Association between gestational weight gain and adverse pregnancy outcomes: cohort analysis from South Asia and Sub-Saharan Africa
Introduction Studies of gestational weight gain (GWG) and adverse pregnancy outcomes seldom focus on low-to-middle-income countries (LMICs), despite their high burden of morbidity and mortality. We examined GWG patterns and adverse pregnancy outcomes in a consortium of pregnancy cohorts from LMICs.M...
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2025-02-01
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| author | Anisur Rahman Fyezah Jehan Gary M Shaw Sunil Sazawal Salahuddin Ahmed Abdullah H Baqui David K Stevenson Monjur Rahman Jesmin Pervin Shaki Aktar Rasheda Khanam Sayedur Rahman Nitya Wadhwa Ge Zhang Huan Xu Usma Mehmood Shinjini Bhatnagar Jeffrey S A Stringer Bellington Vwalika Waqasuddin Khan Nabidul Haque Chowdhury Imran Nisar Javairia Khalid Nima Aghaeepour U Tin Nu Yuri V Sebastião Ramachandran Thiruvengadam Ayushi Bapu Koundinya Desiraju Fatma Kabole Muhammad Farrukh Qazi Margaret Kasaro Bihila Abdalla Bakari |
| author_facet | Anisur Rahman Fyezah Jehan Gary M Shaw Sunil Sazawal Salahuddin Ahmed Abdullah H Baqui David K Stevenson Monjur Rahman Jesmin Pervin Shaki Aktar Rasheda Khanam Sayedur Rahman Nitya Wadhwa Ge Zhang Huan Xu Usma Mehmood Shinjini Bhatnagar Jeffrey S A Stringer Bellington Vwalika Waqasuddin Khan Nabidul Haque Chowdhury Imran Nisar Javairia Khalid Nima Aghaeepour U Tin Nu Yuri V Sebastião Ramachandran Thiruvengadam Ayushi Bapu Koundinya Desiraju Fatma Kabole Muhammad Farrukh Qazi Margaret Kasaro Bihila Abdalla Bakari |
| author_sort | Anisur Rahman |
| collection | DOAJ |
| description | Introduction Studies of gestational weight gain (GWG) and adverse pregnancy outcomes seldom focus on low-to-middle-income countries (LMICs), despite their high burden of morbidity and mortality. We examined GWG patterns and adverse pregnancy outcomes in a consortium of pregnancy cohorts from LMICs.Methods We analysed data from five observational pregnancy cohorts in Bangladesh (two cohorts), India, Pakistan and Zambia. The study population comprised 15 286 singleton pregnancies with two or more maternal antenatal weight measurements. We estimated reference values for GWG using longitudinal models and calculated weight gain for gestational age Z-scores. We then estimated the associated risks of preterm birth, low birth weight, and small for gestational age, stratified by maternal body mass index (BMI), using marginal generalised linear models and plotted non-linear trends in the associations.Results The median baseline maternal and gestational age were 24 years (IQR, 21–28) and 13 weeks (IQR 11–16), respectively, with 23% of participants having underweight BMI. The median GWG was 6.8 kg (4.2–9.4) and varied across cohorts from 6.1 kg (3.7–8.5; Bangladesh) to 7.0 kg (4.0–10.0; Zambia). The risk of preterm birth (13%) increased with lower GWG Z-scores among underweight (adjusted risk ratio (ARR), 1.4; 95% CI, 1.1 to 1.9 for lowest Z-score group) and normal BMI participants (ARR, 1.1; 95% CI, 1.0 to 1.2). The risk of low birth weight (25%) increased with lower GWG Z-scores in all BMI strata except obese participants (ARR, 1.7; 95% CI 1.5 to 1.9 among underweight). The risk of small for gestational age (36%) increased with lower GWG Z-scores in all BMI strata (ARR, 1.3; 95% CI 1.2 to 1.4 among underweight). In secondary analyses, alternative measures of GWG (adequacy ratio; INTERGROWTH-21st) had associations that were consistent with those from our study-specific Z-scores, except for a less clear association between preterm birth and INTERGROWTH-21st Z-score.Conclusion GWG was associated with preterm birth, low birth weight and small for gestational age. Early pregnancy BMI modified the association between GWG and outcomes in the study setting. |
