Prevalence and determinants of gestational weight gain among pregnant women in Niger

Césaire T Ouédraogo, K Ryan Wessells, Rebecca R Young, M Thierno Faye, Sonja Y Hess, Césaire T Ouédraogo, K Ryan Wessells, Rebecca R Young, M Thierno Faye, Sonja Y Hess

Abstract

Low gestational weight gain (GWG) and low mid-upper arm circumference (MUAC) are associated with adverse pregnancy outcomes. We aimed to assess the prevalence and determinants of low GWG and low MUAC among pregnant women in rural Zinder, Niger. A community-based survey was conducted among 1,384 pregnant women in the catchment areas of 18 integrated health centers in the region of Zinder, Niger. Weight and MUAC were measured during an in-home visit and again 1 month later, when haemoglobin concentration and micronutrient status were also assessed. The prevalence of low GWG was defined based on the 2009 United States Institute of Medicine (U.S. IOM) guidelines (<0.35 kg/week) and less than the third centile of the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) standards. Factors associated with GWG and MUAC were identified using logistic regression models adjusting for season, village, and gestational age. The median (interquartile range) age was 25.0 (20.7, 30.0) years, and 16.4% were ≤19 years. The prevalence of low GWG were 62.9% and 27.5% according to 2009 IOM and less than the third INTERGROWTH-21st centile, respectively; 24.9% had low MUAC. Higher α-1-acid glycoprotein (OR = 1.7, 95% CI [1.1, 2.8]) and C-reactive protein (OR = 1.2, 95% CI [1.02, 1.50]) increased the odds of low GWG. Adolescents (OR = 2.7, 95% CI [1.8, 4.0]), housewives (OR = 1.97, 95% CI [1.36, 2.86]), and those who reported recent food assistance (OR = 1.80, 95% CI [1.04, 3.11]) had higher odds of low MUAC. Prevalence of low GWG and low MUAC was high among pregnant women. Determinants of GWG and MUAC included socio-economic, demographic, and biological factors, although only markers of inflammation were consistent predictors across different definitions of low GWG.

Keywords: low income countries; maternal nutrition; nutritional status; pregnancy; undernutrition; weight gain.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

© 2019 The Authors. Maternal & Child Nutrition published by John Wiley & Sons, Ltd.

