Gestational weight gain and its effect on birth outcomes in sub-Saharan Africa: Systematic review and meta-analysis

Delaying factors influencing the maternal health care disparities in developing countries: A scoping review

Maternal mortality is a critically significant issue in developing countries, where the lifetime risk for a woman in pregnancy or childbirth is approximately one in six. This elevated risk is often linked to delays in accessing and utilizing maternal health care services. Therefore, the study aims to provide a comprehensive understanding of the delaying factors influencing the maternal health care disparities in developing countries using Thaddeus and Maine's Three Delays Model. Researchers searched Science Direct, Pub Med, Pub Med Central, Embase, Medline, Simantic Scholar and Scopus to extract 69 case study articles published between 2015 and 2023 for this scoping review. The search reveals that among the three primary delay factors (Delay 1- patient, Delay 2- en-route or geographical, and Delay 3- service factors), patient-related factors contribute most to adverse outcomes across Asia, which is often deeply rooted in socio-economic and cultural discrepancy. All three delays significantly hinder maternal health care access in Africa with Delay 2 remaining a persistent challenge. Along with en-route causalities and security risks, many African countries face an acute shortage of emergency obstetric care infrastructure. While, increasing awareness and addressing cultural barriers are essential for achieving better health outcomes across Asia, expanding free maternal health care policies, reducing indirect costs and improving community engagement found to be more significant for African regions. In Latin American countries, Delay 3 is the primary challenge, driven by persistent disparities in health care quality, understaffing, and inconsistent service delivery. The study therefore concludes that bringing structural changes is utmost necessary by framing policies from grass root level understanding to reduce the prevailing maternal health care disparities in developing part of the world.

Effect of nutrition education integrating the health belief model and theory of planned behavior during pregnancy on gestational weight gain and birth weight in Southeast Ethiopia using complex analyses

BACKGROUND

The incidence of inadequate or excessive gestational weight gain (GWG) is an indicator of reproductive health problems. However, scientific evidence for the effect of nutrition education during pregnancy on GWG and neonatal birth weight (BW) in urban settings in Ethiopia is sparse. This study aimed to assess the effect of nutrition education during pregnancy on GWG and neonatal birth weight (BW) in urban settings in Southeast Ethiopia.

METHODS

A community-based two-arm parallel cluster randomized controlled trial was conducted among 447 randomly selected pregnant women attending antenatal care (224 intervention and 223 control) from February to December 2021. Study participants were selected by multistage cluster sampling followed by systematic sampling. Women receiving the intervention received six nutrition education sessions, while women in the control group received standard care. GWG was the difference between the last recorded weight before delivery and the weight recorded during the first trimester. BW was measured within the first hour of delivery. The generalized structural equations model (GSEM) and structural equations model (SEM) were used to examine the direct, indirect, and total effects of nutrition education on GWG and BW via the dietary diversity score (DDS), food security (FS), and knowledge.

RESULTS

The GSEM revealed that receiving intervention during pregnancy had a total effect on GWG [(AOR = 2.056, 95% CI: 1.705, 2.695)]. Having dietary diversity had direct and total effects on GWG [(AOR = 1.105, 95% CI: 1.022, 1.196)]. Having food security had a total effect on GWG [(AOR = 1.928, 95% CI: 1.817, 2.052)]. Having fruit and vegetable knowledge had a total effect on GWG [(AOR = 1.971, 95% CI: 1.856, 2.105)]. The SEM revealed that receiving intervention during pregnancy had a direct effect on BW (unstandardized β = 0.144, 95% CI: 0.034, 0.252). Similarly, it revealed that receiving intervention during pregnancy had a direct effect on DDS (β = 0.580, 95% CI: 0.024, 1.038). Likewise, it indicated that receiving intervention during pregnancy had a total effect on increasing BW (β = 0.137, 95% CI: 0.029, 0.243). Nevertheless, there was no statistically observed indirect effect of nutrition education during pregnancy on GWG and BW via mediators.

CONCLUSION

The SEM revealed that receiving nutrition education interventions during pregnancy had a total effect on GWG and direct and total effects on BW. The generalized structural equation modelling (GSEM) and structural equation modelling (SEM) findings show that integrating theory-based nutrition education during pregnancy will improve gestational weight gain (GWG) and birth weight (BW) in Ethiopia.

TRIAL REGISTRATION

The trial was registered on Pan African Clinical Trials Registry (PACTR202201731802989, retrospectively registered on 24/01/ 2022).

The Impact of Excessive Gestational Weight Gain on Adverse Perinatal Outcomes: A Systematic Review

Background/Objectives: The purpose of this study was to systematically review the potential effects of a pregnant woman's excessive gestational weight gain on adverse perinatal outcomes affecting the mother and the fetus/neonate. Methods: Medline/PubMed, Scopus, CADTH Grey Matters and National Archive of PhD Theses were systematically searched for all relevant studies published. Assessments of the risk of bias in the included studies were made according to the tool "The Newcastle-Ottawa Scale (NOS)". Results: Five publications met all the inclusion criteria and were included in this review. The risk of bias in all the included studies was low. One study supports the detrimental effect of excessive gestational weight gain on the risk of gestational diabetes mellitus, one study on the risk of preterm birth, five studies on the risk of macrosomia-high birthweight of the neonate, three studies on the risk of a large-for-gestational-age neonate, three studies on the risk of hypertensive disorders of pregnancy, one study on the risk of gestational hypertension and preeclampsia, five studies on the risk of delivery by cesarean section and one study on the risk of neonatal hypoglycemia requiring treatment. One study supports the beneficial effect of excessive gestational weight gain on the risk of preterm birth, two studies on the risk of a small-for-gestational-age neonate and two studies on the risk of low birthweight of the neonate. Conclusions: The study presents the most recent and strong evidence regarding the negative effect of excessive gestational weight gain on most adverse perinatal outcomes. However, excessive gestational weight gain has a beneficial effect in a very limited number of outcomes.

