Addressing cultural, racial and ethnic discrepancies in guideline discordant gestational weight gain: a systematic review and meta-analysis

Denize, Kathryn M; Acharya, Nina; Prince, Stéphanie A.; Silva, Danilo Fernandes da; Harvey, Alysha; Ferraro, Zachary M.; Adamo, Kristi B.

doi:10.7717/peerj.5407

Cited by 20 publications

(17 citation statements)

References 118 publications

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“…Importantly, several studies have concluded that migrant women, may have an increased risk of obesity, as well as adverse pregnancy outcomes [ 8 – 11 ], as compared with native-born women. According to data, particularly from the USA, the prevalence of unhealthy BMI and GWG differs between ethnic groups [ 12 – 15 ] (e.g. white, black, Hispanic, Asian).…”

Section: Introductionmentioning

confidence: 99%

Body mass index and gestational weight gain in migrant women by birth regions compared with Swedish-born women: A registry linkage study of 0.5 million pregnancies

et al. 2020

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Introduction Women migrating to high-income countries may have increased risks of adverse pregnancy outcomes as compared with native-born women. However, little is known whether migrant women are more likely to have unhealthy body mass index (BMI) or gestational weight gain (GWG), which is of importance considering the well-established links between unhealthy BMI and GWG with adverse pregnancy outcomes. Hence, the aim of the study was to examine the prevalence and estimate odds ratios (ORs) of underweight and obesity in the first trimester as well as inadequate and excessive GWG across birth regions in migrant (first-generation) and Swedish-born women in a population-based sample of pregnant women in Sweden. Methods This population-based study included 535 609 pregnancies from the Swedish Pregnancy Register between the years 2010–2018. This register has a coverage of approximately 90% and includes data on body weight, height, birth country and educational attainment. BMI in the first trimester of pregnancy was classified as underweight, normal weight, overweight and obesity whereas GWG was classified as inadequate, adequate and excessive according to the recommendations from the National Academy of Medicine, USA. BMI and GWG were examined according to 7 birth regions and the 100 individual birth countries. Adjusted ORs of underweight, obesity as well as inadequate or excessive GWG by birth regions were estimated using multinomial logistic regression. Results There were large disparities in unhealthy BMI and GWG across birth regions. For instance, women born in North Africa and Middle East and Sub-Saharan Africa had 1.40 (95% CI 1.35–1.44) and 2.13 (95% CI 2.03–2.23) higher odds of obesity compared with women born in Sweden. However, women born in Sub-Saharan Africa had also considerably higher odds of underweight (OR, 2.93 [95% CI 2.70–3.18]) and inadequate GWG (OR, 1.97 [95% CI 1.87–2.07]). The limitations of the study include the lack of a validated measure of acculturation and that the study only had data on first-generation migration. Conclusions The large differences across the 7 regions and 100 countries highlights the importance of considering birth region and country-specific risks of unhealthy BMI and GWG in first-generation migrant women. Furthermore, inadequate GWG was common among pregnant first-generation migrant women, especially in women born in Sub-Saharan Africa, which demonstrates the need to promote adequate GWG, not only the avoidance of excessive GWG. Thus, our findings also indicate that additional support and interventions may be needed for first-generation migrant women from certain birth regions and countries in order to tackle the observed disparities in unhealthy BMI and GWG. Although further studies are needed, our results are useful for identifying groups of women at increased risk of unhealthy BMI and weight gain during pregnancy.

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Section: Introductionmentioning

confidence: 99%

Body mass index and gestational weight gain in migrant women by birth regions compared with Swedish-born women: A registry linkage study of 0.5 million pregnancies

et al. 2020

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“…First, the guidelines published by the IOM are solely based on the data of American women [8]. Since GWG may be influenced by various factors, which may be social, environmental, or genetic, the values for appropriate GWG are different for each ethnic group [9][10][11][12][13]. Second, the World Health Organization (WHO) has set the cutoff for the overweight body mass index (BMI) category at 23 for the Asian population, which is different from Western standards [14].…”

Section: Introductionmentioning

confidence: 99%

Gestational weight gain in twin pregnancies in Korea: application of the 2009 Institute of Medicine recommendations

