Obesity or Underweight-What is Worse in Pregnancy?

Prevalence and determinants of moderate-to-severe anaemia in the third trimester of pregnancy: a multicenter cross-sectional study in Lagos, Nigeria

The high burden of anaemia during pregnancy underscores the urgent need to gain a comprehensive understanding of the factors contributing to its widespread occurrence. Our study assessed the prevalence and the trends of moderate-to-severe anaemia (MSA) in late pregnancy (28 to 36 weeks) and then investigated the key determinants driving this prevalence among women in Lagos, Nigeria. We conducted a secondary data analysis involving 1216 women enrolled in the Predict-PPH study between January and March 2023. We employed a multivariate binary logistic regression model with a backward stepwise selection approach to identify significant predictors of MSA. The study revealed a 14.5% prevalence of MSA during pregnancy. Independent predictors of MSA included having given birth to two or more children (adjusted odds ratio = 1.46, 95% confidence interval: 1.03-2.07), having a maternal body mass index (BMI) of 28 kg/m2 or higher (adjusted odds ratio = 1.84, 95% confidence interval: 1.29-2.61), having less than tertiary education (adjusted odds ratio = 1.51, 95% confidence interval: 1.08-2.11), and being unemployed (adjusted odds ratio = 1.97, 95% confidence interval: 1.19-3.26). It is crucial for pregnant women, particularly those with higher parities and elevated BMI, to be monitored regularly for anaemia and its consequences during their antenatal care. Additionally, addressing the link between low education, unemployment, and anaemia necessitates comprehensive strategies that empower women in terms of education and economic status to enhance the overall well-being of individuals and communities, ultimately reducing the prevalence of anaemia and associated health issues in pregnancy.

Comparison of Feto-maternal Outcomes Among Various BMI Groups As Per Asia Pacific Standards: An Observational Retrospective Comparative Study in a Private Tertiary Care Center in Delhi

Objective

To compare the feto-maternal outcomes among various BMI groups as per Asia Pacific Standards.

Method

This is a retrospective non-interventional observational study on 1396 antenatal women with singleton pregnancy. Their BMI based on pre-pregnancy weight was calculated and the women were divided into various groups as per Asia Pacific standards for BMI classification. Details of associated morbidities and delivery outcomes were noted in a pre-structured proforma and a comparison was made among the various groups using Chi square test. A p value of < 0.05 was taken as significant.

Results

Among the 1396 women under study, 10.6% were underweight, 36% had normal weight, 21% were overweight while 32% were obese or very obese. There was a significant association of low BMI with preterm labor (p value 0.03) and fetal growth restriction (p value < 0.01). Overweight and obese women were found to be more prone to hypertensive disorders of pregnancy (p value- 0.002), gestational diabetes (p value- 0.003) and overweight women were more prone to cholestasis of pregnancy (p value 0.03). The women with higher BMI had a significantly higher requirement of induction of labor (p value-0.0002). There was significant increased number of babies more than 90th percentile in overweight and obese women (p value 0.003). However, there was no change in Neonatal ICU admissions (p value 0.85) or neonatal mortality.

Conclusion

Asia Pacific references should be used for studies related to all studies on BMI and pregnancy. All women having BMI outside the normal BMI spectrum are at increased risk of antenatal and postnatal complications. Early identification of such women will enable careful evaluation and counseling to improve the reproductive outcome and feto-maternal health.

Maternal factors associated with iron deficiency without anaemia in early pregnancy: ECLIPSES study

