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Influence of gestational weight gain on low birth weight in short-statured South Indian pregnant women

European Journal of Clinical Nutrition volume 72, pages 752–760 (2018)Cite this article

Subjects

Abstract

Background/objectives

India contributes to one-third of the global burden of low birth weight (LBW) neonates, which is associated with increased risk of mortality and adverse consequences on long-term health. Factors leading to LBW are multidimensional and maternal short stature is an important component with an inter-generational effect. On the contrary gestational weight gain (GWG) shows an independent positive influence on birth weight. The aim of the present study therefore was to determine the influence of GWG on birth weight in short pregnant women.

Subjects/methods

A prospective observational cohort of 1254 pregnant women was studied. Total, second and third trimester GWG per week were computed. Women were divided into two groups, “short” and “not-short”, using a cut off of 152 cm that corresponded to the 25th percentile for height in the cohort. Association of tertiles of GWG with LBW was examined using log binomial regression analysis.

Results

“Short” women in highest tertile of total GWG had a significantly reduced adjusted relative risk (ARR 0.37, 95% confidence interval 0.16–0.83, P = 0.016) for LBW, compared to the lowest tertile. However, there was no significant increase in risk for cesarean section (CS) with increasing tertiles of total GWG.

Conclusions

In women with height <152 cm a significant reduced risk for LBW was observed with the greatest total GWG, without a significant increase in the risk for CS. This suggests that improving GWG in short women may be beneficial for the birth weight of the offspring.

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References

  1. Lee ACC, Katz J, Blencowe H, Cousens S, Kozuki N, Vogel JP, et al. National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010. Lancet Glob Heal. 2013;1:e26–e36.

  2. UN Children’s Fund (UNICEF), The State of the World’s Children 2012. Children in an Urban World, February 2012.

  3. Mumbare SS, Maindarkar G, Darade R, Yengl S, Tolani MK, Patole K. Maternal risk factors associated with term low birth weight neonates: A matched-pair case control study. Indian Pediatr. 2012;49:25–8.

    Article  PubMed  Google Scholar 

  4. Vishwanath Kumar HM, Kumar GV, Cheluvegowda GK, Mahesh SH. Maternal and neonatal factors among low birth weight babies: A tertiary care hospital based study. Curr Pediatr Res. 2014;18(2):73–5.

    Google Scholar 

  5. WHO. Global nutrition targets 2025: low birth weight policy brief (WHO/NMH/NHD/14.5). (Geneva, Switzerland: World Health Organization, 2014).

    Google Scholar 

  6. Kramer MS. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ. 1987;65(5):663–737.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. McDonald SD, Han Z, Mulla S, Beyene J, Knowledge Synthesis G. Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses. BMJ. 2010;341:c3428.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Han Z, Mulla S, Beyene J, Liao G, McDonald SD. Maternal underweight and the risk of preterm birth and low birth weight: A systematic review and meta-analyses. Int J Epidemiol. 2011;40:65–101.

    Article  PubMed  Google Scholar 

  9. Han Z, Lutsiv O, Mulla S, McDonald SD. Maternal height and the risk of preterm birth and low birth weight: a systematic review and meta-analyses. J Obstet Gynaecol Can. 2012;34(8):721–46.

    Article  PubMed  Google Scholar 

  10. Kader M, Perera NKPP. Socio-Economic and Nutritional Determinants of Low Birth Weight in India. North American. J Med Sci. 2014;6(7):302–308.

    Google Scholar 

  11. Elshibly EM, Schmalisch G. The effect of maternal anthropometric characteristics and social factors on gestational age and birth weight in Sudanese newborn infants. BMC Public Health. 2008;8:244.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Britto RP, de A, Florêncio TMT, Benedito Silva AA, Sesso R, Cavalcante JC, Sawaya AL. Influence of maternal height and weight on low birth weight: a cross-sectional study in poor communities of northeastern Brazil. PLoS ONE. 2013;8(11):1–8.