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| institution | Kabale University |
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| language | English |
| publishDate | 2025-02-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Public Health |
| spelling | doaj-art-eeda00dfed4b4db3a4d5eeb3f86892782025-02-04T17:50:08ZengBMJ Publishing GroupBMJ Public Health2753-42942025-02-013110.1136/bmjph-2024-000900Association between gestational weight gain and adverse pregnancy outcomes: cohort analysis from South Asia and Sub-Saharan AfricaAnisur Rahman0Fyezah Jehan1Gary M Shaw2Sunil Sazawal3Salahuddin Ahmed4Abdullah H Baqui5David K Stevenson6Monjur Rahman7Jesmin Pervin8Shaki Aktar9Rasheda Khanam10Sayedur Rahman11Nitya Wadhwa12Ge Zhang13Huan Xu14Usma Mehmood15Shinjini Bhatnagar16Jeffrey S A Stringer17Bellington Vwalika18Waqasuddin Khan19Nabidul Haque Chowdhury20Imran Nisar21Javairia Khalid22Nima Aghaeepour23U Tin Nu24Yuri V Sebastião25Ramachandran Thiruvengadam26 Ayushi27Bapu Koundinya Desiraju28Fatma Kabole29Muhammad Farrukh Qazi30Margaret Kasaro31Bihila Abdalla Bakari329 University College London, London, UKDepartment of Pediatrics and Child Health, Aga Khan University, Karachi, PakistanDepartment of Pediatrics, Stanford University, Stanford, California, USACenter for Public Health Kinetics, New Delhi, IndiaProjahnmo Research Foundation, Dhaka, BangladeshInternational Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USADepartment of Pediatrics, Stanford University School of Medicine, Stanford, California, USANutritional and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, BangladeshMaternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, BangladeshMaternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, BangladeshInternational Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USAProjahnmo Research Foundation, Dhaka, BangladeshTranslational Health Science and Technology Institute, Faridababd, Haryana, IndiaDepartment of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, ChinaCenter for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children’s Hospital Medical Center and March of Dimes Prematurity Research Center Ohio Collaborative, Cincinnati, Ohio, USABiorepository and Omics Research Group, Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Sindh, Pakistan1Department of Pediatrics, Center for Diarrheal Research, All India Institute of Medical Sciences, New Delhi, India5 Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, USASchool of Medicine, University of Zambia, Lusaka, ZambiaBiorepository and Omics Research Group, Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Sindh, PakistanProjahnmo Research Foundation, Dhaka, BangladeshBiorepository and Omics Research Group, Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Sindh, PakistanBiorepository and Omics Research Group, Department of Pediatrics and Child Health, Faculty of Health Sciences, Medical College, The Aga Khan University, Karachi, Sindh, PakistanDepartment of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USAMaternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, BangladeshDivision of Global Women`s Health, Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USAMaternal and Child Health Program, Translational Health Science and Technology Institute, Faridabad, Haryana, IndiaMaternal and Child Health Program, Translational Health Science and Technology Institute, Faridabad, Haryana, IndiaMaternal and Child Health Program, Translational Health Science and Technology Institute, Faridabad, Haryana, IndiaMinistry of Health, Zanzibar, Tanzania, United Republic ofDepartment of Pediatrics and Child Health, Medical College, Aga Khan University, Karachi, PakistanDivision of Global Women`s Health, Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USAMinistry of Health, Zanzibar, Tanzania, United Republic ofIntroduction Studies of gestational weight