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Association between late pregnancy A/G ratio and the risk of neonatal admission for neonatal hyperbilirubinemia

BMC Pregnancy and Childbirth volume 25, Article number: 563 (2025) Cite this article

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.

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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).

Fig. 1
figure 1

Flowchart for the study population

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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/m2). 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: < 1.15; G2:1.15–1.40; G3: > 1.40) with multivariable logistic regression to calculate adjusted ORs and 95% CIs, 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 ± 438.3 g, 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
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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 threefold 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 < 1.29 was significant only in older mothers (adjusted OR = 0.52, 95% CI: 0.31–0.87). No significant interactions were detected (all P for interaction > 0.05).

Fig. 2
figure 2

Fitting curves of late pregnancy A/G ratio and risk of admission for NHB. Note: 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 OR, shaded band: 95% CI; horizontal green dashed line: odds ratio of 1.0, vertical dashed line: A/G ratio values for 1.15, 1.29, 1.40 thresholds

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Table 2 Multivariate logistic regression of late pregnancy A/G ratio and risk of admission for NHB
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Fig. 3
figure 3

Multivariate logistic regression analysis of late pregnancy A/G ratio and risk of admission for NHB in different ages. Note: Adjusted covariates are the same as in Table 2, Model III. 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. 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

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Table 3 Multivariate logistic regression analysis of late pregnancy A/G ratio and risk of admission for NHB in different ages
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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 (< 1.15 or > 1.40) conferred 2–threefold 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 [22,23,24]. 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.

Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.

References

  1. 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.

    Article  PubMed  Google Scholar 

  2. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Olusanya BO, Kaplan M, Hansen T. Neonatal hyperbilirubinaemia: a global perspective. Lancet Child Adolesc Health. 2018;2(8):610–20.

    Article  PubMed  Google Scholar 

  4. Olusanya 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.

    Article  PubMed  Google Scholar 

  5. Wu 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.

    Article  PubMed  PubMed Central  Google Scholar 

  6. GBD 2019 Diseases and Injuries Collaborators. Global 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):1204–22.

  7. Navaee 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.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Liu B, Curl CL, Brantsæter 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.

    Article  PubMed  Google Scholar 

  9. Qin R, Ding Y, Lu Q, et al. Associations of maternal dietary patterns during pregnancy and fetal intrauterine development. Front Nutr. 2022;9:985665.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Strawa 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):1783–9.

    Article  CAS  PubMed  Google Scholar 

  11. Chen 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.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Dong H, Jin Y. Editorial: Rising stars in nutrition and inflammation. Front Nutr. 2023;10:1197351.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Emeribe 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.

    PubMed  Google Scholar 

  14. 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):1256–60.

    PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114(1):297–316.

  17. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  21. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. 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):520–8.

    PubMed  PubMed Central  Google Scholar 

  23. 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):281–9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 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.

    Article  CAS  PubMed  Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. Bertschy G, Iannaccone M, Grosso Marra W, Bogliatto F. Obstetric echodynamics: Approaching a new field of multidisciplinary action. Int J Cardiol. 2024;403:131850.

    Article  PubMed  Google Scholar 

  27. Hussain T, Murtaza G, Metwally E, et al. The Role of Oxidative Stress and Antioxidant Balance in Pregnancy. Mediators Inflamm. 2021;2021:9962860.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 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):368–75.

    Article  CAS  PubMed  Google Scholar 

  29. 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):e664–84.

    Article  PubMed  Google Scholar 

  30. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Yuk HD, Ku JH. Role of Systemic Inflammatory Response Markers in Urothelial Carcinoma. Front Oncol. 2020;10:1473.

    Article  PubMed  PubMed Central  Google Scholar 

  32. 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.

    Article  CAS  PubMed  Google Scholar 

  33. 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.

    Article  CAS  PubMed  Google Scholar 

  34. 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):333–40.

    PubMed  PubMed Central  Google Scholar 

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Acknowledgements

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.

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Author notes

  1. Hongjuan Wei and Xin Chang contributed equally to this study.

Authors and Affiliations

  1. Department of Pediatric, Nanjing Lishui People’s Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China

    Hongjuan Wei, Rufeng Ji & Yinyan Tang

  2. Department of Ultrasound Medicine, Nanjing Lishui People’s Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China

    Xin Chang

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Contributions

This study was designed by all of the authors. Hongjuan Wei will provide supervision throughout the study as a principal investigator. Xin Chang drafted the manuscript under direct supervision of Hongjuan Wei (Corresponding author). All authors read and approved the final manuscript. Rufeng Ji and Yinyan Tang are contributed to literature search, data extraction and analysis.

Corresponding author

Correspondence to Hongjuan Wei.

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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.

The study was approved by the Human Ethics Committee of Nanjing Lishui People’s Hospital.

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The authors declare no competing interests.

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Wei, H., Chang, X., Ji, R. et al. Association between late pregnancy A/G ratio and the risk of neonatal admission for neonatal hyperbilirubinemia. BMC Pregnancy Childbirth 25, 563 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12884-025-07706-w

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BMC Pregnancy and Childbirth

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