The relative influence of maternal nutritional status before and during pregnancy on birth outcomes in Vietnam

Young, Melissa; Nguyen, Phuong Hong; Addo, O Yaw; Wu, Hao; Nguyen, Hieu; Pham, Hoa; Martorell, Reynaldo; Ramakrishnan, Usha

doi:10.1016/j.ejogrb.2015.09.018

Cited by 46 publications

(55 citation statements)

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“…In our population, three quarters of women gained below the IOM recommendations and these women were 2.5 times more likely to give birth to a SGA baby. This research is consistent with prior research confirming the importance of maternal nutrition during pregnancy [2, 14, 30]. …”

Section: Discussionsupporting

confidence: 93%

“…This paper expands on our previous research demonstrating a similar and independent impact of maternal nutrition before (pre-pregnancy weight) and during (total gestational weight gain) pregnancy [14] and provides evidence that the timing of weight gain also matters. By using advanced statistical methods the importance of conditional weight gain during three time periods (≤ 20 wk, 21–29 wk and ≥ 30 wk) pregnancy was examined.…”

Section: Discussionsupporting

confidence: 77%

“…Using prospective data starting pre-pregnancy through delivery from the PRECONCEPT randomized controlled trial in Thai Nguyen, Vietnam, we have previously demonstrated similar and independent effects of maternal nutrition before and during pregnancy on birth outcomes [14]. In the current study, our objective is to examine the relative importance of timing of gestational weight gain during pregnancy on fetal growth and birth outcomes.…”

Section: Introductionmentioning

confidence: 97%

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Timing of Gestational Weight Gain on Fetal Growth and Infant Size at Birth in Vietnam

et al. 2017

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ObjectiveTo examine the importance of timing of gestational weight gain during three time periods: 1: ≤ 20 weeks gestation), 2: 21–29 weeks) and 3: ≥ 30 weeks) on fetal growth and infant birth size.MethodsStudy uses secondary data from the PRECONCEPT randomized controlled trial in Thai Nguyen province, Vietnam (n = 1436). Prospective data were collected on women starting pre-pregnancy through delivery. Maternal conditional weight gain (CWG) was defined as window-specific weight gains, uncorrelated with pre-pregnancy body mass index and all prior body weights. Fetal biometry, was assessed by ultrasound measurements of head and abdomen circumferences, biparietal diameter, and femoral length throughout pregnancy. Birth size outcomes included weight and length, and head, abdomen and mid upper arm circumferences as well as small for gestational age (SGA). Adjusted generalized linear and logistic models were used to examine associations.ResultsOverall, three-quarters of women gained below the Institute of Medicine guidelines, and these women were 2.5 times more likely to give birth to a SGA infant. Maternal CWG in the first window (≤ 20 weeks), followed by 21–29 weeks, had the greatest association on all parameters of fetal growth (except abdomen circumference) and infant size at birth. For birth weight, a 1 SD increase CWG in the first 20 weeks had 3 times the influence compared to later CWG (≥ 30 weeks) (111 g vs. 39 g) and was associated with a 43% reduction in SGA risk (OR (95% CI): 0.57 (0.46–0.70).ConclusionThere is a need to target women before or early in pregnancy to ensure adequate nutrition to maximize impact on fetal growth and birth size.Trial RegistrationClinicalTrials.gov, NCT01665378

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 97%

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Timing of Gestational Weight Gain on Fetal Growth and Infant Size at Birth in Vietnam

et al. 2017

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“…Part of the relevant literature comprises studies in which maternal weight has been used as an indicator of nutritional status with the aim of providing information about which women are most at risk of delivering an SGA baby and at what time points an intervention might be most effective. The majority of studies have reported positive relations of prepregnancy weight or gestational weight gain with birth weight (11–24), thereby suggesting a need to improve nutritional status before conception as well as during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Preconceptional and gestational weight trajectories and risk of delivering a small-for-gestational-age baby in rural Gambia,

