Association Between Late Pregnancy A/G Ratio and The Risk of Neonatal Admission for Neonatal Hyperbilirubinemia

Association Between Late Pregnancy A/G Ratio and The Risk of Neonatal Admission for Neonatal Hyperbilirubinemia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association Between Late Pregnancy A/G Ratio and The Risk of Neonatal Admission for Neonatal Hyperbilirubinemia Hongjuan Wei, xin Chang, rufeng Ji, Yinyan Tang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6053821/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 13 May, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted 6 You are reading this latest preprint version Abstract Objective To investigate the association between late pregnancy A/G (Albumin to globulin) ratio and the risk of admission for neonatal hyperbilirubinemia (NHB) . Methods This cross-sectional study selected mothers in labor and their newborns delivered at Nanjing Lishui People's Hospital, from January to December 2022. Multivariate logistic regression was utilized to analyze the relationship between late pregnancy A/G ratio and the risk of admission for NHB. Results Out of 1432 pregnant women, 15.7% of newborns were admitted for NHB. Outcome 1: Dichotomizing the A/G ratio at 1.29, the risk of NHB admission decreased by 33% (95% CI : 0.46-0.97) for every 0.1 increase in A/G ratio<1.29. Conversely, when the A/G ratio≥1.29, the risk of NHB admission increased by 16% (95% CI : 1.01-1.32) for each 0.1 increase in A/G ratio. Outcome 2: When A/G ratio was categorized into three groups using thresholds of 1.15 and 1.40, the risk of NHB admission increased by 107% (95% CI : 1.17-3.66) for G1 and 60% (95% CI : 1.16-2.19) for G3, compared to G2. Conclusion Late pregnancy A/G ratio is closely associated with the risk of admission for NHB. A/G ratio within different ranges affects the risk of NHB in varying directions and to different extents. Monitoring the A/G ratio may help identify pregnancies at higher risk of NHB. Late pregnancy Albumin to globulin ratio Neonatal hyperbilirubinemia Patient admission Figures Figure 1 Figure 2 Figure 3 Introduction Neonatal hyperbilirubinemia (NHB) is a prevalent condition, affecting nearly two-thirds of healthy term infants and almost all preterm infants. It is a common cause of hospitalization[ 1 ] and can result in acute bilirubin encephalopathy or kernicterus, leading to neurological complications or death[ 2 ]. The 2016 and 2019 Global Burden of Disease studies ranked NHB among the top causes of death in early and late neonates[ 3 , 4 ] and as the fourth most common disease among children[ 5 , 6 ]. The nutritional status of women during the perinatal period is crucial for maternal health and fetal development[ 7 ]. Maternal malnutrition and inappropriate weight gain during pregnancy can negatively impact the offspring's health[ 8 , 9 ]. The A/G ratio primarily reflects liver function and nutritional status[ 10 ]. Mothers can indirectly influence the A/G ratio by improving relevant health conditions, and its fluctuations are associated with various chronic diseases and inflammatory conditions[ 11 , 12 ], all of which play a critical role in fetal development and health. Maternal malnutrition may affect liver development, thereby reducing its ability to metabolize bilirubin [ 13 ]. Chronic inflammation can activate both maternal and fetal immune systems, increasing the risk of NHB[ 14 ]. Therefore, we hypothesize that the maternal A/G ratio may influence the fetal growth environment and physiological functions, potentially contributing to the development of NHB. Thus, this study aims to systematically investigate the A/G-NHB association, with particular focus on establishing its predictive value and potential clinical applications in risk stratification and neonatal monitoring. Materials and Methods Study population This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. This cohort study enrolled 1,521 pregnant women ≥ 35 weeks who delivered at Nanjing Lishui People's Hospital (NJLSPH) from January 1 to December 31, 2022. The exclusion criteria were as follows:(1) A/G ratio missing cases, (2) twin pregnancies, and (3) maternal blood type missing cases. Ultimately, 1432 singleton pregnancies were analyzed in the study. (Fig. 1 ). Admission criteria for NHB are serum total bilirubin above the 95th percentile or meeting the criteria for phototherapy at different gestational ages, different hourly ages and different risk factors[ 15 , 16 ]. Ethical approval for the study was obtained from the Medical Ethics Committee of NJLSPH (approval number: 2023KY1010-02). As this study had a retrospective design and only de-identified and anonymized participant information was used, the need for written informed consent was waived by the Institutional Review Board (IRB) of NJLSPH. This study was registered at the Chinese Clinical Trial Registry Center (Registration Number: ChiCTR 2300076629). Data collection and measurement All data were extracted from the hospital Health Information System (HIS). Maternal social characteristics, gestational and delivery information, and neonatal data were collected. Maternal characteristics included age, ethnicity, education, blood type, pre-pregnancy BMI. Gestational and delivery details, such as in vitro fertilization (IVF), gestational week, delivery type, gestational weight gain (GWG), hypertensive disorders in pregnancy (HDP), gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP), and hypothyroidism during pregnancy. Neonatal information included sex, birth weight, time of jaundice onset and peak, time of admission, and jaundice progression. Pre-pregnancy BMI was calculated as pre-pregnancy body mass divided by height squared (kg/m 2 ). The A/G ratio and other biochemical parameters were measured at the time of hospital admission (before delivery). If admission testing was not possible due to rapid labor, late-pregnancy results (≥ 28 weeks-onset of labor)[ 17 ] were used. All measurements were performed in the NJLSPH laboratory using the standardized GPO-POD (Glycerol Phosphate Oxidase-Peroxidase) enzymatic colorimetric assay. Statistical Analysis All analyses were performed using R Statistical Software (Version 4.2.2, http:/www.R-project.org , The R Foundation) and Free Statistics analysis platform(Version 1.9, Beijing,China). Descriptive analyses were performed for all participants. Categorical variables were provided as percentages (%). Continuous variables were expressed as median (quartile) or mean ± standard deviation, depending on the data distribution. In this study, Chi-square tests, T-tests, and Kruskal-Wallis tests were used to compare categorical variables, normally distributed continuous variables, and non-normally distributed continuous variables, respectively. The A/G ratio was analyzed as a continuous variable, with effect sizes expressed per 0.1-unit increase. To examine the nonlinear relationship between maternal A/G ratio and NHB admission risk, a generalized additive model (GAM) with cubic splines was employed. The A/G ratio was modeled as a continuous variable with four knots (5th, 35th,65th and 95th) suggested by Harrell. This analysis revealed a statistically significant U-shaped relationship ( P for nonlinearity = 0.027). The inflection point (A/G ratio = 1.29) was identified through recursive analysis and validated by bootstrapping. Subsequently, segmented multivariate linear regression analysis was performed for A/G ratio < 1.29 and ≥ 1.29. Additionally, categorical analysis was conducted using predefined cut-offs (G1:1.40) with multivariable logistic regression to calculate adjusted OR s and 95% CI s, controlling for relevant covariates. Covariates were adjusted based on two primary criteria: (1) variables previously established as confounders in the literature, and (2) a change in the adjusted odds ratio ( OR ) of ≥ 10% upon their inclusion in the model, indicating meaningful confounding. Model I adjusted for sociodemographic factors; Model II added perinatal variables; Model III further included neonatal characteristics to address residual confounding. Given that the average age of pregnant women in this study was 29.7 years (± 4.4), age of 30 years was utilized for stratification threshold. Results Population characteristics The study included 1,432 mother-newborn pairs, with 225 neonates (15.7%) requiring hospitalization for NHB. As shown in Table 1 , neonates admitted for NHB had significantly shorter weeks of gestation (38.8 ± 1.2 vs 39.1 ± 1.1 weeks, p < 0.001) and lower birth weight (3339.4 ± 442.3 vs 3416.4 ± 438.3g, P = 0.016) compared to non-admitted infants. Maternal factors associated with NHB admission included higher rates of HDP (12.4% vs 7.7%, P = 0.019), lower prevalence of anaemia (6.7% vs 12.7%, P = 0.010), and increased cesarean delivery (64.0% vs 51.3%, P = 0.002). Biochemical analysis revealed a modest but statistically significant elevation in A/G ratio among NHB cases (1.6 ± 0.2 vs 1.5 ± 0.2, P = 0.023). Other maternal and neonatal characteristics, including ethnicity, education level, and additional liver function markers, showed no significant differences between groups. Table 1 Characteristics of mothers and newborns. Total (n = 1432) Non-admission (n = 1207) Admission for NHB (n = 225) P Age, year † 29.7 ± 4.4 29.8 ± 4.4 29.5 ± 4.5 0.425 Ethnicity, (%) 0.105 Han Chinese 1420 (99.2) 1199 (99.3) 221 (98.2) Other 12 (0.8) 8 (0.7) 4 (1.8) Education, (%) 0.242 Elementary School 32 (2.2) 28 (2.3) 4 (1.8) Junior High School 256 (17.9) 223 (18.5) 33 (14.7) High School 158 (11.0) 124 (10.3) 34 (15.1) Junior college 126 (8.8) 110 (9.1) 16 (7.1) College 434 (30.3) 372 (30.8) 62 (27.6) Bachelor 395 (27.6) 325 (26.9) 70 (31.1) Master + a 31 (2.2) 25 (2.1) 6 (2.7) Blood Type, n (%) 0.372 A, Rh+ 443 (30.9) 376 (31.2) 67 (29.8) AB, Rh+ 122 (8.5) 105 (8.7) 17 (7.6) B, Rh- 1 (0.1) 1 (0.1) 0 (0) B, Rh+ 366 (25.6) 317 (26.3) 49 (21.8) O, Rh- 2 (0.1) 2 (0.2) 0 (0) O, Rh+ 498 (34.8) 406 (33.6) 92 (40.9) IVF, n (%) 0.571 No 1392 (97.2) 1172 (97.1) 220 (97.8) Yes 40 (2.8) 35 (2.9) 5 (2.2) Weeks of Gestation, week † 39.1 ± 1.2 39.1 ± 1.1 38.8 ± 1.2 < 0.001 Parity, n (%) 0.162 1 493 (34.4) 398 (33.0) 95 (42.2) 2 406 (28.4) 347 (28.7) 59 (26.2) 3 257 (17.9) 223 (18.5) 34 (15.1) 4 167 (11.7) 146 (12.1) 21 (9.3) 5 74 (5.2) 64 (5.3) 10 (4.4) 6 + b 35 (2.4) 29 (2.4) 6 (2.7) Number of Births, n (%) 0.019 1 660 (46.1) 536 (44.4) 124 (55.1) 2 648 (45.3) 558 (46.2) 90 (40.0) 3 111 (7.8) 101 (8.4) 10 (4.4) 4 13 (0.9) 12 (1.0) 1 (0.4) GWG, kg † 14.2 ± 4.8 14.3 ± 4.9 14.0 ± 4.8 0.447 Pre-pregnancy BMI, kg/m 2† 22.4 ± 3.6 22.4 ± 3.6 22.5 ± 3.8 0.539 HDP, n (%) 0.019 No 1311 (91.6) 1114 (92.3) 197 (87.6) Yes 121 (8.4) 93 (7.7) 28 (12.4) GDM, n (%) 0.252 No 1050 (73.3) 892 (73.9) 158 (70.2) Yes 382 (26.7) 315 (26.1) 67 (29.8) ICP, n (%) 0.498 No 1415 (98.8) 1191 (98.7) 224 (99.6) Yes 17 (1.2) 16 (1.3) 1 (0.4) Hypothyroidism during Pregnancy, n(%) 0.695 No 1308 (91.3) 1104 (91.5) 204 (90.7) Yes 124 (8.7) 103 (8.5) 21 (9.3) Anaemia during pregnancy, n (%) 0.010 No 1264 (88.3) 1054 (87.3) 210 (93.3) Yes 168 (11.7) 153 (12.7) 15 (6.7) Delivery mode, n (%) 0.002 Vaginal delivery 555 (38.8) 487 (40.3) 68 (30.2) Cesarean section 763 (53.3) 619 (51.3) 144 (64.0) Vaginal delivery to cesarean section 114 (8.0) 101 (8.4) 13 (5.8) ALB, g/L † 36.7 ± 2.4 36.7 ± 2.3 36.6 ± 2.7 0.591 GLO, g/L † 27.1 ± 3.4 27.1 ± 3.4 26.8 ± 3.8 0.272 A/G † 1.5 ± 0.2 1.5 ± 0.2 1.6 ± 0.2 0.023 ALT, U/L † 18.5 ± 25.5 18.8 ± 26.6 17.2 ± 17.7 0.382 AST, U/L † 21.5 ± 16.1 21.7 ± 17.0 20.4 ± 9.5 0.263 TBA, umol/L † 2.0 ± 1.4 2.0 ± 1.3 2.0 ± 1.5 0.913 TBIL, umol/L † 7.6 ± 3.5 7.6 ± 3.5 7.6 ± 3.2 0.997 UREA, mmol/L † 3.5 ± 1.0 3.5 ± 1.0 3.4 ± 0.9 0.281 UA, umol/L † 316.7 ± 77.8 315.8 ± 76.8 321.3 ± 82.9 0.338 TG, mmol/L ‡ 3.7 (2.9, 4.7) 3.7 (2.9, 4.7) 3.7 (3.0, 4.7) 0.556 LDL-C, mmol/L † 3.8 ± 0.8 3.8 ± 0.8 3.9 ± 0.8 0.326 HDL-C, mmol/L † 1.9 ± 0.4 1.9 ± 0.4 1.9 ± 0.3 0.731 Sex, n (%) 0.784 Male 739 (51.6) 621 (51.4) 118 (52.4) Female 693 (48.4) 586 (48.6) 107 (47.6) BW, g † 3404.3 ± 439.7 3416.4 ± 438.3 3339.4 ± 442.3 0.016 Note: † Mean ± standard deviation description, ‡ Quartile description Abbreviations: IVF: In Vitro Fertilization; GWG: Gestational Weight Gain; HDP: Hypertensive disorders in pregnancy; GDM: Gestational Diabetes Mellitus; ICP: Intrahepatic Cholestasis during Pregnancy; ALB: Albumin; GLO: Globulin; A/G: Albumin/Globulin; ALT: alanine aminotransferase; AST: aspartate aminotransferase; TBA: Total Bile Acids; TBIL: Total Bilirubin; UA: Uric Acid; TG: triglycerides; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol. a Master+: Including master's degree and higher. b 6+: Including pregnancy 6 times and above. Association between A/G ratio and NHB risk Spline analysis revealed a significant U-shaped association between A/G ratio and NHB risk ( P for nonlinearity = 0.027), with an inflection point at A/G ratio = 1.29 (Fig. 2 ). Below 1.29, each 0.1-unit increase in A/G ratio was associated with 33% lower NHB risk (adjusted OR = 0.67, 95% CI : 0.46–0.97); above 1.29, each increase conferred 16% higher risk (adjusted OR = 1.16, 95% CI : 1.01–1.32) (Table 2 ). Categorical analysis showed both low (G1: OR = 2.07, 95% CI : 1.17–3.66) and high (G3: OR = 1.60, 95% CI : 1.16–2.19) A/G ratio increased risk compared to G2. Age-stratified analyses demonstrated stronger associations in mothers ≥ 30 years (Fig. 3 ). For A/G ratio < 1.15, older mothers had nearly 3-fold higher NHB risk (adjusted OR = 2.77, 95% CI : 1.37–5.62) versus younger mothers (adjusted OR = 1.18, 95% CI : 0.39–3.60) (Table 3 ). The protective effect of A/G ratio 0.05). Table 2 Multivariate logistic regression of late pregnancy A/G ratio and risk of admission for NHB. Total n n/N (%) Crude Model OR (95% CI ) P Model Ⅰ OR (95% CI ) P Model Ⅱ OR (95% CI ) P Model Ⅲ OR (95% CI ) P A/G in 3 groups G2 (1.15 ≤ A/G ≤ 1.40) 733 97 (13.2) Ref Ref Ref Ref G1 (A/G 1.40) 606 107 (17.7) 1.41 (1.04–1.90) 0.025 1.43 (1.06–1.94) 0.020 1.60 (1.17–2.20) 0.003 1.60 (1.16–2.19) 0.004 A/G in 2 groups < 1.29 450 68 (15.1) 0.75 (0.55–1.03) 0.078 0.71 (0.51–0.99) 0.041 0.68 (0.47–0.99) 0.041 0.67 (0.46–0.97) 0.032 ≥ 1.29 982 157 (16.0) 1.14 (1.01–1.30) 0.039 1.16 (1.02–1.31) 0.026 1.16 (1.01–1.32) 0.033 1.16 (1.01–1.32) 0.033 Note: Model Ⅰ: Age, ethnicity, education, blood type, BMI. Model Ⅱ: ModelⅠ + IVF, gestational age, Parity, Number of Births, GWG, HDP, GDM, ICP, hypothyroidism during pregnancy, anaemia during pregnancy, delivery mode. Model Ⅲ: Model Ⅱ + BW, sex of the newborn. The A/G ratio was analyzed as a continuous variable, with effect sizes expressed per 0.1-unit increase. The A/G ratio was categorized into two groups with cut-off points at 1.29 and three groups (G1, G2, and G3) with cut-off points at 1.15 and 1.40. G1: A/G 1.40. Table 3 Multivariate logistic regression analysis of late pregnancy A/G ratio and risk of admission for NHB in different ages. Subgroup n n/N (%) Crude Model OR (95% CI ) P Adjusted Model OR (95% CI ) P P for interaction < 30y 0.329 G2 349 53 (15.2) 1(Ref) 1(Ref) G1 28 5 (17.9) 1.21 (0.44–3.33) 0.707 1.18 (0.39–3.60) 0.771 G3 292 56 (19.2) 1.33 (0.88-2.00) 0.181 1.54 (0.98–2.43) 0.063 ≥ 30y G2 384 44 (11.5) 1(Ref) 1(Ref) G1 65 16 (24.6) 2.52 (1.32–4.81) 0.005 2.77 (1.37–5.62) 0.005 G3 314 51 (16.2) 1.50 (0.97–2.31) 0.068 1.83 (1.14–2.93) 0.012 < 30y 0.822 A/G < 1.29 197 32 (16.2) 0.91 (0.51–1.62) 0.760 0.89 (0.40–2.02) 0.788 A/G ≥ 1.29 472 82 (17.4) 1.18 (0.98–1.41) 0.077 1.20 (0.98–1.46) 0.075 ≥ 30y A/G < 1.29 253 36 (14.2) 0.67 (0.46–0.98) 0.041 0.52 (0.31–0.87) 0.013 A/G ≥ 1.29 510 75 (14.7) 1.12 (0.93–1.34) 0.234 1.18 (0.97–1.44) 0.096 Note: Adjusted covariates are the same as in Table 2 , Model III. The A/G ratio was analyzed as a continuous variable, with effect sizes expressed per 0.1-unit increase. The A/G ratio was categorized into two groups with cut-off points at 1.29 and three groups (G1, G2, and G3) with cut-off points at 1.15 and 1.40. G1: A/G 1.40. Discussion Summary of key findings This study demonstrates a significant U-shaped association between late-pregnancy A/G ratio and NHB admission risk, with an inflection point at 1.29. Below this threshold, each 0.1-unit increase in A/G ratio was associated with a 33% reduction in NHB risk ( OR = 0.67, 95% CI : 0.46–0.97), while above it, each increment increased risk by 16% ( OR = 1.16, 95% CI : 1.01–1.32). Age-stratified analyses revealed these associations were particularly pronounced in mothers aged ≥ 30 years, where extreme A/G ratio values ( 1.40) conferred 2–3 fold higher NHB risk compared to intermediate values. The results suggest that there is an association between A/G ratio levels in late pregnancy and the risk of admission for NHB, but there may be some special populations. Comparison with other studies and clinical implications The growth and development of the fetus depend entirely on the mother's nutrient intake, and a balanced and adequate nutritional intake is essential for ensuring the healthy growth of infants[ 18 ]. Additionally, the nutritional status of the mother during pregnancy directly affects her own health[ 19 , 20 ]. A/G ratio levels are indicative of the body's nutritional status and immune function[ 21 ] and has been identified as a prognostic factor in various disease conditions[ 22 – 24 ]. Changes in A/G ratio levels can occur due to dehydration or fluid retention, and a decrease in the A/G ratio may be attributed to a reduction in albumin and/or an elevation in globulin levels. Pregnancy is a special physiological stage characterized by an increase in blood volume[ 25 , 26 ]. Hemodilution can lead to lower plasma proteins, and fluctuations in plasma proteins can also be caused by haemoconcentration due to other factors. The advantage of A/G ratio is that it is a ratio and its fluctuation is in the same direction during dehydration or fluid retention, so the ratio is more stable. In order to observe whether the association between A/G ratio and the risk of admission for NHB exists stably in different populations, subgroup analyses were performed in this study. The mean ages of overall, admitted, and non-admitted groups were 29.7, 29.5, and 29.8 years, respectively, which were all close to 30 years of age. Therefore, the study was not stratified by the traditional 35 of high maternal age, but rather by 30 years of age. Our findings corroborate and extend existing literature on maternal biomarkers and neonatal outcomes. The association between low A/G ratio and increased NHB risk aligns with emerging evidence on maternal nutritional status and fetal development. For instance, a study by Hussain T et al. emphasized the role of maternal oxidative stress in placental inflammation, which can lead to NHB[ 27 ]. Similarly, our study supports the notion that maternal health indicators, such as the A/G ratio, can serve as predictive markers for neonatal conditions. However, our comprehensive evaluation of the A/G ratio as a composite indicator of maternal health offers unique advantages over studies focusing solely on individual proteins or inflammatory markers. Recent work by Zhang et al. demonstrated similar U-shaped relationships between maternal serum proteins and adverse pregnancy outcomes, though their study did not examine NHB specifically[ 28 ]. Our identification of 1.29 as the optimal inflection point provides a quantitative threshold that could be readily implemented in clinical practice. This finding is particularly significant given that the A/G ratio inherently accounts for the physiological hemodilution of pregnancy, making it more stable than absolute protein measurements across different gestational ages. The age-dependent effects we observed (stronger associations in mothers ≥ 30 years) resonate with the growing recognition of "inflammaging" in reproductive health. Recent studies have shown that age-related changes in protein metabolism may amplify the impact of nutritional deficiencies during pregnancy[ 29 , 30 ]. Our findings suggest that this phenomenon may extend to neonatal bilirubin metabolism as well. This highlights the importance of considering maternal age in the assessment of NHB risk. Through multivariate and subgroup analyses, our study revealed that in cases of low A/G ratio, the risk of neonatal admission for NHB appeared to decrease with an increase in A/G ratio. This suggests that interventions aimed at elevating albumin levels to increase the A/G ratio may help reduce the risk of neonatal admission for NHB. However, this trend was not observed in the younger age group (mothers < 30 years), indicating that the relationship between A/G ratio and NHB risk may be more complex in this demographic. Further analysis and exploration are required to elucidate the underlying mechanisms. The cut-off values for low A/G ratio identified in our study were 1.29 and 1.15 when divided into two and three groups, respectively. The exact cut-off value for low A/G ratio is not yet definitive, and further research is needed to establish this threshold more precisely. When A/G ratio are high, our study showed an increasing tendency of NHB admission risk across all populations. This suggests that factors leading to decreased globulin levels, which in turn increase the A/G ratio, may contribute to a higher risk of NHB admission. Overall, our results indicate that the A/G ratio can serve as a simple and effective early biomarker to identify pregnancies at high risk of NHB admission. This finding underscores the potential clinical utility of monitoring the A/G ratio during pregnancy to facilitate early intervention and improve neonatal outcomes. Biological mechanisms The exact mechanism by which the A/G ratio affects neonatal jaundice remains unclear. Albumin and globulin are the principal serum proteins in the body and to some extent reflect the systemic inflammatory response. As a result, the A/G ratio