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Niyi JL, Li Z, Zumah F. Association between Gestational Weight Gain and Maternal and Birth Outcomes in Northern Ghana. BIOMED RESEARCH INTERNATIONAL 2024; 2024:5526942. [PMID: 38726293 PMCID: PMC11081748 DOI: 10.1155/2024/5526942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/01/2024] [Accepted: 04/22/2024] [Indexed: 05/12/2024]
Abstract
Background Although inappropriate gestational weight gain is considered closely related to adverse maternal and birth outcomes globally, little evidence was found in low- and middle-income countries. Study Objectives. This study is aimed at identifying the determinants of gestational weight gain and examine the association between gestational weight gain and maternal and birth outcomes in the Northern Region of Ghana. Study Methods. The study used a facility-based cross-sectional study design involving 611 antenatal and delivery records in Tatale district, Tamale west, and Gushegu municipal hospitals. A two-stage sampling method involving cluster and simple random sampling was employed. Descriptive statistical analysis and measures of central tendency were used to describe the sample. The multinomial logistic regression model was used to determine the determinants of gestational weight gain and its association with maternal and birth outcomes. Results Among the 611 women included in the study, 516 (84.45%) had inadequate gestational weight gain, and 19 (3.11%) had excessive gestational weight gain. The gestational weight gain ranged from 2 kg to 25 kg with a mean of 7.26 ± 3.70 kg. The risk factor for inadequate gestational weight gain was low prepregnancy BMI (adjusted odds ratio (AOR) = 1.33, 95% CI = 1.18 - 2.57, P = 0.002). Pregnant women who had inadequate gestational weight gain were significantly less likely to deliver through caesarean section (AOR = 0.27, 95% CI = 0.12 - 0.61, P = 0.002), and those who had excessive weight gain were more likely to undergo caesarean section (AOR = 19.81, 95% CI = 5.38 - 72.91, P = 0.001). The odds of premature delivery (birth < 37 weeks) among pregnant women with inadequate weight gain were 2.88 (95% CI = 1.27 - 6.50, P = 0.011). Furthermore, subjects who had excessive weight gain were 43.80 times more likely to give birth to babies with macrosomia (95% CI = 7.07 - 271.23, P = 0.001). Conclusion Inappropriate gestational weight gain is prevalent in Ghana, which is associated with caesarean section, preterm delivery, delivery complications, and macrosomia. Urgent policy interventions are needed to improve on the frequent monitoring and management of gestational weight gain of pregnant women till term.
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Affiliation(s)
- John Lapah Niyi
- Ghana Health Service, Gushegu Municipal Health Directorate, Gushegu, Ghana
| | - Zhihui Li
- Vanke School of Public Health, Tsinghua University, 100084 Beijing, China
- Institute for Health China, Tsinghua University, 100084 Beijing, China
| | - Fidelis Zumah
- School of Collective Intelligence, Mohammed VI Polytechnic University (UM6P), Rabat, Morocco
- University of Ghana Medical Centre Ltd, Legon, Accra, Ghana
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Perumal N, Wang D, Darling AM, Liu E, Wang M, Ahmed T, Christian P, Dewey KG, Kac G, Kennedy SH, Subramoney V, Briggs B, Fawzi WW. Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: individual participant data meta-analysis. BMJ 2023; 382:e072249. [PMID: 37734757 PMCID: PMC10512803 DOI: 10.1136/bmj-2022-072249] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To estimate the associations between gestational weight gain (GWG) during pregnancy and neonatal outcomes in low and middle income countries. DESIGN Individual participant data meta-analysis. SETTING Prospective pregnancy studies from 24 low and middle income countries. MAIN OUTCOME MEASURES Nine neonatal outcomes related to timing (preterm birth) and anthropometry (weight, length, and head circumference) at birth, stillbirths, and neonatal death. ANALYSIS METHODS A systematic search was conducted in PubMed, Embase, and Web of Science which identified 53 prospective pregnancy studies published after the year 2000 with data on GWG, timing and anthropometry at birth, and neonatal mortality. GWG adequacy was defined as the ratio of the observed maternal weight gain over the recommended weight gain based on the Institute of Medicine body mass index specific guidelines, which are derived from data in high income settings, and the INTERGROWTH-21st GWG standards. Study specific estimates, adjusted for confounders, were generated and then pooled using random effects meta-analysis