Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: Individual participant data meta-analysis

Nandita Perumal; Dongqing Wang; Anne Marie Darling; Enju Liu; Molin Wang; Tahmeed Ahmed; Parul Christian; Kathryn G. Dewey; Gilberto Kac; Stephen H. Kennedy; Vishak Subramoney; Brittany Briggs; Wafaie W. Fawzi; GWG Pooling Project Consortium

doi:10.1136/bmj-2022-072249

Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: Individual participant data meta-analysis

Nandita Perumal^*
, Dongqing Wang
, Anne Marie Darling
, Enju Liu
, Molin Wang
, Tahmeed Ahmed
, Parul Christian
, Kathryn G. Dewey
, Gilberto Kac
, Stephen H. Kennedy
, Vishak Subramoney
, Brittany Briggs
, Wafaie W. Fawzi
, GWG Pooling Project Consortium

^*Tämän työn vastaava kirjoittaja

Tutkimustuotos: Artikkeli › Tieteellinen › vertaisarvioitu

51 Sitaatiot (Scopus)

12 Lataukset (Pure)

Abstrakti

Objective To estimate the associations between gestational weight gain (GWG) during pregnancy and neonatal outcomes in low and middle income countries. Design Individual participant data meta-analysis. Setting Prospective pregnancy studies from 24 low and middle income countries. Main outcome measures Nine neonatal outcomes related to timing (preterm birth) and anthropometry (weight, length, and head circumference) at birth, stillbirths, and neonatal death. Analysis methods A systematic search was conducted in PubMed, Embase, and Web of Science which identified 53 prospective pregnancy studies published after the year 2000 with data on GWG, timing and anthropometry at birth, and neonatal mortality. GWG adequacy was defined as the ratio of the observed maternal weight gain over the recommended weight gain based on the Institute of Medicine body mass index specific guidelines, which are derived from data in high income settings, and the INTERGROWTH-21st GWG standards. Study specific estimates, adjusted for confounders, were generated and then pooled using random effects meta-analysis models. Maternal age and body mass index before pregnancy were examined as potential modifiers of the associations between GWG adequacy and neonatal outcomes. Results Overall, 55% of participants had severely inadequate (<70%) or moderately inadequate (70% to <90%) GWG, 22% had adequate GWG (90-125%), and 23% had excessive GWG (≥125%). Severely inadequate GWG was associated with a higher risk of low birthweight (adjusted relative risk 1.62, 95% confidence interval 1.51 to 1.72; 48 studies, 93 337 participants; τ²=0.006), small for gestational age (1.44, 1.36 to 1.54; 51 studies, 93 191 participants; τ²=0.016), short for gestational age (1.47, 1.29 to 1.69; 40 studies, 83 827 participants; τ²=0.074), and microcephaly (1.57, 1.31 to 1.88; 31 studies, 80 046 participants; τ²=0.145) compared with adequate GWG. Excessive GWG was associated with a higher risk of preterm birth (1.22, 1.13 to 1.31; 48 studies, 103 762 participants; τ²=0.008), large for gestational age (1.44, 1.33 to 1.57; 47 studies, 90 044 participants; τ²t2=0.009), and macrosomia (1.52, 1.33 to 1.73; 29 studies, 68 138 participants; τ²=0) compared with adequate GWG. The direction and magnitude of the associations between GWG adequacy and several neonatal outcomes were modified by maternal age and body mass index before pregnancy. Conclusions Inadequate and excessive GWG are associated with a higher risk of adverse neonatal outcomes across settings. Interventions to promote optimal GWG during pregnancy are likely to reduce the burden of adverse neonatal outcomes, however further research is needed to assess optimal ranges of GWG based on data from low and middle income countries.

Alkuperäiskieli	Englanti
Artikkeli	e072249
Julkaisu	BMJ
Vuosikerta	382
DOI - pysyväislinkit	https://doi.org/10.1136/bmj-2022-072249
Tila	Julkaistu - 2023
OKM-julkaisutyyppi	A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä

Rahoitus

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: financial support for the submitted work from the Bill and Melinda Gates Foundation, the Canadian Institutes of Health Research, the National Institutes of Health, the European Union’s Seventh Framework Programme and the Spanish Government, the UK Medical Research Council and the Department for International Development (DFID) under the MRC/DFID Concordat agreement, the National Council for Scientific and Technological Development (CNPq), Maria Cecilia Souto Vidigal Foundation Brazil, São Paulo State Research Foundation (FAPESP), Fondo Nestlé-Funsalud, Coordination for the Improvement of Higher Education Personnel (CAPES) and the Wellcome Trust; financial support from the World Health Organization for performance of work for the project ‘Global gestational weight gain standards’ to GK and the Family Larsson-Rosenquist Foundation to SHK; no other associations or activities that could appear to have influenced the submitted work. Funding: This study was supported by funding from the Bill and Melinda Gates Foundation (OPP1204850) and the Canadian Institutes of Health Research Fellowship Award to NP. The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication.