Comparison of two proxies for the preconception weight using data from a pre-pregnancy cohort in Benin: Weight measured in the first trimester of pregnancy vs estimated by Thomas' formula

Accurate determination of pre-pregnancy weight is essential for optimal pregnancy monitoring and antenatal care. Determining pre-pregnancy weight in limited-resources settings is challenging for both clinical practice and public health research. From a 2014-2017 pre-pregnancy cohort in Benin, we evaluated the agreement between the measured pre-pregnancy weight (MPPW) and two proxies: (i) the first trimester pregnancy weight (FTPW) and (ii) the estimated pre-pregnancy weight (EPPW) using Thomas & al. formula. We analysed data from 302 pregnant women with both pre-pregnancy weight measured within 3 months before conception and weight measured during the first trimester. Using segmented linear regression, we first assessed up to which gestational age the weight measured during the first trimester could reasonably estimate the MPPW. Then the Bland & Altman method was used to assess agreement between MPPW and the two proxies. Additional analyses were performed to assess the sensitivity of results to the timing of measurement of either MPPW or the two proxies. On average, FTPW did not feature significant difference with MPPW up to 13.03 (11.99-14.06) weeks of gestational age. FTPW, measured on average at 7 ± 2.4 weeks of gestation, and the EPPW showed similar Bland & Altman limits of agreement with the MPPW. However, while the FTPW slightly underestimated the MPPW by a mean of-0.16 (-0.08; +0.39) kg, the EPPW overestimated it by a mean of + 0.43 (+0.20; +0.66) kg. Minor differences in these results were observed when the MPPW was assessed earlier or within three months before pregnancy, or according to the gestational age at the time of the proxy's measurement. In conclusion, in Southern Benin and up to 12-14 weeks of pregnancy, the FTPW appeared to be a good proxy of the MPPW while using Thomas' formula did not enhance pre-pregnancy weight estimation.

Associations of Maternal Nutritional Status and Supplementation with Fetal, Newborn, and Infant Outcomes in Low-Income and Middle-Income Settings: An Overview of Reviews

BACKGROUND/OBJECTIVES

Despite advances in maternal nutritional knowledge, the effect of maternal diet, micronutrient status and undernutrition, and the effect of maternal supplementation on fetal, neonatal and infant outcomes still have gaps in the literature. This overview of reviews is intended to assess the available information on these issues and identify the main maternal nutritional factors associated with offspring outcomes in low- and middle-income countries as possible targets for public health interventions.

METHODS

The literature search was performed in Medline (PubMed) and Cochrane Library datasets in June 2024. Pre-specified outcomes in offspring were pooled using standard meta-analytical methods.

RESULTS

We found consistent evidence on the impact of maternal undernutrition indicated by low body mass index (BMI), mid-upper arm circumference (MUAC), and stature, but not of individual micronutrient status, on intrauterine-growth retardation, preterm birth, low birth weight, and small for gestational age, with research showing a possible effect of maternal undernutrition in later child nutritional status. Studies on micronutrient supplementation showed possible beneficial effects of iron, vitamin D, and multiple micronutrients on birthweight and/or decreasing small for gestational age, as well as a possible effect of calcium on preterm birth reduction. Interventions showing more consistent beneficial outcomes were balanced protein-energy and lipid base supplements, which demonstrated improved weight in newborns from supplemented mothers and a decreased risk of adverse neonatal outcomes.

CONCLUSIONS

Further research is needed to identify the benefits and risks of maternal individual micronutrient supplementation on neonatal and further child outcomes.

The therapeutic potential of gelsolin in attenuating cytokine storm, ARDS, and ALI in severe COVID-19

Severe COVID-19 cases often progress to life-threatening conditions such as acute respiratory distress syndrome (ARDS), sepsis, and multiple organ dysfunction syndrome (MODS). Gelsolin (GSN), an actin-binding protein with anti-inflammatory and immunomodulatory properties, is a promising therapeutic target for severe COVID-19. Plasma GSN levels are significantly decreased in critical illnesses, including COVID-19, correlating with dysregulated immune responses and poor outcomes. GSN supplementation may mitigate acute lung injury, ARDS, and sepsis, which share pathophysiological features with severe COVID-19, by scavenging actin, modulating cytokine production, enhancing macrophage phagocytosis, and stabilizing the alveolar-capillary barrier. Preliminary data indicate that recombinant human plasma GSN improves oxygenation and lung function in severe COVID-19 patients with ARDS. Although further research is needed to optimize GSN therapy, current evidence supports its potential to mitigate severe consequences of COVID-19 and improve patient outcomes. This review provides a comprehensive analysis of the biological characteristics, mechanisms, and therapeutic value of GSN in severe COVID-19.

Association between Gestational Weight Gain and Maternal and Birth Outcomes in Northern Ghana

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.

Gestational weight gain and its association with maternal and neonatal outcomes among pregnant women with normal pre-pregnancy body mass index from a Middle Eastern country

BACKGROUND

Inappropriate gestational weight gain (GWG) is one of the leading health problems during pregnancy. Little is known about the association of GWG with the pregnancy outcomes among Middle Eastern pregnant women.

