Gestational weight gain and maternal immediate perinatal and postpartum outcomes in low and middle income countries: individual participant data meta-analyses.
To estimate the associations between gestational weight gain and maternal immediate perinatal and postpartum outcomes by pooling data from low and middle income countries.
Individual participant data meta-analyses.
PubMed, Embase, Web of Science, and Cochrane Library, based on three searches (Search 1: all prospective studies published from January 2000 to May 2021; Search 2: randomized controlled trials of balanced energy and protein supplementation published until June 2021; Search 3: randomized controlled trials of anti-infectious agents published until August 2021).
Prospective studies (randomised controlled trials or observational cohort studies) with measured maternal weight during pregnancy and data available on maternal height, based in populations from low and middle income countries with no underlying conditions.
The analyses included 156 300 women from 61 studies and 23 countries, with most participants based in South Asia (n=78 454, 50.2%) and sub-Saharan Africa (n=36 327, 23.2%). Compared with women with adequate (90-125%) gestational weight gain, women with excessive (>125%) gestational weight gain had a higher risk of caesarean delivery (risk ratio 1.10, 95% confidence interval 1.06 to 1.13, τ2=0.000) and emergency caesarean delivery (risk ratio 1.22, 1.03 to 1.43, τ2=0.000). Women with moderately (70% to <90%) or severely inadequate (<70%) versus adequate gestational weight gain had lower risks for caesarean delivery (risk ratio in women with moderately inadequate gestational weight gain 0.88, 95% confidence interval 0.84 to 0.92, τ2=0.004; risk ratio in women with severely inadequate gestational weight gain 0.82, 0.77 to 0.88, τ2=0.010) and emergency caesarean delivery (risk ratio in moderately inadequate gestational weight gain 0.82, 0.71 to 0.95, τ2=0.004; risk ratio in severely inadequate gestational weight gain 0.73, 0.56 to 0.96, τ2=0.103). Excessive versus adequate gestational weight gain was associated with higher postpartum weight retained at any time point (mean difference 2.00 kg, 95% confidence interval 1.49 to 2.50, τ2=1.317), whereas moderately and severely inadequate gestational weight gain were associated with lower retained weight compared with adequate gestational weight gain. Similar trends were found for postpartum body mass index. Severely inadequate gestational weight gain was associated with lower systolic and diastolic blood pressure at any time point post partum than adequate gestational weight gain. No associations were observed for other outcomes including postpartum depressive symptoms or breastfeeding. Evidence indicating an interaction between gestational weight gain and body mass index before pregnancy was found when examining the risk of caesarean delivery and postpartum weight retention, body mass index, and systolic blood pressure as outcomes.
These findings support the association between suboptimal gestational weight gain and adverse maternal outcomes in the immediate perinatal and postpartum periods. Further research examining the consequences of suboptimal gestational weight gain in low and middle income countries would be valuable to inform potential strategies to improve long term maternal health.
PROSPERO CRD42023432836.
Individual participant data meta-analyses.
PubMed, Embase, Web of Science, and Cochrane Library, based on three searches (Search 1: all prospective studies published from January 2000 to May 2021; Search 2: randomized controlled trials of balanced energy and protein supplementation published until June 2021; Search 3: randomized controlled trials of anti-infectious agents published until August 2021).
Prospective studies (randomised controlled trials or observational cohort studies) with measured maternal weight during pregnancy and data available on maternal height, based in populations from low and middle income countries with no underlying conditions.
The analyses included 156 300 women from 61 studies and 23 countries, with most participants based in South Asia (n=78 454, 50.2%) and sub-Saharan Africa (n=36 327, 23.2%). Compared with women with adequate (90-125%) gestational weight gain, women with excessive (>125%) gestational weight gain had a higher risk of caesarean delivery (risk ratio 1.10, 95% confidence interval 1.06 to 1.13, τ2=0.000) and emergency caesarean delivery (risk ratio 1.22, 1.03 to 1.43, τ2=0.000). Women with moderately (70% to <90%) or severely inadequate (<70%) versus adequate gestational weight gain had lower risks for caesarean delivery (risk ratio in women with moderately inadequate gestational weight gain 0.88, 95% confidence interval 0.84 to 0.92, τ2=0.004; risk ratio in women with severely inadequate gestational weight gain 0.82, 0.77 to 0.88, τ2=0.010) and emergency caesarean delivery (risk ratio in moderately inadequate gestational weight gain 0.82, 0.71 to 0.95, τ2=0.004; risk ratio in severely inadequate gestational weight gain 0.73, 0.56 to 0.96, τ2=0.103). Excessive versus adequate gestational weight gain was associated with higher postpartum weight retained at any time point (mean difference 2.00 kg, 95% confidence interval 1.49 to 2.50, τ2=1.317), whereas moderately and severely inadequate gestational weight gain were associated with lower retained weight compared with adequate gestational weight gain. Similar trends were found for postpartum body mass index. Severely inadequate gestational weight gain was associated with lower systolic and diastolic blood pressure at any time point post partum than adequate gestational weight gain. No associations were observed for other outcomes including postpartum depressive symptoms or breastfeeding. Evidence indicating an interaction between gestational weight gain and body mass index before pregnancy was found when examining the risk of caesarean delivery and postpartum weight retention, body mass index, and systolic blood pressure as outcomes.