Several population-specific genetic, sociodemographic, and maternal lifestyle factors are related to iron status in early pregnancy, and their identification would allow preventive actions to be taken. The study aimed to identify maternal factors associated with iron deficiency (ID) in early pregnancy in non-anaemic pregnant women from a European Mediterranean country. Cross-sectional study using the initial population of the ECLIPSES study performed in non-anaemic pregnant women before gestational week 12. Serum ferritin (SF) and haemoglobin concentrations were measured to evaluate iron status, and ID was defined as SF < 15 µg/L. Several sociodemographic and lifestyle data were recorded and used as covariates in the multivariate-adjusted regression models. Out of the 791 participants, 13.9% had ID in early pregnancy. Underweight (OR 3.70, 95%CI 1.22, 15.53) and parity (1 child: OR 2.03, 95%CI 1.06, 3.88; ≥ 2 children: OR 6.96, 95%CI 3.09, 15.69) increased the odds of ID, while a high intake of total meat (≥ 108.57 g/day: OR 0.37, 95%CI 0.15, 0.87), red/processed meat (≥ 74.29 g/day: OR 0.70, 95%CI 0.35, 0.98), protein (≥ 65.05 g/day: OR 0.85, 95%CI 0.30, 0.99), and dietary iron (≥ 8.58 mg/day: OR 0.58, 95%CI 0.35, 0.94) protected against it. Smoking was also associated with a reduction in ID odds (OR 0.34, 95%CI 0.12, 0.99). Baseline BMI, parity, smoking, and diet are associated with ID in early pregnancy in non-anaemic women. Pregnancy planning policies should focus on women at higher risk of ID, such as those who are underweight, multiparous, or following vegetarian diets. This clinical trial was registered at www.clinicaltrialsregister.eu as EudraCT number 2012-005,480-28 and at www.clinicaltrials.gov with identification number NCT03196882.

Reported health, social support, stress and associations with choline intake in pregnant women in central South Africa: the NuEMI study 2018-2019

BACKGROUND

The health and well-being of pregnant women can influence pregnancy outcomes and are closely associated with social support and experiences of stress. Poor nutrition predisposes to poor health with choline intake affecting pregnancy outcome. This study determined reported health, social support, and stress and how these factors are associated with choline intake in pregnancy.

METHODS

A cross sectional study was performed. Pregnant women in their second and third trimesters attending a high-risk antenatal clinic at a regional hospital in Bloemfontein, South Africa, were included. Trained fieldworkers obtained information during structured interviews using standardised questionnaires. Logistic regression with backward selection (p < 0.05) was used to select significant independent factors associated with choline intake. Variables with a p-value < 0.15 in bivariate analysis were considered for inclusion in the model.

RESULTS

Median age and gestation in the sample (N = 682) were 31.8 years and 32.0 weeks, respectively. Most participants (84.7%) consumed less than the adequate intake (AI) of 450 mg of choline per day. Most participants (69.0%) were either overweight or obese. One in eight participants (12.6%) reported not having anyone that could help them in times of need, more than one third (36.0%) reported having unpayable debt and one in twelve (8.4%) reported experiencing physical abuse by their partners. Normotensive participants and those using anti-retroviral therapy (ART) (thus HIV-infected), were more likely to consume choline in amounts below the AI (p = 0.042 and p = 0.011, respectively). Logistic regression analysis showed that the odds of consuming choline in amounts below the AI were lower for participants that were not using ART versus those using ART, with an odds ratio of 0.53.

CONCLUSION

HIV-infected participants were more likely to consume choline in levels below the AI. This vulnerable group should be the focus of targeted efforts to improve choline intake.

Adequacy of antenatal care services utilisation and its effect on anaemia in pregnancy

Anaemia in pregnancy remains a critical public health concern in many countries including Ghana and it poses severe consequences in the short to long-term for women and their unborn babies. Although antenatal care (ANC) is largely provided for pregnant women, the extent its utilisation protects against anaemia in pregnancy remains largely understudied. The study assessed the adequacy of ANC services utilisation and its effect on anaemia among pregnant women in the Wa Municipality of Ghana. A facility-based cross-sectional survey was conducted. Probability proportionate to size sampling and systematic random sampling were used to select the facilities and 353 respondents. While 80⋅2 % of the pregnant women reported having received a sufficient number of ANC services provided, the prevalence of the overall ANC adequacy was only 44⋅2 %. After adjusting for potential confounders, pregnant women who could not achieve adequate ANC attendance were 2⋅3 times more likely to be anaemic in the third trimester of gestation AOR = 2⋅26 (95 % CI 1⋅05, 4⋅89), compared to their counterparts who maintained adequate ANC attendance. Adequate ANC attendance was a consistent and significant predictor of anaemia in pregnancy in the third trimester. Health and nutrition education on the need for early initiation of ANC attendance and support for the consumption of diversified diets are two possible interventions that can help contain anaemia in pregnancy.

Population estimates and determinants of severe maternal thinness in India

OBJECTIVE

To examine prevalence, risk factors, and consequences of maternal severe thinness in India.

