Magnitude and determinants of inadequate third-trimester weight gain in rural Bangladesh

Gestational weight gain at the national, regional, and income group levels based on 234 national household surveys from 70 low-income and middle-income countries

Gestational weight gain (GWG) estimates enable the identification of populations of women at risk for adverse outcomes. We described GWG distribution in low- and middle-income countries (LMICs). Demographic and Health Surveys and other national surveys were used to calculate the average GWG by regressing the weight of pregnant women (15-49 years) at the time of the interview on their gestational age, adjusting for sociodemographic factors. A mixed-effects hierarchical model was built with survey-specific GWG as the dependent variable and restricted cubic splines for survey year, super-region, and country-level covariates (total fertility rate, gross domestic product, and average female body mass index) to predict the national, regional, and income level average GWG in 2020. Uncertainty ranges (UR) were obtained using bootstrap. Estimates were compared with the Institute of Medicine's GWG recommendations for women with normal weight (11.5kg) and underweight (12.5kg). Survey data were available for 70 LMICs (234 data points, 1991-2022). Predicted country-specific GWG for 2020 ranged from 2.6 to 13.5kg. Ten countries presented estimates above the recommendation for women with underweight; nine of which were from Central Europe, Eastern Europe, and Central Asia; apart from one, these were upper-middle income. Regional GWG was estimated at 5.4kg (95%UR 3.1,7.7) in Sub-Saharan Africa; 6.2kg (95%UR 3.4,9.0) in North Africa and the Middle East; 8.6kg (95%UR 6.0,11.3) in South Asia; 9.3kg (95%UR 6.2,12.3) in Southeast Asia, East Asia, and Oceania; 10.0kg (95%UR 7.1,12.9) in Latin America and the Caribbean; and 13.0kg (95%UR 9.0,16.9) in Central and Eastern Europe, and Central Asia. A gradient was observed across income: 5.3kg (95%UR 2.7,7.9) for low-income, 7.6kg (95%UR 5.2,10.1) for lower-middle-income, and 9.8kg (95%UR 7.1,12.5) for upper-middle-income countries. No income group achieved the minimum recommended weight gain. GWG was estimated to be insufficient in almost all LMICs. Improved data and monitoring are crucial for impactful interventions.

Effects of maternal exposure to biomass cooking fuel on birth size and body proportionality in full-term infants born by vaginal delivery

It remains unclear whether and how maternal exposure to biomass fuel influences infant anthropometry or body proportionality at birth, which are linked to their survival, physical growth, and neurodevelopment. Therefore, this study seeks to explore the association between household-level exposure to biomass cooking fuels and infant size and body proportionality at birth among women in rural Bangladesh. A total of 909 women were derived from the Pregnancy Weight Gain study, which was conducted in Matlab, a rural area of Bangladesh. Infant's weight (g), length (cm), head circumference (cm), small for gestational age (SGAW), short for gestational age (SGAL), low head circumference for gestational age (SGAHC), ponderal index, and cephalization index at birth were the outcomes studied. Of the women, 721 (79.3%) were dependent on biomass fuel. Compared to infants born to mothers who used gas for cooking, those born to biomass users had lower weight (β - 94.3, CI - 155.9, - 32.6), length (β - 0.36, 95% CI - 0.68, - 0.04), head circumference (β - 0.24, CI - 0.47, - 0.02) and higher cephalization index (β 0.03, CI 0.01, 0.05) at birth. Maternal biomass exposure is more likely to lead to symmetric SGA, although there is evidence for some brain-sparing effects.

Impact of Pre-Gestational BMI and Gestational Weight Gain on Fetal Development Outcomes in Adolescent Pregnant Women

Background. Gestational weight gain (GWG) constitutes an essential aspect of the gestational process. Due to factors such as pregestational body mass index (BMI), nutritional intake, level of physical activity, and psychological aspects, the recommended GWG may not be achieved, leading to adverse neonatal outcomes. Adolescents, due to their physiological and mental developmental stage, are at a higher risk of inappropriate GWG. Our aim is to highlight the importance of GWG in our population and to determine the correlation with perinatal outcomes. Methods. Pregnant adolescents who attended a tertiary care institution for prenatal care were included; maternal data such as preBMI and GWG were used to determine maternal and neonatal outcomes using the chi-square test and OR determination. Results. A total of 202 adolescent pregnant patients were included, comprising those with inadequate GWG (n = 70), adequate GWG (n = 85), and excessive GWG (n = 47). A statistically significant association was found between low BMI and inadequate GWG. Patients with inadequate GWG demonstrated a correlation with IUGR and low birth weight, while patients with excessive GWG gave birth to macrosomic neonates. Conclusion. We concluded that previous habits play a significant role in determining weight gain throughout pregnancy. GWG has a direct impact on neonatal growth and development.