PURPOSE

To examine the relationship between GWG and maternal and neonatal outcomes among pregnant women with normal pre-pregnancy BMI.

METHODS

This retrospective cohort study was conducted in Oman among 763 healthy women with normal pre-pregnancy BMI between August 1, 2021, and June 30, 2022. Maternal and neonatal outcomes were retrieved from participants' medical records using a standardized form. The analytical tools included descriptive statistics and the chi-square test.

RESULTS

Descriptive statistics showed 22.6 % and 21.4 % of the study participants gained weight above or below the guidelines, respectively. The findings from the chi-square test showed a significant association between total GWG and the incidence of emergency caesarean section (p < .01), gestational diabetes mellitus (p < .01), and gestational hypertension (p < .01), macrosomia (p < .01), small for gestational age (p < .01), large for gestational age (p < .01), low birth weight (p < .01), intrauterine growth retardation (p < .01), and preterm birth (p < .01).

CONCLUSION AND IMPLICATIONS FOR PRACTICE

Our study found that inappropriate gestational weight gain (GWG) contributes to several adverse maternal and neonatal outcomes. We recommend that Ministries of Health in Middle East and North Africa area includes GWG as a risk factor for pregnancy-related adverse outcomes. Midwives should closely monitor and manage GWG to ensure optimal pregnancy outcomes. In addition, midwives should encourage mothers to maintain GWG within the recommended range using various strategies such as continuous counselling and motivational health promotion interventions.

Associations between gestational weight gain under different guidelines and adverse birth outcomes: A secondary analysis of a randomized controlled trial in rural western China

Several gestational weight gain (GWG) guidelines have been established based on monocenter or multicenter researches. We aimed to examine the associations between categories of GWG under the Institute of Medicine (IOM) recommendation guideline, the Chinese National Health Commission (NHC) guideline, and weight-gain-for-gestational-age z-scores derived from the INTERGROWTH-21st Project and adverse birth outcomes. We used data from an antenatal micronutrient supplementation trial in rural western China between 2002 and 2006. Maternal weekly average GWG during the second and third trimesters was calculated and classified into inadequate, adequate and excessive GWG according to the IOM and NHC, respectively. Weight-gain-for-gestational-age z-scores derived from the INTERGROWTH-21st Project were grouped into three subgroups using two approaches: z-score percentile<25th, 25th to 75th, >75th and z-score <-1, -1 to 1, >1 SD. Infant birth weight and gestational age were measured using standard approaches. Generalized linear model with binomial family and logit link was applied to estimate the odds ratio (OR) and 95% confidential intervals (CI) for GWG categories and adverse birth outcomes. Among 1,239 women with normal weight (18.5 kg/m2 to 23.9 kg/m2) during early pregnancy, 18.0% and 34.2% were classified as adequate GWG according to IOM and NHC, respectively. Less than half of Chinese women reached optimal GWG by any recommendation guideline. According to NHC, excessive GWG showed a significant association with macrosomia (OR 3.75, 95% CI 1.03, 13.74), large-for-gestation-age (LGA) (OR 2.12, 95% CI 1.01, 4.45), and inadequate GWG was associated with post-term birth (OR 2.25, 95% CI 1.21, 4.16), compared with adequate GWG. Inappropriate GWG was associated with adverse birth outcomes even among women with normal weight during early pregnancy. The monitoring and interventions of weight status during pregnancy, especially for the second and third trimesters, are of great public health importance for optimal birth outcomes. Additionally, developing guideline of appropriate GWG ranges should account for the traits of regional population.

Magnitude and Factors Associated with Gestational Weight Gain Adequacy among Pregnant Women in South Gondar Zone, Northwest Ethiopia

Background

Weight gain during pregnancy depends on the maternal prepregnancy weight and height. Inappropriate weight gain has negative consequences, including the health care system and society because of its adverse birth outcomes.

Objective

This study aimed to assess the magnitude and factors associated with gestational weight gain in Northwest Ethiopia.

Methods

From September 2018 to June 2019, a community-based prospective follow-up study was conducted in Northwest Ethiopia. A total of 422 pregnant women were followed from conception to delivery and the data were collected using a multistage sampling technique. Stata 14 standard edition (SE) software was used for data analysis. Multinomial logistic regression was used to determine the relationship between dependent and independent variables. P value of ≤0.05 was used to determine statistical significance.

Results

Majority of the participants had normal weight gain [65.12%, 95% confidence interval (CI): 60.08, 69.85]. Besides this, the rate of inadequate and overadequate weight gain was 21.53% (95% CI: 17.60, 26.05) and 13.35% (95% CI: 10.22, 17.25), respectively. Inadequate weight gain was linked to meal frequency [adjusted odd ratio (AOR): 0.52, 95% CI: 0.28, 0.97], targeted supplementary feeding program (TSFP) enrollment (AOR: 2.47; 95% CI: 1.35, 4.50), parity (AOR: 0.18; 95% CI: 0.05, 0.62), and alcohol consumption history (AOR: 0.47; 95% CI: 0.25, 0.88), whereas overadequate weight gain was associated with residency (AOR: 5.22; 95% CI: 2.43, 11.22) and TSFP status (AOR: 2.22; 95% CI: 1.08, 4.57).

Conclusions

This study revealed a notable magnitude of both inadequate and overadequate weight gain. It found that good meal frequency, alcohol consumption, parity, and TSFP enrollment were associated with a reduced risk of inadequate weight gain during pregnancy. In addition, the study identified residence and TSFP enrollment as factors linked to overadequate weight gain during pregnancy.