has been utilized as an inflammatory index to evaluate the systemic inflammatory state of the host[ 31 ]. Oxidative stress is a primary cause of inflammation[ 32 ], and maternal oxidative stress can lead to placental inflammation. The placenta serves as the connection between the mother and the newborn, and placental oxidative stress and inflammation play a crucial role in fetal immune function and neurodevelopment[ 33 ]. Inflammation can lead to the destruction of neonatal erythrocytes, resulting in haemolysis. Furthermore, inflammation can severely inhibit enzymes in the neonatal liver, leading to disruptions in bilirubin metabolism and resulting in elevated bilirubin levels[ 34 ], and there may be other mechanisms that need to be further investigated. Study Strengths and Limitations The strength of this study is that it analyses the relationship between A/G ratio and risk of admission for NHB, an indicator that has not yet received significant attention by clinicians, and provides meaningful data on A/G ratio and its correlation with the risk of admission. Nonetheless, the present study has several limitations that warrant consideration. First, as an observational study, our findings demonstrate associations rather than causal relationships. Despite rigorous adjustment for known confounders, unmeasured or residual confounding (e.g., undetected maternal comorbidities or lifestyle factors) may persist. Second, the maternal A/G ratio is influenced by diverse physiological processes (e.g., inflammation, nutritional status, and hepatic/renal function). Conclusion The results of this study suggest that the late-pregnancy A/G ratio is strongly associated with the risk of neonatal admission for NHB. A/G ratio may serve as an important predictive factor, and monitoring A/G ratio levels may help identify pregnancies at higher risk of NHB. Declarations Authors’ contributions This study was designed by all of the authors. Hongjuan Wei provided supervision throughout the study as a principal investigator. Xin Chang drafted the manuscript under the direct supervision of Hongjuan Wei. All authors have read and approved the final manuscript. Rufeng Ji and Yinyan Tang contributed to literature search, data extraction and analysis. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Consent to participate The study was approved by the Human Ethics Committee of Nanjing Lishui People’s Hospital. Declaration of competing interest No conflict of interest exists in the submission of this manuscript, and the manuscript has been approved by all authors for publication. Data availability The data that support the findings of this study are not publicly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Acknowledgments We gratefully thank Dr. Jie Liu of Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital for his contribution to the statistical support. We also thank Dr. Qilin Yang of Department of Critical care, the Second Affiliated Hospital of Guangzhou Medical University for his contribution to the study design consultations and comments regarding the manuscript. Funding No funding support in the data collection, analysis or preparation of the manuscript. References Bhat JA, Sheikh SA, Ara R. Correlation of 25-hydroxy vitamin D level with neonatal hyperbilirubinemia in term healthy newborn: A prospective hospital-based observation study. Int J Pediatr Adolesc Med. 2021. 8(1): 5-9. Li Q, Deng X, Yan J, et al. Neonatal Severe Hyperbilirubinemia Online Registry in Jiangsu Province: protocol for a multicentre, prospective, open, observational cohort study. BMJ Open. 2021. 11(2): e040797. Olusanya BO, Kaplan M, Hansen T. 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Comparative analysis of the nutritional, biochemical and hematological parameters of pregnant women attending the University of Abuja Teaching Hospital, Nigeria. Biomedicine (Taipei). 2022. 12(1): 1-13. Yang LF, Li J, Hu R, Xu LQ, Li YX, Sheng WT. [Association of fatty acid composition in human milk with breast milk jaundice in neonates]. Zhongguo Dang Dai Er Ke Za Zhi. 2020. 22(12): 1256-1260. Kemper AR, Newman TB, Slaughter JL, et al. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics. 2022. 150(3): e2022058859 [pii]. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004. 114(1): 297-316. Godfrey KM, Titcombe P, El-Heis S, Albert BB, Tham EH, Barton SJ, et al. Maternal B-vitamin and vitamin D status before, during, and after pregnancy and the influence of supplementation preconception and during pregnancy: Prespecified secondary analysis of the NiPPeR double-blind randomized controlled trial. PLoS Med. 2023;20(12):e1004260. Apostolopoulou A, Tranidou A, Tsakiridis I, Magriplis E, Dagklis T, Chourdakis M. Effects of Nutrition on Maternal Health, Fetal Development, and Perinatal Outcomes. Nutrients. 2024. 16(3): 375. Lackovic M, Jankovic M, Mihajlovic S, et al. Gestational Weight Gain, Pregnancy Related Complications and the Short-Term Risks for the Offspring. J Clin Med. 2024. 13(2): 445. Khammarnia M, Ansari-Moghaddam A, Kakhki FG, Clark C, Barahouei FB. Maternal macronutrient and energy intake during pregnancy: a systematic review and meta-analysis. BMC Public Health. 2024. 24(1): 478. Chen J, Xie C, Yang Y, et al. Association between albumin-to-globulin ratio and the risk of overall survival in advanced non-small cell lung cancer patients with anlotinib treatment: a retrospective cohort study. BMC Pulm Med. 2023. 23(1): 275. Li J, Li Z, Hao S, et al. Inversed albumin-to-globulin ratio and underlying liver disease severity as a prognostic factor for survival in hepatocellular carcinoma patients undergoing transarterial chemoembolization. Diagn Interv Radiol. 2023. 29(3): 520-528. Wang YT, Kuo LT, Lai CH, et al. Low Pretreatment Albumin-to-Globulin Ratios Predict Poor Survival Outcomes in Patients with Head and Neck Cancer: A Systematic Review and Meta-analysis. J Cancer. 2023. 14(2): 281-289. Hulzebos CV, van Imhoff DE, Bos AF, Ahlfors CE, Verkade HJ, Dijk PH. Usefulness of the bilirubin/albumin ratio for predicting bilirubin-induced neurotoxicity in premature infants. Arch Dis Child Fetal Neonatal Ed. 2008. 93(5): F384-8. DeVore GR, Polanco B. Assessing maternal cardiac function by obstetricians: technique and reference ranges. Am J Obstet Gynecol. 2023. 229(2): 155.e1-155.e18. Bertschy G, Iannaccone M, Grosso Marra W, Bogliatto F. Obstetric echodynamics: Approaching a new field of multidisciplinary action. Int J Cardiol. 2024. 403: 131850. Hussain T, Murtaza G, Metwally E, et al. The Role of Oxidative Stress and Antioxidant Balance in Pregnancy. Mediators Inflamm. 2021. 2021: 9962860. Xiong T, Wu Y, Huang L, et al. Association of the maternal serum albumin level with fetal growth and fetal growth restriction in term-born singletons: a prospective cohort study. Fertil Steril. 2022. 117(2): 368-375. Agarwala A, Dixon DL, Gianos E, et al. Dyslipidemia management in women of reproductive potential: An Expert Clinical Consensus from the National Lipid Association. J Clin Lipidol. 2024. 18(5): e664-e684. Puche-Juarez M, Toledano JM, Hinojosa-Nogueira D, et al. Diet, Advanced Maternal Age, and Neonatal Outcomes: Results from the GESTAGE Study. Nutrients. 2025. 17(2): 321. Yuk HD, Ku JH. Role of Systemic Inflammatory Response Markers in Urothelial Carcinoma. Front Oncol. 2020. 10: 1473. Aye IL, Waddell BJ, Mark PJ, Keelan JA. Oxysterols exert proinflammatory effects in placental trophoblasts via TLR4-dependent, cholesterol-sensitive activation of NF-κB. Mol Hum Reprod. 2012. 18(7): 341-53. Al-Gubory KH, Fowler PA, Garrel C. The roles of cellular reactive oxygen species, oxidative stress and antioxidants in pregnancy outcomes. Int J Biochem Cell Biol. 2010. 42(10): 1634-50. Liu Y, Sun X, Wang Y, Xing C, Li L, Zhou S. Evaluation of Associated Markers of Neonatal Pathological Jaundice Due to Bacterial Infection. Iran J Public Health. 2021. 50(2): 333-340. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 13 May, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted Editorial decision: Accepted 09 May, 2025 Reviews received at journal 07 May, 2025 Reviewers agreed at journal 26 Apr, 2025 Reviewers invited by journal 21 Apr, 2025 Submission checks completed at journal 20 Apr, 2025 First submitted to journal 16 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6053821","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":445610917,"identity":"222ee7a3-0846-415f-88d4-b4e5e28ec72a","order_by":0,"name":"Hongjuan Wei","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYDCCA1BagoGHweCDgY0dMVoYG2BaDGcUpCWTpoWZ58MhCA8f4DueY/7wZ9thOckZuQeKbQwOMDOwHz66AZ8WyTNvDBsk2w4bS0vkJRjnGNzhY+BJS7uBT4vBjRzDBsO2w4nzpHMMgFqeMTNI8JgR1pLYdrgerMXC4DBjA1FaDrYdTpAGaWEgRovkmWeFMxvOpRvOnP/GwLDHIC2ZjZBf+I4nb/j4o8xaXuLMGTODH39s7PjZDx/Dq4WBIcOAgZGtGcRiMwCT+JWDQPoDBoY/dSAW8wPCqkfBKBgFo2AkAgDDmVD8IwxmzAAAAABJRU5ErkJggg==","orcid":"","institution":"Zhongda Hospital Southeast University","correspondingAuthor":true,"prefix":"","firstName":"Hongjuan","middleName":"","lastName":"Wei","suffix":""},{"id":445610918,"identity":"629fa01a-bc07-4f65-9001-803952e23b73","order_by":1,"name":"xin Chang","email":"","orcid":"","institution":"Zhongda Hospital Southeast University","correspondingAuthor":false,"prefix":"","firstName":"xin","middleName":"","lastName":"Chang","suffix":""},{"id":445610919,"identity":"bc420628-cb16-454a-af07-7f5012f99f2c","order_by":2,"name":"rufeng Ji","email":"","orcid":"","institution":"Zhongda Hospital Southeast University","correspondingAuthor":false,"prefix":"","firstName":"rufeng","middleName":"","lastName":"Ji","suffix":""},{"id":445610920,"identity":"36f0e01b-00e0-4460-b957-065c2a01f84c","order_by":3,"name":"Yinyan Tang","email":"","orcid":"","institution":"Zhongda Hospital Southeast University","correspondingAuthor":false,"prefix":"","firstName":"Yinyan","middleName":"","lastName":"Tang","suffix":""}],"badges":[],"createdAt":"2025-02-18 07:53:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6053821/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6053821/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12884-025-07706-w","type":"published","date":"2025-05-13T15:57:24+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":81690424,"identity":"7bdf0c60-8ac8-4e89-889a-a9e72102cbf4","added_by":"auto","created_at":"2025-04-30 11:29:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":14577,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart for the study population.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6053821/v1/a40e9c09542af71915a3501c.png"},{"id":81691651,"identity":"45cac698-e89d-4344-b8b4-2c4ca3a6dca1","added_by":"auto","created_at":"2025-04-30 11:37:38","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":37784,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFitting curves of late pregnancy A/G ratio and risk of admission for NHB.