Body mass index and gestational weight gain in migrant women by birth regions compared with Swedish-born women: A registry linkage study of 0.5 million pregnancies

Abstract

Introduction Women migrating to high-income countries may have increased risks of adverse pregnancy outcomes as compared with native-born women. However, little is known whether migrant women are more likely to have unhealthy body mass index (BMI) or gestational weight gain (GWG), which is of importance considering the well-established links between unhealthy BMI and GWG with adverse pregnancy outcomes. Hence, the aim of the study was to examine the prevalence and estimate odds ratios (ORs) of underweight and obesity in the first trimester as well as inadequate and excessive GWG across birth regions in migrant (first-generation) and Swedish-born women in a population-based sample of pregnant women in Sweden. Methods This population-based study included 535 609 pregnancies from the Swedish Pregnancy Register between the years 2010–2018. This register has a coverage of approximately 90% and includes data on body weight, height, birth country and educational attainment. BMI in the first trimester of pregnancy was classified as underweight, normal weight, overweight and obesity whereas GWG was classified as inadequate, adequate and excessive according to the recommendations from the National Academy of Medicine, USA. BMI and GWG were examined according to 7 birth regions and the 100 individual birth countries. Adjusted ORs of underweight, obesity as well as inadequate or excessive GWG by birth regions were estimated using multinomial logistic regression. Results There were large disparities in unhealthy BMI and GWG across birth regions. For instance, women born in North Africa and Middle East and Sub-Saharan Africa had 1.40 (95% CI 1.35–1.44) and 2.13 (95% CI 2.03–2.23) higher odds of obesity compared with women born in Sweden. However, women born in Sub-Saharan Africa had also considerably higher odds of underweight (OR, 2.93 [95% CI 2.70–3.18]) and inadequate GWG (OR, 1.97 [95% CI 1.87–2.07]). The limitations of the study include the lack of a validated measure of acculturation and that the study only had data on first-generation migration. Conclusions The large differences across the 7 regions and 100 countries highlights the importance of considering birth region and country-specific risks of unhealthy BMI and GWG in first-generation migrant women. Furthermore, inadequate GWG was common among pregnant first-generation migrant women, especially in women born in Sub-Saharan Africa, which demonstrates the need to promote adequate GWG, not only the avoidance of excessive GWG. Thus, our findings also indicate that additional support and interventions may be needed for first-generation migrant women from certain birth regions and countries in order to tackle the observed disparities in unhealthy BMI and GWG. Although further studies are needed, our results are useful for identifying groups of women at increased risk of unhealthy BMI and weight gain during pregnancy.

Effectiveness of a Smartphone App to Promote Healthy Weight Gain, Diet, and Physical Activity During Pregnancy (HealthyMoms): Randomized Controlled Trial

“…This may influence generalizability to women with lower socioeconomic status although we found no evidence that the intervention effect differed according to educational attainment. Correspondingly, the prevalence of women with overweight and obesity in this study was somewhat lower than the general pregnant population in Sweden (29% vs 37%) [ 4 ]. Nevertheless, the prevalence of inadequate and excessive GWG in the trial (13% inadequate, 50% excessive) was similar to the general population (18% inadequate, 47% excessive) [ 4 ].…”

“…Correspondingly, the prevalence of women with overweight and obesity in this study was somewhat lower than the general pregnant population in Sweden (29% vs 37%) [ 4 ]. Nevertheless, the prevalence of inadequate and excessive GWG in the trial (13% inadequate, 50% excessive) was similar to the general population (18% inadequate, 47% excessive) [ 4 ]. Besides, because we did not conduct randomization stratified by pre-pregnancy BMI, the number of women with overweight/obesity was slightly different in the intervention and control group which may somewhat decrease statistical power.…”

“…Altogether, these results indicate that the HealthyMoms app has potential to be a valuable tool to promote healthy diet and weight gain in pregnant women. Access to scalable and cost-effective interventions such as the HealthyMoms app may be of importance in order to counteract the high prevalence of excessive GWG in Sweden and globally [ 1 , 2 , 4 ] and its negative implications on pregnancy complications and long-term maternal and fetal health [ 2 , 5 ]. More specifically, the HealthyMoms app is particularly attractive in this context because it is a fully automated stand-alone intervention, which does not rely on additional resources from health care.…”

“…Excessive gestational weight gain (GWG) is a major public health problem [ 1 , 2 ]. In the United States and Europe, around 50% of pregnant women exceed the recommended GWG provided by the National Academy of Medicine [ 1 ] with similar data from Sweden [ 3 , 4 ]. Excessive GWG is associated with increased risk of cesarean delivery, gestational diabetes, pre-eclampsia, and obesity in both mother and child [ 2 , 5 ].…”

Participants’ Engagement and Satisfaction With a Smartphone App Intended to Support Healthy Weight Gain, Diet, and Physical Activity During Pregnancy: Qualitative Study Within the HealthyMoms Trial

“…Excessive GWG is also associated with postpartum weight retention and an increased risk of obesity in the offspring, which are indicators of long-term complications [ 2 , 4 ]. Currently, approximately 50% of pregnant women exceed the commonly applied recommendations from the National Academy of Medicine [ 5 ] and thereby have an increased risk of different pregnancy-related complications [ 4 , 6 ].…”