Pregnancy weight gain in Iranian women attending a cross-sectional study of public health centres in Rasht

Are women in Uganda gaining adequate gestational weight? A prospective study in low income urban Kampala

Background

Pre-pregnancy weight and weight gained during pregnancy significantly influence maternal and infant health. Little information is available regarding optimal gestational weight gain (GWG) in relation to pre-pregnancy body mass index (BMI) in Uganda. The study aimed at determining gestational weight gain (GWG) in women pregnant for the first and second time.

Methods

The study was prospective cohort study which included 221 HIV negative women pregnant for the first or second time. It was conducted in the antenatal clinic of the directorate of gynecology and obstetrics, Mulago hospital and women were recruited at ≤18 weeks of gestation by dates. Follow up measurements were done at 26 and 36 weeks gestation. Measured maternal height and reported pre-pregnancy weight were used to calculate BMI. Depending on BMI category, GWG was categorized as inadequate, adequate and excessive based on the Uganda Ministry of Health guidelines.

Results

The participants’ mean ± standard deviation (Sd) age was 20.9 ± 2.7 years and mean ± Sd BMI was 21.40 ± 2.73 kg/m². None of the participants was obese and 68.8% (n = 132) were pregnant for the first time. The mean ± Sd GWG at time of delivery was 10.58 ± 2.44 kg. Inadequate GWG was recorded in 62.5% (n = 120/192) while only 3.1% (n = 6/192) of the participants gained excessive weight during pregnancy.

Conclusion

About 62% of pregnant women in Kampala did not gain adequate weight during their first/second pregnancy. We recommend that studies be carried out to assess whether the Uganda Ministry of Health recommendations for weight gain during are appropriate for preventing adverse pregnancy outcomes across populations in Uganda.

How weight during pregnancy influences the association between pre-pregnancy body mass index and types of delivery and birth: a comparison of urban and rural areas

BACKGROUND

Women in study areas suffered from the problems of caesarean delivery (CD), low birth weight (LBW), and macrosomia.

OBJECTIVE

To investigate how gestational weight gain (GWG) influences the effect of the pre-pregnancy body mass index (BMI) on the risks of CD, LBW, and macrosomia in urban and rural areas in a city of Iran.

METHODS

We used 767 and 612 eligible subjects from the public health care centers in urban and rural areas respectively.

RESULTS

The risk of CD increased from 74% to 2.62-fold in urban and from 62% to 2.15-fold in rural areas, and the risk of macrosomia increased from 58% to 2.35-fold in urban and from 47% to 96% in rural areas, among obese women compared to normal weight women who gained above median GWG. The risk of LBW increased from 38% to 92% in urban and from 49% to 97% in rural areas among lean women compared to normal weight women who gained below median GWG.

CONCLUSION

These findings strongly support the need to reform adequate pre-pregnancy weight and GWG against the risks of CD and macrosomia among overweight and obese women, and against the risk of LBW among lean women in both areas.

Gestational weight gain and its related social and demographic factors in health care settings of rural and urban areas in northwest Iran

The current study was aimed to evaluate gestational weight gain and its socio-demographic determinants among pregnant women in north-west of Iran. In the current cross-sectional study, four hundred eighty one pregnant women aged 26.12 ± 7.45 years were enrolled. Data on pre-pregnancy weight, height, age, educational attainment, parity, household size, hemoglobin status and total pregnancy weight gain were extracted from routine health center records. The pregnant women were categorized based on their pre-pregnancy body mass index (BMI) as underweight, normal weight and overweight or obese according to the 2009 Institute of Medicine (IOM) recommendations. Participants were also classified according to their educational level into three 'some school', 'high school' and 'college' groups. Gestational weight gain in 27.6% of pregnant women was in normal IOM recommended range; while, weight gain in 49% and 23.2% of pregnant women was below and above recommended range respectively. Women with high educational attainment (≥12 years) have significantly higher weight gain compared with low-educated women (<12 years) (P < 0.001). Age was in negative relationship with gestational weigh gain even after adjusting for confounder effects of residency, educational attainment and household size (r = 0.2, P < 0.001). Our data showed a high prevalence of abnormal gestational weight gain in pregnant women attending to public health centers in northwest of Iran. Moreover educational level, parity and age were significant determinants of gestational weight gain in pregnancy. Special attention should be focused on prenatal nutritional status and health care programs in current health care services in Iran.