METHODS

This mixed methods study analyzed data from the Indian National Family Health Survey (NFHS)-4 (2015-2016) to estimate the prevalence of and risk factors for severe thinness, followed by a desk review of literature from India.

RESULTS

Prevalence of severe thinness (defined by World Health Organization as body mass index [BMI] <16 in adult and BMI for age Z score < -2 SD in adolescents) was higher among pregnant adolescents (4.3%) compared with pregnant adult women (1.9%) and among postpartum adolescent women (6.3%) than postpartum adult women (2.4%) 2-6 months after delivery. Identified research studies showed prevalence of 4%-12% in pregnant women. Only 13/640 districts had at least three cases of severely thin pregnant women; others had lower numbers. Three or more postpartum women aged ≥20 years were severely thin in 32 districts. Among pregnant adolescents, earlier parity increased odds (OR 1.96; 95% CI, 1.18-3.27) of severe thinness. Access to household toilet facility reduced odds (OR 0.72; 95% CI, 0.52-0.99]. Among mothers aged ≥20 years, increasing education level was associated with decreasing odds of severe thinness (secondary: OR 0.74; 95% CI, 0.57-0.96 and Higher: OR 0.54; 95% CI, 0.32-0.91, compared with no education); household wealth and caste were also associated with severe thinness.

CONCLUSION

This paper reveals the geographic pockets that need priority focus for managing severe thinness among pregnant women and mothers in India to limit the immediate and intergenerational adverse consequences emanating from these deprivations.

Screening and management options for severe thinness during pregnancy in India

This paper answers research questions on screening and management of severe thinness in pregnancy, approaches that may potentially work in India, and what more is needed for implementing these approaches at scale. A desk review of studies in the last decade in South Asian countries was carried out collating evidence on six sets of strategies like balanced energy supplementation (BEP) alone and in combination with other interventions like nutrition education. Policies and guidelines from South Asian countries were reviewed to understand the approaches being used. A 10-point grid covering public health dimensions covered by World Health Organization and others was created for discussion with policymakers and implementers, and review of government documents sourced from Ministry of Health and Family Welfare. Eighteen studies were shortlisted covering Bangladesh, India, Nepal, and Pakistan. BEP for longer duration, preconception initiation of supplementation, and better pre-supplementation body mass index (BMI) positively influenced birthweight. Multiple micronutrient supplementation was more effective in improving gestational weight gain among women with better pre-supplementation BMI. Behavior change communication and nutrition education showed positive outcomes on dietary practices like higher dietary diversity. Among South Asian countries, Sri Lanka and Nepal are the only two countries to have management of maternal thinness in their country guidelines. India has at least nine variations of supplementary foods and three variations of full meals for pregnant women, which can be modified to meet additional nutritional needs of those severely thin. Under the National Nutrition Mission, almost all of the globally recommended maternal nutrition interventions are covered, but the challenge of reaching, identifying, and managing cases of maternal severe thinness persists. This paper provides four actions for addressing maternal severe thinness through available public health programs, infrastructure, and human resources.

Developing targeted client communication messages to pregnant women in Bangladesh: a qualitative study

Background

Timely and appropriate evidence-based practices during antenatal care improve maternal and neonatal health. There is a lack of information on how pregnant women and families perceive antenatal care in Bangladesh. The aim of our study was to develop targeted client communication via text messages for increasing antenatal care utilization, as part of an implementation of an electronic registry for maternal and child health.

Methods

Using a phenomenological approach, we conducted this qualitative study from May to June 2017 in two sub-districts of Chandpur district, Bangladesh. We selected study participants by purposive sampling. A total of 24 in-depth interviews were conducted with pregnant women (n = 10), lactating women (n = 5), husbands (n = 5), and mothers-in-law (n = 4). The Health Belief Model (HBM) was used to guide the data collection. Thematic analysis was carried out manually according to the HBM constructs. We used behavior change techniques to inform the development of targeted client communication based on the thematic results.

Results

Almost no respondents mentioned antenatal care as a preventive form of care, and only perceived it as necessary if any complications developed during pregnancy. Knowledge of the content of antenatal care (ANC) and pregnancy complications was low. Women reported a variety of reasons for not attending ANC, including the lack of information on the timing of ANC; lack of decision-making power; long-distance to access care; being busy with household chores, and not being satisfied with the treatment by health care providers. Study participants recommended phone calls as their preferred communication strategy when asked to choose between the phone call and text message, but saw text messages as a feasible option. Based on the findings, we developed a library of 43 automatically customizable text messages to increase ANC utilization.

