Gestational weight gain in 4 low- and middle-income countries and associations with birth outcomes: a secondary analysis of the Women First Trial

Abstract

Background Adequate gestational weight gain (GWG) is essential for healthy fetal growth. However, in low- and middle-income countries, where malnutrition is prevalent, little information is available about GWG and how it might be modified by nutritional status and interventions. Objective We describe GWG and its associations with fetal growth and birth outcomes. We also examined the extent to which prepregnancy BMI, and preconception and early weight gain modify GWG, and its effects on fetal growth. Methods This was a secondary analysis of the Women First Trial, including 2331 women within the Democratic Republic of Congo (DRC), Guatemala, India, and Pakistan, evaluating weight gain from enrollment to ∼12 weeks of gestation and GWG velocity (kg/wk) between ∼12 and 32 weeks of gestation. Adequacy of GWG velocity was compared with 2009 Institute of Medicine recommendations, according to maternal BMI. Early weight gain (EWG), GWG velocity, and adequacy of GWG were related to birth outcomes using linear and Poisson models. Results GWG velocity (mean ± SD) varied by site: 0.22 ± 0.15 kg/wk in DRC, 0.30 ± 0.23 in Pakistan, 0.31 ± 0.14 in Guatemala, and 0.39 ± 0.13 in India, (P <0.0001). An increase of 0.1 kg/wk in maternal GWG was associated with a 0.13 cm (95% CI: 0.07, 0.18, P <0.001) increase in birth length and a 0.032 kg (0.022, 0.042, P <0.001) increase in birth weight. Compared to women with inadequate GWG, women who had adequate GWG delivered newborns with a higher mean length and weight: 47.98 ± 2.04 cm compared with 47.40 ± 2.17 cm (P <0.001) and 2.864 ± 0.425 kg compared with 2.764 ± 0.418 kg (P <0.001). Baseline BMI, EWG, and GWG were all associated with birth length and weight. Conclusions These results underscore the importance of adequate maternal nutrition both before and during pregnancy as a potentially modifiable factor to improve fetal growth.

Associations between Gestational Weight Gain Adequacy and Neonatal Outcomes in Tanzania

“…Poor fetal growth has been associated with an increased risk of mortality, morbidity, and adverse neurodevelopmental consequences later in life [4, 5, 7], whereas excessive fetal growth has been associated with poor maternal perinatal outcomes (e.g., cesarean section) and childhood obesity [1, 28]. The associations of GWG with birth length and head circumference, however, have rarely been evaluated [23, 29, 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., greater than the expected change in weight in a 3-month interval) was associated with higher birthweight and length, suggesting that better maternal nutrition (as measured by higher GWG) may be prioritized for brain growth over other anthropometric parameters [23]. Secondary data from analysis of a multicountry prenatal nutrition supplementation trial conducted in the Democratic Republic of the Congo, Guatemala, India, and Pakistan also found that higher GWG in the first trimester and higher GWG velocity overall were positively associated with birth length and weight [29].…”

The importance of nutrition in pregnancy and lactation: lifelong consequences

“…In LMICs, improved GWG (100 g/wk) was associated with significantly improved birthweight and length, as was baseline prepregnancy BMI, early weight gain, and GWG from 12 to 32 weeks of gestation. 174 …”

Longitudinal Reduction in Diversity of Maternal Gut Microbiota During Pregnancy Is Observed in Multiple Low-Resource Settings: Results From the Women First Trial

“…These changes, together with those observed in Ruminococcaceae and Lachnospiraceae in Guatemala, suggest that these putative SCFA-producing bacteria may be related to glycemic control during pregnancy, and a reduction in abundance might be beneficial for glucose regulation. In the WF participants, who on average had relatively low gestational weight gain and BMI ( Bauserman et al, 2021 ), these genera decreased during pregnancy. Future research, for example, utilizing germ-free mice, is needed to explore the potential causal relation between these SCFA producers and glycemic control during pregnancy.…”