Figures

Figure 1
Figure 1
Flow chart for participants included in the present study

References

    1. Addis Alene, K. , & Mohamed Dohe, A. (2014). Prevalence of anemia and associated factors among pregnant women in an urban area of Eastern Ethiopia. Anemia, 2014, 561567 Retrieved from , 10.1155/2014/561567
    1. Adu‐Afarwuah, S. , Lartey, A. , Okronipa, H. , Ashorn, P. , Ashorn, U. , Zeilani, M. , … Dewey, K. G. (2017). Maternal supplementation with small‐quantity lipid‐based nutrient supplements compared with multiple micronutrients, but not with iron and folic acid, reduces the prevalence of low gestational weight gain in semi‐urban Ghana: a randomized controlled trial. The Journal of Nutrition, 147(4), 697–705. Retrieved from , 10.3945/jn.116.242909
    1. Asefa, F. , & Nemomsa, D. (2016). Gestational weight gain and its associated factors in Harari Regional State: Institution based cross‐sectional study, Eastern Ethiopia. Reproductive Health, 13, 101 Retrieved from , 10.1186/s12978-016-0225-x
    1. Assefa, N. , Berhane, Y. , & Worku, A. (2012). Wealth status, mid upper arm circumference (MUAC) and antenatal care (ANC) are determinants for low birth weight in Kersa, Ethiopia. PLoS ONE, 7(6), e39957 Retrieved from , 10.1371/journal.pone.0039957
    1. Baltussen, R. , Knai, C. , & Sharan, M. (2004). Iron fortification and iron supplementation are cost‐effective interventions to reduce iron deficiency in four subregions of the world. The Journal of Nutrition, 134(10), 2678–2684. Retrieved from , 10.1093/jn/134.10.2678
    1. Begum, F. , Buckshe, K. , & Pande, J. N. (2003). Risk factors associated with preterm labour. Bangladesh Medical Research Council Bulletin, 29(2), 59–66. Retrieved from
    1. Begum, K. , Ouedraogo, C. T. , Wessells, K. R. , Young, R. R. , Faye, M. T. , Wuehler, S. E. , & Hess, S. Y. (2018). Prevalence of and factors associated with antenatal care seeking and adherence to recommended iron‐folic acid supplementation among pregnant women in Zinder, Niger. Maternal & Child Nutrition, 14(Suppl 1), e12466 Retrieved from , 10.1111/mcn.12466
    1. Blencowe, H. , Cousens, S. , Oestergaard, M. Z. , Chou, D. , Moller, A. B. , Narwal, R. , … Lawn, J. E. (2012). National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: A systematic analysis and implications. Lancet, 379(9832), 2162–2172. Retrieved from , 10.1016/S0140-6736(12)60820-4
    1. Caulfield, L. E. , Stoltzfus, R. J. , & Witter, F. R. (1998). Implications of the Institute of Medicine weight gain recommendations for preventing adverse pregnancy outcomes in black and white women. American Journal of Public Health, 88(8), 1168–1174. Retrieved from
    1. Changamire, F. T. , Mwiru, R. S. , Msamanga, G. I. , Spiegelman, D. , Urassa, W. , Hertzmark, E. , … Peterson, K. E. (2014). Macronutrient and sociodemographic determinants of gestational weight gain among HIV‐negative women in Tanzania. Food and Nutrition Bulletin, 35(1), 43–50. Retrieved from , 10.1177/156482651403500106
    1. Cheikh Ismail, L. , Bishop, D. C. , Pang, R. , Ohuma, E. O. , Kac, G. , Abrams, B. , … Villar, J. (2016). Gestational weight gain standards based on women enrolled in the Fetal Growth Longitudinal Study of the INTERGROWTH‐21st Project: a prospective longitudinal cohort study. BMJ, 352, i555 Retrieved from , 10.1136/bmj.i555
    1. Chithambo, S. E. T. (May 2017). Factors associated with the rate of gestational weight gain in rural Mangochi district of Malawi. Master thesis in International Community Health. (Master in International Community Health), University of Oslo, Oslo, Norway. Retrieved from
    1. Coates, J. , Swindale, A. , & Bilinsky, P. (2007). Household food insecurity access scale (HFIAS) for measurement of household food access: Indicator guide (v.3). Washington, DC, USA: FHI 360/FANTA.
    1. Das, J. K. , Salam, R. A. , Thornburg, K. L. , Prentice, A. M. , Campisi, S. , Lassi, Z. S. , … Bhutta, Z. A. (2017). Nutrition in adolescents: physiology, metabolism, and nutritional needs. Annals of the New York Academy of Sciences, 1393(1), 21–33. Retrieved from , 10.1111/nyas.13330