models. Maternal age and body mass index before pregnancy were examined as potential modifiers of the associations between GWG adequacy and neonatal outcomes. RESULTS Overall, 55% of participants had severely inadequate (<70%) or moderately inadequate (70% to <90%) GWG, 22% had adequate GWG (90-125%), and 23% had excessive GWG (≥125%). Severely inadequate GWG was associated with a higher risk of low birthweight (adjusted relative risk 1.62, 95% confidence interval 1.51 to 1.72; 48 studies, 93 337 participants; τ2=0.006), small for gestational age (1.44, 1.36 to 1.54; 51 studies, 93 191 participants; τ2=0.016), short for gestational age (1.47, 1.29 to 1.69; 40 studies, 83 827 participants; τ2=0.074), and microcephaly (1.57, 1.31 to 1.88; 31 studies, 80 046 participants; τ2=0.145) compared with adequate GWG. Excessive GWG was associated with a higher risk of preterm birth (1.22, 1.13 to 1.31; 48 studies, 103 762 participants; τ2=0.008), large for gestational age (1.44, 1.33 to 1.57; 47 studies, 90 044 participants; τ2=0.009), and macrosomia (1.52, 1.33 to 1.73; 29 studies, 68 138 participants; τ2=0) compared with adequate GWG. The direction and magnitude of the associations between GWG adequacy and several neonatal outcomes were modified by maternal age and body mass index before pregnancy. CONCLUSIONS Inadequate and excessive GWG are associated with a higher risk of adverse neonatal outcomes across settings. Interventions to promote optimal GWG during pregnancy are likely to reduce the burden of adverse neonatal outcomes, however further research is needed to assess optimal ranges of GWG based on data from low and middle income countries.
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Affiliation(s)
- Nandita Perumal
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Dongqing Wang
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, USA
| | - Anne Marie Darling
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Biostatistics, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Tahmeed Ahmed
- Nutrition & Clinical Services, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, CA, USA
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Stephen H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | | | - Brittany Briggs
- Certara USA, on behalf of the Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Nutrition, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
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3
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Hunter PJ, Awoyemi T, Ayede AI, Chico RM, David AL, Dewey KG, Duggan CP, Gravett M, Prendergast AJ, Ramakrishnan U, Ashorn P, Klein N. Biological and pathological mechanisms leading to the birth of a small vulnerable newborn. Lancet 2023; 401:1720-1732. [PMID: 37167990 DOI: 10.1016/s0140-6736(23)00573-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 05/13/2023]
Abstract
The pathway to a thriving newborn begins before conception and continues in utero with a healthy placenta and the right balance of nutrients and growth factors that are timed and sequenced alongside hormonal suppression of labour until a mature infant is ready for birth. Optimal nutrition that includes adequate quantities of quality protein, energy, essential fats, and an extensive range of vitamins and minerals not only supports fetal growth but could also prevent preterm birth by supporting the immune system and alleviating oxidative stress. Infection, illness, undernourishment, and harmful environmental exposures can alter this trajectory leading to an infant who is too small due to either poor growth during pregnancy or preterm birth. Systemic inflammation suppresses fetal growth by interfering with growth hormone and its regulation of insulin-like growth factors. Evidence supports the prevention and treatment of several maternal infections during pregnancy to improve newborn health. However, microbes, such as Ureaplasma species, which are able to ascend the cervix and cause membrane rupture and chorioamnionitis, require new strategies for detection and treatment. The surge in fetal cortisol late in pregnancy is essential to parturition at the right time, but acute or chronically high maternal cortisol levels caused by psychological or physical stress could also trigger labour onset prematurely. In every pathway to the small vulnerable newborn, there is a possibility to modify the course of pregnancy by supporting improved nutrition, protection against infection, holistic maternal wellness, and healthy environments.
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Affiliation(s)
- Patricia J Hunter
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK.