These findings support the association between suboptimal gestational weight gain and adverse maternal outcomes in the immediate perinatal and postpartum periods. Further research examining the consequences of suboptimal gestational weight gain in low and middle income countries would be valuable to inform potential strategies to improve long term maternal health.
PROSPERO CRD42023432836.
Authors
Partap Partap, Costa Costa, Liu Liu, Cliffer Cliffer, Wang Wang, Wang Wang, Nookala Nookala, Subramoney Subramoney, Briggs Briggs, Ibraheem Abioye Ibraheem Abioye, Accrombessi Accrombessi, Adu-Afarwuah Adu-Afarwuah, Ahmed Ahmed, Akurut Akurut, Ali Ali, Ali Ali, Alves Alves, Andra Andra, de AraĂşjo de AraĂşjo, Argaw Argaw, Arifeen Arifeen, Artes Artes, Ashorn Ashorn, Ashorn Ashorn, Azizi Azizi, Banda Banda, Bawah Bawah, Bhandari Bhandari, Bhutta Bhutta, Briand Briand, Calvo Calvo, Cardoso Cardoso, de Castro de Castro, Cecatti Cecatti, Chico-Barba Chico-Barba, Chowdhury Chowdhury, Christian Christian, Collins Collins, Costello Costello, Dewey Dewey, Divala Divala, Dombrowski Dombrowski, Drehmer Drehmer, Duggan Duggan, Dwarkanath Dwarkanath, Elliott Elliott, Enkhmaa Enkhmaa, Erchick Erchick, Estrada-Gutierrez Estrada-Gutierrez, Fair Fair, Friis Friis, Fritz Fritz, Gandevani Gandevani, Ganmaa Ganmaa, GarcĂa-Guerra GarcĂa-Guerra, Gernand Gernand, Gomo Gomo, Gondwe Gondwe, González-Ludlow González-Ludlow, Grais Grais, Guindo Guindo, Hallamaa Hallamaa, Hamer Hamer, Hanley-Cook Hanley-Cook, Hien Hien, Huybregts Huybregts, Isanaka Isanaka, Jehan Jehan, Kac Kac, Kajubi Kajubi, Kakuru Kakuru, Kasaro Kasaro, Katz Katz, Khatry Khatry, Krebs Krebs, Kumar Kumar, Kurpad Kurpad, Lachat Lachat, Lama Lama, Lamadrid-Figueroa Lamadrid-Figueroa, Lanou Lanou, Lartey Lartey, Laufer Laufer, Loy Loy, Lipoeto Lipoeto, LĂłpez LĂłpez, Luzia Luzia, Mahmud Mahmud, Maiya Maiya, Maleta Maleta, Manandhar Manandhar, Manary Manary, Mangani Mangani, Marinho Marinho, MartĂnez-Rojano MartĂnez-Rojano, Matias Matias, Matijasevich Matijasevich, McClure McClure, Mengue Mengue, Miller Miller, Moore Moore, Mohamad Mohamad, Jan Mohamed Jan Mohamed, Mridha Mridha, Mugusi Mugusi, Muhammad Muhammad, Muhihi Muhihi, Muñoz-Rocha Muñoz-Rocha, Mutale Mutale, Neufeld Neufeld, Nguyen Nguyen, Nunes Nunes, Ome-Kaius Ome-Kaius, Osrin Osrin, Patson Patson, Pembe Pembe, Perichart-Perera Perichart-Perera, Peterson Peterson, Premji Premji, Prentice Prentice, Quezada-Sánchez Quezada-Sánchez, Rahman Rahman, Ramachandra Ramachandra, Ramakrishnan Ramakrishnan, Rizvi Rizvi, Roberfroid Roberfroid, Rodrigues Rodrigues, Rogerson Rogerson, RondĂł RondĂł, Roth Roth, Sámano Sámano, Saville Saville, Schmidt Schmidt, Semrau Semrau, Shafiq Shafiq, Shaikh Shaikh, Shrestha Shrestha, Da Silva Da Silva, Soltani Soltani, Soofi Soofi, Martorano Martorano, Souza Souza, Stein Stein, Stringer Stringer, Sudfeld Sudfeld, Taneja Taneja, Tehrani Tehrani, Thomas Thomas, Tielsch Tielsch, Toe Toe, Unger Unger, Urassa Urassa, Vaz Vaz, Victor Victor, Webb Webb, West West, Widen Widen, Workman Workman, Wright Wright, Wu Wu, Young Young, Zar Zar, Zeng Zeng, Fawzi Fawzi
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