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Menstrual cycle length identifies perinatal risk information beyond routine metabolic antenatal screening: a
Qian Xia1, Hong Mei2, Dongmei Cao1
1Department of Laboratory Medicine, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
Insights
Long menstrual cycles are linked to preterm birth and low birth weight, independent of gestational diabetes and thyroid dysfunction. This finding suggests menstrual cycle length may offer valuable risk information for adverse pregnancy outcomes.
Area of Science:
- Reproductive Medicine
- Obstetrics and Gynecology
- Perinatal Epidemiology
Background:
- Preterm birth (PTB) and low birth weight (LBW) are critical contributors to neonatal mortality and morbidity.
- High prevalence of gestational diabetes mellitus (GDM) and thyroid dysfunction (TF) in China complicates obstetric risk assessment.
- Identifying novel risk markers for PTB and LBW beyond existing screening is a significant clinical priority.
Purpose of the Study:
- To investigate whether menstrual cycle length provides prognostic information for PTB and LBW that is independent of GDM and TF.
- To assess the potential of routinely available menstrual cycle data as a non-redundant risk marker in obstetric care.
Main Methods:
- Retrospective cohort study of 17,792 singleton deliveries in Wuhan, China (2020-2024).
- Menstrual cycle length categorized as short (<25 days), normal (25-35 days), or long (>35 days).
- Logistic regression models adjusted for GDM and TF; stability analysis, restricted cubic splines, and interaction analyses were performed.
Main Results:
- Long menstrual cycle length (>35 days) was independently associated with increased odds of PTB (aOR 1.36) and LBW (aOR 1.46) after full adjustment.
- Associations remained stable across adjustment models, indicating GDM and TF were not strong confounders.
- Long cycles were linked to impaired fetal growth and higher odds of small-for-gestational-age infants, even at term.
Conclusions:
- Long menstrual cycle length is a potential independent risk marker for PTB and LBW, offering prognostic value beyond GDM and TF screening.
- Clinical utility may involve collecting menstrual history early in pregnancy or preconceptionally.
- Findings require prospective validation in diverse, community-based cohorts to confirm clinical applicability.
Background:
Preterm birth (PTB) and low birth weight (LBW) are leading causes of neonatal mortality and long-term morbidity. In China, the high prevalence of gestational diabetes mellitus (GDM) and thyroid dysfunction (TF) creates a metabolically complex obstetric environment in which identifying risk markers that add value beyond existing screening is a priority. Menstrual cycle length is routinely available, yet whether it provides risk information non-redundant with GDM and TF has not been rigorously examined.
Methods:
Retrospective cohort of 17,792 consecutive singleton deliveries at a tertiary centre in Wuhan, China (2020-2024). Cycle length was recorded at intrapartum admission: short (<25d), normal (25-35d; reference), or long (>35d). Primary outcomes were PTB (<37 weeks) and LBW (<2,500 g). Three nested logistic models were fitted; stability across models was used to assess whether GDM and TF acted as strong confounders. Restricted cubic splines, additive interaction (RERI), population-attributable fractions (PAF), and five sensitivity analyses were used, with Benjamini-Hochberg FDR correction.
Results:
Long cycle (>35d; n = 1,810, 10.2%) was independently associated with PTB (aOR 1.36, 95% CI 1.12-1.64; FDR p = 0.006) and LBW (aOR 1.46, 1.18-1.78; FDR p = 0.002) after full adjustment for GDM and TF. Estimates were stable across progressive adjustment (PTB 1.34→1.36; LBW 1.42→1.46), indicating GDM and TF were not strong confounders. RERI for long cycle × GDM/TF crossed zero for both outcomes, excluding meaningful synergism. RCS showed a monotonic increase from ~30 days. PAF: PTB 3.1% (0.9-5.4%); LBW 3.9% (1.2-6.4%). The birth weight reduction (β = -33 g) attenuated at term (β = -8 g, NS), but long cycle was associated with higher odds of small-for-gestational-age (aOR 1.39, 1.11-1.73), including at term, indicating both earlier delivery and impaired fetal growth. Period length showed no association.
Conclusions:
Long menstrual cycle length was associated with PTB and LBW, not materially attenuated by adjustment for GDM and TF, consistent with prognostic information non-redundant with metabolic screening; however, stable estimates cannot exclude residual confounding or establish an independent pathway. Because cycle length reflects the pre-pregnancy ovulatory interval, any clinical value would lie in collecting menstrual history before conception or in early pregnancy. These findings are hypothesis-generating and require prospective validation in community-based cohorts.
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