Pattern of weight gain in pregnant women in slum areas of Hamadan using multilevel ordinal regression

BACKGROUND

Adequate gestational weight gain (GWG) is an important factor for maternal and fetal health. This is especially important in low-income and slum areas due to limited access to health services and malnutrition. Thus, the purpose of this study is to evaluate the pattern of GWG changes in the slum areas of Hamadan in Iran.

METHODS

In this longitudinal study, the study sample consisted of 509 pregnant women who referred to nine health care clinics in the slum areas of Hamadan. Women's weight gain based on the recommended GWG by U.S. Institute of Medicine (IOM) was divided into three categories: Inadequate weight gain, Adequate weight gain, and Excessive weight gain. In order to evaluate the trend of GWG, a multi-level ordinal model was used.

RESULTS

According to pre-pregnancy BMI, a little more than half people (56.6%) were overweight or obese. 85.4% women in the first trimester and 49.1% in the second trimester did not have adequate GWG, but in the third trimester (38.9%) had adequate GWG. Based on multivariate analysis, pre- pregnancy BMI has a significant effect on the odds of inadequate GWG (P-value = 0.021); with one unit increase in pre-pregnancy BMI, the odds of inadequate GWG grows by 1.07 times compared to adequate and excessive GWG.

CONCLUSIONS

In general, women did not have adequate weight gain in the first and second trimesters.Thus, designing appropriate interventions to achieve optimal GWG seems to be necessary in slums.

Fortified Balanced Energy-Protein Supplementation, Maternal Anemia, and Gestational Weight Gain: A Randomized Controlled Efficacy Trial among Pregnant Women in Rural Burkina Faso

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.

Determinants of Suboptimal Gestational Weight Gain among Antenatal Women Residing in the Highest Gross Domestic Product (GDP) Region of Malaysia

Suboptimal gestational weight gain has been associated with adverse perinatal and maternal outcomes, including increased risk of non-communicable diseases later in life. This study aimed to determine the proportion and determinants of suboptimal GWG. A cross-sectional study was conducted among 475 pregnant women in Selangor between January and March 2020. The study included all pregnant women at their second or third trimester who fulfilled the inclusion and exclusion criteria. A multistage sampling was applied. The GWG adequacy was based on recommendations from the Institute of Medicine (2009). Multinomial logistic regressions were used for data analysis. Out of the 475 respondents, 224 (47.2%) pregnant women had inadequate GWG, 142 (29.9%) had adequate GWG, and 109 (22.9%) had excessive GWG. Multinomial logistic regression showed that having diabetes in pregnancy (AdjOR 2.24, 95% CI: 1.31, 3.83, p = 0.003), middle (M40) monthly household income (AdjOR 2.33, 95% CI: 1.09, 4.96, p = 0.029), low (B40) monthly household income (AdjOR 2.22, 95% CI: 1.07, 4.72, p = 0.039), and an obese pre-pregnancy BMI (AdjOR 2.77, 95% CI: 1.43, 5.35, p = 0.002) were significantly associated with inadequate GWG. Overweight (AdjOR 5.18, 95% CI: 2.52, 10.62, p < 0.001) and obese pre-pregnancy BMIs (AdjOR 17.95, 95% CI: 8.13, 36.95, p < 0.001) were significantly associated with excessive GWG. Improving maternal and perinatal outcomes requires targeted interventions focusing on these modifiable determinants.

Gestational weight gain and pregnancy outcomes: Findings from North Indian pregnancy cohort

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.