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNote: Adjustment covariates are the same as Table 2, Model III. Light blue histogram: the distribution of A/G ratio density in the study population; pink solid line: adjusted \u003cem\u003eOR\u003c/em\u003e, shaded band: 95% \u003cem\u003eCI\u003c/em\u003e; horizontal green dashed line: odds ratio of 1.0, vertical dashed line: A/G ratiovalues for 1.15, 1.29, 1.40 thresholds.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6053821/v1/49050182efa5152d0b7133b9.png"},{"id":81692964,"identity":"2dc3d875-c7e8-4d9a-9aaa-eb53c3156d6d","added_by":"auto","created_at":"2025-04-30 11:45:38","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":90829,"visible":true,"origin":"","legend":"\u003cp\u003eMultivariate logistic regression analysis of late pregnancy A/G ratio and risk of admission for NHB in different ages.\u003c/p\u003e\n\u003cp\u003eNote: Adjusted covariates are the same as in Table 2, Model III.\u003c/p\u003e\n\u003cp\u003eFig A.The relationship between A/G ratio and the risk of admission for NHB in different ages when A/G ratio is grouped according to 1.15, 1.40.\u003c/p\u003e\n\u003cp\u003eFig B.The relationship between A/G ratio and the risk of admission for NHB in different ages when A/G ratio is grouped according to 1.29.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6053821/v1/baa4b2b142920d4abfbd63c6.png"},{"id":83067923,"identity":"ff583153-5d9e-4d9c-a2f6-8b30d6234790","added_by":"auto","created_at":"2025-05-19 16:08:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1304594,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6053821/v1/9bed7dbf-1beb-4c56-807f-5c060bad3593.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association Between Late Pregnancy A/G Ratio and The Risk of Neonatal Admission for Neonatal Hyperbilirubinemia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNeonatal hyperbilirubinemia (NHB) is a prevalent condition, affecting nearly two-thirds of healthy term infants and almost all preterm infants. It is a common cause of hospitalization[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] and can result in acute bilirubin encephalopathy or kernicterus, leading to neurological complications or death[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The 2016 and 2019 Global Burden of Disease studies ranked NHB among the top causes of death in early and late neonates[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] and as the fourth most common disease among children[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The nutritional status of women during the perinatal period is crucial for maternal health and fetal development[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Maternal malnutrition and inappropriate weight gain during pregnancy can negatively impact the offspring's health[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The A/G ratio primarily reflects liver function and nutritional status[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Mothers can indirectly influence the A/G ratio by improving relevant health conditions, and its fluctuations are associated with various chronic diseases and inflammatory conditions[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], all of which play a critical role in fetal development and health. Maternal malnutrition may affect liver development, thereby reducing its ability to metabolize bilirubin [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Chronic inflammation can activate both maternal and fetal immune systems, increasing the risk of NHB[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Therefore, we hypothesize that the maternal A/G ratio may influence the fetal growth environment and physiological functions, potentially contributing to the development of NHB. Thus, this study aims to systematically investigate the A/G-NHB association, with particular focus on establishing its predictive value and potential clinical applications in risk stratification and neonatal monitoring.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eThis study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. This cohort study enrolled 1,521 pregnant women\u0026thinsp;\u0026ge;\u0026thinsp;35 weeks who delivered at Nanjing Lishui People's Hospital (NJLSPH) from January 1 to December 31, 2022. The exclusion criteria were as follows:(1) A/G ratio missing cases, (2) twin pregnancies, and (3) maternal blood type missing cases. Ultimately, 1432 singleton pregnancies were analyzed in the study. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Admission criteria for NHB are serum total bilirubin above the 95th percentile or meeting the criteria for phototherapy at different gestational ages, different hourly ages and different risk factors[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Ethical approval for the study was obtained from the Medical Ethics Committee of NJLSPH (approval number: 2023KY1010-02). As this study had a retrospective design and only de-identified and anonymized participant information was used, the need for written informed consent was waived by the Institutional Review Board (IRB) of NJLSPH. This study was registered at the Chinese Clinical Trial Registry Center (Registration Number: ChiCTR 2300076629).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection and measurement\u003c/h3\u003e\n\u003cp\u003eAll data were extracted from the hospital Health Information System (HIS). Maternal social characteristics, gestational and delivery information, and neonatal data were collected. Maternal characteristics included age, ethnicity, education, blood type, pre-pregnancy BMI. Gestational and delivery details, such as in vitro fertilization (IVF), gestational week, delivery type, gestational weight gain (GWG), hypertensive disorders in pregnancy (HDP), gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP), and hypothyroidism during pregnancy. Neonatal information included sex, birth weight, time of jaundice onset and peak, time of admission, and jaundice progression. Pre-pregnancy BMI was calculated as pre-pregnancy body mass divided by height squared (kg/m\u003csup\u003e2\u003c/sup\u003e). The A/G ratio and other biochemical parameters were measured at the time of hospital admission (before delivery). If admission testing was not possible due to rapid labor, late-pregnancy results (\u0026ge;\u0026thinsp;28 weeks-onset of labor)[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] were used. All measurements were performed in the NJLSPH laboratory using the standardized GPO-POD (Glycerol Phosphate Oxidase-Peroxidase) enzymatic colorimetric assay.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAll analyses were performed using R Statistical Software (Version 4.2.2, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp:/www.R-project.org\u003c/span\u003e\u003cspan address=\"http://www.R-project.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e, The R Foundation) and Free Statistics analysis platform(Version 1.9, Beijing,China). Descriptive analyses were performed for all participants. Categorical variables were provided as percentages (%). Continuous variables were expressed as median (quartile) or mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, depending on the data distribution. In this study, Chi-square tests, T-tests, and Kruskal-Wallis tests were used to compare categorical variables, normally distributed continuous variables, and non-normally distributed continuous variables, respectively. The A/G ratio was analyzed as a continuous variable, with effect sizes expressed per 0.1-unit increase. To examine the nonlinear relationship between maternal A/G ratio and NHB admission risk, a generalized additive model (GAM) with cubic splines was employed. The A/G ratio was modeled as a continuous variable with four knots (5th, 35th,65th and 95th) suggested by Harrell. This analysis revealed a statistically significant U-shaped relationship (\u003cem\u003eP\u003c/em\u003e for nonlinearity\u0026thinsp;=\u0026thinsp;0.027). The inflection point (A/G ratio\u0026thinsp;=\u0026thinsp;1.29) was identified through recursive analysis and validated by bootstrapping. Subsequently, segmented multivariate linear regression analysis was performed for A/G ratio\u0026thinsp;\u0026lt;\u0026thinsp;1.29 and \u0026ge;\u0026thinsp;1.29. Additionally, categorical analysis was conducted using predefined cut-offs (G1:\u0026lt;1.15; G2:1.15\u0026ndash;1.40; G3:\u0026gt;1.40) with multivariable logistic regression to calculate adjusted \u003cem\u003eOR\u003c/em\u003es and 95% \u003cem\u003eCI\u003c/em\u003es, controlling for relevant covariates. Covariates were adjusted based on two primary criteria: (1) variables previously established as confounders in the literature, and (2) a change in the adjusted odds ratio (\u003cem\u003eOR\u003c/em\u003e) of \u0026ge;\u0026thinsp;10% upon their inclusion in the model, indicating meaningful confounding. Model I adjusted for sociodemographic factors; Model II added perinatal variables; Model III further included neonatal characteristics to address residual confounding. Given that the average age of pregnant women in this study was 29.7 years (\u0026plusmn;\u0026thinsp;4.4), age of 30 years was utilized for stratification threshold.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003ePopulation characteristics\u003c/h2\u003e \u003cp\u003eThe study included 1,432 mother-newborn pairs, with 225 neonates (15.7%) requiring hospitalization for NHB. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, neonates admitted for NHB had significantly shorter weeks of gestation (38.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 vs 39.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 weeks, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and lower birth weight (3339.4\u0026thinsp;\u0026plusmn;\u0026thinsp;442.3 vs 3416.4\u0026thinsp;\u0026plusmn;\u0026thinsp;438.3g, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.016) compared to non-admitted infants. Maternal factors associated with NHB admission included higher rates of HDP (12.4% vs 7.7%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.019), lower prevalence of anaemia (6.7% vs 12.7%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.010), and increased cesarean delivery (64.0% vs 51.3%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002). Biochemical analysis revealed a modest but statistically significant elevation in A/G ratio among NHB cases (1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2 vs 1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.023). Other maternal and neonatal characteristics, including ethnicity, education level, and additional liver function markers, showed no significant differences between groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of mothers and newborns.