Nutrition in transition: historical cohort analysis summarising trends in under- and over-nutrition among pregnant women in a marginalised population along the Thailand–Myanmar border from 1986 to 2016

Abstract

The objective of the present study is to summarise trends in under- and over-nutrition in pregnant women on the Thailand–Myanmar border. Refugees contributed data from 1986 to 2016 and migrants from 1999 to 2016 for weight at first antenatal consultation. BMI and gestational weight gain (GWG) data were available during 2004–2016 when height was routinely measured. Risk factors for low and high BMI were analysed for <18·5 kg/m2 or ≥23 kg/m2, respectively. A total of 48 062 pregnancies over 30 years were available for weight analysis and 14 646 pregnancies over 13 years (2004–2016) had BMI measured in first trimester (<14 weeks’ gestational age). Mean weight at first antenatal consultation in any trimester increased over the 30-year period by 2·0 to 5·2 kg for all women. First trimester BMI has been increasing on average by 0·5 kg/m2 for refugees and 0·6 kg/m2 for migrants, every 5 years. The proportion of women with low BMI in the first trimester decreased from 16·7 to 12·7 % for refugees and 23·1 to 20·2 % for migrants, whereas high BMI increased markedly from 16·9 to 33·2 % for refugees and 12·3 to 28·4 % for migrants. Multivariate analysis demonstrated low BMI as positively associated with being Burman, Muslim, primigravid, having malaria during pregnancy and smoking, and negatively associated with refugee as opposed to migrant status. High BMI was positively associated with being Muslim and literate, and negatively associated with age, primigravida, malaria, anaemia and smoking. Mean GWG was 10·0 (sd 3·4), 9·5 (sd 3·6) and 8·3 (sd 4·3) kg, for low, normal and high WHO BMI categories for Asians, respectively.

High levels of pathological jaundice in the first 24 hours and neonatal hyperbilirubinaemia in an epidemiological cohort study on the Thailand-Myanmar border

“…Free maternal and child healthcare is offered and includes pre- and postnatal care, and a birthing unit staffed by skilled birth attendants [ 9 ]. Low income and education, and poor health conditions prevail [ 10 – 12 ]. GA is estimated either by ultrasound (US) at first antenatal consultation (ANC) or by Dubowitz gestational assessment for late attenders [ 13 , 14 ].…”

Feeding practices and risk factors for chronic infant undernutrition among refugees and migrants along the Thailand-Myanmar border: a mixed-methods study

“…Following closure of Shoklo refugee camp in 1998, SMRU moved operations to serve refugees resettled in MLA. As Thailand witnessed a rise in migrant populations through the 1990s, often suffering from malaria, SMRU established MKT and WPA clinics in 1998 and 2004, respectively [36]. In 2014, The Border Consortium estimated a total of 114,569 refugees receiving food rations in the camps within Thailand, with MLA housing the largest number of refugees at 42,542 individuals [37].…”

Cohort profile: molecular signature in pregnancy (MSP): longitudinal high-frequency sampling to characterise cross-omic trajectories in pregnancy in a resource-constrained setting

“…Two-weekly gestational weight, fetal growth and haematocrit were done as malnutrition and anaemia (and formerly malaria) are prevalent pregnancyassociated morbidities. [17][18][19] Ultrasound scans to monitor fetal growth were performed 6-weekly. Throughout the study period, 2850 scans were done; 2693 of these were scans in women with a known, viable birth outcome (157 scans accounted for other pregnancy outcomes).…”

“… 23 24 While the proportion of pregnant women diagnosed with underweight in this population is decreasing, 19.2% (73/381) of pregnancies were still complicated by a diagnosis of underweight. 19 Maternal anaemia defined as haematocrit of less than 30% complicated 16.3% (62/381) of pregnancies and SGA (20.2% (77/381)) according to standards as published by the Intergrowth-21st consortium 25 was also commonly observed and remains a solicitude in this pregnant population. As shown in figure 3 , cohort enrolment in early pregnancy, coupled with the high-frequency sampling provides a plethora of cross-omic data.…”