Analysis of gestational weight gain using nationally representative data

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Research snapshot¹

Adequate gestational weight gain (GWG) is an important measure of maternal health during pregnancy; inadequate GWG is associated with negative maternal and newborn outcomes. To fill the gap in our understanding of GWG levels and the burdens of inadequate and excessive GWG in resource-limited settings, the authors of this paper computed GWG estimates across time using Demographic and Health Survey (DHS) data. A hierarchical model was developed to estimate the mean total GWG and associated uncertainty ranges (URs) for a full-term pregnancy for each country in 2015. Year and country-level covariates were used as predictors and variable selection was guided by the model fit. The final model included year, geographic area, mean adult female body mass index, gross domestic product per capita and total fertility rate.

Gestational weight data was available for 67 of the total 137 low- and middle-income countries (LMICs) in the DHS programme. Latin America and Caribbean (11.80 kg (95% UR: 6.18, 17.41)) and Central Europe, Eastern Europe and Central Asia (11.19 kg (95% UR: 6.16, 16.21)) were the regions with the highest GWG estimates. Sub-Saharan Africa (6.64 kg (95% UR: 3.39, 9.88)) and North Africa and the Middle East (6.80 kg (95% UR: 3.17, 10.43)) were the regions with the lowest estimates. With the exception of Latin America and Caribbean, all regions were below the minimum GWG recommendation for normal-weight women with sub-Saharan Africa and North Africa and the Middle East estimated to meet less than 60% of the minimum recommendation. National estimates for each country show low levels of GWG in Africa, especially in sub-Saharan Africa. The five countries with the lowest GWG estimates were Congo, Afghanistan, Rwanda, Central African Republic and the Democratic Republic of the Congo. Sixteen LMICs met the minimum GWG recommendation for normal-weight women and only one country (Brazil: 14.0kg (95% UR: 2.8, 25.1)) met the minimum recommendation for underweight women.

Results reveal a large burden of inadequate GWG in most LMIC countries and regions. Gestational weight gain is strongly dependent on modifiable maternal factors including nutritional status, dietary intake, physical activity and pre-existing health conditions. Interventions promoting adequate GWG have the potential to improve maternal, foetal and child outcomes across the world.