Effect of physical activity intervention based on a pedometer on physical activity level and anthropometric measures after childbirth: a randomized controlled trial

BACKGROUND

Pregnancy and childbirth are associated with weight gain in women, and retention of weight gained during pregnancy can lead to obesity in later life. Diet and physical activity are factors that can influence the loss of retained pregnancy weight after birth. Exercise guidelines exist for pregnancy, but recommendations for exercise after childbirth are virtually nonexistent. The aim of this study was to evaluate the effect of physical activity intervention based on pedometer on physical activity level and anthropometric measures of women after childbirth.

METHODS

We conducted a randomized controlled trial in which 66 women who had given birth 6 weeks to 6 months prior were randomly assigned to receive either a 12 week tailored program encouraging increased walking using a pedometer (intervention group, n = 32) or routine postpartum care (control group, n = 34). During the 12-week study period, each woman in the intervention group wore a pedometer and recorded her daily step count. The women were advised to increase their steps by 500 per week until they achieved the first target of 5000 steps per day and then continued to increase it to minimum of 10,000 steps per day by the end of 12th week. Assessed outcomes included anthropometric measures, physical activity level, and energy expenditure per week. Data were analyzed using the paired t-test, independent t-test, Mann-Whitney, chi-square, Wilcoxon, covariance analysis, and the general linear model repeated measures procedure as appropriate.

RESULTS

After 12 weeks, women in the intervention group had significantly increased their physical activity and energy expenditure per week (4394 vs. 1651 calorie, p < 0.001). Significant differences between-group in weight (P = 0.001), Body Mass Index (P = 0.001), waist circumference (P = 0.001), hip circumference (P = 0.032) and waist-hip ratio (P = 0.02) were presented after the intervention. The intervention group significantly increased their mean daily step count over the study period (from 3249 before, to 9960 after the intervention, p < 0.001).

CONCLUSION

A physical activity intervention based on pedometer is an effective means to increase physical activity; reducing retention of weight gained during pregnancy and can improve anthropometric measures in postpartum women.

TRIAL REGISTRATION

ISRCTN: IRCT201105026362N1.

Low gestational weight gain and the risk of preterm birth and low birthweight: a systematic review and meta-analyses

BACKGROUND

Low gestational weight gain is common, with potential adverse perinatal outcomes.

OBJECTIVE

To determine the relation between low gestational weight gain and preterm birth and low birthweight in singletons in developing and developed countries.

DATA SOURCES

Medline, EMBASE and reference lists were searched, identifying 6,283 titles and abstracts.

METHODS OF STUDY SELECTION

Following the MOOSE consensus statement, two assessors independently reviewed titles, abstracts, full articles, extracted data and assessed quality.

RESULTS

Fifty-five studies, 37 cohort and 18 case-control, were included, involving 3,467,638 women. In the cohort studies (crude data, generally supported where available by adjusted data and case-control studies), women with low total gestational weight gain had increases in preterm birth <37 weeks [RR 1.64 (95%CI 1.62-1.65)], 32-36 weeks [RR 1.39 (95%CI 1.38-1.40)] and ≤ 32 weeks [RR 3.80 (95%CI 3.72-3.88)]. Low total gestational weight gain was associated with increased risks of low birthweight <2,500 g [RR 1.85 (95%CI 1.72-2.00)], in developing and developed countries [RR 1.84 (95%CI 1.71-1.99) and RR 3.02 (95%CI 1.37-6.63), respectively], 1,500-2,500 g [RR 2.02 (95%CI 1.88-2.17)] and <1,500 g (RR 2.00 (95%CI 1.67-2.40)]. Women with low weekly gestational weight gain were at increased risk of preterm birth [RR 1.56 (95%CI 1.26-1.94)], 32-36 weeks [RR 2.43 (95%CI 2.37-2.50)] and ≤ 32 weeks [RR 2.31 (95%CI 2.20-2.42)] but not low birthweight [RR 1.64 (95%CI 0.89-3.02)].

