The impact of maternal adiposity specialization on infant birthweight: upper versus lower body fat

Adverse Maternal Nutritional Status Affects Birth Weight among Rural Mothers of Maharashtra

Maternal anthropometry and its influence on the birth weight has been studied widely, but effects of maternal undernutrition in-utero depicted by surrogate measures of sitting height and head circumference are largely unknown. We have studied the maternal sitting height along with other conventional nutritional status indicators at registration in predicting the risk of low birth weight (LBW) among 204 young rural women. Information on socio-demographic and economic profile, anthropometric measurements at registration and neonatal birth weight after delivery was recorded. Mothers were thin (mean weight; 46.4±6.1 kg), had short stature (mean height: 153.3±5.7 cm) and 33.8% were undernourished (body mass index (BMI) <18.5 kg/m²). Prevalence of LBW was 27.5%. Maternal weight, height, BMI, head circumference, sitting height and %body fat at registration were significantly (p<0.05) associated with birth weight. Significant risks for LBW were observed for low (<42.26 kg) weight (OR=3.69; CI: 1.6-8.1), short (<150 cm) height (OR=2.3; CI: 1-5.1), low (<18.5 kg/m²) BMI (OR=3.27; CI: 1.4-7.3), low (<70 cm) sitting height (OR=2.3; CI: 1.0-5.1), small (<52 cm) head circumference (OR=3.3; CI: 1.6-7.1), and low (<22.7%) %body fat (OR=4.98; CI: 2.2-11.2). Interestingly, these risks remained significant for sitting height (OR=3.4; CI: 1.5-7.6, OR=2.5; CI: 1.1-5.8) and head circumference (OR=2.4; CI: 1.1-5.6, OR=2.2; CI: 0.9-5.03) even after adjusting for BMI and %body fat respectively indicating their independent influence. Our findings highlight that in addition to the current maternal undernourishment, maternal undernourishment in-utero (small head circumference and short sitting height) imposes risk for LBW.

Risk factors for low birth weight among rural and urban Malaysian women

BACKGROUND

Low birth weight prevalence in Malaysia remains high. Socioeconomic background may lead to differences in physical activity and maternal nutritional status, which may play an important role in birth outcomes.

METHODS

This prospective cross-sectional study aimed to identify rural-urban differences in risk factors for low birth weight among women in Malaysia. Pregnant women at ≥20 weeks of gestation in urban and rural Malaysia (n = 437) completed questionnaires on sociodemographic characteristics and physical activity. Weight and middle-upper arm circumference were measured. Infant birth outcomes were extracted from medical records.

RESULTS

The overall prevalence of low birth weight infants was 6.38%. Rural women had more low birth weight infants than urban women (9.8% vs 2.0%, p = 0.03). Findings showed rural women were less sedentary (p = 0.003) and participated in more household/caregiving activities (p = 0.036), sports activities (p = 0.01) and less occupational activity (p < 0.001) than urban women. Logistic regression revealed that older age (OR = 1.395, 95% Cl = 1.053 to 1.846), low parity (OR = 0.256, 95% Cl = 0.088-0.747) and low middle-upper arm circumference (OR = 0.738, 95% Cl = 0.552 to 0.987) increased the risk of low birth weight infants in rural, but not in urban women.

CONCLUSIONS

We observed differences in risk factors for low birth weight between urban and rural pregnant women. Age, malnutrition and low parity were risk factors for low birth weight among rural pregnant women. Our findings suggest that rural pregnant women with low nutritional status should be encouraged to monitor their middle-upper arm circumference consistently throughout pregnancy. Improving nutritional status in rural pregnant women may reduce the risk of low birth weight infants in this population.

PEARLS randomized lifestyle trial in pregnant Hispanic women with overweight/obesity: gestational weight gain and offspring birthweight

BACKGROUND

Inappropriate gestational weight gain (GWG) has been associated with adverse perinatal events. High rates of GWG have been reported among Hispanic women. Observational studies indicate that dietary and physical activity interventions during the prenatal period may improve maternal and infant health, but very few randomized trials have been conducted among high-risk overweight/obese Hispanic women. Accordingly, we conducted a lifestyle intervention among high-risk pregnant women and evaluated its impact on achieving appropriate GWG and on improving birthweight.

METHODS

Eligible overweight/obese women presenting at the University Hospital in Puerto Rico with a singleton pregnancy before 16 gestational weeks were recruited and randomized to lifestyle intervention (n=15) or control group (n=16). The lifestyle intervention focused on improving physical activity and diet quality and optimizing caloric intake. We evaluated the impact of the lifestyle intervention on achieving appropriate GWG and on infant birthweight. Poisson and linear regression analyses were performed.

RESULTS

The primary intent to treat analysis showed no significant effect on achievement of appropriate GWG/week through 36 weeks in the intervention group (4/15 women) when compared with the control group (3/16 women) (adjusted incidence rate ratio =1.14; 95% CI: 0.20, 6.67). Although not statistically significant, women in the intervention group (6/15) were 1.7 times more likely to achieve appropriate weekly GWG until delivery when compared with controls (4/16 women) (adjusted incidence rate ratio = 1.67; 95% CI: 0.40, 6.94). We observed lower adjusted birthweight-for-length z-scores in the intervention compared with the control group among male newborns with z-score difference -1.74 (-3.04, -0.43), but not among females -0.83 (-3.85, 2.19). These analyses were adjusted for age and baseline body mass index.

CONCLUSION

Although larger studies are required to determine whether women with obesity may benefit from prenatal lifestyle interventions targeting GWG, our results are suggestive of the intervention improving adherence to established Institute of Medicine guidelines.