The relationship of pre-pregnancy body mass index with maternal anthropometric indices, weight retention and the baby's weight and nutrition in the first 6 months post-partum

PURPOSE

Pre-pregnancy body fat mass is one of the important indicators of the mother's and the infant's health. Therefore, the purpose of this study was to investigate relationship of pre-pregnancy body mass index (PPBMI) with maternal anthropometric indices and weight retention as well as the baby's weight and nutrition in the first 6 months post-partum.

MATERIALS AND METHODS

This is a prospective cohort study including 397 mothers giving birth to healthy babies and referring to health centers in Ahvaz (southwest of Iran) in 2022. The following data were extracted from the participants' electronic record: body mass index (BMI) before or at the beginning of pregnancy, gestational weight gain, and weight at the time of delivery. In addition to demographic information, the following data were also evaluated: maternal anthropometric indices including weight, hip and waist circumference, and conicity index during the first 10 days post-partum, along with the weight and nutrition pattern of the baby 2, 4 and 6 months post-partum.

RESULTS

The mean age of the mothers was 29.96±5.7 years. The frequency of mothers according to BMI classification (i.e., underweight, normal, overweight, and obese) was 4.3%, 38.5%, 37%, and 20.3%, respectively. In this study, PPBMI had a significant relationship with decreasive changes of weight, waist and hip circumferen and conicity index after child birth, 2, 4 and 6 months post-partum (P<0.05) but the mean reduction of these anthropoemetric indices at 6th month postpartum were not related to PPBMI (P>0.05). However, this relationship was not significant when it came to the weight of the baby (P > .05). The lowest reduction in weight, waist and hip circumference and conicity index belonged to overweight mothers but the highest frequency of mothers with excesive gestational weight gain, the lowest frequency of breastfeeding until 6 months and also the lowest values of postpartum weight retention were observed in obese mothers (P<0.05).

CONCLUSION

According to the findings of this study, the decrease in anthropometric indices up to 6 months after delivery in overweight mothers is less than other BMI groups, but the consequences related to weight and nutrition in infants of obese mothers need special attention. Also, the results re-emphasize the importance of focusing on provision of educational and counseling services to mothers in order to improve their nutrition and weight, especially before pregnancy.

The Effects of Antenatal Interventions on Gestational Weight Gain in Low- and Middle-Income Countries: Protocol for a Systematic Review

BACKGROUND

Gestational weight gain (GWG) is a crucial determinant of maternal and child outcomes yet remains an underused target for antenatal interventions in low- and middle-income countries (LMICs).

OBJECTIVE

This systematic review aims to identify and summarize educational, behavioral, nutritional, and medical interventions on GWG from randomized controlled trials conducted in LMICs.

METHODS

Randomized controlled trials that documented the effects of antenatal interventions on GWG in LMICs will be included. The interventions of interest will be educational, behavioral, nutritional, or medical. A systematic literature search will be conducted using PubMed, Embase, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library from the inception of each database through October 2022 (with an updated search in January 2024). A total of 2 team members will independently perform the screening of studies and data extraction. A narrative synthesis of all the included studies will be provided. The risk of bias will be assessed using the Cochrane Risk of Bias tool. The certainty of the evidence for each homogeneous group of interventions will be assessed using the GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach. A narrative synthesis of the included studies will be conducted to summarize mean differences (with 95% CIs) for continuous outcomes and risk ratios, rate ratios, hazard ratios, or odds ratios (with 95% CIs) for dichotomous or categorical outcomes. Available information on the costs of interventions will also be summarized to facilitate the adoption and scale-up of effective GWG interventions.

RESULTS

The development of the research questions, search strategy, and search protocol was started on September 20, 2022. The database searches and the importation of the identified records into Covidence were performed on October 7, 2022. As of September 2023, the title and abstract screening was ongoing. The target completion time of this systematic review is April 2024.

CONCLUSIONS

Without effective interventions to manage GWG, the potential to improve maternal and child health through optimal GWG remains unrealized in LMICs. This systematic review will inform the design and implementation of antenatal interventions to prevent inadequate and excessive GWG in resource-limited settings.

TRIAL REGISTRATION

PROSPERO (International Prospective Register of Systematic Reviews) CRD42022366354; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=366354.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/48234.

Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: individual participant data meta-analysis

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.

Gestational weight gain among pregnant women in Ibadan, Nigeria: Pattern, predictors and pregnancy outcomes

BACKGROUND

Gestational weight gain (GWG) is a risk factor for adverse pregnancy outcomes, future obesity and chronic diseases among women. However, has not received much attention in many low and middle-income countries such as Nigeria. We investigated the pattern, associated factors and pregnancy outcomes of GWG in Ibadan, Nigeria, using the Ibadan Pregnancy Cohort Study (IbPCS).

METHODOLOGY

The IbPCS is a multicentre prospective cohort study conducted among 1745 pregnant women recruited from four health facilities in Ibadan, Nigeria. GWG, the primary outcome, was categorised according to the Institute of Medicine's classification into insufficient, adequate and excessive weight gain. Pregnancy outcomes were the secondary outcome variables. Logistic regression analysis (Adjusted odds ratios and 95% confidence interval CI) was used to examine associations, and Poisson regression analyses were used to investigate associations with outcomes.