Rahoittajat	Rahoittajan numero
Fondo Nestlé-Funsalud
National Institutes of Health
The Bill and Melinda Gates Foundation	OPP1204850
World Health Organization
Wellcome Trust
Seventh Framework Programme
Family Larsson‐Rosenquist Foundation
Memphis Research Consortium
Canadian Institutes of Health Research
Medical Research Council
Department for International Development, UK Government
Fundação de Amparo à Pesquisa do Estado de São Paulo
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Conselho Nacional de Desenvolvimento Científico e Tecnológico
Fundação Maria Cecilia Souto Vidigal

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SDG 3 – Hyvä terveys ja hyvinvointi

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10.1136/bmj-2022-072249Lisenssi: CC BY

bmj-2022-072249.fullFinal published version, 602 KBLisenssi: CC BY

https://urn.fi/URN:NBN:fi:tuni-202401101324Lisenssi: CC BY

Siteeraa tätä

Perumal, N., Wang, D., Darling, A. M., Liu, E., Wang, M., Ahmed, T., Christian, P., Dewey, K. G., Kac, G., Kennedy, S. H., Subramoney, V., Briggs, B., Fawzi, W. W., & GWG Pooling Project Consortium (2023). Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: Individual participant data meta-analysis. BMJ, 382, Artikkeli e072249. https://doi.org/10.1136/bmj-2022-072249

@article{d5111980e64341f5bef7ac686e805719,

title = "Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: Individual participant data meta-analysis",

abstract = "Objective To estimate the associations between gestational weight gain (GWG) during pregnancy and neonatal outcomes in low and middle income countries. Design Individual participant data meta-analysis. Setting Prospective pregnancy studies from 24 low and middle income countries. Main outcome measures Nine neonatal outcomes related to timing (preterm birth) and anthropometry (weight, length, and head circumference) at birth, stillbirths, and neonatal death. Analysis methods A systematic search was conducted in PubMed, Embase, and Web of Science which identified 53 prospective pregnancy studies published after the year 2000 with data on GWG, timing and anthropometry at birth, and neonatal mortality. GWG adequacy was defined as the ratio of the observed maternal weight gain over the recommended weight gain based on the Institute of Medicine body mass index specific guidelines, which are derived from data in high income settings, and the INTERGROWTH-21st GWG standards. Study specific estimates, adjusted for confounders, were generated and then pooled using random effects meta-analysis models. Maternal age and body mass index before pregnancy were examined as potential modifiers of the associations between GWG adequacy and neonatal outcomes. Results Overall, 55\% of participants had severely inadequate (<70\%) or moderately inadequate (70\% to <90\%) GWG, 22\% had adequate GWG (90-125\%), and 23\% had excessive GWG (≥125\%). Severely inadequate GWG was associated with a higher risk of low birthweight (adjusted relative risk 1.62, 95\% confidence interval 1.51 to 1.72; 48 studies, 93 337 participants; τ2=0.006), small for gestational age (1.44, 1.36 to 1.54; 51 studies, 93 191 participants; τ2=0.016), short for gestational age (1.47, 1.29 to 1.69; 40 studies, 83 827 participants; τ2=0.074), and microcephaly (1.57, 1.31 to 1.88; 31 studies, 80 046 participants; τ2=0.145) compared with adequate GWG. Excessive GWG was associated with a higher risk of preterm birth (1.22, 1.13 to 1.31; 48 studies, 103 762 participants; τ2=0.008), large for gestational age (1.44, 1.33 to 1.57; 47 studies, 90 044 participants; τ2t2=0.009), and macrosomia (1.52, 1.33 to 1.73; 29 studies, 68 138 participants; τ2=0) compared with adequate GWG. The direction and magnitude of the associations between GWG adequacy and several neonatal outcomes were modified by maternal age and body mass index before pregnancy. Conclusions Inadequate and excessive GWG are associated with a higher risk of adverse neonatal outcomes across settings. Interventions to promote optimal GWG during pregnancy are likely to reduce the burden of adverse neonatal outcomes, however further research is needed to assess optimal ranges of GWG based on data from low and middle income countries.",