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1432)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-admission\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;1207)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdmission for NHB\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;225)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, year\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.425\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthnicity, (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.105\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHan Chinese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1420 (99.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1199 (99.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e221 (98.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation, (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.242\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElementary School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior High School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e256 (17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e223 (18.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e158 (11.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e124 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (15.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior college\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e126 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e110 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollege\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e434 (30.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e372 (30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (27.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e395 (27.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e325 (26.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70 (31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaster\u0026thinsp;+\u0026thinsp;\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood Type, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.372\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA, Rh+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e443 (30.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e376 (31.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67 (29.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAB, Rh+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122 (8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105 (8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB, Rh-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB, Rh+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e366 (25.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e317 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49 (21.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eO, Rh-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eO, Rh+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e498 (34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e406 (33.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92 (40.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVF, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.571\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1392 (97.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1172 (97.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e220 (97.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeeks of Gestation, week\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParity, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.162\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e493 (34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e398 (33.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95 (42.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e406 (28.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e347 (28.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (26.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e257 (17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e223 (18.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (15.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e167 (11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e146 (12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74 (5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026thinsp;+\u0026thinsp;\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Births, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e660 (46.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e536 (44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e124 (55.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e648 (45.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e558 (46.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e111 (7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101 (8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGWG, kg\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.447\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-pregnancy BMI, kg/m\u003csup\u003e2\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.539\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDP, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1311 (91.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1114 (92.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e197 (87.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e121 (8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGDM, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.252\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1050 (73.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e892 (73.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e158 (70.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e382 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e315 (26.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67 (29.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICP, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.498\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1415 (98.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1191 (98.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e224 (99.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypothyroidism during Pregnancy, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.695\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1308 (91.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1104 (91.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e204 (90.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e124 (8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103 (8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnaemia during pregnancy, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1264 (88.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1054 (87.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e210 (93.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e168 (11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e153 (12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelivery mode, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaginal delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e555 (38.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e487 (40.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68 (30.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e763 (53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e619 (51.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e144 (64.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaginal delivery to cesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101 (8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALB, g/L\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.591\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGLO, g/L\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.272\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA/G \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT, U/L\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.5\u0026thinsp;\u0026plusmn;\u0026thinsp;25.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.8\u0026thinsp;\u0026plusmn;\u0026thinsp;26.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.2\u0026thinsp;\u0026plusmn;\u0026thinsp;17.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.382\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST, U/L\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.5\u0026thinsp;\u0026plusmn;\u0026thinsp;16.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.7\u0026thinsp;\u0026plusmn;\u0026thinsp;17.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.4\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.263\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTBA, umol/L\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.913\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTBIL, umol/L\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUREA, mmol/L\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.281\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUA, umol/L\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e316.7\u0026thinsp;\u0026plusmn;\u0026thinsp;77.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e315.8\u0026thinsp;\u0026plusmn;\u0026thinsp;76.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e321.3\u0026thinsp;\u0026plusmn;\u0026thinsp;82.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.338\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTG, mmol/L\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.7 (2.9, 4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.7 (2.9, 4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.7 (3.0, 4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.556\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL-C, mmol/L\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.326\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDL-C, mmol/L\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.731\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.784\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e739 (51.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e621 (51.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e118 (52.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e693 (48.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e586 (48.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e107 (47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBW, g\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3404.3\u0026thinsp;\u0026plusmn;\u0026thinsp;439.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3416.4\u0026thinsp;\u0026plusmn;\u0026thinsp;438.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3339.4\u0026thinsp;\u0026plusmn;\u0026thinsp;442.