Association of Household Food Insecurity with Nutritional Status and Mental Health of Pregnant Women in Rural Bangladesh

Food insecurity may affect women’s health; however, pertinent research is scant among pregnant women. This study investigated the association of household food insecurity (HFI) with the nutritional status and mental health of 672 early-gestation (5–16 weeks) pregnant women with a singleton fetus, who participated in the screening activity of a community-based trial (NCT04868669) in Matlab, Bangladesh. Height (cm), weight (kg), body mass index (kg/m²), mid-upper arm circumference (MUAC) (cm), depression, anxiety, and stress were the outcomes studied. HFI was assessed using the Household Food Insecurity Access Scale. Women’s depression, anxiety, and stress were assessed using the Depression, Anxiety, and Stress Scales-21. Propensity score matching based weighted multivariable linear and logistic regression were used to evaluate the independent association of HFI with the outcomes. In adjusted models, pregnant women from food-insecure households in rural Matlab were on average 2.0 cm shorter (β = −2.0, 95% CI: −3.3, −0.7), 2.0 kg lighter (β = −2.0, 95% CI: −3.4, −0.7), and had 0.6 cm lower MUAC (β = −0.6, 95% CI: −1.1, −0.1) than their food-secure counterparts. HFI was associated with higher odds of depression (OR = 3.3, 95% CI: 1.8, 5.9), anxiety (OR = 6.1, 95% CI: 3.7, 10.0), and stress (OR = 4.8, 95% CI: 1.6, 14.2) among the women. Public health measures should focus on ensuring proper nutrition during the critical growth periods of life, pregnancy, and external environmental shocks, to mitigate the adverse effects of HFI on women’s health.

Pre-conception and prenatal factors influencing gestational weight gain: a prospective study in Tigray region, northern Ethiopia

Background

In low-income countries, the high prevalence of pre-pregnancy undernutrition remains a challenge for the future health of women and their offspring. On top of good nutrition, adequate gestational weight gain has been recognized as an essential prerequisite for optimal maternal and child health outcomes. However, good-quality data on factors influencing gestational weight gain is lacking. Therefore, this study was aimed to prospectively identify pre-conception and prenatal factors influencing gestational weight gain in Ethiopia.

Methods

A population based prospective study was undertaken between February 2018 and January 2019 in the Tigray region, northern Ethiopia. Firstly, the weight of non-pregnant women of reproductive age living in the study area was measured between August and October 2017. Subsequently, eligible pregnant women identified during the study period were included consecutively and followed until birth. Data were collected through an interviewer-administered questionnaire and anthropometric measurements complemented with secondary data. Gestational weight gain, i.e., the difference between 32 to 36 weeks of gestation and pre-pregnancy weights, was classified as per the Institute of Medicine (IOM) guideline. Linear, spline, and logistic regression models were used to estimate the influence of pre-conception and prenatal factors on gestational weight gain.

Results

The mean gestational weight gain (standard deviation[SD]) was 10.6 (2.3) kg. Overall, 64.0% (95% CI 60.9, 67.1) of the women did not achieve adequate weight gain. Factors associated with higher gestational weight gain were higher women empowerment (B 0.60, 95% CI 0.06, 1.14), dietary diversity (B 0.39, 95% CI 0.03, 0.76), pre-pregnancy body mass index (B 0.13, 95% CI 0.05, 0.22), and haemoglobin (B 0.54, 95% CI 0.45, 0.64). Additionally, adequate prenatal care (B 0.58, 95% CI 0.28, 0.88) was associated with higher gestational weight gain.

Conclusions

Adequate gestational weight gain was not achieved by most women in the study area, primarily not by those who were underweight before pregnancy. Interventions that advance women’s empowerment, dietary quality, pre-pregnancy nutritional status, and prenatal care utilization may improve gestational weight gain and contribute to optimizing maternal and child health outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04171-z.

Institute of Medicine Recommendations on the Rate of Gestational Weight Gain and Perinatal Outcomes in Rural Bangladesh

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.

Seasonal trends and maternal characteristics as predictors of maternal undernutrition and low birthweight in Eastern Maharashtra, India