| | | | - Adejumoke I Ayede
- Department of Paediatrics, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - R Matthew Chico
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Anna L David
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Kathryn G Dewey
- Department of Nutrition, University of California at Davis, Davis, CA, USA
| | - Christopher P Duggan
- Department of Nutrition and Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA; Center for Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Gravett
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, USA
| | - Andrew J Prendergast
- Blizard Institute, Queen Mary University of London, London, UK; Zvitambo Institute for Maternal & Child Health Research, Harare, Zimbabwe
| | | | - Per Ashorn
- Center for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Nigel Klein
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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Liu E, Wang D, Darling AM, Perumal N, Wang M, Ahmed T, Christian P, Dewey KG, Kac G, Kennedy S, Subramoney V, Briggs B, Fawzi WW. Effects of prenatal nutritional supplements on gestational weight gain in low- and middle-income countries: a meta-analysis of individual participant data. Am J Clin Nutr 2022; 116:1864-1876. [PMID: 36130877 PMCID: PMC10843965 DOI: 10.1093/ajcn/nqac259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/29/2022] [Accepted: 09/13/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Gestational weight gain (GWG) below or above the Institute of Medicine (IOM) recommendations has been associated with adverse perinatal outcomes. Few studies have examined the effect of prenatal nutrient supplementations on GWG in low- and middle-income countries (LMICs). OBJECTIVES We aimed to investigate the effects of multiple micronutrient supplements (MMSs) and small-quantity lipid-based nutrient supplements (LNSs) on GWG in LMICs. METHODS A 2-stage meta-analysis of individual participant data was conducted to examine the effects of MMSs (45,507 women from 14 trials) and small-quantity LNSs (6237 women from 4 trials) on GWG compared with iron and folic acid supplements only. Percentage adequacy of GWG and total weight gain at delivery were calculated according to the IOM 2009 guidelines. Binary outcomes included severely inadequate (percentage adequacy <70%), inadequate (<90%), and excessive (>125%) GWG. Results from individual trials were pooled using fixed-effects inverse-variance models. Heterogeneity was examined using I2, stratified analysis, and meta-regression. RESULTS MMSs resulted in a greater percentage adequacy of GWG [weighted mean difference (WMD): 0.86%; 95% CI: 0.28%, 1.44%; P < 0.01] and higher GWG at delivery (WMD: 209 g; 95% CI: 139, 280 g; P < 0.01) than among those in the control arm. Women who received MMSs had a 2.9% reduced risk of severely inadequate GWG (RR: 0.971; 95% CI: 0.956, 0.987; P < 0.01). No association was found between small-quantity LNSs and GWG percentage adequacy (WMD: 1.51%; 95% CI: -0.38%, 3.40%; P = 0.21). Neither MMSs nor small-quantity LNSs were associated with excessive GWG. CONCLUSIONS Maternal MMSs were associated with greater GWG percentage adequacy and total GWG at delivery than was iron and folic acid only. This finding is consistent with previous results on birth outcomes and will inform policy development and local recommendations of switching routine prenatal iron and folic acid supplements to MMSs.
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Affiliation(s)
- Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA, USA
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Dongqing Wang
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, USA
| | - Anne M Darling
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Nandita Perumal
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Biostatistics, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Tahmeed Ahmed
- Nutrition & Clinical Services, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Stephen Kennedy
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | | | - Brittany Briggs
- Certara USA, Inc. on behalf of the Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - members of the GWG Pooling Project Consortium
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA, USA
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Biostatistics, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Nutrition & Clinical Services, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Nutrition, University of California, Davis, Davis, CA, USA
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- Certara Canada, Montreal, Quebec, Canada
- DVPL Tech
- Certara USA, Inc. on behalf of the Bill & Melinda Gates Foundation, Seattle, WA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
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5
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Hanley-Cook G, Toe LC, Tesfamariam K, de Kok B, Argaw A, Compaoré A, Ouédraogo M, Dailey-Chwalibóg T, Kolsteren P, Lachat C, Huybregts L. Fortified Balanced Energy-Protein Supplementation, Maternal Anemia, and Gestational Weight Gain: A Randomized Controlled Efficacy Trial among Pregnant Women in Rural Burkina Faso. J Nutr 2022; 152:2277-2286. [PMID: 35906874 PMCID: PMC9535447 DOI: 10.1093/jn/nxac171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Anemia and suboptimal gestational weight gain (GWG) are associated with adverse maternal and birth outcomes. Limited research indicates that balanced energy-protein (BEP) supplements reduce the incidence of inadequate GWG. OBJECTIVES We assessed the efficacy of a micronutrient-fortified BEP supplement on the secondary outcomes of anemia, GWG, GWG rate, and GWG in relation to the Institute of Medicine (IOM)'s recommendations, as compared with an iron-folic acid (IFA) tablet. METHODS We conducted a randomized controlled trial in Burkina Faso, among pregnant women (15-40 y old) enrolled at <21 weeks of gestation. Women received either BEP and IFA (intervention) or IFA (control). Hemoglobin (g/dL) concentrations were measured at baseline and the third antenatal care visit (ANC), whereas maternal weight was measured at baseline and all subsequent ∼7-weekly ANCs. GWG (kg) was calculated as a woman's last weight measurement (at ∼36 weeks of gestation) minus weight at enrollment, whereas GWG rate (kg/wk) was GWG divided by the time between the first and last weight measurements. GWG adequacy (%) was computed as GWG divided by the IOM's recommendation. Binary outcomes included severely inadequate, inadequate, and excessive GWG. Statistical analyses followed the intention-to-treat principle. Linear regression and probability models were fitted for the continuous and binary outcomes, respectively, adjusting for baseline measurements. RESULTS Women in the BEP group tended to have higher, but nonsignificantly different, GWG (0.28 kg; 95% CI: -0.05, 0.58 kg; P = 0.099). Furthermore, there were no significant differences in prenatal anemia prevalence, GWG rate, GWG adequacy, or incidence of inadequate or excessive GWG. Findings were robust to model adjustments and complete case and per protocol analyses. CONCLUSIONS This trial does not provide evidence that fortified BEP supplementation reduces maternal anemia or increases GWG, as compared with IFA. In conjunction with the small, but positive, effects of maternal BEP supplementation on birth outcomes, our findings warrant the investigation of additional biochemical and postnatal outcomes.This trial was registered at clinicaltrials.gov as NCT03533712.
