Background: Hypertensive disorders of pregnancy (HDP) are major obstetric complications that seriously threaten maternal and neonatal health. Current research predominantly focuses on preeclampsia (PE). However, systematic comparisons across all four HDP subtypes—gestational hypertension (GH), preeclampsia (PE), chronic hypertension (CH), and superimposed preeclampsia (SPE) remain limited, hindering a deeper understanding of their heterogeneous risks and precise management. Objective: This study aimed to systematically analyze the epidemiological trends, independent risk factors, and differential impacts on maternal and neonatal outcomes of HDP and its subtypes, based on large–sample clinical data. Methods: This retrospective cohort study was conducted at a single tertiary care center in southern China, including 20,081 pregnant women who delivered at Guangxi Zhuang Autonomous Region People's Hospital between January 2019 and December 2024. Participants were classified into an HDP group ( n = 1,334) and a non–HDP group ( n = 18,747) based on discharge diagnoses. The HDP group was further subdivided into GH, PE, CH, and SPE. Baseline characteristics and pregnancy outcomes were collected. Multinomial logistic regression was used to identify factors associated with each HDP subtype vs. non-HDP. Multivariate logistic regression was used to assess associations between HDP subtypes and adverse outcomes, and adjusted models were constructed to assess independent risks. Given the small SPE sample ( n = 24), CH and SPE were combined (CH-SPE) for multivariable analyses to ensure model stability. Sensitivity analyses separating CH and SPE were also performed to assess the robustness of findings. Results: From 2019 to 2024, the overall incidence of HDP was 6.6%, with CH incidence increased by 78.2% (from 0.6% to 1.0%), and SPE incidence increased from 0.1% in 2019 to 0.7% in 2024. Multinomial analysis identified advanced maternal age (≥35 years), pre–pregnancy overweight/obesity, elevated fasting blood glucose (FBG), and gestational diabetes mellitus (GDM) as common risk factors for all HDP subtypes. Significant heterogeneity was observed among subtypes: PE demonstrated the strongest association with twin pregnancy ( OR =4.071, 95% CI : 2.843––5.828), and elevated serum creatinine (Cr) was a specific risk factor for PE. CH–SPE was significantly associated with assisted reproductive technology (ART) ( OR =2.032, 95% CI : 2.278––3.230), while higher education level was a unique protective factor (Postgraduate vs. Junior high school or below: OR =0.413, 95% CI : 0.259––0.660). All HDP subtypes significantly increased the risks of cesarean delivery with CH–SPE group (adjusted OR =3.399, 95% CI : 2.408––4.798) having the highest risk. Adverse neonatal outcomes (LBW and SGA) were predominantly concentrated in the PE and CH–SPE subtypes. Conclusion: Significant heterogeneity exists in risk factors and maternal–neonatal outcomes across different HDP subtypes. This study highlights the rapidly increasing incidence and unique risk profiles of chronic hypertension–based subtypes, emphasizing the urgency for precise screening and management pre–pregnancy and during early gestation. The findings provide important evidence for subtype–stratified risk assessment and individualized clinical intervention in HDP.

Early pregnancy prehypertension (PHT) has been suggested as a potential associated factor for adverse pregnancy outcomes, but the association with neonatal

Objective: Maternal iron status is a key determinant of perinatal outcomes, yet the combined effects of hemoglobin (Hb) and ferritin (SF) across trimesters remain poorly characterized. This study aimed to evaluate the associations between combined Hb-SF phenotypes and adverse perinatal outcomes across three trimesters in a large cohort of pregnancy women. Methods: This retrospective cohort study included 10,225 pregnant women with serial Hb and SF measurements across the first, second and third trimesters. Six combined Hb-SF phenotypes were defined based on first-trimester Hb and SF levels: Normal, High Hb, iron deficiency without anemia (IDWA), iron deficiency with hemoconcentration (ID-HC), iron deficiency anemia (IDA), and non-iron deficiency anemia (Non-ID Anemia). Logistic regression and restricted cubic spline (RCS) analyses were performed to assess associations with five primary outcomes: gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), preterm birth (PTB), small for gestational age (SGA), and large for gestational age (LGA). A simplified four-category sensitivity analysis was conducted to test the robustness of the findings. Results: The High Hb phenotype was consistently associated with higher odds of GDM (aOR = 1.17, 95% CI: 1.03–1.32) and HDP (aOR range: 1.32–1.94), particularly in the first and second trimesters. In contrast, IDWA and IDA were associated with lower odds of GDM, HDP, PTB, and SGA (aOR range: 0.58–0.80), predominantly in the second and third trimesters. However, IDA and IDWA were associated with higher odds of LGA (aOR range: 1.32–1.66). RCS analyses revealed nonlinear dose-response relationships for Hb with HDP and LGA, and for SF with GDM and LGA. Sensitivity analysis confirmed the robustness of these associations. Conclusion: Combined Hb-SF phenotyping provides valuable risk stratification beyond single-indicator approaches. High Hb was associated with higher odds of GDM and HDP, while IDWA and IDA showed inverse associations with several adverse outcomes but positive associations with LGA. Nonlinear dose-response relationships further suggested the presence of possible Hb/SF ranges associated with lower odds of certain adverse outcomes, though these data-driven findings require prospective validation. These findings highlight the complexity of maternal iron status and suggest that individualized antenatal iron management, informed by combined phenotyping, merits further investigation.