Conclusions

Pregnant women and family members had limited knowledge about antenatal care and pregnancy complications. Effective health information through text messages could increase awareness of antenatal care among the pregnant women in Bangladesh. This study presents an example of designing targeted client communication to increase antenatal care utilization within formal scientific frameworks, including a taxonomy of behavior change techniques.

Trial registration

ISRCTN69491836. Registered on December 06, 2018. Retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10811-y.

Population estimates, consequences, and risk factors of obesity among pregnant and postpartum women in India: Results from a national survey and policy recommendations

OBJECTIVE

To examine prevalence, risk factors, and consequences of maternal obesity; and provide evidence on current policies and programs to manage maternal obesity in India.

METHODS

This is a mixed-methods study. We analyzed the National Family Health Survey (NFHS)-4 data (2015-16) to estimate the prevalence and risk factors of obesity, followed by a desk review of literature and stakeholder mapping with interviews to develop policy guidance.

RESULTS

National prevalence of obesity (defined by WHO as body mass index ≥25) was comparable among pregnant (12%) and postpartum women (13%) ≥20 years of age. A high prevalence of obesity (>40%) was observed in over 30 districts in multiple states. Older maternal age, urban residence, increasing wealth quintile, and secondary education were associated with increased odds of obesity among pregnant and postpartum women; higher education increased odds among postpartum women only (OR 1.90; 95% CI, 1.44-2.52). Dietary variables were not associated with obesity. Several implementation challenges across healthcare system blocks were observed at policy level.

CONCLUSION

Overall prevalence of obesity in India during and after pregnancy is high, with huge variation across districts. Policy and programs must be state-specific focusing on prevention, screening, and management of obesity among pregnant and postpartum women.

Obesity in Pregnancy: Obstetrician' s Obstacle

Obesity in pregnancy is associated with several complications which today's obstetricians have to face often. Overcoming these obstacles is truly challenging. There is a steady rise in incidence of overweight or obese women at reproductive age group in India and as well as other countries. Recent advances in bariatric medicine as well bariatric surgery have led to increasing number of pregnancies in obese women. Since obesity is associated with adverse maternal and fetal outcome, it is considered as a high-risk pregnancy and such pregnancies need to be managed in maternity units which are well equipped with necessary infrastructure and availability of expert multidisciplinary faculty. This editorial will look into various challenges and difficulties faced by obstetricians and provide practical tips for managing obese pregnant women. We are introducing a new type of article "Invited Debate," with this issue. It deals with pros and cons of bariatric surgery. I sincerely hope that readers are benefitted from views and reviews presented in the invited debate as well as the editorial.

Sociodemographic, obstetric and psychological determinants of obesity among women in early to mid-pregnancy in South India

Background: Worldwide, the occurrence of obesity has markedly increased over the past decades with serious public health consequences. Obese pregnant women are more likely to develop hypertension, pre-eclampsia and gestational diabetes, resulting in obstetric complications which in turn may contribute to an increase in adverse child outcomes and maternal mortality. The present study was done to determine the prevalence of obesity and its association with socio-demographic variables, obstetric history and mental health. Methods: This study was nested within an ongoing cohort study, CASCADE, in a public hospital in Bangalore. The study participants comprised of 280 pregnant women who were 18 years of age and above, with a gestational age of less than 24 weeks, enrolled between a period of August 1st, 2017 until April 30th, 2018. Weight and height were measured using calibrated devices to calculate the body mass index. Results: The prevalence of obesity was observed to be 33.9% among the pregnant mothers. Obesity was found to be significantly associated with age, history of abortion, gravidity on multivariate logistic regression. No association was found with depression and anxiety. Conclusions: Obesity is an important health concern among urban pregnant women in the region of South India. The prevalence is much higher than that reported in other studies. Increasing age, multigravidity and past history of abortion were significantly associated with maternal obesity.