CONCLUSIONS

In this systematic review, we determined that singletons born to women with low total gestational weight gain have higher risks of preterm birth and low birthweight, with the lower the gain, the higher the risks.

Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses

BACKGROUND

Despite the current obesity epidemic, maternal underweight remains a common occurrence with potential adverse perinatal outcomes. Our objective was to determine the relationship between maternal underweight and preterm birth (PTB) and low birth weight (LBW) in singleton pregnancies in developing and developed countries.

METHODS

We followed the MOOSE consensus statement. We searched MEDLINE and EMBASE from their inceptions. We included studies that assessed the effect of maternal underweight compared with normal weight according to body mass index in singleton gestations on our two primary outcomes: PTB (<37 weeks) and LBW (<2500 g). Two assessors independently reviewed citations, extracted data and assessed quality.

RESULTS

A total of 78 studies were included involving 1 025 794 women. The overall risk of PTB was increased in the cohort studies of underweight women [adjusted relative risk (RR) 1.29, 95% confidence interval (CI) 1.15-1.46], as were the risks of spontaneous PTB (adjusted RR 1.32, 95% CI 1.10-1.57) and induced PTB (adjusted RR 1.21, 95% CI 1.07-1.36). Underweight women had an increased risk of an LBW infant (adjusted RR 1.64, 95% CI 1.38-1.94). In developed countries, underweight women had an increased risk of PTB (RR 1.22, 95% CI 1.15-1.30) but not in developing countries (RR 0.99, 95% CI 0.67-1.45). In both developed and developing countries, underweight women were at increased risk of having an LBW infant (RR 1.48, 95% CI 1.29-1.68, and RR 1.52, 95% CI 1.25-1.85, respectively).

CONCLUSIONS

In this systematic review and meta-analyses, we determined that singletons born to underweight women have higher risks of PTB (overall, spontaneous and induced) and LBW than those born to women with normal weight.

Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses

OBJECTIVE

To determine the relation between overweight and obesity in mothers and preterm birth and low birth weight in singleton pregnancies in developed and developing countries.

DESIGN

Systematic review and meta-analyses.

DATA SOURCES

Medline and Embase from their inceptions, and reference lists of identified articles.

STUDY SELECTION

Studies including a reference group of women with normal body mass index that assessed the effect of overweight and obesity on two primary outcomes: preterm birth (before 37 weeks) and low birth weight (<2500 g).

DATA EXTRACTION

Two assessors independently reviewed titles, abstracts, and full articles, extracted data using a piloted data collection form, and assessed quality.

DATA SYNTHESIS

84 studies (64 cohort and 20 case-control) were included, totalling 1 095 834 women. Although the overall risk of preterm birth was similar in overweight and obese women and women of normal weight, the risk of induced preterm birth was increased in overweight and obese women (relative risk 1.30, 95% confidence interval 1.23 to 1.37). Although overall the risk of having an infant of low birth weight was decreased in overweight and obese women (0.84, 0.75 to 0.95), the decrease was greater in developing countries than in developed countries (0.58, 0.47 to 0.71 v 0.90, 0.79 to 1.01). After accounting for publication bias, the apparent protective effect of overweight and obesity on low birth weight disappeared with the addition of imputed "missing" studies (0.95, 0.85 to 1.07), whereas the risk of preterm birth appeared significantly higher in overweight and obese women (1.24, 1.13 to 1.37).