Few studies have assessed whether women and infants in rural and peri-urban communities in South Asia experience seasonal fluctuations in nutritional status; however, a handful of studies have documented seasonal variability in risk factors for undernutrition including food availability, physical activity and infections. We used data from the Maternal and Newborn Health (MNH) registry, a population-based pregnancy and birth registry in Eastern Maharashtra, India, to analyse seasonal trends in birthweight and maternal nutritional status-body mass index (BMI) and haemoglobin-in the first trimester of pregnancy. We plotted monthly and seasonal trends in birthweight, and maternal BMI and haemoglobin, and used multivariable regression models to identify seasonal and maternal characteristics that predicted each outcome. Between October 2014 and January 2018, MNH included 29,253 livebirths with recorded birthweight. BMI was assessed in 15,252 women less than 12 weeks of gestation and haemoglobin in 18,278 women less than 13 weeks of gestation. Maternal characteristics (age, education, parity and height) were significantly associated with nutritional status; however, there were minimal seasonal fluctuations in birthweight or maternal nutrition. There were significant secular trends in maternal haemoglobin; between 2014 and 2018, the prevalence of maternal anaemia decreased from 91% to 79% and moderate or severe anaemia from 53% to 37%. The prevalence of maternal underweight (45.3%) and overweight (9.8%) and low birthweight (19.1%) remained relatively constant over the study period. Our findings highlight that in some rural and peri-urban areas in South Asia, tackling systemic drivers of malnutrition may be more effective than targeted interventions based on season.

Factors associated with moderate wasting among marginalized 6 to 23-month aged children in Bangladesh: Findings of the Suchana program baseline survey data

Suchana-a large-scale, 7-year nutrition program that started in 2015-is being implemented in 250,000 households in the marginalized segment in north-east Bangladesh, with the aim of improving childhood nutrition status. Untreated childhood moderate wasting may develop to severe wasting, which is associated with a 10-fold higher risk of mortality compared to children of normal weight relative to height/length. Identifying the diverse, age-specific risk factors for moderate wasting may help such programs to formulate tailored interventions to prevent and treat childhood malnutrition in rural communities. The objective of this study was to identify the age-specific factors associated with moderate wasting among 6‒23-month-old children in beneficiary households. Cross-sectional data on 4,400 children was collected through systematic sampling between November 2016 and February 2017 using the Suchana beneficiary list. In total, 8.1% of 6‒11 month-olds and 10.3% of 12‒23 month-olds suffered moderate wasting; 12‒23-month-olds had a 1.3-fold higher risk of moderate wasting than 6‒11-month-olds. Our results of logistic regression models suggest that larger household size, higher maternal body mass index (BMI), and maternal food consumption status more than usual during the recent pregnancy were associated with a reduced risk of moderate wasting among 6‒11-month-olds. Higher maternal BMI, normal maternal food consumption status during last pregnancy, being female and maternal knowledge on diarrheal management, were associated with a reduced risk of moderate wasting among 12‒23-month-olds. In conclusion, beyond maternal BMI and maternal food consumption status during the last pregnancy, the factors associated with moderate wasting among 6‒23-month-olds in the poorest households in Bangladesh are age-specific.

Factors associated with insufficient weight gain among Mexican pregnant women with HIV infection receiving antiretroviral therapy

Objective

We identified clinical, dietary, and socioeconomic factors associated with insufficient gestational weight gain among Mexican pregnant women with human immunodeficiency virus (HIV) infection.

Methods

This was a cross-sectional study involving 112 pregnant women with HIV infection receiving antiretroviral therapy (ART). Data including viral load, complete blood analysis, and CD4 counts were extracted from medical records. An inquiry form was used to collect data on socioeconomic status and frequency of food intake. Pre-gestational weight was calculated based on pregnancy weight to obtain the body mass index (BMI) and weight gain for gestational age according the US Institute of Medicine. Of the study population, 68.7% were in consensual union, 31.3% were single, and 33.9% belonged to the two lowest socioeconomic strata. The median age and CD4 count were 27 (interquartile range [IQR]: 23–32) years and 418 (IQR: 267–591), respectively. The adequacy of energy was 91.8% (IQR: 74.1–117.7). The median energy intake from protein was 13.5% (IQR: 12.2–14.9) and from lipids, 35.5% (IQR: 31.1–40.3). Pregnant women with gastrointestinal symptoms and CD4 count <350 were seven times more likely to have folate deficiency (odds ratio [OR] 7.8, 95% confidence interval [CI] 1.6–38.1; p = 0.009) and six times more likely to have poor zinc intake (OR 6.7, 95% CI 1.3–36.8; p = 0.014). In all, 42.9% of the pregnant women consumed iron and folic acid supplements and 54.4% consumed multivitamin supplements. Moreover, 45.5% had a normal pre-gestational BMI, 41.1% were classified overweight, and 13.4% had obesity, whereas 62.5% showed insufficient gestational weight gain, and 18.8% experienced weight loss. The variables associated with insufficient weight gain were consensual union (OR 5.3, 95% CI 1.9–15.0; p = 0.002) and belonging to the lowest socioeconomic stratum (E) (OR 3.1, 95% CI 1.0–9.2; p = 0.046).