Choi¹,

Hong²,

Jeon³

et al. 2020

Obstet Gynecol Sci

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Objective To investigate the effect of gestational weight gain (GWG) on maternal and neonatal outcomes based on the Institute of Medicine (IOM) guidelines for twin pregnancies. Methods This study included women with twin pregnancies who delivered at Seoul National University Bundang Hospital. Based on the weight gain per gestational week according to the 2009 IOM guidelines, the subjects were divided into the following 3 groups: inadequate, adequate, and excessive GWG. We compared the maternal and neonatal outcomes of each group. Results A total of 1,738 twin pregnancies were included in our study. Of these cases, 881, 694, and 163 (50.7%, 39.9%, and 9.4%, respectively) twin pregnancies were categorized into the inadequate, adequate, and excessive GWG groups, respectively. In the inadequate GWG group, the risks of preterm birth <34 weeks (aOR, 2.33, 95% confidence interval [CI], 1.63-3.34) and delivering neonates who were small for gestational age (aOR, 1.92, 95% CI, 1.42-2.60) were increased, and the risk of preeclampsia (aOR, 0.49, 95% CI, 0.32-0.76) was decreased. The excessive GWG group had an increased risk of the neonates being large for gestational age (aOR, 1.79, 95% CI, 1.15-2.81). Conclusion The 2009 IOM recommendations for GWG can be applied to Korean women with twin pregnancies to help achieve optimal maternal and neonatal outcomes. However, more than half of the women were categorized as having inadequate weight gain according to the guidelines. Further studies should be performed to obtain Korean national references for GWG in twin pregnancies.

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“…Second, intrinsic ethnic differences may affect the GWG profile of Tibetan women. Some studies have investigated whether ethnic differences could change the relationship between GWG and perinatal outcomes 17,20,21 , and the conclusions are positive. Consistent with these studies, our findings clearly indicated that it might not be appropriate to continue to use the 2009 IOM recommendations in the Tibetan population, and ethnicity-specific recommendations for GWG should be properly addressed.…”

Section: Discussionmentioning

confidence: 99%

Optimal Gestational Weight Gain for Tibetans Based on Prepregnancy Body Mass Index

Chen

Zhou²,

Yan

et al. 2020

Sci Rep

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We aimed to estimate the optimal gestational weight gain (GWG) in tibetan women and to evaluate the appropriateness of the institute of Medicine (ioM) GWG recommendations for tibetan women. We analyzed data from 1474 Tibetan women from a cross-sectional study conducted in 2019. According to the three different body mass index (BMI) classification criteria (WHO BMI categories, WHO Asian BMi categories, chinese BMi categories), we estimated the association of GWG with pregnancy outcomes (neonate birthweight and mode of delivery) using a polynomial regression model, and the optimal GWG in each BMI group was calculated. The risk of adverse outcomes showed a U-shaped curve with increasing GWG. The optimal GWG of Tibetan women based on the WHO BMI categories was 17.2 kg (range, 13.3 to 20.9 kg) for underweight, 9.3 kg (5.8 to 12.9 kg) for normal weight, and 5.2 kg (1.3 to 9.1 kg) for overweight. Underweight Tibetan mothers may gain more gestational weight than recommend by the IOM guidelines. However, normal weight Tibetan mothers are likely to benefit from gaining less weight than that recommended by the ioM. the GWG recommendations based on the ioM guidelines might not be appropriate for Tibetan women, and ethnicity-specific recommendations for GWG should be properly addressed. Prepregnancy body mass index (BMI) and gestational weight gain (GWG) have been known as robust predictors of pregnancy outcomes of the mother and offspring. Excessive GWG is associated with additional adverse health risks, including a greater risk of gestational hypertension, gestational diabetes mellitus, postmature birth, cesarean section, and macrosomia. In contrast, low prepregnancy BMI and inadequate GWG have been linked to small-for-gestational-age infants and premature birth 1-6. Therefore, appropriate GWG, in addition to proper prepregnancy BMI, has been repeatedly shown to be important to optimize pregnancy outcomes. Over the past 60 years, the optimal GWG recommendations have been revised several times due to changes in the demographic and nutrition statuses of women in the United States 7-10. In 2009, the Institute of Medicine (IOM) published the latest revised GWG guidelines based on the World Health Organization (WHO) BMI categories and recommended an optimal GWG of 12.5~18.0 kg for underweight pregnant women (prepregnancy BMI < 18.5 kg/m 2), 11.5~16.0 kg for normal weight pregnant women (prepregnancy BMI 18.5-24.9 kg/m 2), 7.0~11.5 kg for overweight pregnant women (prepregnancy BMI 25.0~29.9 kg/m 2) and 5~9.1 kg for obese pregnant women (prepregnancy BMI ≥ 30 kg/m 2). The guidelines also recommended the ranges of GWG for the second and third trimesters 10. Although the current 2009 IOM GWG guidelines are more rigorous and complete than the previous guidelines, the recommendations were primarily based on Caucasian women; thus, they were more appropriate in the United States and Europe. Therefore, their generalizability has always been controversial worldwide. Moreover, some researchers believe that the 2009 IOM recommendations do ...

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Addressing cultural, racial and ethnic discrepancies in guideline discordant gestational weight gain: a systematic review and meta-analysis

Cited by 20 publications

References 118 publications

Body mass index and gestational weight gain in migrant women by birth regions compared with Swedish-born women: A registry linkage study of 0.5 million pregnancies

Body mass index and gestational weight gain in migrant women by birth regions compared with Swedish-born women: A registry linkage study of 0.5 million pregnancies

Gestational weight gain in twin pregnancies in Korea: application of the 2009 Institute of Medicine recommendations

Optimal Gestational Weight Gain for Tibetans Based on Prepregnancy Body Mass Index

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