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: \u003csup\u003e\u0026dagger;\u003c/sup\u003e Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation description, \u003csup\u003e\u0026Dagger;\u003c/sup\u003e Quartile description\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAbbreviations: IVF: In Vitro Fertilization; GWG: Gestational Weight Gain; HDP: Hypertensive disorders in pregnancy; GDM: Gestational Diabetes Mellitus; ICP: Intrahepatic Cholestasis during Pregnancy; ALB: Albumin; GLO: Globulin; A/G: Albumin/Globulin; ALT: alanine aminotransferase; AST: aspartate aminotransferase; TBA: Total Bile Acids; TBIL: Total Bilirubin; UA: Uric Acid; TG: triglycerides; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol. \u003csup\u003ea\u003c/sup\u003eMaster+: Including master's degree and higher. \u003csup\u003eb\u003c/sup\u003e6+: Including pregnancy 6 times and above.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAssociation between A/G ratio and NHB risk\u003c/h2\u003e \u003cp\u003eSpline analysis revealed a significant U-shaped association between A/G ratio and NHB risk (\u003cem\u003eP\u003c/em\u003e for nonlinearity\u0026thinsp;=\u0026thinsp;0.027), with an inflection point at A/G ratio\u0026thinsp;=\u0026thinsp;1.29 (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Below 1.29, each 0.1-unit increase in A/G ratio was associated with 33% lower NHB risk (adjusted \u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.67, 95% \u003cem\u003eCI\u003c/em\u003e: 0.46\u0026ndash;0.97); above 1.29, each increase conferred 16% higher risk (adjusted \u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.16, 95% \u003cem\u003eCI\u003c/em\u003e: 1.01\u0026ndash;1.32) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Categorical analysis showed both low (G1: \u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.07, 95% \u003cem\u003eCI\u003c/em\u003e: 1.17\u0026ndash;3.66) and high (G3: \u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.60, 95% \u003cem\u003eCI\u003c/em\u003e: 1.16\u0026ndash;2.19) A/G ratio increased risk compared to G2. Age-stratified analyses demonstrated stronger associations in mothers\u0026thinsp;\u0026ge;\u0026thinsp;30 years (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). For A/G ratio\u0026thinsp;\u0026lt;\u0026thinsp;1.15, older mothers had nearly 3-fold higher NHB risk (adjusted \u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.77, 95% \u003cem\u003eCI\u003c/em\u003e: 1.37\u0026ndash;5.62) versus younger mothers (adjusted \u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.18, 95% \u003cem\u003eCI\u003c/em\u003e: 0.39\u0026ndash;3.60) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The protective effect of A/G ratio\u0026thinsp;\u0026lt;\u0026thinsp;1.29 was significant only in older mothers (adjusted \u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.52, 95% \u003cem\u003eCI\u003c/em\u003e: 0.31\u0026ndash;0.87). No significant interactions were detected (all \u003cem\u003eP\u003c/em\u003e for interaction\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate logistic regression of late pregnancy A/G ratio and risk of admission for NHB.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal n\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en/N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCrude Model\u003c/p\u003e \u003cp\u003e\u003cem\u003eOR\u003c/em\u003e (95% \u003cem\u003eCI\u003c/em\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eModel Ⅰ\u003c/p\u003e \u003cp\u003e\u003cem\u003eOR\u003c/em\u003e (95% \u003cem\u003eCI\u003c/em\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eModel Ⅱ\u003c/p\u003e \u003cp\u003e\u003cem\u003eOR\u003c/em\u003e (95% \u003cem\u003eCI\u003c/em\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eModel Ⅲ\u003c/p\u003e \u003cp\u003e\u003cem\u003eOR\u003c/em\u003e (95% \u003cem\u003eCI\u003c/em\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA/G in 3 groups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eG2 (1.15\u0026thinsp;\u0026le;\u0026thinsp;A/G\u0026thinsp;\u0026le;\u0026thinsp;1.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e733\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eG1 (A/G\u0026thinsp;\u0026lt;\u0026thinsp;1.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (22.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.91 (1.12\u0026ndash;3.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.12 (1.23\u0026ndash;3.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.05 (1.16\u0026ndash;3.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.07 (1.17\u0026ndash;3.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eG3 (A/G\u0026thinsp;\u0026gt;\u0026thinsp;1.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e606\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e107 (17.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.41 (1.04\u0026ndash;1.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.43 (1.06\u0026ndash;1.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.60 (1.17\u0026ndash;2.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.60 (1.16\u0026ndash;2.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eA/G in 2 groups\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e450\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68 (15.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.75 (0.55\u0026ndash;1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.71 (0.51\u0026ndash;0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.68 (0.47\u0026ndash;0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.67 (0.46\u0026ndash;0.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e982\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e157 (16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.14 (1.01\u0026ndash;1.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.16 (1.02\u0026ndash;1.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.16 (1.01\u0026ndash;1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.16 (1.01\u0026ndash;1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003eNote:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003eModel Ⅰ: Age, ethnicity, education, blood type, BMI.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003eModel Ⅱ: ModelⅠ + IVF, gestational age, Parity, Number of Births, GWG, HDP, GDM, ICP, hypothyroidism during pregnancy, anaemia during pregnancy, delivery mode.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003eModel Ⅲ: Model Ⅱ + BW, sex of the newborn.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003eThe A/G ratio was analyzed as a continuous variable, with effect sizes expressed per 0.1-unit increase. The A/G ratio was categorized into two groups with cut-off points at 1.29 and three groups (G1, G2, and G3) with cut-off points at 1.15 and 1.40. G1: A/G\u0026thinsp;\u0026lt;\u0026thinsp;1.15; G2: 1.15\u0026thinsp;\u0026le;\u0026thinsp;A/G\u0026thinsp;\u0026le;\u0026thinsp;1.40; G3: A/G\u0026thinsp;\u0026gt;\u0026thinsp;1.40.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate logistic regression analysis of late pregnancy A/G ratio and risk of admission for NHB in different ages.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSubgroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en/N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCrude Model \u003cem\u003eOR\u003c/em\u003e (95% \u003cem\u003eCI\u003c/em\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdjusted Model \u003cem\u003eOR\u003c/em\u003e (95% \u003cem\u003eCI\u003c/em\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e for interaction\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;30y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.329\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eG2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e349\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53 (15.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eG1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.21 (0.44\u0026ndash;3.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.707\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.18 (0.39\u0026ndash;3.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.771\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eG3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e292\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56 (19.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.33 (0.88-2.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.54 (0.98\u0026ndash;2.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;30y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eG2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44 (11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eG1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16 (24.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.52 (1.32\u0026ndash;4.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.77 (1.37\u0026ndash;5.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eG3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e314\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51 (16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.50 (0.97\u0026ndash;2.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.83 (1.14\u0026ndash;2.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;30y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.822\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA/G\u0026thinsp;\u0026lt;\u0026thinsp;1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32 (16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.91 (0.51\u0026ndash;1.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.760\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.89 (0.40\u0026ndash;2.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.788\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA/G\u0026thinsp;\u0026ge;\u0026thinsp;1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e472\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e82 (17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.18 (0.98\u0026ndash;1.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.20 (0.98\u0026ndash;1.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;30y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA/G\u0026thinsp;\u0026lt;\u0026thinsp;1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e253\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36 (14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.67 (0.46\u0026ndash;0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.52 (0.31\u0026ndash;0.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA/G\u0026thinsp;\u0026ge;\u0026thinsp;1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e510\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75 (14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.12 (0.93\u0026ndash;1.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.18 (0.97\u0026ndash;1.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eNote: Adjusted covariates are the same as in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Model III.