gain (GWG) and adverse pregnancy outcomes seldom focus on low-to-middle-income countries (LMICs), despite their high burden of morbidity and mortality. We examined GWG patterns and adverse pregnancy outcomes in a consortium of pregnancy cohorts from LMICs.Methods We analysed data from five observational pregnancy cohorts in Bangladesh (two cohorts), India, Pakistan and Zambia. The study population comprised 15 286 singleton pregnancies with two or more maternal antenatal weight measurements. We estimated reference values for GWG using longitudinal models and calculated weight gain for gestational age Z-scores. We then estimated the associated risks of preterm birth, low birth weight, and small for gestational age, stratified by maternal body mass index (BMI), using marginal generalised linear models and plotted non-linear trends in the associations.Results The median baseline maternal and gestational age were 24 years (IQR, 21–28) and 13 weeks (IQR 11–16), respectively, with 23% of participants having underweight BMI. The median GWG was 6.8 kg (4.2–9.4) and varied across cohorts from 6.1 kg (3.7–8.5; Bangladesh) to 7.0 kg (4.0–10.0; Zambia). The risk of preterm birth (13%) increased with lower GWG Z-scores among underweight (adjusted risk ratio (ARR), 1.4; 95% CI, 1.1 to 1.9 for lowest Z-score group) and normal BMI participants (ARR, 1.1; 95% CI, 1.0 to 1.2). The risk of low birth weight (25%) increased with lower GWG Z-scores in all BMI strata except obese participants (ARR, 1.7; 95% CI 1.5 to 1.9 among underweight). The risk of small for gestational age (36%) increased with lower GWG Z-scores in all BMI strata (ARR, 1.3; 95% CI 1.2 to 1.4 among underweight). In secondary analyses, alternative measures of GWG (adequacy ratio; INTERGROWTH-21st) had associations that were consistent with those from our study-specific Z-scores, except for a less clear association between preterm birth and INTERGROWTH-21st Z-score.Conclusion GWG was associated with preterm birth, low birth weight and small for gestational age. Early pregnancy BMI modified the association between GWG and outcomes in the study setting.https://bmjpublichealth.bmj.com/content/3/1/e000900.full |
| spellingShingle | Anisur Rahman Fyezah Jehan Gary M Shaw Sunil Sazawal Salahuddin Ahmed Abdullah H Baqui David K Stevenson Monjur Rahman Jesmin Pervin Shaki Aktar Rasheda Khanam Sayedur Rahman Nitya Wadhwa Ge Zhang Huan Xu Usma Mehmood Shinjini Bhatnagar Jeffrey S A Stringer Bellington Vwalika Waqasuddin Khan Nabidul Haque Chowdhury Imran Nisar Javairia Khalid Nima Aghaeepour U Tin Nu Yuri V Sebastião Ramachandran Thiruvengadam Ayushi Bapu Koundinya Desiraju Fatma Kabole Muhammad Farrukh Qazi Margaret Kasaro Bihila Abdalla Bakari Association between gestational weight gain and adverse pregnancy outcomes: cohort analysis from South Asia and Sub-Saharan Africa BMJ Public Health |
| title | Association between gestational weight gain and adverse pregnancy outcomes: cohort analysis from South Asia and Sub-Saharan Africa |
| title_full | Association between gestational weight gain and adverse pregnancy outcomes: cohort analysis from South Asia and Sub-Saharan Africa |
| title_fullStr | Association between gestational weight gain and adverse pregnancy outcomes: cohort analysis from South Asia and Sub-Saharan Africa |
| title_full_unstemmed | Association between gestational weight gain and adverse pregnancy outcomes: cohort analysis from South Asia and Sub-Saharan Africa |
| title_short | Association between gestational weight gain and adverse pregnancy outcomes: cohort analysis from South Asia and Sub-Saharan Africa |
| title_sort | association between gestational weight gain and adverse pregnancy outcomes cohort analysis from south asia and sub saharan africa |
| url | https://bmjpublichealth.bmj.com/content/3/1/e000900.full |
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