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Nutrition during the early life cycle

Gestational weight gain trajectories in GARBH–Ini pregnancy cohort in North India and a comparative analysis with global references



To describe the pattern of gestational weight gain (GWG), derive reference centiles for GWG specific to North Indian population, and to compare the weight gain across different periods of gestation with the INTERGROWTH–21st reference.


A prospective pregnancy (GARBH-Ini) cohort was initiated and followed between May 2015 and June 2019 in a district hospital, Gurguram, North India. GWG centile curves were modelled by Generalized Additive Models for Location, Scale and Shape method (n = 2844) and compared with INTERGROWTH-21st reference. The independent association of GWG with biological and social predictors was assessed using multivariable regression analysis.


Percentiles (3rd, 10th, 50th, 90th and 97th) for each completed week from 18–40 weeks of gestation were derived from smoothed centile curves. The median GWG across pregnancy during specific antenatal visits was 1.29 at 18, 4.44 at 26, 5.8 at 30 and 9.06 kg at 40 weeks of gestation. Nearly 26% of participants had GWG < 10th centile at 18–20 weeks as per INTERGROWTH–21st reference and this increased to 45% at delivery. Significant predictors of GWG included maternal age, height, first trimester body mass index, parity, type of family, and use of clean fuel for cooking.


These GWG percentiles will serve as a useful reference, particularly during the WHO recommended antenatal visit schedule for optimum pregnancy outcomes, for clinicians and researchers. Multiple independent biological and social predictors of GWG suggest that single interventions are unlikely to bridge the gap between general Indian population and international references.

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Fig. 1: Study flow.
Fig. 2: Gestational weight gain trajectories and their comparison with INTERGROWTH-21st standard.
Fig. 3: Smoothed centile curves shown for participants in different BMI categories.

Data availability

Data described in the manuscript will be made available upon request pending approval.

Code availability

Analysis code will be made available upon request with the objective of use.


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Prof. MK Bhan will always be remembered reverently for his critical scientific and technical feedback. We greatly appreciate the extraordinary efforts from Drs. A Gambhir and S Sinha from DBT-India for supporting the GARBH–Ini program. We recognize the efforts of the research physicians, study nurses, clinical and laboratory technicians, field workers, internal quality improvement team, project and the data management team of GARBH–Ini cohort. This work was funded by the Department of Biotechnology, Ministry of Science and Technology, Govt. of India (BT/PR9983/MED/97/194/2013) and for some components of the biorepository by the Grand Challenges India – All Children Thriving Program (supported by the Programme Management Unit), Biotechnology Industry Research Assistance Council (BIRAC/GCI/0114/03/14–ACT).

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Authors and Affiliations




SB, UCMN, NW, RT, KS, SM, NP, MJ, RB, PM, RT, and GARBH-Ini study team: conducted the GARBH–Ini cohort study and acquired the data; SB, RT, and BKD conceived the research questions and designed the analysis; BKD and RT analyzed data; SB, UCMN, HSS, SR, and RT guided and provided feedback on the analysis and interpretation of results; SB, RT, and BKD wrote the paper. All authors critically reviewed and approved the final manuscript.

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Correspondence to Shinjini Bhatnagar.

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Thiruvengadam, R., Desiraju, B.K., Natchu, U.C.M. et al. Gestational weight gain trajectories in GARBH–Ini pregnancy cohort in North India and a comparative analysis with global references. Eur J Clin Nutr 76, 855–862 (2022).

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