author = "Nandita Perumal and Dongqing Wang and Darling, \{Anne Marie\} and Enju Liu and Molin Wang and Tahmeed Ahmed and Parul Christian and Dewey, \{Kathryn G.\} and Gilberto Kac and Kennedy, \{Stephen H.\} and Vishak Subramoney and Brittany Briggs and Fawzi, \{Wafaie W.\} and \{GWG Pooling Project Consortium\} and Abioye, \{Ajibola Ibraheem\} and Manfred Accrombessi and Seth Adu-Afarwua and Alves, \{Joao Guilherme\} and \{De Ara{\'u}jo\}, \{Carla Adriane Leal\} and Shams Arifeen and Rinaldo Artes and Per Ashorn and Ulla Ashorn and Ayoola, \{Omolola Olukemi\} and Gabriela Chico-Barb and Robin Bernstein and Bhutta, \{Zulfiqar A.\} and Val{\'e}rie Briand and Calvo, \{Elvira Beatriz\} and Cardoso, \{Marly Augusto\} and Yue Cheng and Clayton, \{Peter Ellis\} and Collins, \{Shalean M.\} and Cruickshank, \{John Kennedy\} and Delanjathan Devakumar and Duggan, \{Christopher P.\} and Pratibha Dwarkanath and Fair, \{Frankie J.\} and Henrik Friis and Gernand, \{Alison D.\} and Shibani Ghosh and Exnevia Gomo and Rebecca Grais and Ousmane Guindo and Gutierrez, \{Guadalupe Estrada\} and Hambidge, \{K. Michael\} and Teija Kulmala and Kenneth Maleta and Charles Mangani and Minyanga Nkhoma and Juha Pyykk{\"o}",

year = "2023",

doi = "10.1136/bmj-2022-072249",

language = "English",

volume = "382",

journal = "BMJ",

issn = "0959-8138",

publisher = "BMJ Publishing Group",

}

Perumal, N, Wang, D, Darling, AM, Liu, E, Wang, M, Ahmed, T, Christian, P, Dewey, KG, Kac, G, Kennedy, SH, Subramoney, V, Briggs, B, Fawzi, WW & GWG Pooling Project Consortium 2023, 'Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: Individual participant data meta-analysis', BMJ, Vuosikerta 382, e072249. https://doi.org/10.1136/bmj-2022-072249

TY - JOUR

T1 - Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries

T2 - Individual participant data meta-analysis

AU - Perumal, Nandita

AU - Wang, Dongqing

AU - Darling, Anne Marie

AU - Liu, Enju

AU - Wang, Molin

AU - Ahmed, Tahmeed

AU - Christian, Parul

AU - Dewey, Kathryn G.

AU - Kac, Gilberto

AU - Kennedy, Stephen H.

AU - Subramoney, Vishak

AU - Briggs, Brittany

AU - Fawzi, Wafaie W.

AU - GWG Pooling Project Consortium

AU - Abioye, Ajibola Ibraheem

AU - Accrombessi, Manfred

AU - Adu-Afarwua, Seth

AU - Alves, Joao Guilherme

AU - De Araújo, Carla Adriane Leal

AU - Arifeen, Shams

AU - Artes, Rinaldo

AU - Ashorn, Per

AU - Ashorn, Ulla

AU - Ayoola, Omolola Olukemi

AU - Chico-Barb, Gabriela

AU - Bernstein, Robin

AU - Bhutta, Zulfiqar A.

AU - Briand, Valérie

AU - Calvo, Elvira Beatriz

AU - Cardoso, Marly Augusto

AU - Cheng, Yue

AU - Clayton, Peter Ellis

AU - Collins, Shalean M.

AU - Cruickshank, John Kennedy

AU - Devakumar, Delanjathan

AU - Duggan, Christopher P.

AU - Dwarkanath, Pratibha

AU - Fair, Frankie J.

AU - Friis, Henrik

AU - Gernand, Alison D.