RESULTS

Only 16.9% of women had optimal GWG, 56.8% had excessive GWG, and 26.9% had insufficient GWG. Excessive GWG was associated with high income '> #20,000-' (AOR: 1.64, 95% CI: 1.25-2.17), being overweight (AOR: 2.12, 95% CI: 1.52-2.95) and obese (AOR: 1.47, 95% CI: 1.02-2.13) after adjusting for confounders. In contrast, increased odds of insufficient GWG have associated women with depression (AOR: 1.70, 95% CI 1.17-2.47). There was no significant association between inappropriate GWG and pregnancy outcomes However, there was an increased odds for postpartum haemorrhage (AOR: 2.44, 95% CI 1.14-5.22) among women with obesity and excessive GWG.

CONCLUSIONS

Excessive GWG was the most typical form of GWG among our study participants and was associated with high maternal income, and being overweight or obese. GWG needs to be monitored during antenatal care, and interventions that promote appropriate GWG should be implemented among pregnant women in Nigeria.

Associations of Diet Quality, Socioeconomic Factors, and Nutritional Status with Gestational Weight Gain among Pregnant Women in Dar es Salaam, Tanzania

Background

Gestational weight gain (GWG) is a modifiable factor associated with maternal and child health outcomes, but the relationship between diet quality and GWG has not been evaluated using metrics validated for low-income and middle-income countries (LMICs).

Objective

This study aimed to investigate relationships between diet quality, socioeconomic characteristics, and GWG adequacy using the novel Global Diet Quality Score (GDQS), the first diet quality indicator validated for use across LMIC.

Methods

Weights of pregnant women enrolled between 12 and 27 wk of gestation (N = 7577) were recorded in Dar es Salaam, Tanzania, from 2001 to 2005 during a prenatal micronutrient supplementation trial. GWG adequacy was the ratio of measured GWG to Institute of Medicine-recommended GWG, categorized into severely inadequate (<70%), inadequate (70 to <90%), adequate (90 to <125%), or excessive (≥125%). Dietary data were collected using 24-h recalls. Multinomial logit models were used to estimate relationships between GDQS tercile, macronutrient intake, nutritional status, and socioeconomic characteristics and GWG.

Results

GDQS scores in the second [relative risk (RR): 0.82; 95% confidence interval (CI): 0.70, 0.97] tercile were associated with lower risk of inadequate weight gain than those in the first tercile. Increased protein intake was associated with higher risk of severely inadequate GWG (RR: 1.06; 95% CI: 1.02, 1.09). Nutritional status and socioeconomic factors were associated with GWG: underweight prepregnancy BMI (in kg/m2) with a higher risk of severely inadequate GWG (RR: 1.49; 95% CI: 1.12, 1.99), overweight or obese BMI with a higher risk of excessive GWG (RR: 6.80; 95% CI: 5.34, 8.66), and a higher education (RR: 0.61; 95% CI: 0.42, 0.89), wealth (RR: 0.68; 95% CI: 0.48, 0.80), and height (RR: 0.96; 95% CI: 0.95, 0.98) with a lower risk of severely inadequate GWG.

Conclusions

Dietary indicators showed few associations with GWG. However, stronger relationships were revealed between GWG, nutritional status, and several socioeconomic factors.This trial was registered at clinicaltrials.gov as NCT00197548.

Strengthening maternal nutrition counselling during routine health services: a gap analysis to guide country programmes

OBJECTIVE

The WHO recommends counselling on healthy eating, weight gain, and physical activity during antenatal care (ANC) and postnatal care (PNC), yet advice and information are often not tailored to women's nutritional needs and contexts. The purpose of the gap analysis was to identify key elements related to the provision of maternal nutrition counselling during routine health contacts and provide programme considerations to strengthen quality service delivery.

DESIGN

A search of PubMed, Cochrane Library, CINAHL Plus and Scopus databases was conducted to retrieve studies from January 2010 to December 2021. Using inclusion criteria, quantitative, qualitative and mixed methods studies were included in the final gap analysis.

SETTING

Low-, middle- and high-income country contexts.

PARTICIPANTS

Following application of gap analysis criteria, thirty-seven articles from sixteen countries were included in the analysis.

RESULTS

Gaps in delivery of maternal nutrition counselling include provider capacity building, frequency, content and delivery platforms. Globally, counselling on appropriate weight gain during pregnancy is often not delivered with the desired content nor quality, while targeted counselling to overweight and obese women was provided in several high-income country contexts. Delivery of maternal nutrition counselling through multiple delivery platforms demonstrated improvements in maternal diet and/or weight gain during pregnancy.

CONCLUSIONS

Strengthening the integration of maternal nutrition counselling into pre- and in-service curricula, routine health provider training, supportive supervision and provider mentoring is needed. Future efforts may consider generating global and regional weight gain guidelines and incorporating maternal nutrition counselling indicators as part of quality-of-care ANC/PNC standards and routine health systems.

Effects of prenatal nutritional supplements on gestational weight gain in low- and middle-income countries: a meta-analysis of individual participant data

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.

