TY - JOUR
T1 - Risk factors for inadequate and excessive gestational weight gain in 25 low-and middle-income countries
T2 - An individual-level participant meta-Analysis
AU - Members of the GWG Pooling Project Consortium
AU - Darling, Anne Marie
AU - Wang, Dongqing
AU - Perumal, Nandita
AU - Liu, Enju
AU - Wang, Molin
AU - Ahmed, Tahmeed
AU - Christian, Parul
AU - Dewey, Kathryn G.
AU - Kac, Gilberto
AU - Kennedy, Stephen H.
AU - Subramoney, Vishak
AU - Briggs, Brittany
AU - Fawzi, Wafaie W.
AU - Abioye, Ajibola Ibraheem
AU - Adu-Afarwuah, Seth
AU - Ali, Hasmot
AU - Alidu, Huseini Wiisibie
AU - Alves, Joao Guilherme
AU - de Araújo, Carla Adriane Leal
AU - Arifeen, Shams
AU - Artes, Rinaldo
AU - Ashorn, Per
AU - Ashorn, Ulla
AU - Ayoola, Omolola Olukemi
AU - Azizi, Fereidoun
AU - Bawah, Ahmed Tijani
AU - Behboudi-Gandevani, Samira
AU - Bernstein, Robin
AU - Bhutta, Zulfiqar
AU - Briand, Valérie
AU - Calvo, Elvira Beatriz
AU - Cardoso, Marly Augusto
AU - Carrara, Verena I.
AU - Carrilho, Thaís Rangel Bousquet
AU - Cheng, Yue
AU - Chico-Barba, Gabriela
AU - Clayton, Peter Ellis
AU - Collins, Shalean M.
AU - Costello, Anthony M.
AU - Cruickshank, John Kennedy
AU - Duggan, Christopher P.
AU - Dwarkanath, Pratibha
AU - Estrada-Gutierrez, Guadalupe
AU - Fair, Frankie J.
AU - Farias, Dayana Rodrigues
AU - Friis, Henrik
AU - Gernand, Alison D.
AU - Ghosh, Shibani
AU - Gomo, Exnevia
AU - Hashmi, Ahmar H.
N1 - Publisher Copyright:
© 2023 Public Library of Science. All rights reserved.
PY - 2023/7
Y1 - 2023/7
N2 - 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.
AB - 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.
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U2 - 10.1371/journal.pmed.1004236
DO - 10.1371/journal.pmed.1004236
M3 - Article
C2 - 37486938
AN - SCOPUS:85166736461
SN - 1549-1277
VL - 20
JO - PLoS Medicine
JF - PLoS Medicine
IS - 7
M1 - e1004236
ER -