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Affiliation(s)
- Giles Hanley-Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Laeticia C Toe
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium.,Nutrition and Metabolic Diseases Unit, Health Sciences Research Institute (IRSS), Bobo-Dioulasso, Burkina Faso
| | - Kokeb Tesfamariam
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Brenda de Kok
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Alemayehu Argaw
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Anderson Compaoré
- AFRICSanté (Health Research and Expertise Training Agency for Africa), Bobo-Dioulasso, Burkina Faso
| | - Moctar Ouédraogo
- AFRICSanté (Health Research and Expertise Training Agency for Africa), Bobo-Dioulasso, Burkina Faso
| | - Trenton Dailey-Chwalibóg
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium.,Poverty, Health, and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, USA
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Dangat K, Gupte S, Wagh G, Lalwani S, Randhir K, Madiwale S, Pisal H, Kadam V, Gundu S, Chandhiok N, Kulkarni B, Joshi S, Fall C, Sachdev HS. Gestational weight gain in the REVAMP pregnancy cohort in Western India: Comparison with international and national references. Front Med (Lausanne) 2022; 9:1022990. [PMID: 36275827 PMCID: PMC9579320 DOI: 10.3389/fmed.2022.1022990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To determine the trimester specific gestational weight gain (GWG) in a population of pregnant women from Western India and compare it with the Intergrowth-21st international and an Indian reference (GARBH-Ini cohort-Group for Advanced Research on BirtH outcomes). Study design A prospective longitudinal observational study was undertaken in Pune, West India and data for gestational weight gain was collected [the REVAMP study (Research Exploring Various Aspects and Mechanisms in Preeclampsia)]. Generalized Additive Models for Location, Scale and Shape method (GAMLSS model) were used to create GWG centile curves according to gestational age, stratified by BMI at recruitment (n = 640) and compared with Intergrowth-21st reference and GARBH-Ini cohort. Multivariable regression analysis was used to evaluate the relationship between GWG and antenatal risk factors. Results The median GWG was 1.68, 5.80, 7.06, and 11.56 kg at gestational ages 18, 26, 30, and 40 weeks, respectively. In our study, pregnant women gained less weight throughout pregnancy compared to Intergrowth-21st study, but more weight compared to the GARBH-Ini cohort centile curves in all the BMI categories. GWG in overweight/obese women (BMI ≥ 25) was significantly lower (<0.001) as compared to underweight (BMI < 18.5), or normal weight women (BMI ≥ 18.5 and <25). The median GWG at 40 weeks in underweight, normal and overweight/obese women was 13.18, 11.74, and 10.48 kg, respectively. Higher maternal BMI, older maternal age, higher parity and higher hemoglobin concentrations were associated with lower GWG, while taller maternal height was associated with greater GWG. Conclusion GWG of Indian women is lower than the prescriptive standards of the Intergrowth charts.
