Associations of body mass index and gestational weight gain with term pregnancy outcomes in urban Cameroon: a retrospective cohort study in a tertiary hospital

Abstract

BackgroundObesity is a rising public health issue worldwide. Guidelines regarding maternal body mass index (BMI) and gestational weight gain (GWG) are missing in Cameroon where maternal mortality rate remains very high. We hypothesized that obesity and inappropriate GWG are associated with poor pregnancy outcomes. We aimed at assessing associations of BMI and GWG with pregnancy outcomes.MethodsThis was a retrospective cohort study at the Yaoundé Central Hospital. We included women with term singleton deliveries in the post-partum ward. The World Health Organisation classification of BMI and the United States Institute Of Medicine (IOM) categories of GWG were used to stratify participants. Poor maternal outcome was defined by the occurence of caesarean section, preeclampsia or obstetrical haemorrhage. Poor perinatal outcome was defined by the occurence of perinatal death, admission in intensive care unit, low birth weight, macrosomia or fifth minute Apgar score <7. Multiple logistic regressions were used to calculate unadjusted and adjusted Odds Ratios (uOR, aOR) for poor maternal outcome (PMO) and for poor perinatal outcome (PPO) in each category of BMI and GWG. Adjustment was done for age, scarred uterus, sickle cell disease, malaria, human immunodeficiency virus (HIV) infection, parity and smoking.ResultsOf the 462 participants, 17 (4 %) were underweight (BMI < 18.5), 228 (49 %) had normal pre-pregnancy BMI, 152 (33 %) were overweight (25 ≤ BMI < 30) and 65 (14 %) were obese (BMI ≥ 30). Following the IOM recommendations, GWG was normal for 186 (40 %) participants, less than recommended for 131 (28 %) and above the recommended norms for 145 (32 %). GWG above the IOM recommendation was significantly associated with PMO (aOR: 1.7, 95 % CI 1.1–2.8). GWG less than the IOM recommended values, overweight and obesity were not significantly associated with poor pregnancy outcomes.ConclusionWhile waiting for local recommendations for GWG, the IOM recommendations can be used for Cameroonian women as far as maternal outcome is concerned. Unlike in studies in different ethnic and racial groups, abnormal BMI was not associated with poor pregnancy outcomes in our cohort of Cameroonian women.

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

“…Table 1 describes the characteristics of the studies included in this review. Five studies were from Nigeria [6,7,[42][43][44]; four from Cameroon [45][46][47][48]; four each from Ethiopia [2,35,49,50] and Ghana [39,[51][52][53]; two studies from South Africa [54,55] and Malawi [28,56]; and one each from Uganda [9], Kenya [57], Niger [58], Benin [40], and the Democratic Republic of Congo [59]. Based on a country's income status [60], two studies were from upper middleincome countries [54,55]; fourteen from lower middle-income countries [6, 7, 39, 42-48, 51-53, 57] and ten from low-income countries [2,9,28,35,40,49,50,56,58,59].…”

“…Gondwe et al also reported that 15.6% of women who gained inadequate gestational weight gave birth to LBW babies; 7.6% of women who gained adequate gestational weight gave birth to LBW babies [28]; and none of the women who gained excess gestational weight in Nemomsa et al [49] and Gondwe et al [28] gave birth to LBW babies. In another study, 8.6% of women who gained inadequate weight, 11.5% of women who gained adequate weight, and 6.9% of women who gained excess gestational weight gave birth to LBW babies [45]. In another study, the proportion of LBW was 9.7% and 2.3% among women who gained < 10 kg and 10 to 15 kg, respectively [6].…”

“…Eight studies reported GWG separately for each category of woman's pre-pregnancy weight [2,7,9,35,42,53,54,56], and the author of one study provided these data upon email request [35]. Four studies [9,44,45,48] used self-reported pre-pregnancy weight while three studies [52,54,59] used weight after 20 weeks of gestation and one study [56] used weight at 24 weeks of gestation. It was not clear when and how pre-pregnancy weight was measured in two studies [46,58] (Table 1).…”

“…Macrosomia. Seven studies reported an association between GWG and macrosomia [6,[43][44][45][46][47]50]. Of these, five studies defined macrosomia as birth weight of � 4 kg [6,[43][44][45]50], while two studies did not clearly show how they defined macrosomia [46,47].…”

Associations of maternal pre-pregnancy body mass index and gestational weight gain with birth outcomes in Shanghai, China

“…The same is true for studies of maternal pre-pregnancy BMI. Some studies reported that overweight/obese women had a higher incidence of fetal macrosomia and LGA infants1640, or overweight/obese women were at increased risk of SGA infants20, while others reported that overweight/obesity was not associated with either low birthweight infants or fetal macrosomia41. However, two large Chinese studies conducted in Tianjin (n = 33,973) and Hebei, Jiangsu, and Zhejiang provinces (n = 292,568), respectively, showed that both overweight/obesity and excessive GWG increased the risks of fetal macrosomia and LGA infants, and both underweight and inadequate GWG were the risk factors for low birthweight and SGA infants1921.…”