Abstract
ObjectiveTo estimate the effect of inadequate maternal weight gain in the third trimester on the risk of intrauterine growth restriction (IUGR) in rural Bangladesh.MethodsThis study analyzed data from 1,463 mother-infant pairs in Matlab, Bangladesh which were available through the electronic databases of Matlab Health and Demographic Surveillance System and Matlab hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). All the mothers were admitted to Matlab hospital for childbirth from January 2012 to December 2014, and they had singleton live births at term. Third-trimester weight gain (kg) was calculated by subtracting the estimated weight at the end of the second trimester from the weight taken before childbirth. Inadequate third-trimester weight gain was defined as 4 kg or less irrespective of pre-gravid nutritional status. IUGR was defined as a birth weight below 2500 g in full-term newborns (LBW-Term), and a birth weight for gestational age and infant sex less than the 10th percentile (SGA-10th) and 2 standard deviations below the mean birth weight (SGA-2SD) based on the international newborn standards from the INTERGROWTH-21st project. Multivariable logistic regression models were fitted to determine the independent effect of inadequate weight gain in the third trimester on the risk of IUGR.ResultsA total of 824 (56.3%) women experienced inadequate weight gain in the third trimester of pregnancy. In this study, 215 (14.7%), 573 (39.2%) and 220 (15.0%) infants were born as LBW-Term, SGA-10th and SGA-2SD, respectively. In the multivariable logistic regression models, compared to adequate weight gain in the third-trimester, the odds ratios (OR) for LBW-Term, SGA-10th and SGA-2SD for inadequate weight gain were 1.8 (95% CI: 1.3, 2.5; p < 0.001), 1.4 (95% CI: 1.1, 1.8; p = 0.002) and 1.8 (95% CI: 1.3, 2.4; p = 0.001), respectively.ConclusionsBoth inadequate third-trimester weight gain and IUGR are prevailing public health concerns in rural Bangladesh. Inadequate weight gain in the third trimester substantially increased the risk of IUGR. Public health programs focusing on the promotion of adequate weight gain in the third trimester of pregnancy with an ultimate aim to decrease IUGR should be implemented.
Highlights
Intrauterine growth restriction (IUGR), a process of reduced fetal growth velocity failing the fetus to attain its growth potential, is associated with an increased risk of childhood mortality and morbidity, cognitive impairment, higher incidence of chronic diseases in adulthood and overall reduced human capital [f1–4]
Inadequate weight gain in the third trimester substantially increased the risk of IUGR
Public health programs focusing on the promotion of adequate weight gain in the third trimester of pregnancy with an ultimate aim to decrease IUGR should be implemented
Summary
Intrauterine growth restriction (IUGR), a process of reduced fetal growth velocity failing the fetus to attain its growth potential, is associated with an increased risk of childhood mortality and morbidity, cognitive impairment, higher incidence of chronic diseases in adulthood and overall reduced human capital [f1–4]. Weight gain in the first trimester of pregnancy has generally been found to be unrelated to birth weight, probably because of the minimal fetal growth during this period [9,10,11]. Several epidemiologic studies have reported a strong association of second-trimester weight gain with birth weight [11,12,13,14]. Strauss and Dietz have reported an approximately two-fold increase in the risk of IUGR with low maternal weight gain in either the second or the third trimester [11]. Drehmer et al present evidence that suboptimal maternal weight gain in the second but not in the third trimester is associated with an elevated risk of SGA [16]. Contemporary studies examining the association of adequacy of third-trimester weight gain with fetal growth are scarce
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