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Affiliation(s)
- Kamini Dangat
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | | | - Girija Wagh
- Department of Obstetrics and Gynecology, Bharati Medical College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Sanjay Lalwani
- Department of Pediatrics, Bharati Medical College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Karuna Randhir
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Shweta Madiwale
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Hemlata Pisal
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Vrushali Kadam
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Shridevi Gundu
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Nomita Chandhiok
- Division of Reproductive, Biology, Maternal and Child Health (RBMCH) and Nutrition, Indian Council of Medical Research, New Delhi, India
| | - Bharati Kulkarni
- Division of Reproductive, Biology, Maternal and Child Health (RBMCH) and Nutrition, Indian Council of Medical Research, New Delhi, India
| | - Sadhana Joshi
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Caroline Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Harshpal Singh Sachdev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
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7
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Liu E, Wang D, Darling AM, Perumal N, Wang M, Urassa W, Pembe A, Fawzi WW. Multivitamin Supplementation Is Associated with Greater Adequacy of Gestational Weight Gain among Pregnant Women in Tanzania. J Nutr 2022; 152:1091-1098. [PMID: 34964890 PMCID: PMC8970983 DOI: 10.1093/jn/nxab448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/02/2021] [Accepted: 12/23/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Gestational weight gain (GWG) is a modifiable risk factor associated with adverse birth outcomes. Studies have shown that the provision of multiple micronutrient supplements to pregnant women reduces the risk of low birth weight. However, the effect of multiple micronutrient supplements on GWG has been understudied. OBJECTIVES We examined the effect of daily supplementation of pregnant women with multivitamins on GWG in relation to the GWG recommendation by the Institute of Medicine (IOM). METHODS Pregnant women with gestational age between 12 and 27 wk were randomly assigned to receive daily multivitamins or placebo until delivery. Weight was measured at enrollment and every follow-up visit. Percentage adequacy of GWG was calculated as actual GWG divided by the recommended GWG according to the IOM recommendation. Binary outcomes included severely inadequate (<70%), inadequate (<90%), and excessive GWG (≥125%). The analysis included 7573 women with singleton pregnancies. Multiple linear regression models were used to examine the association between multivitamin supplementation and percentage adequacy of GWG, and log-binomial models were used for binary outcomes. RESULTS The mean percentage adequacy of GWG was 96.7% in the multivitamin arm and 94.4% in the placebo arm, with a mean difference of 2.3% (95% CI: 0.3%, 4.2%; P = 0.022). Compared with women in the placebo arm, those who received multivitamins had a lower risk of severely inadequate GWG (RR: 0.90; 95% CI: 0.83, 0.97; P = 0.008) and inadequate GWG (RR: 0.95; 95% CI: 0.91, 0.99; P = 0.018). No significant difference was found in excessive GWG. CONCLUSIONS Multivitamin supplementation increased GWG and reduced the risk of severely inadequate and inadequate GWG among pregnant women in Tanzania. Together with previously reported beneficial effects of the supplements on birth outcomes in low- and middle-income countries, our findings support scaling up the use of prenatal supplements that include multivitamins in addition to iron and folic acid.This trial was registered at clinicaltrials.gov as NCT00197548.
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Affiliation(s)
- Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Dongqing Wang
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Anne Marie Darling
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Nandita Perumal
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Biostatistics, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Willy Urassa
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrea Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
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8
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Perumal N, Wang D, Darling AM, Wang M, Liu E, Urassa W, Pembe AB, Fawzi WW. Associations between gestational weight gain adequacy and neonatal outcomes in Tanzania. ANNALS OF NUTRITION AND METABOLISM 2022; 78:156-165. [DOI: 10.1159/000522197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/24/2022] [Indexed: 11/19/2022]
Abstract
Introduction: Gestational weight gain (GWG) is associated with fetal and newborn health; however, data from sub-Saharan Africa are limited.
Methods: We used data from a prenatal micronutrient supplementation trial among a cohort of HIV-negative pregnant women in Dar es Salaam, Tanzania to estimate the relationships between GWG and newborn outcomes. GWG adequacy was defined as the ratio of the total observed weight gain over the recommended weight gain based on the Institute of Medicine body mass index (BMI)-specific guidelines. Newborn outcomes assessed were: stillbirth, perinatal death, preterm birth, low birthweight, macrosomia, small-for-gestational age (SGA), large-for-gestational age (LGA), stunting at birth, and microcephaly. Modified Poisson regressions with robust standard error were used to estimate the relative risk of newborn outcomes as a function of GWG adequacy.
Results: Of 7561 women included in this study, 51% had severely inadequate (<70%) or inadequate GWG (70-90%), 31% had adequate GWG (90-125%), and 18% had excessive GWG (≥125%). Compared to adequate GWG, severely inadequate GWG was associated with a higher risk of low birthweight, SGA, stunting at birth, and microcephaly; whereas excessive GWG was associated with a higher risk of LGA and macrosomia.
Conclusion: Interventions to support optimal gestational weight gain are needed and are likely to improve newborn outcomes.
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Chowdhury R, ▪ N, Choudhary TS, Dhabhai N, Mittal P, Dewan R, Kaur J, Chaudhary R, Tamaria A, Bahl R, Taneja S, Bhandari N. Gestational weight gain and pregnancy outcomes: Findings from North Indian pregnancy cohort. MATERNAL & CHILD NUTRITION 2022. [PMCID: PMC8710111 DOI: 10.1111/mcn.13238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite the high prevalence of inadequate gestational weight gain (GWG) and adverse pregnancy outcomes, very few studies have addressed the association between GWG and pregnancy outcomes in South Asia. Our objectives were to estimate the prevalence of GWG during the second and third trimesters within, below and above the Institute of Medicine (IOM) guidelines, and to estimate the effect of the rate and adequacy of GWG on gestational age at the time of delivery, weight, length, length‐for‐age z‐score (LAZ), weight‐for‐length z‐score (WLZ) and adverse pregnancy outcomes, namely prematurity, small‐for‐gestational age (SGA), low birth weight (LBW), stunting and wasting at birth. We analysed data from the intervention group of the Women and Infants Integrated Interventions for Growth Study (WINGS), which is an ongoing individually randomized factorial design study. Of the 1332 women analysed, 40.2% [95% confidence interval (CI) 37.5 to 42.8] had GWG below the IOM guidelines. For every 100‐g/week increase in GWG, birth weight increased by 61 g, birth length by 0.16 cm, LAZ score by 0.08 SD, WLZ score by 0.14 SD, and gestational age at birth by 0.48 days. Women with GWG below the IOM guidelines had a higher relative risk of adverse pregnancy outcomes (44% for LBW, 27% for SGA, 32% for stunting and 42% for wasting at birth) than women who had GWG within the IOM guidelines, except for prematurity. The association between GWG and LAZ scores at birth was modified by early pregnancy body mass index (BMI). GWG is a strong predictor of newborn anthropometric outcomes and duration of gestation but not prematurity.
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Affiliation(s)
- Ranadip Chowdhury
- Centre for Health Research and Development Society for Applied Studies New Delhi India
| | - Nitika ▪
- Centre for Health Research and Development Society for Applied Studies New Delhi India
| | - Tarun Shankar Choudhary
- Knowledge Integration and Translational Platform (KnIT), Centre for Health Research and Development Society for Applied Studies New Delhi India
| | - Neeta Dhabhai
- Centre for Health Research and Development Society for Applied Studies New Delhi India
| | - Pratima Mittal
- Vardhman Mahavir Medical College and Safdarjung Hospital New Delhi India
| | - Rupali Dewan
- Vardhman Mahavir Medical College and Safdarjung Hospital New Delhi India
| | - Jasmine Kaur
- Centre for Health Research and Development Society for Applied Studies New Delhi India
| | - Ritu Chaudhary
- Centre for Health Research and Development Society for Applied Studies New Delhi India
| | - Anuradha Tamaria
- Centre for Health Research and Development Society for Applied Studies New Delhi India
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child, Adolescent Health and Aging World Health Organization Geneva Switzerland
| | - Sunita Taneja
- Centre for Health Research and Development Society for Applied Studies New Delhi India
| | - Nita Bhandari
- Centre for Health Research and Development Society for Applied Studies New Delhi India
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Sámano R, Chico-Barba G, Flores-Quijano ME, Godínez-Martínez E, Martínez-Rojano H, Ortiz-Hernandez L, Nájera-Medina O, Hernández-Trejo M, Hurtado-Solache C. Association of Pregestational BMI and Gestational Weight Gain with Maternal and Neonatal Outcomes in Adolescents and Adults from Mexico City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:280. [PMID: 35010540 PMCID: PMC8750657 DOI: 10.3390/ijerph19010280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/13/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
During pregnancy, adolescents experience physiological changes different from adults because they have not concluded their physical growth. Therefore, maternal and neonatal outcomes may not be the same. This paper aimed to analyze the association between pregestational BMI (pBMI) and gestational weight gain (GWG) with maternal and neonatal outcomes in adolescent and adult pregnant women. The authors performed an observational study that included 1112 women, where 52.6% (n = 585) were adolescents. Sociodemographic information, pBMI, GWG, neonatal anthropometric measures, and maternal and neonatal outcomes were obtained. Adolescent women had a mean lower (21.4 vs. 26.2, p ≤ 0.001) pBMI than adults and a higher gestational weight gain (12.3 vs. 10.7 kg, p ≤ 0.001). According to Poisson regression models, gestational diabetes is positively associated with insufficient GWG and with pregestational obesity. Furthermore, the probability of developing pregnancy-induced hypertension increased with pBMI of obesity compared to normal weight. Preeclampsia, anemia, and preterm birth were not associated with GWG. Insufficient GWG was a risk factor, and being overweight was a protective factor for low birth weight and small for gestational age. We conclude that pBMI, GWG, and age group were associated only with gestational diabetes and low birth weight.
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Affiliation(s)
- Reyna Sámano
- Coordinación de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, Mexico City 11000, Mexico; (M.E.F.-Q.); (E.G.-M.)
