Timing of Gestational Weight Gain on Fetal Growth and Infant Size at Birth in Vietnam

Melissa F Young, Phuong Hong Nguyen, O Yaw Addo, Hoa Pham, Son Nguyen, Reynaldo Martorell, Usha Ramakrishnan, Melissa F Young, Phuong Hong Nguyen, O Yaw Addo, Hoa Pham, Son Nguyen, Reynaldo Martorell, Usha Ramakrishnan

Abstract

Objective: To examine the importance of timing of gestational weight gain during three time periods: 1: ≤ 20 weeks gestation), 2: 21-29 weeks) and 3: ≥ 30 weeks) on fetal growth and infant birth size.

Methods: Study uses secondary data from the PRECONCEPT randomized controlled trial in Thai Nguyen province, Vietnam (n = 1436). Prospective data were collected on women starting pre-pregnancy through delivery. Maternal conditional weight gain (CWG) was defined as window-specific weight gains, uncorrelated with pre-pregnancy body mass index and all prior body weights. Fetal biometry, was assessed by ultrasound measurements of head and abdomen circumferences, biparietal diameter, and femoral length throughout pregnancy. Birth size outcomes included weight and length, and head, abdomen and mid upper arm circumferences as well as small for gestational age (SGA). Adjusted generalized linear and logistic models were used to examine associations.

Results: Overall, three-quarters of women gained below the Institute of Medicine guidelines, and these women were 2.5 times more likely to give birth to a SGA infant. Maternal CWG in the first window (≤ 20 weeks), followed by 21-29 weeks, had the greatest association on all parameters of fetal growth (except abdomen circumference) and infant size at birth. For birth weight, a 1 SD increase CWG in the first 20 weeks had 3 times the influence compared to later CWG (≥ 30 weeks) (111 g vs. 39 g) and was associated with a 43% reduction in SGA risk (OR (95% CI): 0.57 (0.46-0.70).

Conclusion: There is a need to target women before or early in pregnancy to ensure adequate nutrition to maximize impact on fetal growth and birth size.

Trial registration: ClinicalTrials.gov, NCT01665378.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Flow diagram of participant progress…
Fig 1. Flow diagram of participant progress throughout the study.