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eThe A/G ratio was analyzed as a continuous variable, with effect sizes expressed per 0.1-unit increase. The A/G ratio was categorized into two groups with cut-off points at 1.29 and three groups (G1, G2, and G3) with cut-off points at 1.15 and 1.40. G1: A/G\u0026thinsp;\u0026lt;\u0026thinsp;1.15; G2: 1.15\u0026thinsp;\u0026le;\u0026thinsp;A/G\u0026thinsp;\u0026le;\u0026thinsp;1.40; G3: A/G\u0026thinsp;\u0026gt;\u0026thinsp;1.40.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eSummary of key findings\u003c/h2\u003e \u003cp\u003eThis study demonstrates a significant U-shaped association between late-pregnancy A/G ratio and NHB admission risk, with an inflection point at 1.29. Below this threshold, each 0.1-unit increase in A/G ratio was associated with a 33% reduction in NHB risk (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.67, 95% \u003cem\u003eCI\u003c/em\u003e: 0.46\u0026ndash;0.97), while above it, each increment increased risk by 16% (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.16, 95% \u003cem\u003eCI\u003c/em\u003e: 1.01\u0026ndash;1.32). Age-stratified analyses revealed these associations were particularly pronounced in mothers aged\u0026thinsp;\u0026ge;\u0026thinsp;30 years, where extreme A/G ratio values (\u0026lt;\u0026thinsp;1.15 or \u0026gt;\u0026thinsp;1.40) conferred 2\u0026ndash;3 fold higher NHB risk compared to intermediate values. The results suggest that there is an association between A/G ratio levels in late pregnancy and the risk of admission for NHB, but there may be some special populations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eComparison with other studies and clinical implications\u003c/h2\u003e \u003cp\u003eThe growth and development of the fetus depend entirely on the mother's nutrient intake, and a balanced and adequate nutritional intake is essential for ensuring the healthy growth of infants[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Additionally, the nutritional status of the mother during pregnancy directly affects her own health[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. A/G ratio levels are indicative of the body's nutritional status and immune function[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and has been identified as a prognostic factor in various disease conditions[\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Changes in A/G ratio levels can occur due to dehydration or fluid retention, and a decrease in the A/G ratio may be attributed to a reduction in albumin and/or an elevation in globulin levels. Pregnancy is a special physiological stage characterized by an increase in blood volume[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Hemodilution can lead to lower plasma proteins, and fluctuations in plasma proteins can also be caused by haemoconcentration due to other factors. The advantage of A/G ratio is that it is a ratio and its fluctuation is in the same direction during dehydration or fluid retention, so the ratio is more stable. In order to observe whether the association between A/G ratio and the risk of admission for NHB exists stably in different populations, subgroup analyses were performed in this study. The mean ages of overall, admitted, and non-admitted groups were 29.7, 29.5, and 29.8 years, respectively, which were all close to 30 years of age. Therefore, the study was not stratified by the traditional 35 of high maternal age, but rather by 30 years of age.\u003c/p\u003e \u003cp\u003eOur findings corroborate and extend existing literature on maternal biomarkers and neonatal outcomes. The association between low A/G ratio and increased NHB risk aligns with emerging evidence on maternal nutritional status and fetal development. For instance, a study by Hussain T et al. emphasized the role of maternal oxidative stress in placental inflammation, which can lead to NHB[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Similarly, our study supports the notion that maternal health indicators, such as the A/G ratio, can serve as predictive markers for neonatal conditions. However, our comprehensive evaluation of the A/G ratio as a composite indicator of maternal health offers unique advantages over studies focusing solely on individual proteins or inflammatory markers. Recent work by Zhang et al. demonstrated similar U-shaped relationships between maternal serum proteins and adverse pregnancy outcomes, though their study did not examine NHB specifically[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Our identification of 1.29 as the optimal inflection point provides a quantitative threshold that could be readily implemented in clinical practice. This finding is particularly significant given that the A/G ratio inherently accounts for the physiological hemodilution of pregnancy, making it more stable than absolute protein measurements across different gestational ages. The age-dependent effects we observed (stronger associations in mothers\u0026thinsp;\u0026ge;\u0026thinsp;30 years) resonate with the growing recognition of \"inflammaging\" in reproductive health. Recent studies have shown that age-related changes in protein metabolism may amplify the impact of nutritional deficiencies during pregnancy[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Our findings suggest that this phenomenon may extend to neonatal bilirubin metabolism as well. This highlights the importance of considering maternal age in the assessment of NHB risk.\u003c/p\u003e \u003cp\u003eThrough multivariate and subgroup analyses, our study revealed that in cases of low A/G ratio, the risk of neonatal admission for NHB appeared to decrease with an increase in A/G ratio. This suggests that interventions aimed at elevating albumin levels to increase the A/G ratio may help reduce the risk of neonatal admission for NHB. However, this trend was not observed in the younger age group (mothers\u0026thinsp;\u0026lt;\u0026thinsp;30 years), indicating that the relationship between A/G ratio and NHB risk may be more complex in this demographic. Further analysis and exploration are required to elucidate the underlying mechanisms. The cut-off values for low A/G ratio identified in our study were 1.29 and 1.15 when divided into two and three groups, respectively. The exact cut-off value for low A/G ratio is not yet definitive, and further research is needed to establish this threshold more precisely. When A/G ratio are high, our study showed an increasing tendency of NHB admission risk across all populations. This suggests that factors leading to decreased globulin levels, which in turn increase the A/G ratio, may contribute to a higher risk of NHB admission.\u003c/p\u003e \u003cp\u003eOverall, our results indicate that the A/G ratio can serve as a simple and effective early biomarker to identify pregnancies at high risk of NHB admission. This finding underscores the potential clinical utility of monitoring the A/G ratio during pregnancy to facilitate early intervention and improve neonatal outcomes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eBiological mechanisms\u003c/h2\u003e \u003cp\u003eThe exact mechanism by which the A/G ratio affects neonatal jaundice remains unclear. Albumin and globulin are the principal serum proteins in the body and to some extent reflect the systemic inflammatory response. As a result, the A/G ratio has been utilized as an inflammatory index to evaluate the systemic inflammatory state of the host[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Oxidative stress is a primary cause of inflammation[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], and maternal oxidative stress can lead to placental inflammation. The placenta serves as the connection between the mother and the newborn, and placental oxidative stress and inflammation play a crucial role in fetal immune function and neurodevelopment[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Inflammation can lead to the destruction of neonatal erythrocytes, resulting in haemolysis. Furthermore, inflammation can severely inhibit enzymes in the neonatal liver, leading to disruptions in bilirubin metabolism and resulting in elevated bilirubin levels[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], and there may be other mechanisms that need to be further investigated.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStudy Strengths and Limitations\u003c/h2\u003e \u003cp\u003eThe strength of this study is that it analyses the relationship between A/G ratio and risk of admission for NHB, an indicator that has not yet received significant attention by clinicians, and provides meaningful data on A/G ratio and its correlation with the risk of admission. Nonetheless, the present study has several limitations that warrant consideration. First, as an observational study, our findings demonstrate associations rather than causal relationships. Despite rigorous adjustment for known confounders, unmeasured or residual confounding (e.g., undetected maternal comorbidities or lifestyle factors) may persist. Second, the maternal A/G ratio is influenced by diverse physiological processes (e.g., inflammation, nutritional status, and hepatic/renal function).\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results of this study suggest that\u0026nbsp;the late-pregnancy A/G ratio\u0026nbsp;is strongly associated with the risk of neonatal admission for NHB.\u0026nbsp;A/G\u0026nbsp;ratio may serve as an important predictive factor, and monitoring A/G ratio levels may help identify pregnancies at higher risk of NHB.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was designed by all of the authors.\u0026nbsp;Hongjuan Wei provided supervision\u0026nbsp;throughout the study as a principal investigator. Xin Chang drafted the manuscript under the direct supervision of Hongjuan Wei. All authors\u0026nbsp;have read\u0026nbsp;and approved the final manuscript. Rufeng Ji and Yinyan Tang contributed to literature search, data extraction and analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Human Ethics Committee of Nanjing Lishui People\u0026rsquo;s Hospital.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of competing interest\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNo conflict of interest exists in the submission of this manuscript, and the manuscript\u0026nbsp;has been\u0026nbsp;approved by all authors for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are not\u0026nbsp;publicly\u0026nbsp;available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe gratefully thank Dr. Jie Liu of Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital for his contribution to the statistical support. We also thank Dr. Qilin Yang of Department of Critical care, the Second Affiliated Hospital of Guangzhou Medical University for his contribution to the study design consultations and comments regarding the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding support in the data collection, analysis or preparation of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBhat JA, Sheikh SA, Ara R. Correlation of 25-hydroxy vitamin D level with neonatal hyperbilirubinemia in term healthy newborn: A prospective hospital-based observation study. Int J Pediatr Adolesc Med. 2021. 