- Programa de Posgrado Doctorado en Ciencias Biológicas y de la Salud, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Mexico City 04960, Mexico; (L.O.-H.); (O.N.-M.)
| | - Gabriela Chico-Barba
- Coordinación de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, Mexico City 11000, Mexico; (M.E.F.-Q.); (E.G.-M.)
- Escuela de Enfermería, Facultad de Ciencias de la Salud, Universidad Panamericana, Mexico City 03920, Mexico
- Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - María Eugenia Flores-Quijano
- Coordinación de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, Mexico City 11000, Mexico; (M.E.F.-Q.); (E.G.-M.)
| | - Estela Godínez-Martínez
- Coordinación de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Secretaría de Salud, Mexico City 11000, Mexico; (M.E.F.-Q.); (E.G.-M.)
| | - Hugo Martínez-Rojano
- Sección de Posgrado e Investigación de la Escuela Superior de Medicina del Instituto Politécnico Nacional, Mexico City 11340, Mexico;
| | - Luis Ortiz-Hernandez
- Programa de Posgrado Doctorado en Ciencias Biológicas y de la Salud, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Mexico City 04960, Mexico; (L.O.-H.); (O.N.-M.)
- Departamento de Atención a la Salud, Universidad Autónoma Metropolitana Xochimilco, Mexico City 04960, Mexico
| | - Oralia Nájera-Medina
- Programa de Posgrado Doctorado en Ciencias Biológicas y de la Salud, División de Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Mexico City 04960, Mexico; (L.O.-H.); (O.N.-M.)
- Departamento de Atención a la Salud, Universidad Autónoma Metropolitana Xochimilco, Mexico City 04960, Mexico
| | - María Hernández-Trejo
- Departamento de Neurobiología del Desarrollo, Instituto Nacional de Perinatología, Secretaría de Salud, Mexico City 11000, Mexico;
| | - Cristopher Hurtado-Solache
- Escuela de Ciencias de la Salud, Universidad del Valle de México-Chapultepec, Mexico City 11810, Mexico;
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Nakandakare P, Nicoletti CF, Noronha NY, Nonino CB, Argentato PP, Dejani NN, Luzia LA, Rogero MM, Rondó PHC. Associations between obesity-related gene expression in maternal and cord blood and newborn adiposity: findings from the Araraquara Cohort study. Int J Obes (Lond) 2021; 45:1958-1966. [PMID: 34002037 DOI: 10.1038/s41366-021-00857-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 04/22/2021] [Accepted: 04/30/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND/OBJECTIVES Genes involved in the regulation of metabolism, adipose tissue deposition, inflammation, and the appetite-satiety axis may play an important role in fetal development, and possibly induce permanent metabolic changes and fat accumulation. In this study we investigated: (1) obesity-related gene expression in maternal and cord blood of overweight/obese and normal-weight pregnant women; (2) associations between obesity-related gene expression in maternal and cord blood; and (3) associations of gene expression in each of maternal and cord blood with newborn adiposity. SUBJECTS/METHODS Twenty-five overweight/obese and 32 normal-weight pregnant women were selected from the Araraquara Cohort Study according to their pre-pregnancy BMI. Maternal and cord blood gene expression of LEPR, STAT3, PPARG, TLR4, IL-6, IL-10, FTO, MC4R, TNF-α, and NFκB were investigated by relative real-time PCR quantification. The body composition of the newborns was assessed by air displacement plethysmography. Associations between maternal and cord blood gene expression and markers of newborn adiposity (weight, BMI, and fat mass%) were explored by linear regression models controlling for maternal age, pre-pregnancy BMI, maternal gestational weight gain, gestational age, and newborn sex. RESULTS There was higher TLR4, NFκB, and TNF-a expression, and lower IL-6 expression, in overweight/obese pregnant women and their respective newborns compared with normal-weight women and their newborns (p < 0.001). Maternal PPARG gene expression was associated with both weight and fat mass % of the newborns, and cord blood IL-10 expression was associated with BMI and fat mass %, controlling for confounders. CONCLUSION To our knowledge, this is the first study to evaluate the relationship of maternal and cord blood gene expression with adiposity markers of the newborn. Our results provide evidence for the contribution of maternal and cord blood gene expression-particularly maternal PPARG and TLR4 expression, and cord blood IL-10 expression-to newborn weight, BMI, and fat mass %.
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Affiliation(s)
- P Nakandakare
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - C F Nicoletti
- Laboratory of Nutrigenomics Studies, Department of Health Science, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - N Y Noronha
- Department of Internal Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - C B Nonino
- Laboratory of Nutrigenomics Studies, Department of Health Science, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - P P Argentato
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - N N Dejani
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - L A Luzia
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - M M Rogero
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - P H C Rondó
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, Brazil.
