Abstract
The objective of the present study is to summarise trends in under- and over-nutrition in pregnant women on the Thailand-Myanmar border. Refugees contributed data from 1986 to 2016 and migrants from 1999 to 2016 for weight at first antenatal consultation. BMI and gestational weight gain (GWG) data were available during 2004-2016 when height was routinely measured. Risk factors for low and high BMI were analysed for <18·5 kg/m2 or ≥23 kg/m2, respectively. A total of 48 062 pregnancies over 30 years were available for weight analysis and 14 646 pregnancies over 13 years (2004-2016) had BMI measured in first trimester (<14 weeks' gestational age). Mean weight at first antenatal consultation in any trimester increased over the 30-year period by 2·0 to 5·2 kg for all women. First trimester BMI has been increasing on average by 0·5 kg/m2 for refugees and 0·6 kg/m2 for migrants, every 5 years. The proportion of women with low BMI in the first trimester decreased from 16·7 to 12·7 % for refugees and 23·1 to 20·2 % for migrants, whereas high BMI increased markedly from 16·9 to 33·2 % for refugees and 12·3 to 28·4 % for migrants. Multivariate analysis demonstrated low BMI as positively associated with being Burman, Muslim, primigravid, having malaria during pregnancy and smoking, and negatively associated with refugee as opposed to migrant status. High BMI was positively associated with being Muslim and literate, and negatively associated with age, primigravida, malaria, anaemia and smoking. Mean GWG was 10·0 (sd 3·4), 9·5 (sd 3·6) and 8·3 (sd 4·3) kg, for low, normal and high WHO BMI categories for Asians, respectively.
Highlights
Low- and middle-income countries (LMIC) face a dual epidemic of under- and over-nutrition in women of reproductive age
Persistent problems with undernutrition are exacerbated by a rapid rise in overweight and obesity and concomitant rise in diet-related chronic disease[1,5,7]. These problems are felt in Asian populations that are at increased risk of diet-related non-communicable disease (CVD, stroke, hypertension and diabetes) for similar measures of nutritional status compared with Western populations[7,8,9]
Increasingly within Asia, trends in BMI and gestational weight gain (GWG) are important determinants of disease related to nutrition in pregnancy: overweight and excessive GWG can lead to gestational hypertension, gestational diabetes and macrosomia complicating delivery, while being underweight in pregnancy is associated with pre-eclampsia, intra-uterine growth restriction and low infant birth weight[10,11,12,13,14,15,16]
Summary
Low- and middle-income countries (LMIC) face a dual epidemic of under- and over-nutrition in women of reproductive age. In the context of this nutrition transition, the new trends in over-nutrition have been linked to greater access to and consumption of energy-dense diets high in fats, tobacco use and increasingly These problems are felt in Asian populations that are at increased risk of diet-related non-communicable disease (CVD, stroke, hypertension and diabetes) for similar measures of nutritional status compared with Western populations[7,8,9]. With a growing global need to address the health of refugees, displaced persons and migrant communities in both LMIC and high-income countries, we examine changes in nutritional status among pregnant women from the Thailand–Myanmar border: in the setting of a protracted refugee situation and among a large and growing migrant worker population from Myanmar The objective of this manuscript is to describe trends in over- and under-nutrition using weight (1986–2016) and BMI at first antenatal presentation (2004–2016) and GWG (2004–2016) in these marginalised populations
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