Gestational Weight Gain and Associated Factors in a Tertiary Hospital in Southwest Nigeria: A Cohort Study

Main Article Content

Adebayo Adekunle Akadri
Elizabeth Oluwakemi Grillo
Oluwaseyi Isaiah Odelola
Olumuyiwa Olalekan Adelowo
Odutola Olawale Odugbem
Omobolanle Motunrayo Akadri

Keywords

Birth weight, Body mass index, Gestational, Institute of Medicine, Nigeria, Predictors, Pregnancy, Weight gain

Abstract

Background: Gestational weight gain (GWG) is an important determinant of maternal and foetal wellbeing. Evidence suggests that there is heterogeneity in GWG across countries and regions based on the influence of several factors. This study was designed to investigate GWG, associated factors, and pregnancy outcome among women who gave birth at Babcock University Teaching Hospital, Nigeria.    


Methodology: A prospective cohort study carried out on 220 pregnant women who registered for antenatal care before gestational age of 13 weeks and recruited between June 2022 and May 2024. GWG was categorized into adequate, inadequate or excessive according to the United States Institute of Medicine (IOM) guidelines. Logistic regression analysis was used to investigate predictors of GWG, while Relative Risk was reported for pregnancy outcomes.  


Results: Adequate GWG, inadequate GWG and Excessive GWG were achieved by 29.1%, 40.5% and 30.5% of the women, respectively. The median (95% CI) GWG in all study participants was 9.8 (8.8-10.3) Kg. Older maternal age [OR 2.5(1.3-5.0); P=0.013], multiparity [OR 8.2(1.3-51.8); P=0.025] and middle/upper socioeconomic class [OR 14.6(2.1-99.2); P=0.006] predicted increased likelihood of inadequate GWG while being overweight [OR 0.2(0.1-0.4); P<0.001] and obese [OR 0.06(0.02-0.20); P<0.001] were associated with reduced likelihood of inadequate GWG. None of the variables studied predicted excessive GWG. In terms of pregnancy outcome, women with inadequate GWG had a 30% reduced risk of caesarean delivery compared to those with adequate GWG [RR 0.7(0.6-0.9); P= 0.036]. The mean birth weight of babies born to women with inadequate GWG was significantly lower than that of babies born to women with adequate GWG (T-test = 2.998; P=0.003).


Conclusion: A substantial proportion of study participants had suboptimal GWG (inadequate and excessive), with only a third meeting the IOM recommendations. There is a need for targeted counselling for older, multiparous, and upper socioeconomic class women on adequate GWG.

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References

1. Ferraro ZM, Barrowman N, Prud Homme D, Walker M, Wen SW, Rodger M, et al. Excessive gestational weight gain predicts large for gestational age neonates independent of maternal body mass index. J Matern Fetal Neonatal Med 2012; 25: 538-542. doi: 10.3109/14767058.2011.638953.

2. Sivalingarajah R, Abeykoon W. Influences of maternal weight gain during pregnancy on selected fetal outcomes. Journal of Gynecology and Obstetrics 2019; 7(4): 120-124. doi: 10.11648/j.jgo.20190704.15

3. Phelan S. Pregnancy: a “teachable moment” for weight control and obesity prevention. Am J Obstet Gynecol. 2010;202(135):e1–8.

4. Akgun N, Keskin HL, Ustuner I, Pekcan G, Avsar AF. Factors affecting pregnancy weight gain and relationships with maternal/fetal outcomes in Turkey. Saudi Med J. 2017;38(5):503-508. doi: 10.15537/smj.2017.5.19378.

5. Power ML, Lott ML, Mackeen AD, DiBari J, Schulkin J. A retrospective study of gestational weight gain in relation to the Institute of Medicine's recommendations by maternal body mass index in rural Pennsylvania from 2006 to 2015. BMC Pregnancy Childbirth. 2018;18(1):239. doi: 10.1186/s12884-018-1883-1.