AU - Ghosh, Shibani

AU - Gomo, Exnevia

AU - Grais, Rebecca

AU - Guindo, Ousmane

AU - Gutierrez, Guadalupe Estrada

AU - Hambidge, K. Michael

AU - Kulmala, Teija

AU - Maleta, Kenneth

AU - Mangani, Charles

AU - Nkhoma, Minyanga

AU - Pyykkö, Juha

PY - 2023

Y1 - 2023

N2 - Objective To estimate the associations between gestational weight gain (GWG) during pregnancy and neonatal outcomes in low and middle income countries. Design Individual participant data meta-analysis. Setting Prospective pregnancy studies from 24 low and middle income countries. Main outcome measures Nine neonatal outcomes related to timing (preterm birth) and anthropometry (weight, length, and head circumference) at birth, stillbirths, and neonatal death. Analysis methods A systematic search was conducted in PubMed, Embase, and Web of Science which identified 53 prospective pregnancy studies published after the year 2000 with data on GWG, timing and anthropometry at birth, and neonatal mortality. GWG adequacy was defined as the ratio of the observed maternal weight gain over the recommended weight gain based on the Institute of Medicine body mass index specific guidelines, which are derived from data in high income settings, and the INTERGROWTH-21st GWG standards. Study specific estimates, adjusted for confounders, were generated and then pooled using random effects meta-analysis models. Maternal age and body mass index before pregnancy were examined as potential modifiers of the associations between GWG adequacy and neonatal outcomes. Results Overall, 55% of participants had severely inadequate (<70%) or moderately inadequate (70% to <90%) GWG, 22% had adequate GWG (90-125%), and 23% had excessive GWG (≥125%). Severely inadequate GWG was associated with a higher risk of low birthweight (adjusted relative risk 1.62, 95% confidence interval 1.51 to 1.72; 48 studies, 93 337 participants; τ2=0.006), small for gestational age (1.44, 1.36 to 1.54; 51 studies, 93 191 participants; τ2=0.016), short for gestational age (1.47, 1.29 to 1.69; 40 studies, 83 827 participants; τ2=0.074), and microcephaly (1.57, 1.31 to 1.88; 31 studies, 80 046 participants; τ2=0.145) compared with adequate GWG. Excessive GWG was associated with a higher risk of preterm birth (1.22, 1.13 to 1.31; 48 studies, 103 762 participants; τ2=0.008), large for gestational age (1.44, 1.33 to 1.57; 47 studies, 90 044 participants; τ2t2=0.009), and macrosomia (1.52, 1.33 to 1.73; 29 studies, 68 138 participants; τ2=0) compared with adequate GWG. The direction and magnitude of the associations between GWG adequacy and several neonatal outcomes were modified by maternal age and body mass index before pregnancy. Conclusions Inadequate and excessive GWG are associated with a higher risk of adverse neonatal outcomes across settings. Interventions to promote optimal GWG during pregnancy are likely to reduce the burden of adverse neonatal outcomes, however further research is needed to assess optimal ranges of GWG based on data from low and middle income countries.

AB - Objective To estimate the associations between gestational weight gain (GWG) during pregnancy and neonatal outcomes in low and middle income countries. Design Individual participant data meta-analysis. Setting Prospective pregnancy studies from 24 low and middle income countries. Main outcome measures Nine neonatal outcomes related to timing (preterm birth) and anthropometry (weight, length, and head circumference) at birth, stillbirths, and neonatal death. Analysis methods A systematic search was conducted in PubMed, Embase, and Web of Science which identified 53 prospective pregnancy studies published after the year 2000 with data on GWG, timing and anthropometry at birth, and neonatal mortality. GWG adequacy was defined as the ratio of the observed maternal weight gain over the recommended weight gain based on the Institute of Medicine body mass index specific guidelines, which are derived from data in high income settings, and the INTERGROWTH-21st GWG standards. Study specific estimates, adjusted for confounders, were generated and then pooled using random effects meta-analysis models. Maternal age and body mass index before pregnancy were examined as potential modifiers of the associations between GWG adequacy and neonatal outcomes. Results Overall, 55% of participants had severely inadequate (<70%) or moderately inadequate (70% to <90%) GWG, 22% had adequate GWG (90-125%), and 23% had excessive GWG (≥125%). Severely inadequate GWG was associated with a higher risk of low birthweight (adjusted relative risk 1.62, 95% confidence interval 1.51 to 1.72; 48 studies, 93 337 participants; τ2=0.006), small for gestational age (1.44, 1.36 to 1.54; 51 studies, 93 191 participants; τ2=0.016), short for gestational age (1.47, 1.29 to 1.69; 40 studies, 83 827 participants; τ2=0.074), and microcephaly (1.57, 1.31 to 1.88; 31 studies, 80 046 participants; τ2=0.145) compared with adequate GWG. Excessive GWG was associated with a higher risk of preterm birth (1.22, 1.13 to 1.31; 48 studies, 103 762 participants; τ2=0.008), large for gestational age (1.44, 1.33 to 1.57; 47 studies, 90 044 participants; τ2t2=0.009), and macrosomia (1.52, 1.33 to 1.73; 29 studies, 68 138 participants; τ2=0) compared with adequate GWG. The direction and magnitude of the associations between GWG adequacy and several neonatal outcomes were modified by maternal age and body mass index before pregnancy. Conclusions Inadequate and excessive GWG are associated with a higher risk of adverse neonatal outcomes across settings. Interventions to promote optimal GWG during pregnancy are likely to reduce the burden of adverse neonatal outcomes, however further research is needed to assess optimal ranges of GWG based on data from low and middle income countries.

U2 - 10.1136/bmj-2022-072249

DO - 10.1136/bmj-2022-072249

M3 - Article

C2 - 37734757

AN - SCOPUS:85171957040

SN - 0959-8138

VL - 382

JO - BMJ

JF - BMJ

M1 - e072249

ER -

Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: Individual participant data meta-analysis

Abstrakti

Rahoitus

YK:n kestävän kehityksen tavoitteet

Julkaisufoorumi-taso

!!ASJC Scopus subject areas

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