Objective: To investigate the associations between a four-group classification based on early-pregnancy FBG and subsequent GDM status and maternal and neonatal outcomes, and to characterize the FBG-HDP dose-response relationship. Methods: This retrospective cohort study included 15,245 women with singleton pregnancies. Participants were categorized into four groups based on early-pregnancy FBG (< 5.1 vs ≥ 5.1 mmol/L) and subsequent GDM status: Normoglycemia (normal FBG without GDM), GDM-Regression (elevated FBG without GDM), Late-onset GDM (normal FBG with GDM), and GDM-Maintained (elevated FBG with GDM). Multivariable logistic regression was used to estimate adjusted odds ratios (aOR) for outcomes. Restricted cubic spline regression was used to examine the dose-response relationship between FBG and HDP. Results: The incidence of HDP increased progressively across groups: Normoglycemia 4.6%, GDM-Regression 6.9%, Late-onset GDM 8.1%, and GDM-Maintained 11.0% ( P for trend <0.001). Compared with Normoglycemia, the aOR for HDP was 1.32 (95% CI : 1.03–1.68) for GDM-Regression, 1.53 (95% CI : 1.28–1.83) for Late-onset GDM, and 1.65 (95% CI : 1.23–2.18) for GDM-Maintained. GDM-Regression was associated with reduced SGA risk ( aOR : 0.69, 95% CI : 0.53–0.87) but elevated LGA ( aOR : 1.45, 95% CI : 1.21–1.74) and macrosomia ( aOR : 1.62, 95% CI : 1.19–2.17) risks. GDM-Maintained showed the highest risks for LGA ( aOR : 1.68), macrosomia ( aOR : 1.81), preterm birth ( aOR : 1.78), and neonatal asphyxia ( aOR : 2.15). Restricted cubic spline analysis revealed a nonlinear relationship between FBG and HDP (overall P < 0.001; P for nonlinearity=0.036), with a statistical inflection point at 4.52 mmol/L. Stratified analyses showed consistent associations across age, BMI, ethnicity, and parity subgroups (all P for interaction >0.05). Sensitivity analyses using alternative FBG cutoffs (≥5.3 and ≥5.6 mmol/L) confirmed the robustness of these findings. Conclusions: The four-group classification based on early-pregnancy FBG and subsequent GDM status may be useful for stratifying the risk of adverse pregnancy outcomes. The observed inflection point warrants further investigation. These findings support the potential value of early-pregnancy glycemic assessment in refining risk characterization for pregnant women.

Background The prevalence of mild thalassemia remains high among women of reproductive age in thalassemia-endemic areas, and the prevalence of anemia during pregnancy has significantly increased. Both conditions affect neonatal birth weight, but the existence of a synergistic interaction remains unclear. Objective This study was conducted to investigate the independent and combined effects of mild thalassemia genotypes and first-trimester anemia on neonatal birth weight and to assess their value in risk stratification. Methods A retrospective cohort study was conducted in which 3453 singleton pregnant women who delivered at Guangxi Zhuang Autonomous Region People's Hospital between 2019 and 2023 were included. Participants were categorized into four groups based on thalassemia genotype and first-trimester anemia status. Neonatal birth weight was the primary outcome. Multivariate linear regression and stratified analyses were performed to assess associations. Interaction was evaluated by introducing a product term and calculating the relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (SI). Results Neonatal birth weight significantly differed among the four groups (P = 0.021), with the lowest weight observed in the thalassemia with anemia group (G3: 3148.99 ± 396.16 g). Stratified analysis revealed that among anemic women, those with thalassemia had significantly lower neonatal birth weights than those without thalassemia did (α-thalassemia: β = -82.26, P = 0.038; β-thalassemia: β = -81.19, P = 0.034). Among women with α-thalassemia, anemia was independently associated with reduced neonatal birth weight (β = -61.48, P = 0.027). Interaction analysis revealed a significant multiplicative interaction effect between thalassemia and anemia on neonatal birth weight (β = -69.14; P = 0.037), and the RERI indicated evidence of an additive interaction (β = -79.14; P = 0.042). Conclusions The interaction between mild thalassemia and first-trimester anemia may affect neonatal birth weight. The combination of thalassemia and anemia, particularly α-thalassemia, represents a noteworthy potential high-risk phenotype. This study provides targeted evidence to support neonatal weight management and risk stratification in pregnant women from thalassemia-endemic areas.