Johnson

Elmrayed

Sosseh

et al. 2017

The American Journal of Clinical Nutrition

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Background: Maternal nutritional status is a key determinant of small for gestational age (SGA), but some knowledge gaps remain, particularly regarding the role of the energy balance entering pregnancy.Objective: We investigated how preconceptional and gestational weight trajectories (summarized by individual-level traits) are associated with SGA risk in rural Gambia.Design: The sample comprised 670 women in a trial with serial weight data (7310 observations) that were available before and during pregnancy. Individual trajectories from 6 mo before conception to 30 wk of gestation were produced with the use of multilevel modeling. Summary traits were expressed as weight z scores [weight z score at 3 mo preconception (zwt−3 mo), weight z score at conception, weight z score at 3 mo postconception, weight z score at 7 mo postconception (zwt+7 mo), and conditional measures that represented the change from the preceding time] and were related to SGA risk with the use of Poisson regression with confounder adjustment; linear splines were used to account for nonlinearity.Results: Maternal weight at each time point had a consistent nonlinear relation with SGA risk. For example, the zwt−3 mo estimate was stronger in women with values ≤0.5 (RR: 0.736; 95% CI: 0.594, 0.910) than in women with values >0.5 (RR: 0.920; 95% CI: 0.682, 1.241). The former group had the highest observed SGA prevalence. Focusing on weight change, only conditional zwt+7 mo was associated with SGA and only in women with values >−0.5 (RR: 0.579; 95% CI: 0.463, 0.724).Conclusions: Protection against delivering an SGA neonate offered by greater preconceptional or gestational weight may be most pronounced in more undernourished and vulnerable women. Independent of this possibility, greater second- and third-trimester weight gain beyond a threshold may be protective. This trial was registered at http://www.isrctn.com/ as ISRCTN49285450.

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“…Inadequate food intakes and infections as well as early childhood malnutrition, underweight, and anemia contribute to short stature. Poor preconception nutrition, low preconception bodyweight, short maternal stature, and adolescent pregnancy as well as short intervals in birth spacing are associated with LBW [19-21]. Preconception underweight is associated with an increased risk of intrauterine growth retardation resulting in an SGA infant [20, 22].…”

Section: Linear Growth From Preconception To Beyond the First 1000 Dmentioning

confidence: 99%

World Perspective on the Epidemiology of Stunting between 1990 and 2015

2017

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Background: Stunting is the most prevalent form of child undernutrition with current worldwide estimates at 156 million. The majority of these children reside in low- and middle-income countries. When stunting prevails to adulthood, optimal growth potential and economic productivity are minimized. Results: In 2015 there were 98.5 million fewer stunted children under 5 years of age than in 1990. In East Asia and Pacific and South Asia, the stunting prevalence decreased by 24.8 and 25%, respectively. Minimal declines were observed in Latin America and the Caribbean at 12.6%, in the Middle East and North Africa at 12.9%, and in sub-Saharan Africa at 13.4%. But because large populations of children under 5 years of age are distributed disproportionately, decreases in prevalence do not translate to fewer numbers of stunted children globally. In sub-Saharan Africa, the number of stunted children increased by 12.4 million between 1990 and 2015. Conclusions: Adult height is dependent on nutrition-specific or nutrition-sensitive factors. Nutrition-specific factors can be targeted according to their impact at critical points of development and therefore offer multiple windows of opportunity for interventions. To date, many interventions focus on the first 1,000 days, but opportunities may extend into later childhood and adolescence.

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The relative influence of maternal nutritional status before and during pregnancy on birth outcomes in Vietnam

Cited by 46 publications

References 20 publications

Timing of Gestational Weight Gain on Fetal Growth and Infant Size at Birth in Vietnam

Timing of Gestational Weight Gain on Fetal Growth and Infant Size at Birth in Vietnam

Preconceptional and gestational weight trajectories and risk of delivering a small-for-gestational-age baby in rural Gambia,

World Perspective on the Epidemiology of Stunting between 1990 and 2015

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