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Nandita Perumal, PhD MPH
Postdoctoral Research Fellow
Harvard School of Public Health
Boston, Massachusetts, United States
Disclosure: Disclosure(s): No relevant financial relationship(s) with ineligible companies to disclose.
.jpg "Dongqing Wang, PhD, MPH photo")
Dongqing Wang, PhD, MPH
Postdoctoral Research Fellow
Harvard T.H. Chan School of Public Health
Boston, Massachusetts, United States
Anne Marie Darling, PhD
Harvard T.H. Chan School of Public Health
Boston, Massachusetts, United States
Enju Liu, PhD
Boston Children's Hospital
Boston, Massachusetts, United States
Molin Wang, PhD
Harvard T.H. Chan School of Public Health
Boston, Massachusetts, United States
Tahmeed Ahmed, MBBS, PhD
Nutrition and Clinical Services Division, International Center for Diarrhoeal Disease Research, Bangladesh
Dhaka, Dhaka, Bangladesh
Parul Christian, DrPH
Professor
Center for Human Nutrition, JiVitA Project, Department of International Health, Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland, United States
Kathryn G. Dewey, Ph.D.
Distinguished Professor Emerita
University of California, Davis
Davis, California, United States
Gilberto Kac, PhD
Professor
Federal University of Rio de Janeiro
Rio de Janeiro, Rio de Janeiro, Brazil
Stephen Kennedy
Nuffield Department of Women's & Reproductive Health
Wafaie W. Fawzi, MBBS, MPH, MS, DrPH
Professor
Harvard T.H. Chan School of Public Health
Boston, Massachusetts, United States
Gestational weight gain (GWG) during pregnancy is an important predictor of fetal and newborn health; however, few studies have focused on the associations between GWG and neonatal outcomes in low- and middle-income countries (LMIC). We aimed to estimate the associations between GWG and neonatal outcomes using data from prospective pregnancy studies in LMICs.
Methods:
We conducted a two-stage meta-analysis of data from 111,464 pregnant participants in 53 prospective studies from 24 LMICs to estimate the associations between GWG and neonatal outcomes. GWG adequacy was defined as the ratio of the observed weight gain over the recommended weight gain based on the Institute of Medicine body mass index (BMI)-specific guidelines. Study-specific estimates were generated and then pooled using random-effects models. We further assessed whether maternal pre-pregnancy BMI and age modified the associations between GWG adequacy and neonatal outcomes.
Results:
Overall, 55% of participants had severely inadequate ( < 70%) or moderately inadequate (70 to < 90%) GWG, 22% had adequate GWG (90 to 125%), and 23% had excessive GWG (≥125%). Severely inadequate GWG was associated with a higher risk of low birthweight (adjusted relative risk [RR] 1.83, 95% confidence intervals [CI]: 1.54, 2.04), small-for-gestational age (RR 1.76, 95% CI: 1.55, 1.99), short-for-gestational age (RR 1.61, 95% CI: 1.36, 1.91), and microcephaly (RR 1.73, 95% CI: 1.41, 2.13). Excessive GWG was associated with a higher risk of preterm birth (RR 1.31, 95% CI: 1.18, 1.44), large-for-gestational age (RR 1.57, 95% CI: 1.41, 1.75), and macrosomia (RR 1.58, 95% CI: 1.30, 1.91). Associations between suboptimal GWG and neonatal outcomes were modified by maternal pre-pregnancy BMI and age, such that the magnitude of the relationships were higher for women with underweight or overweight/obesity and for adolescent girls compared to women with normal weight or women 20-29 years of age, respectively.
Conclusions: Inadequate and excessive GWG are associated with a higher risk of adverse neonatal outcomes across settings. Interventions to promote optimal GWG during pregnancy are likely to reduce the burden of adverse neonatal outcomes in LMICs.
Funding Sources:
This study was supported by funding from the Bill and Melinda Gates Foundation (OPP1204850) and the Canadian Institutes of Health Research Fellowship to NP.