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12
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Hasan SMT, Khan MA, Ahmed T. Institute of Medicine Recommendations on the Rate of Gestational Weight Gain and Perinatal Outcomes in Rural Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126519. [PMID: 34204323 PMCID: PMC8296315 DOI: 10.3390/ijerph18126519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/01/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022]
Abstract
Although validated in other parts of the world, the suitability of the U.S. Institute of Medicine (IOM) 2009 recommendations on gestational weight gain (GWG) for Bangladeshi women remains to be examined. We evaluated the association between the weekly rate of weight gain during the second and third trimester of pregnancy, categorized according to IOM recommendations, and adverse perinatal outcomes among 1569 pregnant women with singleton live births in rural Matlab, Bangladesh. Gaining weight at rates below the IOM recommendations was associated with higher odds of preterm birth (adjusted odds ratio (AOR) = 2.0, 95% CI: 1.1-3.6), low birth weight (AOR = 1.4, 95% CI: 1.03-2.0), small-for-gestational-age newborns (AOR = 1.3, 95% CI: 1.04-1.7), and poor neonatal outcome (severe neonatal morbidity or death, AOR = 2.4, 95% CI: 1.03-5.6). A GWG rate above the recommendations was associated with higher odds of cesarean delivery (AOR = 1.7, 95% CI: 1.1-2.6), preterm birth (AOR = 2.2, 95% CI: 1.1-4.4), large-for-gestational-age newborns (AOR = 5.9, 95% CI: 1.5-23.1), and poor neonatal outcome (AOR = 2.7, 95% CI: 1.04-7.0). Our results suggest that the IOM 2009 recommendations on GWG rate during the second and third trimester may be suitable for guiding rural Bangladeshi women in the prenatal period, although the women should aim for rates near the lower bound of the range.
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Affiliation(s)
- S. M. Tafsir Hasan
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh; (M.A.K.); (T.A.)
- Correspondence: ; Tel.: +880-1709651470
| | - Md Alfazal Khan
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh; (M.A.K.); (T.A.)
- Health System and Population Studies Division, icddr,b, Dhaka 1212, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh; (M.A.K.); (T.A.)
- Office of the Executive Director, icddr,b, Dhaka 1212, Bangladesh
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13
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Kac G, Arnold CD, Matias SL, Mridha MK, Dewey KG. Gestational weight gain and newborn anthropometric outcomes in rural Bangladesh. MATERNAL AND CHILD NUTRITION 2019; 15:e12816. [PMID: 30903801 DOI: 10.1111/mcn.12816] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/07/2019] [Accepted: 03/15/2019] [Indexed: 12/17/2022]
Abstract
Low gestational weight gain (GWG) is a known predictor of fetal growth restriction in higher income countries, but there is little information on this association in lower income countries. Our objective is to describe the association between GWG and birth outcomes among pregnant women in rural Bangladesh. Pregnant women were identified in a community-based programme and enrolled into the study at an average of 13 weeks' gestation (n = 4,011). Maternal weight and height were measured at enrolment, maternal weight was measured at 36 weeks' gestation, and newborns were measured after birth. Rate of GWG (g/weeks) was calculated, and women were categorized as having adequate or inadequate GWG (Institute of Medicine recommendations). Newborn anthropometric outcomes included weight-for-age z score (WAZ), length-for-age z score (LAZ), head-circumference-for-age z score (HCZ), body mass index (BMI)-for-age z score (BMIZ), low birthweight (LBW < 2,500 g), WAZ < -2, LAZ < -2, HCZ < -2, BMIZ < -2, and small for gestational age (SGA: <10th percentile). Multivariate models were adjusted for confounders. Only 26% of the 2,562 women in these analyses had adequate GWG. Compared with newborns of women with inadequate GWG, infants of women with adequate GWG had a lower risk of adverse anthropometric outcomes (relative risk [95% confidence interval]: LBW = 0.68 [0.59, 0.80], LAZ < -2 = 0.64 [0.51, 0.80], HCZ < -2 = 0.75 [0.60, 0.93], BMIZ < -2 = 0.70 [0.59, 0.83], and SGA = 0.80 [0.73, 0.86]), but there was no significant difference in mean (SE) duration of gestation, 39.7 (0.08) versus 39.7 (0.05) weeks. In this population, GWG rate is a strong predictor of newborn anthropometric outcomes, but not duration of gestation.
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Affiliation(s)
- Gilberto Kac
- Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Charles D Arnold
- Department of Nutrition, University of California, Davis, Davis, California
| | - Susana L Matias
- Department of Nutrition, University of California, Davis, Davis, California
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, California
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