CONCLUSIONS

Overweight and obese women have increased risks of preterm birth and induced preterm birth and, after accounting for publication bias, appeared to have increased risks of preterm birth overall. The beneficial effects of maternal overweight and obesity on low birth weight were greater in developing countries and disappeared after accounting for publication bias.

Weight retention from early pregnancy to three years postpartum: a study in Iranian women

OBJECTIVES

to examine weight retention from early pregnancy to three years postpartum in Iranian women.

DESIGN

a prospective cohort study.

SETTING

12 health centres selected at random in urban and rural areas in Guilan.

PARTICIPANTS

1315 pregnant women (705 in urban areas and 610 in rural areas) who regularly attended health centres for antenatal care and growth monitoring of their babies.

MEASUREMENTS

details of weight, height, pregnancy weight gain, body weight at one to three years postpartum, mother's age, parity, duration of any breast feeding, education and employment status of women who carried singleton fetuses and delivered at term were collected at the first antenatal visit. The women were categorised based on their pre-pregnancy body mass index, weight retention at one to three years postpartum, employment status and educational levels.

FINDINGS

women who gained more weight than recommended during pregnancy tended to be heavier at three years postpartum than women who gained weight within the recommended ranges during pregnancy (7.0 + or - 5.3 versus 4.8 + or - 6.7 kg; p < 0.0001). Less-educated women were at greater risk for inadequate pregnancy weight gain than other educational groups, and they had less weight retention at three years postpartum than other educational groups. Also, weight retention for primiparous women was higher than that for multiparous women (5.4 + or - 6.6 versus 3.8 + or - 6.3 kg; p < 0.0001). The results of logistic regression analysis revealed that only total pregnancy weight gain was independently related to major weight retention (> or = 4 kg) at three years postpartum (odds ratio 1.34, 95% confidence intervals 1.03-1.74; p = 0.02).

CONCLUSION

a high body mass index before pregnancy is not associated with increased risk of retaining more weight after pregnancy. On the other hand, total pregnancy weight gain was the most important determinant of weight retention at three years postpartum in this population of Iranian women.

Urban and rural differences in pregnancy weight gain in Guilan, northern Iran

OBJECTIVES

This study aimed to compare pregnancy weight gain and weight gain patterns in a group of Iranian women who attended urban and rural public health centers for prenatal care in Guilan, Iran.

DESIGN

A secondary data analysis using routinely collected health centers data.

SETTING

12 randomly selected health centers in urban and rural areas in Guilan.

PARTICIPANTS

A total of 2,047 pregnant women (1,097 in urban areas and 950 in rural areas) who regularly attended health centers for prenatal care and delivered between June 2003 and August 2006.

MEASUREMENTS

Data on prepregnancy weight, height, pregnancy weight gain, mother's age, parity, education and infant birth weight were extracted from the health records. The women were categorized based on their prepregnancy body mass index as underweight, normal weight and overweight.

FINDINGS

These results showed that among normal weight women, 41.1% of urban and 56.6% of rural women had weight gains below the Institute of Medicine (IOM) recommendation (P<0.0001). Among underweight women, 48.1% of urban and 65.8% of rural women had weight gains below the IOM recommendation (P<0.0001). Rural women with normal prepregnancy weight gained less weight than the urban women in the second trimester of their pregnancy (5.7+/-2.9 kg vs. 4.6+/-2.5 kg, P<0.0001). The underweight rural women gained less weight in both the second and the third trimesters of their pregnancy than the urban women. While the overall prevalence of having low birth weight (LBW) infants for underweight women were 5.2% only 1.9 % of those who gained adequate pregnancy weight gain had LBW infants.

CONCLUSION

This study indicated that a considerable proportion of the women both in urban and rural areas in Guilan, Iran had inadequate pregnancy weight gain. These results showed that prenatal care in terms of pregnancy weight gain in the present health system is not satisfactory.