Risk factors for inadequate and excessive gestational weight gain in 25 low-and middle-income countries: An individual-level participant meta-Analysis

Issued Date

2023-07-01

Resource Type

Article

ISSN

15491277

eISSN

15491676

DOI

10.1371/journal.pmed.1004236

Scopus ID

2-s2.0-85166736461

Pubmed ID

37486938

Journal Title

PLoS Medicine

Volume

20

Issue

7

Rights Holder(s)

SCOPUS

Bibliographic Citation

PLoS Medicine Vol.20 No.7 (2023)

Suggested Citation

Darling A.M., Wang D., Perumal N., Liu E., Wang M., Ahmed T., Christian P., Dewey K.G., Kac G., Kennedy S.H., Subramoney V., Briggs B., Fawzi W.W., Abioye A.I., Adu-Afarwuah S., Ali H., Alidu H.W., Alves J.G., de Araújo C.A.L., Arifeen S., Artes R., Ashorn P., Ashorn U., Ayoola O.O., Azizi F., Bawah A.T., Behboudi-Gandevani S., Bernstein R., Bhutta Z., Briand V., Calvo E.B., Cardoso M.A., Carrara V.I., Carrilho T.R.B., Cheng Y., Chico-Barba G., Clayton P.E., Collins S.M., Costello A.M., Cruickshank J.K., Duggan C.P., Dwarkanath P., Estrada-Gutierrez G., Fair F.J., Farias D.R., Friis H., Gernand A.D., Ghosh S., Gomo E., Gondwe A., Grais R., Guindo O., Hallamaa L., Hambidge K.M., Hashmi A.H., Huybregts L., Iqbal R., da Silva Junior J.R., Isanaka S., Chan H.T.H., Katz J., Khatry S.K., Kolsteren P., Krebs N., Kulmala T., Kumar P., Kurpad A.V., Labrique A., Lachat C., Lartey A., Lauer J.M., Li Q., Loy S.L., Lipoeto N.I., López L.B., Mahmud A.A., Maiya G.A., Maleta K., Malta M.B., Manandhar D.S., Mangani C., Martínez-Rojano H., Martin-Prevel Y., Martorell R., Matias S.L., McClure E.M., McGready R., Miller J.D., Mohamed H.J.J., Mohamad M., Moore S., Mosquera P.S., Mridha M.K., Mugusi F.M., Muñoz-Manrique C., Nanga S., Natamba B.K., Ome-Kaius M., Osrin D., Pembe A.B. Risk factors for inadequate and excessive gestational weight gain in 25 low-and middle-income countries: An individual-level participant meta-Analysis. PLoS Medicine Vol.20 No.7 (2023). doi:10.1371/journal.pmed.1004236 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/98454

Title

Risk factors for inadequate and excessive gestational weight gain in 25 low-and middle-income countries: An individual-level participant meta-Analysis

Author(s)

Darling A.M.
 Wang D.
 Perumal N.
 Liu E.
 Wang M.
 Ahmed T.
 Christian P.
 Dewey K.G.
 Kac G.
 Kennedy S.H.
 Subramoney V.
 Briggs B.
 Fawzi W.W.
 Abioye A.I.
 Adu-Afarwuah S.
 Ali H.
 Alidu H.W.
 Alves J.G.
 de Araújo C.A.L.
 Arifeen S.
 Artes R.
 Ashorn P.
 Ashorn U.
 Ayoola O.O.
 Azizi F.
 Bawah A.T.
 Behboudi-Gandevani S.
 Bernstein R.
 Bhutta Z.
 Briand V.
 Calvo E.B.
 Cardoso M.A.
 Carrara V.I.
 Carrilho T.R.B.
 Cheng Y.
 Chico-Barba G.
 Clayton P.E.
 Collins S.M.
 Costello A.M.
 Cruickshank J.K.
 Duggan C.P.
 Dwarkanath P.
 Estrada-Gutierrez G.
 Fair F.J.
 Farias D.R.
 Friis H.
 Gernand A.D.
 Ghosh S.
 Gomo E.
 Gondwe A.
 Grais R.
 Guindo O.
 Hallamaa L.
 Hambidge K.M.
 Hashmi A.H.
 Huybregts L.
 Iqbal R.
 da Silva Junior J.R.
 Isanaka S.
 Chan H.T.H.
 Katz J.
 Khatry S.K.
 Kolsteren P.
 Krebs N.
 Kulmala T.
 Kumar P.
 Kurpad A.V.
 Labrique A.
 Lachat C.
 Lartey A.
 Lauer J.M.
 Li Q.
 Loy S.L.
 Lipoeto N.I.
 López L.B.
 Mahmud A.A.
 Maiya G.A.
 Maleta K.
 Malta M.B.
 Manandhar D.S.
 Mangani C.
 Martínez-Rojano H.
 Martin-Prevel Y.
 Martorell R.
 Matias S.L.
 McClure E.M.
 McGready R.
 Miller J.D.
 Mohamed H.J.J.
 Mohamad M.
 Moore S.
 Mosquera P.S.
 Mridha M.K.
 Mugusi F.M.
 Muñoz-Manrique C.
 Nanga S.
 Natamba B.K.
 Ome-Kaius M.
 Osrin D.
 Pembe A.B.

