and NSAG (AOR=1.78, 95% CI 1.45-2.17). Whereas underweight was significantly associated with a lower risk of gestational hypertension (AOR=0.45, 95% CI 0.25-0.82) and caesarean delivery (AOR=0.74, 95% CI 0.62-0.90). The risk of extremely PTB is relatively higher among overweight and obese mothers in a subgroup analysis of PTB (AOR=8.12, 95% CI=1.11 to