Association of pre-pregnancy body mass index and first-trimester remnant cholesterol level with risk of large for gestational age

Background: To evaluate the associations of pre-pregnancy body mass index (BMI) and first-trimester remnant cholesterol (RC) level with the risk of large for gestational age (LGA) infants. Methods: A prospective cohort study was conducted in Southeastern China, including 11,319 pregnant women. Logistic regression was used to examine the associations of pre-pregnancy BMI and RC level with LGA. Restricted cubic spline regression was applied to assess the dose-response relationship between RC level and LGA risk. Mediation analysis was performed to evaluate the potential mediation role of gestational diabetes mellitus (GDM) in the associations of pre-pregnancy BMI and RC level with LGA. Results: (odds ratio (OR) = 1.60; 95% CI = 1.31 ~ 1.95) and those in the highest tertile of RC (OR = 2.09; 95% CI = 1.67 ~ 2.61). No significant multiplicative or additive interactions were observed between BMI and RC level on LGA risk. Gestational diabetes mellitus mediated 0.91% (RC) and 1.15% (BMI) of effects. Population-attributable risk estimates indicated that 6.69 and 19.68% of LGA cases could be attributed to high pre-pregnancy BMI and elevated RC levels, respectively. Conclusions: Elevated RC and pre-pregnancy BMI are independent LGA risk factors, with minimal GDM mediation. Managing lipid profiles, particularly RC, is important even in high-BMI women.