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

Pooling Project Consortium; Kennedy Cruickshank

doi:10.1136/bmj-2022-072249

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

Pooling Project Consortium, Kennedy Cruickshank

Nutritional Sciences

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Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: individual participant data meta-analysis
BMJ 2023; 382 doi: https://doi.org/10.1136/bmj-2022-072249 (Published 21 September 2023)
Cite this as: BMJ 2023;382:e072249
Article
Metrics
Responses
Peer review
Nandita Perumal, assistant professor12, Dongqing Wang, assistant professor3, Anne Marie Darling, research associate2, Enju Liu, assistant professor45, Molin Wang, associate professor67, Tahmeed Ahmed, executive8, Parul Christian, professor9, Kathryn G Dewey, distinguished professor emerita10, Gilberto Kac, professor11, Stephen H Kennedy, professor12, Vishak Subramoney, director13, Brittany Briggs, consultant14, Wafaie W Fawzi, professor2615 on behalf of the GWG Pooling Project Consortium
Author affiliations
Correspondence to: N Perumal [email protected]
Accepted 8 August 2023
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; τ2=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.

Original language	English
Article number	e072249
Journal	BMJ
DOIs	https://doi.org/10.1136/bmj-2022-072249
Publication status	Published - 21 Sept 2023

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10.1136/bmj-2022-072249

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@article{1e89c2dcfa6f45adb10f214dee93670a,

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

abstract = "CCBY Open accessResearchSuboptimal gestational weight gain and neonatal outcomes in low and middle income countries: individual participant data meta-analysisBMJ 2023; 382 doi: https://doi.org/10.1136/bmj-2022-072249 (Published 21 September 2023)Cite this as: BMJ 2023;382:e072249ArticleMetricsResponsesPeer reviewNandita Perumal, assistant professor12, Dongqing Wang, assistant professor3, Anne Marie Darling, research associate2, Enju Liu, assistant professor45, Molin Wang, associate professor67, Tahmeed Ahmed, executive8, Parul Christian, professor9, Kathryn G Dewey, distinguished professor emerita10, Gilberto Kac, professor11, Stephen H Kennedy, professor12, Vishak Subramoney, director13, Brittany Briggs, consultant14, Wafaie W Fawzi, professor2615 on behalf of the GWG Pooling Project ConsortiumAuthor affiliationsCorrespondence to: N Perumal [email protected] 8 August 2023AbstractObjective 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; τ2=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 {Pooling Project Consortium} and Kennedy Cruickshank",

year = "2023",

month = sep,

day = "21",

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

language = "English",

journal = "BMJ",

issn = "0959-8146",

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TY - JOUR

T1 - Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: 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 - Pooling Project Consortium

AU - Cruickshank, Kennedy

PY - 2023/9/21

Y1 - 2023/9/21

N2 - CCBY Open accessResearchSuboptimal gestational weight gain and neonatal outcomes in low and middle income countries: individual participant data meta-analysisBMJ 2023; 382 doi: https://doi.org/10.1136/bmj-2022-072249 (Published 21 September 2023)Cite this as: BMJ 2023;382:e072249ArticleMetricsResponsesPeer reviewNandita Perumal, assistant professor12, Dongqing Wang, assistant professor3, Anne Marie Darling, research associate2, Enju Liu, assistant professor45, Molin Wang, associate professor67, Tahmeed Ahmed, executive8, Parul Christian, professor9, Kathryn G Dewey, distinguished professor emerita10, Gilberto Kac, professor11, Stephen H Kennedy, professor12, Vishak Subramoney, director13, Brittany Briggs, consultant14, Wafaie W Fawzi, professor2615 on behalf of the GWG Pooling Project ConsortiumAuthor affiliationsCorrespondence to: N Perumal [email protected] 8 August 2023AbstractObjective 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; τ2=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 - CCBY Open accessResearchSuboptimal gestational weight gain and neonatal outcomes in low and middle income countries: individual participant data meta-analysisBMJ 2023; 382 doi: https://doi.org/10.1136/bmj-2022-072249 (Published 21 September 2023)Cite this as: BMJ 2023;382:e072249ArticleMetricsResponsesPeer reviewNandita Perumal, assistant professor12, Dongqing Wang, assistant professor3, Anne Marie Darling, research associate2, Enju Liu, assistant professor45, Molin Wang, associate professor67, Tahmeed Ahmed, executive8, Parul Christian, professor9, Kathryn G Dewey, distinguished professor emerita10, Gilberto Kac, professor11, Stephen H Kennedy, professor12, Vishak Subramoney, director13, Brittany Briggs, consultant14, Wafaie W Fawzi, professor2615 on behalf of the GWG Pooling Project ConsortiumAuthor affiliationsCorrespondence to: N Perumal [email protected] 8 August 2023AbstractObjective 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; τ2=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

SN - 0959-8146

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

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