    1. Edwards, L. E. , Hellerstedt, W. L. , Alton, I. R. , Story, M. , & Himes, J. H. (1996). Pregnancy complications and birth outcomes in obese and normal‐weight women: effects of gestational weight change. Obstetrics and Gynecology, 87(3), 389–394. Retrieved from
    1. FAO and FHI 360 (2016). Minimum dietary diversity for women: A guide for the measurement. Rome, Italy: FAO.
    1. Figueiredo, A. , Gomes‐Filho, I. S. , Silva, R. B. , Pereira, P. P. S. , Mata, F. , Lyrio, A. O. , … Pereira, M. G. (2018). Maternal anemia and low birth weight: A systematic review and meta‐analysis. Nutrients, 10(5). Retrieved from). , 10.3390/nu10050601
    1. Gebre, B. , Biadgilign, S. , Taddese, Z. , Legesse, T. , & Letebo, M. (2018). Determinants of malnutrition among pregnant and lactating women under humanitarian setting in Ethiopia. BMC Nutrition, 4(1), 11 Retrieved from , 10.1186/s40795-018-0222-2
    1. Ghosh, S. , Trevino, J. A. , Davis, D. , Shrestha, R. , Bhattarai, A. , Anusree, K. , … Webb, P. (2017). Factors associated with mid upper arm circumference in pregnant women in Banke, Nepal. Paper presented at the Experimental Biology, Chicago, IL, USA. Available at
    1. Goiburu, M. E. , Alfonzo, L. E. , Aranda, A. L. , Riveros, M. E. , & Ughelli, M. A. (2006). Clinical nutrition knowledge in health care members of university hospitals of Paraguay. Nutrition Hospital, 25(5), 591–595.
    1. Hamad, R. , Cohen, A. K. , & Rehkopf, D. H. (2016). Changing national guidelines is not enough: the impact of 1990 IOM recommendations on gestational weight gain among US women. International Journal of Obesity , 40(10), 1529‐1534. Retrieved from . 10.1038/ijo.2016.97
    1. Harper, L. M. , Chang, J. J. , & Macones, G. A. (2011). Adolescent pregnancy and gestational weight gain: Do the Institute of Medicine recommendations apply? American Journal of Obstetrics and Gynecology, 205(2), 140 e141‐148. Retrieved from , 10.1016/j.ajog.2011.03.053
    1. Hedderson, M. M. , Weiss, N. S. , Sacks, D. A. , Pettitt, D. J. , Selby, J. V. , Quesenberry, C. P. , & Ferrara, A. (2006). Pregnancy weight gain and risk of neonatal complications: Macrosomia, hypoglycemia, and hyperbilirubinemia. Obstetrics and Gynecology, 108(5), 1153–1161. Retrieved from , 10.1097/01.AOG.0000242568.75785.68
    1. Hellerstedt, W. L. , Himes, J. H. , Story, M. , Alton, I. R. , & Edwards, L. E. (1997). The effects of cigarette smoking and gestational weight change on birth outcomes in obese and normal‐weight women. American Journal of Public Health, 87(4), 591–596. Retrieved from
    1. Hess, S. Y. , & Ouedraogo, C. T. (2016). NiMaNu project [Internet]. Open Science Framework. Available at:
    1. Hickey, C. A. , Cliver, S. P. , Goldenberg, R. L. , McNeal, S. F. , & Hoffman, H. J. (1995). Relationship of psychosocial status to low prenatal weight gain among nonobese black and white women delivering at term. Obstetrics and Gynecology, 86(2), 177–183. Retrieved from
    1. Hickey, C. A. , McNeal, S. F. , Menefee, L. , & Ivey, S. (1997). Prenatal weight gain within upper and lower recommended ranges: Effect on birth weight of black and white infants. Obstetrics and Gynecology, 90(4 Pt 1), 489–494. Retrieved from
    1. Hutcheon, J. A. , & Bodnar, L. M. (2018). Good practices for observational studies of maternal weight and weight gain in Pregnancy. Paediatric and Perinatal Epidemiology, 32(2), 152–160. Retrieved from , 10.1111/ppe.12439
    1. Imdad, A. , & Bhutta, Z. A. (2012). Maternal nutrition and birth outcomes: Effect of balanced protein‐energy supplementation. Paediatric and Perinatal Epidemiology, 26(Suppl 1), 178–190. Retrieved from , 10.1111/j.1365-3016.2012.01308.x
    1. Institut National de la Statistique (INS) & ICF International . (2007). Enquête démographique et de santé et à indicateurs multiples du Niger 2006. Calverton, Maryland, USA: Available at:
    1. IOM and NRC (2009). In Rasmussen K. M., & Yaktine A. L. (Eds.), The National Academies Collection: Reports funded by National Institutes of Health. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press; Available online. , 10.17226/12584