Child Survival Crisis Due to Maternal Undernourishment During the COVID Era

The coronavirus disease 2019 (COVID-19) pandemic caused a global crisis, creating the most challenging times faced by any country. The pandemic created a situation that shocked the whole world. It led to a condition of fear, and the ones to take the major hit were the vulnerable groups: children, pregnant women, and the elderly, as well as those belonging to low socio-economic groups who lost their source of daily income. It increased the pressure on already burdened healthcare and information systems and led to a situation where the well-being of even children and pregnant women could not be maintained. COVID-19 increased the risk of undernutrition in children. Though children are observed to be less affected by the virus, they are the hidden victims of the pandemic in terms of falling prey to undernutrition. Child undernutrition can also be linked to maternal malnutrition, starting from the preconception period through the postpartum period. The situation arose due to the rapid steps of mitigation taken to tackle the pandemic, leading to decreased food security, healthcare, and education. Maternal undernutrition leads to complications for the mother during childbirth and has long-term effects on both. It can lead to low birth weight (LBW) babies, postpartum complications, chronic child undernourishment, and even increased maternal and child mortality and morbidity. Because of the pandemic's disruption of immunization facilities, it appears that even preventable childhood diseases will worsen in the coming years. In these post-COVID-19 times, it has become necessary to take measures to improve the overall health status of the population, with special regard to these vulnerable groups. Proper maternal and child health should be targeted at community levels by introducing interventions that prioritize antenatal and postnatal care, nutritional education, immunization of both mother and child, and proper health and sanitation practices. The purpose of this narrative review is to create awareness about the child survival crisis that may occur in the coming years due to undernutrition and the failure of immunization.

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.

Gestational weight gain during the second and third trimesters and adverse pregnancy outcomes, results from a prospective pregnancy cohort in urban Tanzania

BACKGROUND

Appropriate gestational weight gain (GWG) is important for optimal pregnancy outcomes. This study prospectively evaluated the associations between GWG during the second and third trimesters of pregnancy and adverse pregnancy outcomes in an urban Tanzanian pregnancy cohort.

METHODS

We used data from a randomized clinical trial conducted among pregnant women recruited by 27 weeks of gestation in Dar es Salaam, Tanzania (N = 1230). Women's gestational weight was measured at baseline and at monthly antenatal visits. Weekly GWG rate during the second and third trimesters was calculated and characterized as inadequate, adequate, or excessive, in conjunction with measured or imputed early-pregnancy BMI status according to the 2009 Institute of Medicine (IOM) GWG guidelines. We used multivariable Poisson regression with a sandwich variance estimator to calculate risk ratios (RR) for associations of GWG with low birth weight, preterm birth, small for gestational age (SGA), and large for gestational age (LGA). Degree of appropriate GWG defined using additional metrics (i.e., percentage of adequacy, z-score) and potential effect modification by maternal BMI were additionally evaluated.

RESULTS

According to the IOM guidelines, 517 (42.0%), 270 (22.0%), and 443 (36.0%) women were characterized as having inadequate, adequate, and excessive GWG, respectively. Overall, compared to women with adequate GWG, women with inadequate GWG had a lower risk of LGA births (RR = 0.54, 95% CI: 0.36-0.80) and a higher risk of SGA births (RR = 1.32, 95% CI: 0.95-1.81). Women with inadequate GWG as defined by percentage of GWG adequacy had a higher risk of LBW (OR = 1.93, 95% CI: 1.03-3.63). In stratified analyses by early-pregnancy BMI, excessive GWG among women with normal BMI was associated with a higher risk of preterm birth (RR = 1.59, 95% CI: 1.03-2.44).

CONCLUSIONS

A comparatively high percentage of excessive GWG was observed among healthy pregnant women in Tanzania. Both inadequate and excessive GWGs were associated with elevated risks of poor pregnancy outcomes. Future studies among diverse SSA populations are warranted to confirm our findings, and clinical recommendations on optimal GWG should be developed to promote healthy GWG in SSA settings.

TRIAL REGISTRATION

This trial was registered as "Prenatal Iron Supplements: Safety and Efficacy in Tanzania" (NCT01119612; http://clinicaltrials.gov/show/NCT01119612 ).

Multivitamin Supplementation Is Associated with Greater Adequacy of Gestational Weight Gain among Pregnant Women in Tanzania

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.

Associations Between Gestational Weight Gain and Adverse Birth Outcomes: A Population-Based Retrospective Cohort Study of 9 Million Mother-Infant Pairs

Background

Gestational weight gain (GWG) reflects maternal nutrition during pregnancy. However, the associations between maternal GWG and adverse birth outcomes are inconclusive.

Objective

We aimed to examine the associations between maternal GWG and adverse birth outcomes according to maternal pre-pregnancy body mass index (BMI) categories in a large, multiethnic and diverse population in the U.S.

Study Design

We used nationwide birth certificate data from the National Vital Statistics System to examine the association of GWG (below, within and above the Institute of Medicine [IOM] guidelines) with six adverse birth outcomes (preterm birth, low birthweight, macrosomia, small for gestational age [SGA], large for gestational age [LGA], and low Apgar score) according to the pre-pregnancy BMI categories (underweight to obesity grade 3). Multivariable logistic regression analyses were performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs).

Results

A total of 9,191,842 women aged 18–49 years at delivery with live singleton births were included. Among them, 24.5% of women had GWG below IOM guidelines, 27.6% within the guidelines, and 47.9% above the guidelines. Compared with maternal GWG within guidelines, GWG below guidelines was associated with higher odds of preterm birth (OR = 1.52, 95%CI = 1.51–1.53), low birthweight (OR = 1.46, 95%CI = 1.45–1.47) and SGA (OR = 1.44, 95%CI = 1.43–1.45). In contrast, maternal GWG above guidelines was associated with higher odds of macrosomia (OR = 2.12, 95%CI = 2.11–2.14) and LGA (OR = 2.12, 95%CI = 2.11–2.14). In addition, maternal GWG below or above guidelines had slightly higher odds of low Apgar score (below guidelines: OR = 1.04, 95%CI = 1.03–1.06, above guidelines: OR = 1.17, 95%CI = 1.15–1.18). The results were largely similar among women with GWG below or above guidelines across pre-pregnancy BMI categories of underweight, overweight, and obesity grade 1 to grade 3.

