Application of Institute of Medicine's Gestational Weight Gain Recommendations in Asian Population: A Scoping Review

Hanny L Zahroh,Siska Wiramihardja,Yenni Zuhairini,Amillia Siddiq

doi:10.13189/ujph.2022.100116

Abstract

Background. Gestational weight gain (GWG) is an important factor of the well-being of both mother and fetus. Latest recommendation by Institute of Medicine (IOM) was issued in 2009 based on women population in United States, and is classified based on World Health Organization (WHO) body mass index (BMI) cutoffs. Recommendation for Asian population is not currently available. This review aims to review the evidence of the application of said guidelines in Asian population. Method. Articles were searched using Google Scholar and PubMed. Articles published in 2016 or above, with single pregnancies and unlimited to pre-pregnancy BMI categories were selected. Of 1,239 potential articles, 29 were chosen for full-text screening and 9 were included in this review. Result. Mixed trends were found when assessing adequacy of GWG in relation to pre-pregnancy BMI. Article analyzing optimal GWG showed a higher and wider range compared to IOM. Inadequate GWG is associated with a higher risk of small for gestational age (SGA) while excessive GWG is associated with large for gestational age (LGA). Significant differences were found when different categorizations of BMI are used with IOM guidelines. Conclusion. Asian women rarely gain adequate weight by IOM standard. This might lead to increased risk of adverse pregnancy outcomes, such as SGA and LGA. Further researches are needed to study appropriate optimal GWG for Asian population, and/or to modify IOM guidelines to be applied better in Asian population.

Highlights

More than half of the total number of pregnancies worldwide occurs in Asia, where maternal mortality remains a big problem.[1,2] Women nutritional status is closely related to the health of both the mothers and the fetus
Contrary to the 1990's recommendation which used body mass index (BMI) categories derived from Metropolitan Life Insurance tables, the 2009's version is based on World Health Organization (WHO) cutoff points, described as below: 30 kg/m2
This study shown that the risk of small for gestational age (SGA) decreased (OR=0.93, 95% CI) and the risk of large for gestational age (LGA) increased as the Gestational weight gain (GWG) increased by 1 kg

Summary

Introduction

More than half of the total number of pregnancies worldwide occurs in Asia, where maternal mortality remains a big problem.[1,2] Women nutritional status is closely related to the health of both the mothers and the fetus. Pregnancy outcomes are greatly affected by pre-pregnancy body mass index (BMI) and gestational weight gain (GWG). Gestational weight gain is defined as the weight a woman gains between the time of conception and the onset of labor.[5] It supports the growth and development of the fetus and is affected by a number of factors, such as physiologic, behavior, psychologic, environment, 146 Application of Institute of Medicine's Gestational Weight Gain Recommendations in Asian Population: A Scoping Review socioeconomic and cultural background. Latest recommendation by Institute of Medicine (IOM) was issued in 2009 based on women population in United States, and is classified based on World Health Organization (WHO) body mass index (BMI) cutoffs. Asian women rarely gain adequate weight by IOM standard This might lead to increased risk of adverse pregnancy outcomes, such as SGA and LGA.

Objectives

Methods

Conclusion