Association of Maternal Weight Gain during Pregnancy with Newborn Weight and Pregnancy Outcomes in Tulkarem City and Camps.
Dr. Souad Belkebir, MD, MPH, Preventive medicine & PH specialist, Assistant Professor of Community Medicine. An-Najah National University/ Faculty of Medicine and Health Sciences
Email: [email protected]
Mob: +(972) (599) 067599
Background: The amount of gestational weight gained (GWG) is a key determinant for both mother and child pregnancy outcomes. The actual evidence shows strong associations between excessive GWG and: Low (LBW) or high birth weight (HBW), Preterm delivery (PD),Gestational Diabetes Mellitus (GDM), Pre-eclampsia (PE), Cesarean Section (CS) and Postpartum hemorrhage(PH). The main objective of this study is to determine the relationship between GWG with the mentioned outcomes.
Methods: A Retrospective cohort study has been carried out in Tulkarem City at Primary Health Care Center (PHC) of Palestinian Ministry of Health and in 2 United Nations Relief and Works Agency (UNRWA) PHC centers (Tulkarem and Nourshams Camps). 771 files were revised and the following variables were considered: Socio-demographic data, obstetrical and medical history and complications, BMI, and GWG. Descriptive, analytical and multivariate analysis were performed using The Statistical Package of Social Sciences (SPSS) v 20.Significance was considered at p value < 0.05.
Findings: Of the 771 patients included, 326 (42.3%) were from Tulkarem City, 274 (35.5%) from Tulkarem Camp and 171 (22.2%) from Nourshams. The mean age of mothers was 26.5 years (SD=5.81), 42.8% of them under the age of 25. Regarding level of education, 42.5% were tertiary educated, 34.7% university graduates and 22.8% finished primary or secondary education. The majority of thems (44.2%) had a normal BMI at first visit, while (3.8%) were underweight, (32.9%) overweight and (19.1%) obese. Using Institute of Medicine (IOM) Weight Gain Recommendations for Pregnancy, 35.7% of mothers gained weight less than recommended, 36.7% within recommended and 27.6% more than recommended. The incidence of CS was 27.2%. For PD, GDM, PE and PPH, the incidence was 8.9%, 5.6%, 1.7%, and 10.2%, respectively. Regarding newborns, 52.5% were males and 47.5% females, with an overall mean weight of 3,313 gr (SD=511.83). 37 (4.8%) neonates had LBW and 60 (7.8%) HBW. The bi-variate analysis showed a significant association between GWG and BMI at first visit (p < 0.001). Residency, age, education and parity were not found to be statistically associated with GWG status while HBW and PH were (p < 0.001). As a result of the multivariate logistic regression, women who gained above recommendations had a higher risk of having a baby with HBW (OR= 3.4, CI= 1.65 – 7.00) while women who gained less than recommended had a lower risk to develop PPH (OR= 0.44, CI= 0.199 – 0.996). No other associations were found significant.
Interpretation: Gaining weight during pregnancy more than recommended increases the risk of PPH and HBW, which is consistent with the international literature. It is, therefore, of crucial importance to determine a woman’s body mass index at the initial prenatal visit and provide the appropriate counsel regarding the benefits of appropriate weight gain, nutrition and exercise. An individualized care to limit excessive weight gain will help in achieving the best pregnancy outcomes.