Conclusion

Pregnant women with GWG below or above the IOM guidelines have increased odds of selected adverse infant birth outcomes. Monitoring maternal GWG could enable physicians to provide tailored nutrition and exercise advice as well as prenatal care to pregnant women to reduce the likelihood of adverse birth outcomes.

Associations between gestational weight gain adequacy and neonatal outcomes in Tanzania

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.

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.

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.

Plasma concentrations of leptin at mid-pregnancy are associated with gestational weight gain among pregnant women in Tanzania: a prospective cohort study

Background

Gestational weight gain (GWG) has critical implications for maternal and child health. Inflammation and angiogenesis are implicated in various aspects of maternal metabolism that may play a role in gestational weight gain. The associations of inflammatory, angiogenic, and metabolic pathways with GWG are yet to be elucidated. This study evaluated associations between a panel of inflammatory, angiogenic, and metabolic proteins measured in mid-pregnancy and gestational weight gain.

Methods

Pregnant women were enrolled from Dar es Salaam, Tanzania, between 2001 and 2004. The participants were enrolled at mid-pregnancy (12 to 27 weeks of gestation) and followed up until delivery. This analysis focused on a cohort of 1002 women who were primigravid, had singleton live births, had longitudinal measures of gestational weight, and whose mid-pregnancy plasma samples underwent analysis for 18 proteins.

Results

Higher plasma concentrations of leptin (mean difference in GWG percent adequacy comparing highest with lowest quartiles: 10.24; 95% CI 3.31, 17.16; p-trend = 0.003) and chitinase-3-like protein-1 (CH3L1) (mean difference in GWG percent adequacy comparing highest with lowest quartiles: 7.02; 95% CI 0.31, 13.72; p-trend = 0.007) were associated with greater GWG in a dose-response pattern. Higher leptin concentrations were associated with a lower risk of inadequate GWG (risk ratio comparing highest with lowest quartiles: 0.77; 95% CI 0.65, 0.91; p-trend = 0.001) and a higher risk of excessive GWG (risk ratio comparing highest with lowest quartiles: 1.57; 95% CI 1.03, 2.39; p-trend = 0.03). Higher CH3L1 concentrations were associated with a higher risk of excessive GWG (p-trend = 0.007). The associations of leptin and CH3L1 with inadequate GWG were stronger during the second than the third trimester. The other 16 proteins examined were not significantly associated with GWG.

Conclusions

Mid-pregnancy plasma leptin concentrations may be associated with GWG and have clinical predictive utility in identifying women at a higher risk of inadequate or excessive gestational weight gain.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04146-0.

Patterns and predictors of gestational weight gain in Addis Ababa, Central Ethiopia: a prospective cohort study

INTRODUCTION

Gaining excessive or inadequate gestational weight is associated with many adverse maternal and fetal outcomes. Inadequate gestational weight gain (GWG) increases the risk of fetal growth restriction, pre-term birth, and low birth weight. It is a public health concern in sub-Saharan Africa. The aim of this study was to assess the patterns and predictors of GWG in Addis Ababa, Ethiopia.

METHODS

We conducted a prospective cohort study among pregnant women who attended antenatal care in health centres in Addis Ababa, from January to September 2019. Data were collected by a structured questionnaire and checklists and analysed using Stata version-14. Weight at or before 16 weeks gestation was used as a proxy for pre-pregnancy weight. Women's height and baseline weight were measured by data collectors, and we obtained weight at the end of the 24th and 36th weeks of gestation from women's medical records. GWG was categorized as inadequate, adequate and excessive based on the United States Institute of Medicine criteria. Predictors of GWG were identified using multinomial logistic regression.

RESULTS

A total of 395 pregnant women were enrolled in the study. GWG was assessed for 369 (93%) women. The median GWG was 8.7 kg with inter quartile ranges (25th, 75th percentiles) of 7.0 kg and 11.6 kg. More than two-third of the participants, 248 (67.2% [95% CI: 62.2, 72.0%]), gained inadequate weight; 103 (27.9% [95% CI: 23.4, 32.8%]) gained adequate weight; and 18 (4.9% [95% CI: 2.9%, 7.6%]) gained excessive weight. Three quarters (75%) of underweight women gained inadequate gestational weight, whereas 43% of overweight or obese women gained inadequate gestational weight. Being underweight (AOR = 3.30 [95% CI: 1.32, 8.24]) or normal weight (AOR = 2.68 [95% CI: 1.37, 5.24]) before pregnancy increased the odds of gaining inadequate gestational weight compared to overweight or obese women. Not having paid employment was associated with higher odds of gaining inadequate gestational weight compared to women employed outside the home (AOR = 2.17 [95% CI: 1.16, 4.07]).

CONCLUSIONS

Most pregnant women in Addis Ababa gain inadequate gestational weight. In particular, three quarters of underweight women gained inadequate gestational weight. Being underweight, normal weight or having no paid employment were associated with higher odds of inadequate GWG. Promoting adequate GWG in Addis Ababa among underweight and normal weight women may be an important public health initiative.

Gestational weight gain in low-income and middle-income countries: a modelling analysis using nationally representative data

INTRODUCTION

Gestational weight gain (GWG) has important implications for maternal and child health and is an ideal modifiable factor for preconceptional and antenatal care. However, the average levels of GWG across all low-income and middle-income countries of the world have not been characterised using nationally representative data.

