Gestational weight gain and newborn anthropometric outcomes in rural Bangladesh

Abstract

Low gestational weight gain (GWG) is a known predictor of fetal growth restriction in higher income countries, but there is little information on this association in lower income countries. Our objective is to describe the association between GWG and birth outcomes among pregnant women in rural Bangladesh. Pregnant women were identified in a community‐based programme and enrolled into the study at an average of 13 weeks' gestation (n = 4,011). Maternal weight and height were measured at enrolment, maternal weight was measured at 36 weeks' gestation, and newborns were measured after birth. Rate of GWG (g/weeks) was calculated, and women were categorized as having adequate or inadequate GWG (Institute of Medicine recommendations). Newborn anthropometric outcomes included weight‐for‐age z score (WAZ), length‐for‐age z score (LAZ), head‐circumference‐for‐age z score (HCZ), body mass index (BMI)‐for‐age z score (BMIZ), low birthweight (LBW < 2,500 g), WAZ < −2, LAZ < −2, HCZ < −2, BMIZ < −2, and small for gestational age (SGA: <10th percentile). Multivariate models were adjusted for confounders. Only 26% of the 2,562 women in these analyses had adequate GWG. Compared with newborns of women with inadequate GWG, infants of women with adequate GWG had a lower risk of adverse anthropometric outcomes (relative risk [95% confidence interval]: LBW = 0.68 [0.59, 0.80], LAZ < −2 = 0.64 [0.51, 0.80], HCZ < −2 = 0.75 [0.60, 0.93], BMIZ < −2 = 0.70 [0.59, 0.83], and SGA = 0.80 [0.73, 0.86]), but there was no significant difference in mean (SE) duration of gestation, 39.7 (0.08) versus 39.7 (0.05) weeks. In this population, GWG rate is a strong predictor of newborn anthropometric outcomes, but not duration of gestation.

Institute of Medicine Recommendations on the Rate of Gestational Weight Gain and Perinatal Outcomes in Rural Bangladesh

“…We also found that an inadequate rate of weight gain was most frequent among underweight women, and excessive weight gain was common among overweight women. These findings are in line with that of other studies in low- as well as high-income countries [ 6 , 7 , 8 , 9 , 41 ] and highlight the importance of starting pregnancy with a normal body weight and preconception counseling.…”

“…A retrospective chart analysis of data from 29,861 women in 25 U.S. hospitals found higher odds of macrosomia among women with rates of GWG above IOM recommendations (AOR = 2.66, 95% CI: 2.03, 3.48) but did not find any association with weight gain below the recommendations [ 5 ]. In another recent study in two rural sub-districts in northwest Bangladesh, compared to women with inadequate GWG during the second and third trimester, women who gained weight at a rate within the IOM guidelines had a lower risk of delivering LBW and SGA infants [ 41 ].…”

“…In our study, although both inadequate and excessive rates of GWG were found to be associated with adverse perinatal outcomes, the proportion of women experiencing suboptimal GWG rates during the second and third trimester was substantially higher than the proportion of those who gained at rates above the IOM recommendations (56% vs. 19.9%). A recent study that followed pregnant women in two rural sub-districts in northwest Bangladesh from 9–16 weeks to 36 weeks of gestation, showed that 74% of women were gaining weight at rates less than the IOM recommendations [ 41 ]. The National Low-Birth-Weight Survey 2015 estimated that 68% of the women in Bangladesh gained less than 7 kg during the entire pregnancy period [ 48 ].…”

“…Furthermore, the first-trimester weight was available for only a subset of the population; hence, we had to estimate the first-trimester weight for women who were first weighed after 16 weeks of gestation. However, similar methods have been used successfully to estimate prepregnancy BMI in populations lacking accurate knowledge of prepregnancy weight [ 41 , 52 ]. Our data showed a strong correlation between the actual and the predicted weight in the first trimester.…”

Associations between gestational weight gain adequacy and neonatal outcomes in Tanzania

“…[1,27] The associations of GWG with birth length and head circumference, however, have rarely been evaluated. [28–30] Inadequate GWG in this study was positively associated with the risk of stunting and microcephaly at birth. A longitudinal study of 670 pregnant women in The Gambia similarly found that greater GWG at any level was positively associated with head circumference, but only greater GWG above a threshold of 0.5 SD of conditional weight gain (i.e.…”