Association between vomiting in the first trimester and preterm birth: a retrospective birth cohort study in Wuhan, China

OBJECTIVE Although vomiting in the first trimester has been reported to be associated with preterm birth (PTB), findings supporting this association remain inconsistent. Our aim was to assess the association between vomiting and PTB, as well as evaluate if the association is modified by pre-pregnancy body mass index (BMI). DESIGN A retrospective cohort study. SETTING Wuhan, a central city of China. PARTICIPANTS A total of 317 463 pregnant women who had a live, singleton newborn from 1 January 2010 to 23 May 2016 were enrolled in our study. MAIN OUTCOME MEASURE PTB was defined as gestational age <37 gestational weeks. Gestational age was calculated using reports from mothers based on the first day of their last menstrual period. An ultrasound was routinely used to determine gestational age before 12 gestational weeks. RESULTS Of the 317 463 pregnant women, 29.88% (94 857) experienced vomiting in the first trimester and 5.00% (15 889) experienced a PTB. Vomiting in the first trimester increased the risk for PTB and the multivariable adjusted OR was 1.05 (95% CI 1.02 to 1.09). In the stratified analyses, the association of vomiting in the first trimester was significant among underweight women (adjusted OR=1.08, 95% CI 1.04 to 1.17) and normal pre-pregnancy BMI women (adjusted OR=1.06, 95% CI 1.02 to 1.11), but not in overweight women (adjusted OR=1.01, 95% CI 0.90 to 1.14) and obese women (adjusted OR=0.93, 95% CI 0.73 to 1.19). CONCLUSIONS Our study indicates that vomiting in the first trimester was associated with PTB. Additionally, women with underweight and normal pre-pregnancy BMI who experienced vomiting are more likely to have a PTB.