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Mediating role of preterm birth in the relationship between maternal disease and infant development

Shan Tan1, Yiduo Wang2, Changshi Tang3

  • 1Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, China.

BMC Pregnancy and Childbirth
|November 7, 2025
PubMed

Insights

Preterm birth significantly mediates the link between maternal conditions like pregnancy-induced hypertension and gestational diabetes mellitus, impacting infant neurodevelopment and Body Mass Index. This highlights the critical need for managing preterm birth in high-risk pregnancies.

Area of Science:

  • Perinatal Medicine
  • Developmental Pediatrics
  • Reproductive Epidemiology

Background:

  • Preterm birth is a key adverse perinatal outcome.
  • Its role as a mediator between maternal disease and infant outcomes requires further exploration.
  • Maternal diseases can impact infant growth and neurodevelopment.

Purpose of the Study:

  • To investigate if preterm birth mediates the association between maternal diseases and infant outcomes.
  • To assess infant Body Mass Index (BMI), Neonatal Behavioral Neurological Assessment (NBAS), and Gesell Development Schedule (GDS).

Main Methods:

  • Study included 2000 mother-child pairs.
  • Maternal diseases assessed via records and questionnaires.
  • Infant outcomes measured using BMI, NBAS, and GDS by blinded pediatric nurses.
  • Mediation analysis with bootstrapping quantified indirect effects.

Main Results:

  • Preterm birth mediated the link between Pregnancy-Induced Hypertension and NBAS (Indirect effect = -0.653).
  • Preterm birth mediated the link between Gestational Diabetes Mellitus and BMI (Indirect effect = -0.046).

Conclusions:

  • Preterm birth acts as a mediator between maternal diseases and infant growth/neurodevelopment.
  • Mediation analysis is valuable for maternal-infant research.
  • Emphasizes prenatal screening, prevention, and management of preterm birth in pregnancies with maternal disease.
Abstract

Keywords:
Body mass indexGestational diabetes mellitusMediation analysisNeurodevelopmental impairmentPregnancy-Induced hypertensionPreterm birth

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