Conclusion

Dietary strategies to improve gestational weight gain for Mexican women with HIV infection receiving ART must consider clinical and socioeconomic factors.

Effect of Maternal Exposure to Seasons during the Second and Third Trimesters of Pregnancy on Infant Birth Weight in Rural Bangladesh

BACKGROUND

Pregnant women belonging to agricultural communities of low- and middle-income countries often face seasonal food insecurity and energy stress.

OBJECTIVES

We aimed to investigate the effect of maternal exposure to different seasons during the second and third trimesters of pregnancy on infant birth weight in rural Bangladesh.

METHODS

Information on 3831 singleton live births was obtained from the electronic databases of Matlab Health and Demographic Surveillance System and Matlab hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh. We collected information on all term births from July 2011 to June 2015 and excluded congenital anomalies and observations with missing data. Each year was divided into 3 distinct seasons: the post-aman harvest period (January-April), the height of the monsoon (May-August), and the post-aus harvest period (September-December). Seasonal exposure was measured in weeks, and multivariable linear regression models were fitted to determine the independent effect of each week of exposure of different seasons during the second and third trimesters of pregnancy on birth weight.

RESULTS

We observed peak birth weight in the post-aman harvest season, especially among infants born in March (mean ± SD: 2930.5 ± 462.1 g), and the lowest birth weight in the month of July (2830.6 ± 385.4 g) during the monsoon season. Regression analysis showed that exposure to the post-aman harvest season during the third trimester, and the post-aus harvest period during the second trimester of pregnancy had significant positive effects on birth weight. In the final adjusted model, each week of exposure to the post-aman harvest season during the third trimester was associated with a 6.3-g (95% CI: 1.6, 10.9 g; P = 0.008) increase in birth weight.

CONCLUSIONS

Infants born to women who were exposed to the post-aman harvest season for the entire third trimester (14 wk) were associated with 88.2-g higher weight at birth. Further investigations into the complex interplay between seasonal energy stress, maternal, and fetal nutrition and measures to alleviate it are warranted.

Inadequate maternal weight gain in the third trimester increases the risk of intrauterine growth restriction in rural Bangladesh

OBJECTIVE

To estimate the effect of inadequate maternal weight gain in the third trimester on the risk of intrauterine growth restriction (IUGR) in rural Bangladesh.

METHODS

This study analyzed data from 1,463 mother-infant pairs in Matlab, Bangladesh which were available through the electronic databases of Matlab Health and Demographic Surveillance System and Matlab hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). All the mothers were admitted to Matlab hospital for childbirth from January 2012 to December 2014, and they had singleton live births at term. Third-trimester weight gain (kg) was calculated by subtracting the estimated weight at the end of the second trimester from the weight taken before childbirth. Inadequate third-trimester weight gain was defined as 4 kg or less irrespective of pre-gravid nutritional status. IUGR was defined as a birth weight below 2500 g in full-term newborns (LBW-Term), and a birth weight for gestational age and infant sex less than the 10th percentile (SGA-10th) and 2 standard deviations below the mean birth weight (SGA-2SD) based on the international newborn standards from the INTERGROWTH-21st project. Multivariable logistic regression models were fitted to determine the independent effect of inadequate weight gain in the third trimester on the risk of IUGR.

RESULTS

A total of 824 (56.3%) women experienced inadequate weight gain in the third trimester of pregnancy. In this study, 215 (14.7%), 573 (39.2%) and 220 (15.0%) infants were born as LBW-Term, SGA-10th and SGA-2SD, respectively. In the multivariable logistic regression models, compared to adequate weight gain in the third-trimester, the odds ratios (OR) for LBW-Term, SGA-10th and SGA-2SD for inadequate weight gain were 1.8 (95% CI: 1.3, 2.5; p < 0.001), 1.4 (95% CI: 1.1, 1.8; p = 0.002) and 1.8 (95% CI: 1.3, 2.4; p = 0.001), respectively.

CONCLUSIONS

Both inadequate third-trimester weight gain and IUGR are prevailing public health concerns in rural Bangladesh. Inadequate weight gain in the third trimester substantially increased the risk of IUGR. Public health programs focusing on the promotion of adequate weight gain in the third trimester of pregnancy with an ultimate aim to decrease IUGR should be implemented.