    Article  Google Scholar 

  13. International Institute for Population Sciences (IIPS) and Macro International. National Family Health Survey (NFHS-3), 2005-06, Vol. 1 (Mumbai, India: IIPS; 2007).

    Google Scholar 

  14. Kozuki N, Katz J, Lee ACC, Vogel JP, Silveira MF, Sania a, et al. Short maternal stature increases risk of small for-gestational-age and preterm births in low and middle-income countries: Individual participant data meta-analysis and population attributable fraction. J Nutr. 2015;145:2542–50.

    Article  CAS  PubMed  Google Scholar 

  15. Lagiou P, Tamimi RM, Mucci L, Adami H-O, Hsieh C-C, Trichopoulos D. Diet during pregnancy in relation to maternal weight gain and birth size. Eur J Clin Nutr. 2004;58:231–7.

    Article  CAS  PubMed  Google Scholar 

  16. Deierlein AL, Siega-Riz AM, Herring A. Dietary energy density but not glycemic load is associated with gestational weight gain. Am J Clin Nutr. 2008;88:693–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Bergmann MM, Flagg EW, Miracle-McMahill HL, Boeing H. Energy intake and net weight gain in pregnant women according to body mass index (BMI) status. Int J Obes Relat Metab Disord. 1997;21:1010–7.

    Article  CAS  PubMed  Google Scholar 

  18. Hung T-H, Chen S-F, Hsu J-J, Hsieh T-T. Gestational weight gain and risks for adverse perinatal outcomes: A retrospective cohort study based on the 2009 Institute of Medicine guidelines. Taiwan J Obstet Gynecol. 2015;54(4):421–5.

    Article  PubMed  Google Scholar 

  19. Chang M, Kuo C, Chiang K. The Effects of Pre-pregnancy Body Mass Index and Gestational Weight Gain on Neonatal Birth Weight in Taiwan. Int J Nurs Midwifery. 2010;2(2);28–28.

    Google Scholar 

  20. Nohr E, Vaeth M, Baker JL, Sørensen TI, Olsen J, Rasmussen KM. Pregnancy outcomes related to gestational weight gain in women defined by their body mass index, parity, height, and smoking status. Am J Clin Nutr. 2009;90(3):1288–94.

    Article  CAS  PubMed  Google Scholar 

  21. Rasmussen KM, Catalano PM, Yaktine AL. New guidelines for weight gain during pregnancy: what obstetrician/gynecologists should know Weight gain during pregnancy. Curr Opin Obstet Gynecol. 2009;21(6):521–526.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Dzakpasu S, Fahey J, Kirby RS, Tough SC, Chalmers B, Heaman MI, et al. Contribution of prepregnancy body mass index and gestational weight gain to adverse neonatal outcomes: population attributable fractions for Canada. BMC Pregnancy Childbirth. 2015;15(1):21.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Haugen M, Brantsæter AL, Winkvist A, Lissner L, Alexander J, Oftedal B, et al. Associations of pre-pregnancy body mass index and gestational weight gain with pregnancy outcome and postpartum weight retention: a prospective observational cohort study. BMC Pregnancy Childbirth. 2014;14(0403):201.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Dwarkanath P, Barzilay JR, Thomas T, Thomas A, Bhat S, Kurpad AV. High folate and low vitamin B-12 intakes during pregnancy are associated with small-for-gestational age infants in South Indian women: a prospective observational cohort study. Am J Clin Nutr. 2013;98:1450–8.

    Article  CAS  PubMed  Google Scholar 

  25. Viswanathan M, Siega-Riz AM, Moos MK, Deierlein A, Mumford S, Knaack J et al. Outcomes of Maternal Weight Gain, Evidence Report/Technology Assessment No.168. (Prepared by RTI International–University of North Carolina Evidence-based Practice (Center under Contract No. 290-02-0016.) AHRQ Publication No. 08-E009. (Rockville, MD, USA: Agency for Healthcare Research and Quality; 2008)

  26. Maternal anthropometry and pregnancy outcomes: a WHO collaborative study. 1995; 73 (supplement)

  27. Ibáñez L, Potau N, Enriquez G, de Zegher F. Reduced uterine and ovarian size in adolescent girls born small for gestational age. Pediatr Res. 2000;47(5):575–7.

