Abstract
BACKGROUND: Early gestational weight gain (E-GWG) plays a crucial role in fetal development. Its timing and sex-specific impacts have not been thoroughly investigated, especially in Asian populations. METHODS: In this retrospective cohort study, 66,291 mother-infant pairs from the Tianjin Women and Children's Health Care System were analyzed. Linear and logistic regression models were applied to examine the association between E-GWG and birth weight outcomes across BMI groups. We also analyzed the effects of E-GWG on the birth weight of infants born to pregnant women carrying male and female fetuses, respectively. RESULTS: E-GWG had a stronger impact on birth weight z-scores than late GWG (β 0.038 vs. 0.016, P < 0.001). In each BMI subgroup, E-GWG was positively correlated with the risk of LGA and negatively correlated with the risk of SGA (all P < 0.001). The lower the prepregnancy BMI, the more sensitive the birth weight outcomes were to the variation in E-GWG and full-term GWG. The equivalent increase of E-GWG has different effects on the birth weight of male or female newborns. A female newborn has a higher risk of LGA at birth than a male in the underweight, overweight, and obesity group (P < 0.05). Girls' mothers with low pre-pregnancy weight combined with E-GWG less than 10.7 kg had a particularly high risk of SGA. Male newborns have a higher risk of SGA than females with the same insufficient E-GWG in the normal weight and overweight groups. When the E-GWG of mothers with obesity was less than 3.0 kg, the SGA risk was increased for both male (OR 1.764, 95% CI 1.003-3.104) and female newborns (OR 2.540, 95% CI 1.364-4.729) compared with E-GWG more than 8.0 kg. CONCLUSIONS: Insufficient E-GWG of women with underweight highlights the risk of female SGA. Pregnant women with excessive E-GWG should be aware of the risk of LGA, especially those carrying female fetuses. IMPACT: Early GWG showed stronger impacts on birth weight outcomes (LGA/SGA) than late GWG, with BMI/sex effects. Female fetuses showed higher LGA odds with excessive E-GWG in moms with overweight/obesity; insufficient E-GWG in moms with underweight strongly correlated with female-specific SGA vulnerability. Findings warrant BMI/sex-tailored GWG guidelines to optimize Asian perinatal health and reduce long-term metabolic risks.