Author's Affiliation

Faculty of Biology, Medicine and Health
 St. John's Research Institute
 Manipal College of Health professions
 Department of Nutritional Sciences & Toxicology
 University of Health and Allied Sciences, Ghana
 Bordeaux Population Health Research Center (BPH)
 Certara, Canada
 King's Health Partners
 Université de Montpellier
 Universiti Sultan Zainal Abidin
 Duke-NUS Medical School
 Muhimbili University of Health and Allied Sciences
 Nepal Nutrition Intervention Project-Sarlahi
 Insper, Sao Paulo
 Kamuzu Central Hospital
 University of Malawi
 Papua New Guinea Institute of Medical Research
 Universitas Andalas
 Godfrey Huggins School of Medicine
 The Aga Khan University
 Instituto Nacional de Perinatologia
 Universiteit Gent
 Harvard T.H. Chan School of Public Health
 Universiti Sains Malaysia, Health Campus
 Faculty of Medicine, Chiang Mai University
 RTI International
 Sheffield Hallam University
 London School of Hygiene & Tropical Medicine
 Københavns Universitet
 Boston Children's Hospital
 The Hospital for Sick Children
 School of Basic Medical Sciences
 University of Colorado School of Medicine
 Rollins School of Public Health
 The University of North Carolina at Chapel Hill
 Tufts University
 Lancashire Teaching Hospitals NHS Foundation Trust
 Bill & Melinda Gates Foundation
 University College London
 Nord Universitet
 Tulane University School of Public Health and Tropical Medicine
 Boston University
 Instituto Politécnico Nacional
 Shahid Beheshti University of Medical Sciences
 George Mason University
 University of Ghana
 Kasturba Medical College, Manipal
 KK Women's And Children's Hospital
 L'Institut de Santé Globale, Genève
 University of California, Davis
 Epicentre
 Mahidol University
 International Centre for Diarrhoeal Disease Research Bangladesh
 Nuffield Department of Medicine
 BRAC University
 University Hospital of Tampere
 Universidade de São Paulo
 Johns Hopkins Bloomberg School of Public Health
 St. John's Medical College
 St Thomas' Hospital
 Harvard Medical School
 University of Oxford Medical Sciences Division
 Universidad de Buenos Aires
 Pennsylvania State University
 Tongji Medical College of Huazhong University of Science and Technology
 International Food Policy Research Institute
 University of Colorado Boulder
 Universidade Federal do Rio de Janeiro
 JiVitA Maternal and Child Health Research Project
 Ministry of Health
 Ministry of Science
 Cidade Universitária
 Pihlajalinna Medical Center
 Instituto de Medicina Integral Prof
 School of Public Health
 Mother and Infant Research Activities (MIRA)

Corresponding Author(s)

Darling A.M.

Other Contributor(s)

Mahidol University

Abstract

Background Many women experience suboptimal gestational weight gain (GWG) in low-and middleincome countries (LMICs), but our understanding of risk factors associated with GWG in these settings is limited. We investigated the relationships between demographic, anthropometric, lifestyle, and clinical factors and GWG in prospectively collected data from LMICs. Methods and findings We conducted an individual participant-level meta-Analysis of risk factors for GWG outcomes among 138,286 pregnant women with singleton pregnancies in 55 studies (27 randomized controlled trials and 28 prospective cohorts from 25 LMICs). Data sources were identified through PubMed, Embase, and Web of Science searches for articles published from January 2000 to March 2019. Titles and abstracts of articles identified in all databases were independently screened by 2 team members according to the following eligibility criteria: following inclusion criteria: (1) GWG data collection took place in an LMIC; (2) the study was a prospective cohort or randomized trial; (3) study participants were pregnant; and (4) the study was not conducted exclusively among human immunodeficiency virus (HIV)-infected women or women with other health conditions that could limit the generalizability of the results. The Institute of Medicine (IOM) body mass index (BMI)-specific guidelines were used to determine the adequacy of GWG, which we calculated as the ratio of the total observed weight gain over the mean recommended weight gain. Study outcomes included severely inadequate GWG (percent adequacy of GWG 70), inadequate GWG (percent adequacy of GWG 90, inclusive of severely inadequate), and excessive GWG (percent adequacy of GWG 125). Multivariable estimates from each study were pooled using fixedeffects meta-Analysis. Study-specific regression models for each risk factor included all other demographic risk factors measured in a particular study as potential confounders, as well as BMI, maternal height, pre-pregnancy smoking, and chronic hypertension. Risk factors occurring during pregnancy were further adjusted for receipt of study intervention (if any) and 3-month calendar period. The INTERGROWTH-21st standard was used to define high and low GWG among normal weight women in a sensitivity analysis. The prevalence of inadequate GWG was 54%, while the prevalence of excessive weight gain was 22%. In multivariable models, factors that were associated with a higher risk of inadequate GWG included short maternal stature (145 cm), tobacco smoking, and HIV infection. A midupper arm circumference (MUAC) of 28.1 cm was associated with the largest increase in risk for excessive GWG (risk ratio (RR) 3.02, 95% confidence interval (CI) [2.86, 3.19]). The estimated pooled difference in absolute risk between those with MUAC of 28.1 cm compared to those with a MUAC of 24 to 28.09 cm was 5.8% (95% CI 3.1% to 8.4%). Higher levels of education and age 20 years were also associated with an increased risk of excessive GWG. Results using the INTERGROWTH-21st standard among normal weight women were similar but attenuated compared to the results using the IOM guidelines among normal weight women. Limitations of the study s methodology include differences in the availability of risk factors and potential confounders measured in each individual dataset; not all risk factors or potential confounders of interest were available across datasets and data on potential confounders collected across studies. Conclusions Inadequate GWG is a significant public health concern in LMICs. We identified diverse nutritional, behavioral, and clinical risk factors for inadequate GWG, highlighting the need for integrated approaches to optimizing GWG in LMICs. The prevalence of excessive GWG suggests that attention to the emerging burden of excessive GWG in LMICs is also warranted.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/123456789/98454

Collections

Scopus 2023