Poor maternal anthropometric status before conception is associated with a deleterious infant growth during the first year of life: a longitudinal preconceptional cohort

Abstract

Summary Background According to the Developmental Origins of Health and Diseases concept, exposures in the preconception period may be critical. For the first time, we evaluated the effect of preconception poor anthropometric status on infant's growth in sub‐Saharan Africa. Methods A mother‐child cohort was followed prospectively from preconception to 1 year old in Benin. Maternal anthropometric status was assessed by prepregnancy body mass index (BMI), approximated by BMI at the first antenatal visit before 7 weeks' gestation, and gestational weight gain (GWG). BMI was categorized as underweight, normal, overweight, and obesity according to World Health Organization standards. GWG was categorized as low (<7 kg), mild (7‐12 kg), and high (>12 kg). In infant, stunting and wasting were defined as length‐for‐age and weight‐for‐length z scores less than −2 SD, respectively. We evaluated the association between BMI/GWG and infant's weight and length at birth and during the first year of life, as well as with stunting and wasting at 12 months using mixed linear and logistic regression models. Results In multivariate, preconceptional underweight was associated with a lower infant's weight at birth and during the first year (−164 g; 95% CI, −307 to −22; and −342 g; 95% CI, −624 to −61, respectively) and with a higher risk of stunting at 12 months (adjusted odds ratio [aOR] = 3.98; 95% CI, 1.01‐15.85). Furthermore, preconceptional obesity and a high GWG were associated with a higher weight and length at birth and during the first year. Conclusion Underweight and obesity before conception as well as GWG were associated with infant's growth. These results argue for preventive interventions starting as early as the preconception period to support child long‐term health.

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].…”

“…Outcomes, GWG, were reported using the IOM classification. For studies that used arbitrary classifications (for example, � 8.0 kg (inadequate GWG), 8.1 to 16.0 kg (adequate GWG), and �16.1 kg (excessive GWG) [39]; or <7 kg (inadequate GWG), 7 to 12 kg (adequate t GWG), and >12 kg (excessive GWG) [40]), we used the authors' own classifications.…”

“…Sixteen studies [2, 7, 9, 28, 35, 42, 45, 47, 51-56, 58, 59] classified the outcome (GWG) according to the IOM recommendations, but for seven studies [6,39,40,43,44,48,50] standard criteria were not used to measure and classify the outcome, that is the authors classified weight gain using their own method. Three studies reported according to the International Fetal Newborn Growth Standards for the 21st Century (INTERGROWTH-21 st ) guidelines [52,57,58], of which two studies [52,58] used both IOM 2009 and INTERGROWTH-21 st guidelines.…”

“…In two studies [46,58], it was unclear when or how the pre-pregnancy weight of the women was measured. The arbitrary classification of the outcome [6,39,40,43,44,48,50] and unclear classification of BMI and GWG were identified as a major quality issue in the review. Thirdly, there was poor control of confounding factors in many studies [6,9,39,42,43,[46][47][48].…”

Infant growth during the first year of life following a pregnancy lifestyle intervention in routine care—Findings from the cluster‐randomisedGeliStrial

“…6,8 Moreover, total gestational weight gain (GWG) or GWG above a certain threshold (excessive GWG) 9 have been shown to influence weight development of offspring and their obesity risk. 6,8,10,11 Further, early postnatal factors such as breastfeeding pattern and formula feeding, introduction of solid foods, activity or inactivity level, and also sleeping behaviour and exposure to antibiotics are currently discussed to modify the infant's obesity risk in the short-and long-term. 7,12,13 Due to the potential to reverse health consequences of childhood obesity if weight normalisation is achieved by puberty, 14 identifying effective early-life strategies that tackle modifiable risk factors are urgently needed.…”