6. Rasmussen KM, Catalano PM, Yaktine AL. New guidelines for weight gain during pregnancy: what obstetrician/gynecologists should know. Curr Opin Obstet Gynecol. 2009;21(6):521-6. doi: 10.1097/GCO.0b013e328332d24e.

7. Rogozińska E, Zamora J, Marlin N, Betrán AP, Astrup A, Bogaerts A, et al. Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: analysis using individual participant data from randomised trials. BMC Pregnancy Childbirth. 2019;19(1):322. doi: 10.1186/s12884-019-2472-7.

8. Goldstein RF, Abell SK, Ranasinha S, Misso M, Boyle JA, Black MH, et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA. 2017;317(21):2207–25

9. Cheikh Ismail L, Bishop DC, Pang R, Ohuma EO, Kac G, Abrams B, et al. Gestational weight gain standards based on women enrolled in the fetal growth longitudinal study of the INTERGROWTH-21st project: a prospective longitudinal cohort study. BMJ 2016;352:i555. doi: 10.1136/bmj.i555

10. Jiang X, Liu M, Song Y, Mao J, Zhou M, Ma Z, Qian X, Han Z, Duan T. The Institute of Medicine recommendation for gestational weight gain is probably not optimal among non-American pregnant women: a retrospective study from China. J Matern Fetal Neonatal Med. 2019;32(8):1353-1358. doi: 10.1080/14767058.2017.1405388.

11. Arora P, Tamber Aeri B. Gestational Weight Gain among Healthy Pregnant Women from Asia in Comparison with Institute of Medicine (IOM) Guidelines-2009: A Systematic Review. J Pregnancy. 2019;2019:3849596. doi: 10.1155/2019/3849596.

12. Sharma SK, Mudgal SK, Thakur K, Gaur R. How to calculate sample size for observational and experimental nursing research studies? Natl J Physiol Pharm Pharmacol 2020;10(01):1-8.

13. Adeoye IA, Bamgboye EA, Omigbodun AO (2023) Gestational weight gain among pregnant womenin Ibadan, Nigeria: Pattern, predictors and pregnancy outcomes. PLoS ONE 18(8): e0290102. https://doi.org/10.1371/journal.pone.0290102

14. Tayade S, Singh R, Kore J, Gangane N. Maternal Anthropometric measurements, Pre-pregnancy Body Mass Index, and Fetal Growth Parameters - A Rural Experience. Obstet Gynecol Res 2018; 1 (2): 051-064. DOI: 10.26502/ogr009

15. Onwuka CI, Ugwu EO, Onah HE, Obi SN, Onwuka CI, Menuba IE, Okafor II. Patterns of gestational weight gain and its association with birthweight in Nigeria. Niger J Clin Pract. 2017;20(6):754-760. doi: 10.4103/1119-3077.208958.

16. Yang J, Wang M, Tobias DK, Rich-Edwards JW, Darling AM, Abioye AI, Pembe AB, Madzorera I, Fawzi WW. Gestational weight gain during the second and third trimesters and adverse pregnancy outcomes, results from a prospective pregnancy cohort in urban Tanzania. Reprod Health. 2022;19(1):140. doi: 10.1186/s12978-022-01441-7.

17. Asefa F, Cummins A, Dessie Y, Hayen A, Foureur M. Gestational weight gain and its effect on birth outcomes in sub-Saharan Africa: Systematic review and meta-analysis. PLoS One. 2020;15(4):e0231889. doi: 10.1371/journal.pone.0231889.

18. Lu W, Zhang X, Wu J, Mao X, Shen X, Chen Q, Zhang J, Huang L, Tang Q. Association between trimester-specific gestational weight gain and childhood obesity at 5 years of age: results from Shanghai obesity cohort. BMC Pediatr. 2019;19(1):139. doi: 10.1186/s12887-019-1517-4.

19. Costa JC, Wang D, Wang M, Liu E, Partap U, Cliffer I, Fawzi WW. Gestational weight gain at the national, regional, and income group levels based on 234 national household surveys from 70 low-income and middle-income countries. PLOS Glob Public Health. 2024;4(9):e0003484. doi: 10.1371/journal.pgph.0003484.

20. Gebremedhin S, Bekele T. Gestational weight gain in sub-Saharan Africa: Estimation based on pseudo-cohort design. PLoS One. 2021;16(5):e0252247. doi: 10.1371/journal.pone.0252247.

21. Suliga E, Rokita W, Adamczyk-Gruszka O, Pazera G, Cieśla E, Głuszek S. Factors associated with gestational weight gain: a cross-sectional survey. BMC Pregnancy Childbirth. 2018;18(1):465. doi: 10.1186/s12884-018-2112-7.

22. Holowko N, Mishra G, Koupil I. Social inequality in excessive gestational weight gain. Int J Obes. 2014;38:91–6.

23. Campbell EE, Dworatzek PDN, Penava D, de Vrijer B, Gilliland J, Matthews JI, et al. Factors that influence excessive gestational weight gain: moving beyond assessment and counselling. J Matern Fetal Neonatal Med 2016;29:3527–31.

24. Life Cycle Project-Maternal Obesity and Childhood Outcomes Study Group; Voerman E, Santos S, Inskip H, Amiano P, Barros H, et al. Association of gestational weight gain with adverse maternal and infant outcomes. JAMA. 2019;321(17):1702-1715. doi: 10.1001/jama.2019.3820.

25. Zerfu TA, Umeta M, Baye K. Dietary habits, food taboos, and perceptions towards weight gain during pregnancy in Arsi, rural central Ethiopia: a qualitative cross-sectional study. J Health Popul Nutr. 2016;35(1):22. doi: 10.1186/s41043-016-0059-8.

26. Aji AS, Lipoeto NI, Yusrawati Y, Malik SG, Kusmayanti NA, Susanto I, Majidah NM, Nurunniyah S, Alfiana RD, Wahyuningsih W, Vimaleswaran KS. Association between pre-pregnancy body mass index and gestational weight gain on pregnancy outcomes: a cohort study in Indonesian pregnant women. BMC Pregnancy Childbirth. 2022;22(1):492. doi: 10.1186/s12884-022-04815-8.

27. Deputy NP, Andrea JS, Kim SY. Gestational Weight Gain—United States, 2012 and 2013. Morbidity and Mortality Weekly Report (MMWR).2015;64(43):1215–20. https://doi.org/10.15585/mmwr. mm6443a3PMID:26540367

28. Eraslan Sahin M, Col Madendag I. Effect of Gestational Weight Gain on Perinatal Outcomes in Low Risk Pregnancies with Normal Prepregnancy Body Mass Index. Biomed Res Int. 2019 ;2019:3768601. https://doi: 10.1155/2019/3768601

29. Perumal N, Wang D, Darling AM, Liu E, Wang M, Ahmed T, Christian P, Dewey KG, Kac G, Kennedy SH, Subramoney V, Briggs B, Fawzi WW; GWG Pooling Project Consortium. Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: individual participant data meta-analysis. BMJ. 2023;382:e072249. doi: 10.1136/bmj-2022-072249.

30. Ramakrishnan U, Grant F, Goldenberg T, Zongrone A, Martorell R. Effect of women’s nutrition before and during early pregnancy on maternal and infant outcomes: a systematic review. Paediatr Perinat Epidemiol 2012;26(Suppl 1):285-301. doi:10.1111/j.1365 3016.2012.01281.x.

31. Zhong W, Fan X, Hu F, Chen M, Zeng F. Gestational Weight Gain and Its Effects on Maternal and Neonatal Outcome in Women With Twin Pregnancies: A Systematic Review and Meta-Analysis. Front Pediatr. 2021;9:674414. doi: 10.3389/fped.2021.674414.

32. Akadri AA, Imaralu JO, Salami OF, Nwankpa CC, Adepoju AA. Robson classification of caesarean births: implications for reducing caesarean section rate in a private tertiary hospital in Nigeria. BMC Pregnancy Childbirth. 2023;23(1):243. doi: 10.1186/s12884-023-05557-x.