8(1): 5-9.\u003c/li\u003e\n \u003cli\u003eLi Q, Deng X, Yan J, et al. Neonatal Severe Hyperbilirubinemia Online Registry in Jiangsu Province: protocol for a multicentre, prospective, open, observational cohort study. BMJ Open. 2021. 11(2): e040797.\u003c/li\u003e\n \u003cli\u003eOlusanya BO, Kaplan M, Hansen T. Neonatal hyperbilirubinaemia: a global perspective. Lancet Child Adolesc Health. 2018. 2(8): 610-620.\u003c/li\u003e\n \u003cli\u003eOlusanya BO, Teeple S, Kassebaum NJ. The Contribution of Neonatal Jaundice to Global Child Mortality: Findings From the GBD 2016 Study. Pediatrics. 2018. 141(2): e20171471 [pii].\u003c/li\u003e\n \u003cli\u003eWu Y, Xia F, Chen M, et al. Disease burden and attributable risk factors of neonatal disorders and their specific causes in China from 1990 to 2019 and its prediction to 2024. BMC Public Health. 2023. 23(1): 122.\u003c/li\u003e\n \u003cli\u003eGlobal burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020. 396(10258): 1204-1222.\u003c/li\u003e\n \u003cli\u003eNavaee M, Kashanian M, Kabir A, Zamaninour N, Chamari M, Pazouki A. Maternal and fetal/neonatal outcomes in pregnancy, delivery and postpartum following bariatric surgery and comparison with pregnant women with obesity: a study protocol for a prospective cohort. Reprod Health. 2024. 21(1): 8.\u003c/li\u003e\n \u003cli\u003eLiu B, Curl CL, Brants\u0026aelig;ter AL, et al. Perspective: Organic food consumption during pregnancy and the potential effects on maternal and offspring health. Adv Nutr. 2023. 14(1): 12-21.\u003c/li\u003e\n \u003cli\u003eQin R, Ding Y, Lu Q, et al. Associations of maternal dietary patterns during pregnancy and fetal intrauterine development. Front Nutr. 2022. 9: 985665.\u003c/li\u003e\n \u003cli\u003eStrawa A, Skarżyńska E, Zborowska H, Jakimiuk A, Lisowska-Myjak B. Can variability of serum electrophoretic fractions during pregnancy provide knowledge about maternal and fetal health. J Obstet Gynaecol Res. 2020. 46(9): 1783-1789.\u003c/li\u003e\n \u003cli\u003eChen L, Xu M, Huang Q, Liu Y, Ren W. Clinical significance of albumin to globulin ratio among patients with stroke-associated pneumonia. Front Nutr. 2022. 9: 970573.\u003c/li\u003e\n \u003cli\u003eDong H, Jin Y. Editorial: Rising stars in nutrition and inflammation. Front Nutr. 2023. 10: 1197351.\u003c/li\u003e\n \u003cli\u003eEmeribe AU, Dangana A, Isa HA, et al. Comparative analysis of the nutritional, biochemical and hematological parameters of pregnant women attending the University of Abuja Teaching Hospital, Nigeria. Biomedicine (Taipei). 2022. 12(1): 1-13.\u003c/li\u003e\n \u003cli\u003eYang LF, Li J, Hu R, Xu LQ, Li YX, Sheng WT. [Association of fatty acid composition in human milk with breast milk jaundice in neonates]. Zhongguo Dang Dai Er Ke Za Zhi. 2020. 22(12): 1256-1260.\u003c/li\u003e\n \u003cli\u003eKemper AR, Newman TB, Slaughter JL, et al. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics. 2022. 150(3): e2022058859 [pii].\u003c/li\u003e\n \u003cli\u003eManagement of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004. 114(1): 297-316.\u003c/li\u003e\n \u003cli\u003eGodfrey KM, Titcombe P, El-Heis S, Albert BB, Tham EH, Barton SJ, et al. Maternal B-vitamin and vitamin D status before, during, and after pregnancy and the influence of supplementation preconception and during pregnancy: Prespecified secondary analysis of the NiPPeR double-blind randomized controlled trial. PLoS Med. 2023;20(12):e1004260.\u003c/li\u003e\n \u003cli\u003eApostolopoulou A, Tranidou A, Tsakiridis I, Magriplis E, Dagklis T, Chourdakis M. Effects of Nutrition on Maternal Health, Fetal Development, and Perinatal Outcomes. Nutrients. 2024. 16(3): 375.\u003c/li\u003e\n \u003cli\u003eLackovic M, Jankovic M, Mihajlovic S, et al. Gestational Weight Gain, Pregnancy Related Complications and the Short-Term Risks for the Offspring. J Clin Med. 2024. 13(2): 445.\u003c/li\u003e\n \u003cli\u003eKhammarnia M, Ansari-Moghaddam A, Kakhki FG, Clark C, Barahouei FB. Maternal macronutrient and energy intake during pregnancy: a systematic review and meta-analysis. BMC Public Health. 2024. 24(1): 478.\u003c/li\u003e\n \u003cli\u003eChen J, Xie C, Yang Y, et al. Association between albumin-to-globulin ratio and the risk of overall survival in advanced non-small cell lung cancer patients with anlotinib treatment: a retrospective cohort study. BMC Pulm Med. 2023. 23(1): 275.\u003c/li\u003e\n \u003cli\u003eLi J, Li Z, Hao S, et al. Inversed albumin-to-globulin ratio and underlying liver disease severity as a prognostic factor for survival in hepatocellular carcinoma patients undergoing transarterial chemoembolization. Diagn Interv Radiol. 2023. 29(3): 520-528.\u003c/li\u003e\n \u003cli\u003eWang YT, Kuo LT, Lai CH, et al. Low Pretreatment Albumin-to-Globulin Ratios Predict Poor Survival Outcomes in Patients with Head and Neck Cancer: A Systematic Review and Meta-analysis. J Cancer. 2023. 14(2): 281-289.\u003c/li\u003e\n \u003cli\u003eHulzebos CV, van Imhoff DE, Bos AF, Ahlfors CE, Verkade HJ, Dijk PH. Usefulness of the bilirubin/albumin ratio for predicting bilirubin-induced neurotoxicity in premature infants. Arch Dis Child Fetal Neonatal Ed. 2008. 93(5): F384-8.\u003c/li\u003e\n \u003cli\u003eDeVore GR, Polanco B. Assessing maternal cardiac function by obstetricians: technique and reference ranges. Am J Obstet Gynecol. 2023. 229(2): 155.e1-155.e18.\u003c/li\u003e\n \u003cli\u003eBertschy G, Iannaccone M, Grosso Marra W, Bogliatto F. Obstetric echodynamics: Approaching a new field of multidisciplinary action. Int J Cardiol. 2024. 403: 131850.\u003c/li\u003e\n \u003cli\u003eHussain T, Murtaza G, Metwally E, et al. The Role of Oxidative Stress and Antioxidant Balance in Pregnancy. Mediators Inflamm. 2021. 2021: 9962860.\u003c/li\u003e\n \u003cli\u003eXiong T, Wu Y, Huang L, et al. Association of the maternal serum albumin level with fetal growth and fetal growth restriction in term-born singletons: a prospective cohort study. Fertil Steril. 2022. 117(2): 368-375.\u003c/li\u003e\n \u003cli\u003eAgarwala A, Dixon DL, Gianos E, et al. Dyslipidemia management in women of reproductive potential: An Expert Clinical Consensus from the National Lipid Association. J Clin Lipidol. 2024. 18(5): e664-e684.\u003c/li\u003e\n \u003cli\u003ePuche-Juarez M, Toledano JM, Hinojosa-Nogueira D, et al. Diet, Advanced Maternal Age, and Neonatal Outcomes: Results from the GESTAGE Study. Nutrients. 2025. 17(2): 321.\u003c/li\u003e\n \u003cli\u003eYuk HD, Ku JH. Role of Systemic Inflammatory Response Markers in Urothelial Carcinoma. Front Oncol. 2020. 10: 1473.\u003c/li\u003e\n \u003cli\u003eAye IL, Waddell BJ, Mark PJ, Keelan JA. Oxysterols exert proinflammatory effects in placental trophoblasts via TLR4-dependent, cholesterol-sensitive activation of NF-\u0026kappa;B. Mol Hum Reprod. 2012. 18(7): 341-53.\u003c/li\u003e\n \u003cli\u003eAl-Gubory KH, Fowler PA, Garrel C. The roles of cellular reactive oxygen species, oxidative stress and antioxidants in pregnancy outcomes. Int J Biochem Cell Biol. 2010. 42(10): 1634-50.\u003c/li\u003e\n \u003cli\u003eLiu Y, Sun X, Wang Y, Xing C, Li L, Zhou S. Evaluation of Associated Markers of Neonatal Pathological Jaundice Due to Bacterial Infection. Iran J Public Health. 2021. 50(2): 333-340.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Late pregnancy, Albumin to globulin ratio, Neonatal hyperbilirubinemia, Patient admission","lastPublishedDoi":"10.21203/rs.3.rs-6053821/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6053821/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e To investigate the association between late pregnancy A/G (Albumin to globulin) ratio and the risk of admission for neonatal hyperbilirubinemia (NHB) .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eThis cross-sectional study selected mothers in labor and their newborns delivered at Nanjing Lishui People's Hospital, from January to December 2022. Multivariate logistic regression was utilized to analyze the relationship between late pregnancy A/G ratio and the risk of admission for NHB.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e Out of 1432 pregnant women, 15.7% of newborns were admitted for NHB. Outcome 1: Dichotomizing the A/G ratio at 1.29, the risk of NHB admission decreased by 33% (95% \u003cem\u003eCI\u003c/em\u003e: 0.46-0.97) for every 0.1 increase in A/G ratio\u0026lt;1.29. Conversely, when the A/G ratio≥1.29, the risk of NHB admission increased by 16% (95% \u003cem\u003eCI\u003c/em\u003e: 1.01-1.32) for each 0.1 increase in A/G ratio. Outcome 2: When A/G ratio was categorized into three groups using thresholds of 1.15 and 1.40, the risk of NHB admission increased by 107% (95% \u003cem\u003eCI\u003c/em\u003e: 1.17-3.66) for G1 and 60% (95% \u003cem\u003eCI\u003c/em\u003e: 1.16-2.19) for G3, compared to G2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e Late pregnancy A/G ratio is closely associated with the risk of admission for NHB. A/G ratio within different ranges affects the risk of NHB in varying directions and to different extents. Monitoring the A/G ratio may help identify pregnancies at higher risk of NHB.\u003c/p\u003e","manuscriptTitle":"Association Between Late Pregnancy A/G Ratio and The Risk of Neonatal Admission for Neonatal Hyperbilirubinemia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-30 11:29:34","doi":"10.21203/rs.3.rs-6053821/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2025-05-09T05:43:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-07T09:06:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"272668417302961905025173268039275441902","date":"2025-04-27T02:22:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-21T07:26:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-20T22:55:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-04-17T02:04:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"310766c7-dd27-4a1e-a2e3-ea625a9770a4","owner":[],"postedDate":"April 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-19T16:03:42+00:00","versionOfRecord":{"articleIdentity":"rs-6053821","link":"https://doi.org/10.1186/s12884-025-07706-w","journal":{"identity":"bmc-pregnancy-and-childbirth","isVorOnly":false,"title":"BMC Pregnancy and Childbirth"},"publishedOn":"2025-05-13 15:57:24","publishedOnDateReadable":"May 13th, 2025"},"versionCreatedAt":"2025-04-30 11:29:34","video":"","vorDoi":"10.1186/s12884-025-07706-w","vorDoiUrl":"https://doi.org/10.1186/s12884-025-07706-w","workflowStages":[]},"version":"v1","identity":"rs-6053821","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6053821","identity":"rs-6053821","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}