    1. Kalanda, B. F. , Verhoeff, F. H. , Chimsuku, L. , Harper, G. , & Brabin, B. J. (2006). Adverse birth outcomes in a malarious area. Epidemiology and Infection, 134(3), 659–666. Retrieved from , 10.1017/S0950268805005285
    1. Karim, E. , & Mascie‐Taylor, C. G. (1997). The association between birthweight, sociodemographic variables and maternal anthropometry in an urban sample from Dhaka, Bangladesh. Annals of Human Biology, 24(5), 387–401. Retrieved from
    1. Katona, P. , & Katona‐Apte, J. (2008). The interaction between nutrition and infection. Clinical Infectious Diseases, 46(10), 1582–1588. Retrieved from , 10.1086/587658
    1. Kavle, J. A. , & Landry, M. (2018). Addressing barriers to maternal nutrition in low‐ and middle‐income countries: A review of the evidence and programme implications. Maternal & Child Nutrition, 14(1), e12508 Retrieved from , 10.1111/mcn.12508
    1. Klerman, L. V. , Cliver, S. P. , & Goldenberg, R. L. (1998). The impact of short interpregnancy intervals on pregnancy outcomes in a low‐income population. American Journal of Public Health, 88(8), 1182–1185. Retrieved from
    1. Lamstein, S. , Stillman, T. , Koniz‐Booher, P. , Aakesson, A. , Collaiezzi, B. , Williams, T. , … Anson, M. (2014). Evidence of Effective Approaches to Social and Behavior Change Communication for Preventing and Reducing Stunting and Anemia: Report from a Systematic Literature Review. Arlington, VA: Retrieved from
    1. Lechtig, A. (1988). Predicting risk of delivering low birthweight babies: Which indicator is better? Journal of Tropical Pediatrics, 34(1), 34–41. Retrieved from , 10.1093/tropej/34.1.34
    1. Lee, A. C. , Darmstadt, G. L. , Khatry, S. K. , LeClerq, S. C. , Shrestha, S. R. , & Christian, P. (2009). Maternal‐fetal disproportion and birth asphyxia in rural Sarlahi, Nepal. Archives of Pediatrics & Adolescent Medicine, 163(7), 616–623. Retrieved from , 10.1001/archpediatrics.2009.75
    1. Makhoul, Z. , Taren, D. , Duncan, B. , Pandey, P. , Thomson, C. , Winzerling, J. , … Shrestha, R. (2012). Risk factors associated with anemia, iron deficiency and iron deficiency anemia in rural Nepali pregnant women. The Southeast Asian Journal of Tropical Medicine and Public Health, 43(3), 735–746. Retrieved from
    1. Mariyam, A. F. , & Dibaba, B. (2018). Epidemiology of malnutrition among pregnant women and associated factors in central refit valley of Ethiopia, 2016. Journal of Nutritional Disorders and Therapy, 8(1). Retrieved from 10.4172/2161-0509.1000222
    1. Miller, J. E. (1991). Birth intervals and perinatal health: An investigation of three hypotheses. Family Planning Perspectives, 23(2), 62–70. Retrieved from
    1. Mohanty, C. , Prasad, R. , Srikanth Reddy, A. , Ghosh, J. K. , Singh, T. B. , & Das, B. K. (2006). Maternal anthropometry as predictors of low birth weight. Journal of Tropical Pediatrics, 52(1), 24–29. Retrieved from , 10.1093/tropej/fmi059
    1. Mowe, M. , Bosaeus, I. , Rasmussen, H. H. , Kondrup, J. , Unosson, M. , & Irtun, O. (2006). Nutritional routines and attitudes among doctors and nurses in Scandinavia: A questionnaire based survey. Clinical Nutrition, 25(3), 524–532. Retrieved from , 10.1016/j.clnu.2005.11.011
    1. Mowe, M. , Bosaeus, I. , Rasmussen, H. H. , Kondrup, J. , Unosson, M. , Rothenberg, E. , … Scandinavian Nutrition, G. (2008). Insufficient nutritional knowledge among health care workers? Clinical Nutrition, 27(2), 196–202. Retrieved from , 10.1016/j.clnu.2007.10.014
    1. Nielsen, J. N. , Gittelsohn, J. , Anliker, J. , & O'Brien, K. (2006). Interventions to improve diet and weight gain among pregnant adolescents and recommendations for future research. Journal of the American Dietetic Association, 106(11), 1825–1840. Retrieved from , 10.1016/j.jada.2006.08.007
    1. Perkins, J. M. , Subramanian, S. V. , Davey Smith, G. , & Ozaltin, E. (2016). Adult height, nutrition, and population health. Nutrition Reviews, 74(3), 149–165. Retrieved from , 10.1093/nutrit/nuv105
    1. Raiten, D. J. , Sakr Ashour, F. A. , Ross, A. C. , Meydani, S. N. , Dawson, H. D. , Stephensen, C. B. , … Group, I. C. (2015). Inflammation and nutritional science for programs/policies and interpretation of research evidence (INSPIRE). The Journal of Nutrition, 145(5), 1039S–1108S. Retrieved from , 10.3945/jn.114.194571
    1. Rollins, N. C. , Coovadia, H. M. , Bland, R. M. , Coutsoudis, A. , Bennish, M. L. , Patel, D. , & Newell, M. L. (2007). Pregnancy outcomes in HIV‐infected and uninfected women in rural and urban South Africa. Journal of Acquired Immune Deficiency Syndromes, 44(3), 321–328. Retrieved from , 10.1097/QAI.0b013e31802ea4b0
    1. Saaka, M. , Oladele, J. , Larbi, A. , & Hoeschle‐Zeledon, I. (2017). Dietary diversity is not associated with haematological status of pregnant women resident in rural areas of northern Ghana. Journal of Nutrition and Metabolism, 2017, 8497892 Retrieved from , 10.1155/2017/8497892
    1. Schieve, L. A. , Cogswell, M. E. , & Scanlon, K. S. (1998). An empiric evaluation of the Institute of Medicine's pregnancy weight gain guidelines by race. Obstetrics and Gynecology, 91(6), 878–884. Retrieved from
    1. Scrimshaw, N. S. (1977). Effect of infection on nutrient requirements. The American Journal of Clinical Nutrition, 30(9), 1536–1544. Retrieved from , 10.1093/ajcn/30.9.1536
    1. Sebayang, S. K. , Dibley, M. J. , Kelly, P. J. , Shankar, A. V. , Shankar, A. H. , & Group, S. S. (2012). Determinants of low birthweight, small‐for‐gestational‐age and preterm birth in Lombok, Indonesia: Analyses of the birthweight cohort of the SUMMIT trial. Tropical Medicine & International Health, 17(8), 938–950. Retrieved from , 10.1111/j.1365-3156.2012.03039.x
    1. Siega‐Riz, A. M. , & Adair, L. S. (1993). Biological determinants of pregnancy weight gain in a Filipino population. The American Journal of Clinical Nutrition, 57(3), 365–372. Retrieved from , 10.1093/ajcn/57.3.365
    1. Stotland, N. E. , Cheng, Y. W. , Hopkins, L. M. , & Caughey, A. B. (2006). Gestational weight gain and adverse neonatal outcome among term infants. Obstetrics and Gynecology, 108(3 Pt 1), 635–643. Retrieved from , 10.1097/
    1. Strauss, R. S. , & Dietz, W. H. (1999). Low maternal weight gain in the second or third trimester increases the risk for intrauterine growth retardation. The Journal of Nutrition, 129(5), 988–993. Retrieved from , 10.1093/jn/129.5.988
    1. Sukrat, B. , Wilasrusmee, C. , Siribumrungwong, B. , McEvoy, M. , Okascharoen, C. , Attia, J. , & Thakkinstian, A. (2013). Haemoglobin concentration and pregnancy outcomes: a systematic review and meta‐analysis. BioMed Research International, 2013, 769057 Retrieved from , 10.1155/2013/769057
    1. UNICEF (2017). The state of the world's children: A fair chance for every child. In. New York, NY: UNICEF.
    1. United Nations (2008). Designing household survey samples: Pratical guidelines. New York, NY: Department of Economics and Social Affairs, Statistics Division, United Nations.
    1. Ververs, M. T. , Antierens, A. , Sackl, A. , Staderini, N. , & Captier, V. (2013). Which anthropometric indicators identify a pregnant woman as acutely malnourished and predict adverse birth outcomes in the humanitarian context? PLoS Currents, 5, June 7, Edition 1 Retrieved from , 10.1371/currents.dis.54a8b618c1bc031ea140e3f2934599c8
    1. Viswanathan, M. , Siega‐Riz, A. M. , Moos, M. K. , Deierlein, A. , Mumford, S. , Knaach, J. , … Lohr, K. N. (2008). Outcomes of maternal weight gain. Evidence Report/Technology Assessment, 168, 1–223.
    1. Wessells, K. R. , Ouedraogo, C. T. , Young, R. R. , Faye, M. T. , Brito, A. , & Hess, S. Y. (2017). Micronutrient status among pregnant women in Zinder, Niger and risk factors associated with deficiency. Nutrients, 9(5), 430 Retrieved from , 10.3390/nu9050430
    1. WHO expert Committee on physical status . (1995). The use and interpretation of anthropometry. Retrieved from Geneva, Switzerland: Available at

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