Does body mass index early in pregnancy influence the risk of maternal anaemia? An observational study in Indonesian and Ghanaian women

Background

Anaemia is common among pregnant women, especially in low- and middle-income countries (LMICs). While body mass index (BMI) relates to many risk factors for anaemia in pregnancy, little is known about the direct relation with anaemia itself. This is particularly relevant in Southeast Asia and Sub-Saharan Africa where the prevalence of anaemia in pregnancy and the associated adverse outcomes is among the highest worldwide. This study aimed to assess the association between early pregnancy BMI and anaemia at first antenatal care visit in Indonesian and Ghanaian women. In addition, the associations between early pregnancy anaemia and adverse birth outcomes was assessed.

Methods

Prospective cohort studies of women in early pregnancy were conducted in Jakarta, Indonesia (n = 433) and in Accra, Ghana (n = 946), between 2012 and 2014. Linear regression analysis was used to assess relations between early pregnancy BMI and pregnancy haemoglobin levels at booking. Logistic regression analyses were used to assess associations between early pregnancy anaemia as defined by the World Health Organization (WHO) criteria and a composite of adverse birth outcomes including stillbirth, low birth weight and preterm birth.

Results

Indonesian women had lower BMI than Ghanaian women (23.0 vs 25.4 kg/m², p < 0.001) and higher mean haemoglobin levels (12.4 vs 11.1 g/dL, p < 0.001), corresponding to anaemia prevalence of 10 and 44%, respectively. Higher early pregnancy BMI was associated with higher haemoglobin levels in Indonesian (0.054 g/dL/kg/m², 95% CI 0.03 to 0.08, p < 0.001) and Ghanaian women (0.044 g/dL/kg/m², 0.02 to 0.07, p < 0.001). Accordingly, risk for anaemia decreased with higher early pregnancy BMI for Indonesians (adjusted OR 0.88, 0.81 to 0.97, p = 0.01) and Ghanaians (adjusted OR 0.95, 0.92 to 0.98, p < 0.001). No association between anaemia and the composite of adverse birth outcomes was observed.

Conclusion

Higher BMI in early pregnancy is associated with higher haemoglobin levels at antenatal booking and with a reduced risk of anaemia in Indonesian and Ghanaian women.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5704-2) contains supplementary material, which is available to authorized users.

Associations of Body Mass Index and Gestational Weight Gain with Term Pregnancy Outcomes

Introduction:

Obesity is one of the greatest health problems in the world. The World Health Organization (WHO) defined obesity as a disease in which the excess of adipose tissue accumulates in such a degree that is endangers health. Obesity is a very complex multifactor disease that is developed under the influence of genetic and metabolic factors, environment, social and cultural environment as well as bad habits. The causes of obesity can be numerous. The most common source of obesity is the development of energetic imbalance.

Material and methods:

A retrospective study of medical records in the Department of Obstetrics and Gynecology, University Clinical Hospital in Mostar was conducted. It included 1300 pregnant women and their children that were delivered in the time period from January 1^st 2015 to December 31^st 2015. It was conducted a retrospective study which involved 1300 pregnant women who gave births in the Department of Obstetrics and Gynecology of University Clinical Hospital in Mostar in the period from January 1^st 2015 to December 31^st 2015 and their newborns.

Results:

The difference in age of pregnant women with different body mass index was not statistically relevant. The average age of pregnant women with normal body mass was 29.52 ± 5.48, overweight pregnant women 30.30 ± 5.138, and obese pregnant women 30.00 ± 5.103 (F = 2.730; p = 0.066). The youngest was 24, and the oldest was 49 years old. The average gestational age at delivery was 39.23 ± 1.556 (min 28; max. 42 weeks of gestation). The majority of pregnant women; 660 of them (50.8 %), were overweight in the early stages of their pregnancy, there were 322 (24.8 %) obese women, and there were 318 (24.5 %) normal weight women.

At the end of the pregnancy, the highest number was that of obese pregnant women 925 (71.2 %), while 328 (25.2 %) pregnant women were overweight, and only 47 (3.6 %) pregnant women had normal weight.

Conclusion:

Nutritive status and weight gain of a mother during pregnancy are an important indication of her health and of the foetus growth. Overweightness and obesity of a mother before pregnancy and during pregnancy has a negative influence on the health of the mother and infant. Moreover, it is linked with risk and a negative pregnancy outcome. BMI was associated with an increased risk of adverse perinatal outcome.