Work

Nonlinear association between pre-pregnancy body mass index and preterm birth in singleton pregnancies conceived with assisted reproductive technology

Year: 2026

Type: article

Abstract: Objective This study aimed to analyze the correlation between pre-pregnancy body mass index (BMI) and the risk of preterm birth (PTB) in the assisted reproductive technology (ART) population and to determine the optimal BMI associated with the lowest risk of PTB. Design Retrospective cohort study. Setting The National Vital Statistics System birth dataset (January 1, 2019–December 31, 2023) from the National Center for Health Statistics in the United States. Subjects For birth data from 2019 to 2023, women who conceived via ART, with a single live birth, age at delivery ≥18 years and gestational age at delivery of 24 to 41 weeks were included. Women with missing data were excluded. The study included a total of 197,237 women with an average age of 35 ± 5 years. Exposure Pre-pregnancy BMI. Main outcome measures The primary outcome is PTB (<37 weeks). Evaluate the relationship between pre-pregnancy BMI and PTB by adjusting the logistic regression model for confounding variables; using a 4-node restricted cubic spline (RCS) model to assess nonlinear associations; subgroup analysis was performed based on with or without previous termination or fetal loss; finally, sensitivity analysis was conducted to validate the robustness of the results. Results A nonlinear association was observed between pre-pregnancy BMI and PTB ( P for nonlinearity: <0.001). The risk of PTB increases at both low and high BMI levels, with the lowest risk of PTB occurring at approximately 21.6 kg/m 2 [95% confidence interval (CI): (21.3–21.9)]. Subgroup analysis based on with or without previous termination or fetal loss revealed that the lowest risks of PTB were 22.6 kg/m 2 (95% CI: 22.3–22.8) and 21.2 kg/m 2 (95% CI: 20.8–21.6), respectively. The results of the sensitivity analyses remained stable. Conclusion A nonlinear association between pre-pregnancy BMI and PTB was observed in women treated with ART. Lower and higher BMIs were associated with an increased risk of PTB, respectively, with the optimal pre-pregnancy BMI associated with the lowest risk of PTB being approximately 21.6 kg/m 2 . The lowest point may vary depending on whether there was a previous termination or fetal loss.

Source: Frontiers in Nutrition

DOI: 10.3389/fnut.2025.1651462

Authors: Tingting Zhuang, Jingli Sun, Yu Zhang

Institutions: Jinzhou Medical University, General Hospital of Shenyang Military Region

Language: English

Topic: Assisted Reproductive Technology and Twin Pregnancy

Subfield: Pediatrics, Perinatology and Child Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801