METHODS

GWG estimates across time were computed using data from the Demographic and Health Surveys Program. A hierarchical model was developed to estimate the mean total GWG in the year 2015 for all countries to facilitate cross-country comparison. Year and country-level covariates were used as predictors, and variable selection was guided by the model fit. The final model included year (restricted cubic splines), geographical super-region (as defined by the Global Burden of Disease Study), mean adult female body mass index, gross domestic product per capita and total fertility rate. Uncertainty ranges (URs) were generated using non-parametric bootstrapping and a multiple imputation approach. Estimates were also computed for each super-region and region.

RESULTS

Latin America and Caribbean (11.80 kg (95% UR: 6.18, 17.41)) and Central Europe, Eastern Europe and Central Asia (11.19 kg (95% UR: 6.16, 16.21)) were the super-regions with the highest GWG estimates in 2015. Sub-Saharan Africa (6.64 kg (95% UR: 3.39, 9.88)) and North Africa and Middle East (6.80 kg (95% UR: 3.17, 10.43)) were the super-regions with the lowest estimates in 2015. With the exception of Latin America and Caribbean, all super-regions were below the minimum GWG recommendation for normal-weight women, with Sub-Saharan Africa and North Africa and Middle East estimated to meet less than 60% of the minimum recommendation.

CONCLUSION

The levels of GWG are inadequate in most low-income and middle-income countries and regions. Longitudinal monitoring systems and population-based interventions are crucial to combat inadequate GWG in low-income and middle-income countries.

Gestational weight gain in sub-Saharan Africa: Estimation based on pseudo-cohort design

Background

Inadequate or excess gestational weight gain (GWG) leads to multiple undesirable birth outcomes. Yet, in sub-Saharan Africa (SSA) little is known about the weight gain pattern in pregnancy. The purpose of the study is to estimate the average gestational weight gain (GWG) in sub-Saharan Africa (SSA) and to examined whether there had been recent improvements or not.

Methods

Based on cross-sectional anthropometric data extracted from multiple Demographic and Health Surveys conducted in SSA, we estimated the average GWG in the region. Pseudo-cohort design was used to reconstruct GWG trajectories based on aggregated data of 110,482 women extracted from 30 recent surveys. Trend in GWG between 2000 and 2015 was determined using the data of 11 SSA countries. Pre-pregnancy weight was estimated based on the weight of non-pregnant women at risk of conception.

Results

On average, women in SSA gain inadequate weight (6.6 kg, 95% confidence interval, 6.0–7.2) over pregnancy. No meaningful gain was observed in the first trimester; whereas, women in the second and third trimesters put on 2.2 and 3.2 kg, respectively. The highest weight gain (10.5, 8.2–12.9 kg) was observed in Southern African sub-region and the lowest in Western Africa (5.8, 5.0–6.6 kg). The GWG among women who had secondary or above education (9.5, 8.2–10.9 kg) was higher than women with lower education (5.0, 4.3–5.8 kg). Likewise, GWG in women from richest households (9.0, 7.2–10.7 kg) was superior to those from poorest households (6.1, 5.3–7.0 kg). The estimated recent (2015–20) mean GWG (6.6, 5.8–7.4 kg) was not significantly different from what had been at beginning of the new millennium (6.7, 5.9–7.5 kg).

Conclusion

In SSA GWG is extremely low and is not showing improvements.

Adequate antenatal care and ethnicity affect preterm birth in pregnant women living in the tropical rainforest of Suriname

Background

Adequate antenatal care (ANC) services are key for early identification of pregnancy related risk factors and maintaining women’s health during pregnancy. This study aimed to assess the influence of ANC provided by the Medical Mission Primary Health Care Suriname (MMPHCS) and of ethnicity on adverse birth outcomes in Tribal and Indigenous women living in Suriname’s remote tropical rainforest interior.

Method

From April 2017 to December 2018 eligible Tribal and Indigenous women with a singleton pregnancy that received ANC from MMPHCS were included in the study. Data on low birth weight (LBW < 2500 g), preterm birth (PTB < 37 weeks), low Apgar score (< 7 at 5 min), parity (≤1 vs. > 1) and antenatal visits utilization (≥8 vs. < 8) in 15 interior communities were retrospectively analyzed using descriptive statistics, crosstabs and Fisher’s exact tests.

Results

A total of 204 women were included, 100 (49%) were Tribal, mean age was 26 ± 7.2 years and 126 women (62%) had 8 or more ANC visits. One participant had a miscarriage; 22% had adverse birth outcomes: 16 (7.9%) LBW and 30 (14.8%) PTB; 7 women had a child with both PTB and LBW; 5 women had stillbirths. None of the newborns had low Apgar scores. Maternal age, ethnicity, ANC and parity were associated with PTB (χ² = 8,75, p = 0.003, χ² = 4,97, p = 0.025, χ² = 17,45, p < 0.001, χ² = 11,93, p < 0.001 respectively).

Conclusion

Despite an almost 100% study adherence over one fifth of women that received ANC in the interior of Suriname had adverse birth outcomes, in particular PTB and LBW. Younger nulliparous Indigenous women with less than the recommended 8 ANC visits had a higher risk for PTB. The rate of adverse birth outcomes highlights the need for further research to better assess factors influencing perinatal outcomes and to put strategies in place to improve perinatal outcomes. Exposure assessment of this sub-cohort and neurodevelopment testing of their children is ongoing and will further inform on potential adverse health effects associated with environmental exposures including heavy metals such as mercury and lead.