Maternal Nutrition and Inadequate Gestational Weight Gain in Relation to Birth Weight: Results from a Prospective Cohort Study in India

Abstract

Inadequate/excessive gestational weight gain (GWG) can cause adverse pregnancy outcomes and only few studies have described patterns of weight gain in Indian women. Also, studies pertaining to dietary intake throughout gestation are insufficient. This prospective cohort study was conducted to evaluate GWG and nutrient intake in all trimesters of pregnancy and investigate the relationship between themselves along with that of birth weight (BW). Our study was carried out in a population-based prospective birth cohort in Odisha, India. The 418 pregnant women were followed till delivery with measurements of maternal weight, weight gain throughout gestation, and BW. Macronutrients were assessed based on a 24hour dietary recall method in each trimester. Women characterized by underweight prepregnancy body mass index (BMI) were 16.20%, and a total of 6.45% did not comply with current weight gain recommendations. Particularly, overweight and obese women gained more weight than recommended. In a multivariate analysis GWG correlated significantly with BMI (p = 0.03), total calorie intake (p < 0.001) and fat intake (p < 0.001), while BW of newborns correlated significantly with adequacy of weight gain and fat intake (p < 0.001). Though measures are taken by health workers to record the weight but nutritional counseling is not being provided regularly. A high priority should be given to increase awareness among general population regarding the importance of diet in pregnancy and how to adhere to the balanced diet for optimal growth of child.

Maternal pre‐pregnancy body mass index, gestational weight gain trajectory, and risk of adverse perinatal outcomes

“…The older or non‐first‐time pregnant mothers may have more regular lifestyle preferences and therefore have less weight gain, 18 but in the present study, they have higher pre‐pregnancy weight, probably owing to aging or child‐rearing habits. Besides, some studies have also shown that overweight or obese women were more likely to have excessive GWG, 13,18 which is different from our study and other research 12,23,24 …”

“…Besides, some studies have also shown that overweight or obese women were more likely to have excessive GWG, 13,18 which is different from our study and other research. 12,23,24 This may be because the majority of women (59.1%) in this cohort have given birth before and so have gained adequate experience and knowledge of GWG, which helps to reach the suggested GWG in the next pregnancy. Our findings imply that nutrition education to avoid immoderate GWG should be initiated as early as possible, especially among younger or first-time pregnant women, housewives, and overweight/obese women.…”

“…The Institute of Medicine (IOM) has formulated GWG guidelines based on pre‐pregnancy body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters), 11 to minimally lower the negative health consequences for mother and fetus of deficient or excessive GWG. However, the existing observational data mainly originate from the Western world 6,7,12,13 3,14 …”

“…However, the existing observational data mainly originate from the Western world. 6,7,12,13 The pre-pregnancy BMIs of women in eastern Asia are lower than those in western countries. 3,14 The prevalence of GWG categories also largely differ among races and ethnicities, and may affect the risk of pregnancy consequences differently.…”

“…Studies on GWG have tended to spotlight the total GWG or the GWG of a certain trimester. 3,4,6,7,12 Nevertheless, the total GWG is rough and inappropriate in contrast to the GWG trajectory, and is not effective or timely in managing pregnancy weight. To date, however, the GWG trajectories and their probable connections with birth outcomes have been rarely studied.…”