    Article  PubMed  Google Scholar 

  28. Ota E, Hori H, Mori R, Tobe-Gai R, Farrar D. Antenatal dietary education and supplementation to increase energy and protein intake. Cochrane Database Syst Rev. 2015;(6):CD000032.

  29. Mani I, Dwarkanath P, Kurpad AV. Maternal fat and fatty acid intake and birth outcomes in a South Indian population. Int J Epidemiol. 2016;45(2):523–31.

    Article  PubMed  Google Scholar 

  30. Fall CH, Stein CE, Kumaran K, Cox V, Osmond C, Barker DJ, Hales CN. Size at birth, maternal weight, and type 2 diabetes in South India. Diabet Med. 1998;15(3):220–7.

    Article  CAS  PubMed  Google Scholar 

  31. Wrotniak BH, Shults J, Butts S, Stettler N. Gestational weight gain and risk of overweight in the offspring at age 7y in a multicenter, multiethnic cohort study. Am J Clin Nutr. 2008;87(6):1818–24.

    Article  CAS  PubMed  Google Scholar 

  32. Radhakrishnan U, Kolar G, Nirmalan PK. Cross-sectional study of gestational weight gain and perinatal outcomes in pregnant women at a tertiary care center in southern India. J Obstet Gynaecol Res 2014;40(1):25–31.

  33. Gibbons L, Belizán JM, Lauer J, Betrán AP, Merialdi M, Althabe F. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World Heal Rep Backgr Pap. 2010;30:1–31.

  34. International Institute for Population Sciences (IIPS), Macro International (2007) National Family Health Survey (NFHS 3), Vol I (Mumbai, India: IIPS; 2005–06).

  35. Neuman M, Alcock G, Azad K, Kuddus A, Osrin D, More NS, et al. Prevalence and determinants of caesarean section in private and public health facilities in underserved South Asian communities: cross-sectional analysis of data from Bangladesh, India and Nepal. BMJ Open. 2014;4:e005982.

    Article  PubMed  PubMed Central  Google Scholar 

  36. International Institute for Population Sciences. District Level Household and Facility Survey-4 State Fact Sheet Karnataka. 2014;1–8.

  37. 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-21 st Project: a prospective longitudinal cohort study. BMJ. 2016;352:i555.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We greatly appreciate the assistance of Nancy Nanditha M in the collection and entry of data. We thank the women and their infants who participated in this study and the doctors and nurses who made this study possible. A.V.K., T.T., N.S., and P.D. took part in conceptualizing the study, analyzing data and writing the manuscript. P.D. was involved in data collection. C.D. and R.B. provided intellectual inputs and were involved in analyzing data and writing the manuscript. C.D. was supported in part by NIH (K24DK104676) and the Feed the Future Food Innovation Lab for Nutrition, which is funded by the United States Agency for International Development (USAID).

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Authors and Affiliations

  1. Department of Physiology, St John’s Medical College, Bangalore, 560034, India

    Nirupama Shivakumar

  2. Division of Nutrition, St. John’s Research Institute, Bangalore, 560034, India

    Pratibha Dwarkanath & Anura V Kurpad

  3. Department of Biostatistics, Harvard School of Public Health, Boston, MA, 02115, USA

    Ronald Bosch

  4. Division of GI/Nutrition, Boston Children’s Hospital, Boston, MA, 02115, USA

    Christopher Duggan

  5. Division of Epidemiology and Biostatistics, St John’s Research Institute, Bangalore, 560034, India

    Tinku Thomas

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  1. Nirupama Shivakumar
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Correspondence to Tinku Thomas.

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Shivakumar, N., Dwarkanath, P., Bosch, R. et al. Influence of gestational weight gain on low birth weight in short-statured South Indian pregnant women. Eur J Clin Nutr 72, 752–760 (2018). https://doi.org/10.1038/s41430-017-0027-4

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