References

    1. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427–51. 10.1016/S0140-6736(13)60937-X
    1. IOM (Institute of Medicine) and NRC (National Research Council). Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press; 2009.
    1. Abrams B and Selvin S. Maternal weight gain pattern and birth weight. Obstet Gynecol. 1995;86(2):163–9.
    1. Ay L, Kruithof CJ, Bakker R, Steegers EA, Witteman JC, Moll HA, et al. Maternal anthropometrics are associated with fetal size in different periods of pregnancy and at birth. The Generation R Study. BJOG. 2009;116(7):953–63. 10.1111/j.1471-0528.2009.02143.x
    1. Brown JE, Murtaugh MA, Jacobs DR Jr., Margellos HC. Variation in newborn size according to pregnancy weight change by trimester. Am J Clin Nutr. 2002;76(1):205–9.
    1. Hickey CA, Cliver SP, McNeal SF, Hoffman HJ, Goldenberg RL. Prenatal weight gain patterns and birth weight among nonobese black and white women. Obstet Gynecol. 1996;88(4 Pt 1):490–6.
    1. Li RW, Haas JD, Habicht JP. Timing of the influence of maternal nutritional status during pregnancy on fetal growth. Am J Hum Biol. 1998;10(4):529–39.
    1. Margerison-Zilko CE, Shrimali BP, Eskenazi B, Lahiff M, Lindquist AR, Abrams BF. Trimester of maternal gestational weight gain and offspring body weight at birth and age five. Matern Child Health J. 2012;16(6):1215–23. 10.1007/s10995-011-0846-1
    1. Misra VK, Hobel CJ, Sing CF. The effects of maternal weight gain patterns on term birth weight in African-American women. J Matern Fetal Neonatal Med. 2010;23(8):842–9. 10.3109/14767050903387037
    1. Neufeld L, Pelletier DL, Haas JD. The timing of maternal weight gain during pregnancy and fetal growth. Am J Hum Biol. 1999;11(5):627–37. 10.1002/(SICI)1520-6300(199909/10)11:5<627::AID-AJHB6>;2-X
    1. Neufeld LM, Haas JD, Grajeda R, Martorell R. Changes in maternal weight from the first to second trimester of pregnancy are associated with fetal growth and infant length at birth. The Am J Clin Nutr. 2004;79(4):646–52.
    1. Raje L and Ghugre P. Rate and pattern of weight gain in Indian women from the upper income group during pregnancy and its effect on pregnancy outcome. J Dev Orig Health Dis. 2012;3(5):387–92. 10.1017/S2040174412000335
    1. Scholl TO, Hediger ML, Ances IG, Belsky DH, Salmon RW. Weight gain during pregnancy in adolescence: predictive ability of early weight gain. Obstet Gynecol. 1990;75(6):948–53.
    1. Young MF, Nguyen PH, Addo OY, Hao W, Nguyen H, Pham H, et al. The relative influence of maternal nutritional status before and during pregnancy on birth outcomes in Vietnam. Eur J Obstet Gynecol Reprod Biol. 2015;194:223–7. 10.1016/j.ejogrb.2015.09.018
    1. Nguyen PH, Lowe AE, Martorell R, Nguyen H, Pham H, Nguyen S, et al. Rationale, design, methodology and sample characteristics for the Vietnam pre-conceptual micronutrient supplementation trial (PRECONCEPT): a randomized controlled study. BMC Public Health. 2012;12(1):898.
    1. Nguyen PH, Addo OY, Young M, Gonzalez-Casanova I, Pham H, Truong TV, et al. Patterns of fetal growth based on ultrasound measurement and its relationship with small for gestational age at birth in rural Vietnam. Paediatr Perinat Epidemiol. 2016;30(3):256–66. 10.1111/ppe.12276
    1. Meire H and Farrant P. Basic ultrasound. New York: Wiley; 1995.
    1. O'Brien GD and Queenan JT. Growth of the ultrasound fetal femur length during normal pregnancy. Part I. Am J Obstet Gynecol. 1981;141(7):833–7.
    1. Chitty LS, Altman DG, Henderson A, Campbell S. Charts of fetal size: 3. Abdominal measurements. Br J Obstet Gynaecol. 1994;101(2):125–31.
    1. World Health Organizatin (WHO). Child growth standards: Training course and other tools. Accessed 29 August 2016 at .
    1. Deputy NP, Nguyen P, Pham H, Nguyen S, Neufeld L, Martorell R, Ramakrishnan U. Estimating gestational age in Vietnam: Examining the validity of last menstrual period and farr neonatal examination estimates compared with ultrasound estimates. Presented at the Society for Pediatric and Perinatal Epidemiology Research Annual Meeting. Denver, CO; 2015.
    1. Neufeld LM, Haas JD, Grajeda R, Martorell R. Last menstrual period provides the best estimate of gestation length for women in rural Guatemala. Paediatr Perinat Epidemiol. 2006;20(4):290–8. 10.1111/j.1365-3016.2006.00741.x
    1. Villar J, Cheikh Ismail L, Victora CG, Ohuma EO, Bertino E, Altman DG, et al. International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet. 2014;384(9946):857–68. 10.1016/S0140-6736(14)60932-6
    1. Lohman T, Roche A, Martorell R: Anthropometric Standardization Reference Manual. Champaign, IL: Human Kinetics Publishers; 1988.
    1. Consultation WHOE. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–63. 10.1016/S0140-6736(03)15268-3
    1. Adair LS, Fall CH, Osmond C, Stein AD, Martorell R, Ramirez-Zea M, et al. Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies. Lancet. 2013;382(9891):525–34. 10.1016/S0140-6736(13)60103-8
    1. Gwatkin DR, Rutstein S, Johnson K, Suliman E, Wagstaff A, Amouzou A. Socio-economic differences in health, nutrition, and population within developing countries: an overview. Niger J Clin Pract. 2007;10(4):272–82.
    1. Vyas S and Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan. 2006;21(6):459–68. 10.1093/heapol/czl029
    1. Papageorghiou AT, Ohuma EO, Altman DG, Todros T, Cheikh Ismail L, Lambert A, et al. International standards for fetal growth based on serial ultrasound measurements: the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project. Lancet. 2014;384(9946):869–79. 10.1016/S0140-6736(14)61490-2
    1. Siega-Riz AM, Viswanathan M, Moos MK, Deierlein A, Mumford S, Knaack J, et al. A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention. Am J Obstet Gynecol. 2009;201(4):339 e1–14.
    1. Abu-Saad K and Fraser D. Maternal nutrition and birth outcomes. Epidemiol Rev. 2010;32:5–25. Epub 2010/03/20. 10.1093/epirev/mxq001
    1. Davenport MH, Ruchat SM, Giroux I, Sopper MM, Mottola MF. Timing of excessive pregnancy-related weight gain and offspring adiposity at birth. Obstet Gynecol. 2013;122(2 Pt 1):255–61.
    1. Karachaliou M, Georgiou V, Roumeliotaki T, Chalkiadaki G, Daraki V, Koinaki S, et al. Association of trimester-specific gestational weight gain with fetal growth, offspring obesity, and cardiometabolic traits in early childhood. Am J Obstet Gynecol. 2015;212(4):502 e1–14.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren