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The relationship between body mass index before pregnancy and the amount of weight that should be gained during pregnancy: A cross-sectional study.

Byline: Resmiye Ozdilek, Yilda Arzu Aba, Sena Dilek Aksoy, Bulat Aytek Sik and Yasam Kemal Akpak

KEYWORDS: Pregnancy, Body mass index, Weight gain, Obesity; Nutrition.

INTRODUCTION

The nutritional needs of mother candidates increase in line with the physiologic changes that occur during pregnancy and the need for fetal growth. During pregnancy and/or breastfeeding, many women have some prejudices and misconceptions about eating everything and the intake of certain food types.1 Adequate weight gain during pregnancy is important for pregnancy, delivery, and the long-term health consequences of the mother and child. Excessive weight gain during this period was found to be related with gestational diabetes, hypertension, preeclampsia, vaginal birth assisted with intervention, cesarean section and early birth.2-4 In addition to its maternal effects, excessive weight gain during pregnancy includes many metabolic risks, especially macrosomia, and health problems in childhood and adulthood in the newborn.5 Inadequate weight gain increases the risk of having low-birth-weight infants, premature infants, and neonatal diseases.6,7

There is no clear worldwide consensus on ideal weight gain. The guidelines of the Institute of Medicine (IOM), which were established in 1990 and revised in 2009, are the most widely used guidelines in the world, although initially only used in the United States. The IOM gave weight recommendations that should be taken during pregnancy according to maternal body mass index (BMI) before pregnancy. According to this guide, healthy women with low weight (BMI: less than 18.5 kg/m2) should gain 12.5-18 kg, normal weight women (BMI: 18.5-24.9 kg/m2) 11.5-16 kg, overweight women (BMI: 25-29.9 kg/m2) 11-14 kg, and obese women (BMI greater than 30 kg/m2) should only gain 5-9 kg during pregnancy. The IOM guide states that in prenatal health care, the BMI of every pregnant woman should be calculated in the first prenatal follow-up, the appropriate weight gain according to BMI should be recommended, and nutritional and physical counseling should be performed.8

In some studies, it was found that pregnant women who were recommended weight gain according to IOM guidelines had a higher probability of gaining appropriate weight than those who were not given recommendations.9 In this study, we aimed to investigate the relationship between BMI before pregnancy and gestational weight gain in Turkish women, and to compare their weight gain during pregnancy with the weight gain recommendations of the IOM.

METHODS

Our research was planned as a cross-sectional study. Pregnant women with full and regular medical records who were in the 38th or above gestational week and were admitted to a University Hospital's obstetrics and gynecology unit between March 2018 and August 2018 (six months) were included. All antenatal follow-ups of pregnant women were performed at this outpatient clinic. Pregnant women with chronic disease and receiving treatment during antenatal follow-up, with twin pregnancy, with a fetus with a congenital abnormality, and those with nutritional disturbance were excluded. Eight hundred twelve pregnant women with normal antenatal follow-up and who volunteered to participate were included. The data were obtained using a data collection Form prepared by the researchers. The data collection Form consisted of 13 questions that questioned sociodemographic characteristics, obstetric characteristics, and BMI.

The BMIs of the pregnant women were calculated with height and weight measurements in the initiation of pregnancy obtained from prenatal follow-up cards. The data collection Form was completed during face-to-face interviews. The weight gain rates of pregnant women and the eligibility according to the 2009 IOM weight gain guide were calculated.8 Written permission was obtained for this research from the Kocaeli University Ethics Committee for Non-interventional Clinical Research (KOU KAEK 01.03.2018, 2018/97), and from the institution where the data were collected.

Statistical analysis: Data were analyzed using IBM SPSS V23. Compliance with normal distribution was studied using the Shapiro-Wilk test. The Chi-square test was used to compare categorical data. Data without normal distribution are presented in the form of median (minimum-maximum) values. Categorical data are presented as frequency (percentage) values. The level of significance was accepted as P < 0.05.

Table-I: Sociodemographic features of the pregnant women.

Sociodemographic features###n###%

Educational status

Illiterate###42###5.2

Primary school###215###26.5

Secondary school###165###20.3

High school###220###27.1

University###170###20.9

Marital status

Married###80###499

Single###6###0.7

Divorced###2###0.2

Economic status

Income less than expense###82###10.1

Income equal to expense###691###85.1

Income more than expense###39###4.8

Obstetrics features###Mean-Standard###Minimum-

###Deviation###maximum

Gravida###2.30 A+- 1.41###1-8

Parity###0.98 A+- 1.04###0-5

Abortion###0.30 A+- 0.67###0-6

Live birth###0.90 A+- 1.01###0-5

Gestational week###38.97 A+- 1.13###34-44

###Mean-Standard###Minimum-

###Deviation###maximum

Weight before pregnancy###63.74 A+- 11.93###38-104

Total weight taken###14.42 A+- 5.53###5-39

during pregnancy

Body mass index###24.84 A+- 4.62###13.63-40.0

before pregnancy

Body mass index###n###%

classification (kg/m2)

Low weight < 18.5###26###3.2

Normal weight 18.5-24.9###427###52.6

Overweight 25.0-29.9###233###27.5

Obese 30.0###136###16.7

Table-II: Comparison of total weight gain and recommended weight gain according to BMI in pregnancy and the accordance between them.

###Total weight gain in pregnancy

###Recommended weight###Pregnant women###Pregnant women###Pregnant women

###gain according to###with weight gain in###with less weight###with more weight

BMI Classification###body mass index by###the recommended###gain than the###gain than the###P###X2

###the IOM guideline **###limits(n/%)###recommended###recommended

###limits(n/%)###limits(n/%)

Low weight###12.5-18.0 kg###17(65.4)*###7(26.9)###2(7.7)*

Normal weight###11.5-16.0 kg###147(34.4)###103(24.1)*###177(41.5)*

Overweight###7.0-11.5 kg###54(24.2)*###19(8.5)*###150(67.3)*###<0.001###92.33

Obese###5.0-9.0 kg###46(33.8)###2(1.5)*###88(64.7)*

RESULTS

The sociodemographic and obstetric characteristics of 812 pregnant women included in this study are shown in Table-I. The mean age of pregnant women was 27.66 A+- 5.05 (minimum:18; maximum: 47) years. Around one-quarter (26.5%) of the participants were primary school graduates and 20.9% were university graduates. When examined in terms of economic situation, the ratio of those whose incomes were equal to their expenditure was 85.1%. The mean number of pregnancies was 2.30 A+- 1.41 (minimum: 1; maximum: 8), parity was 0.98 A+- 1.04 (minimum: 0; maximum: 5), and gestational week was 38.97 A+- 1.13 (minimum: 34; maximum: 44). The mean BMI of the pregnant women was 24.84 A+- 4.62 (minimum: 13.63; maximum: 40.0) kg/m2, and the mean weight before pregnancy was 63.74 A+- 11.93 (minimum: 38; maximum: 104) kg. According to the BMI values, 3.2% of pregnant women were low weight, 52.6% were normal weight, 27.5% were overweight, and 16.7% were obese (Table-I).

The results of the comparison of total weight gain and recommended weight gain according to BMI in pregnancy are shown in Table-II. There was a statistically significant difference between total weight gain and recommended weight gain according to BMI (p < 0.001). Some 65.4% of those with low weight, 34.4% of normal weight, 24.2% of those who were overweight, and 33.8% with obesity gained weight within the recommended limits. Weight gain less than the recommended limits was found in 26.9% of those with low weight, 24.1% of normal weight women, 8.5% of those who were overweight, and 1.5% of women with obesity. Some 7.7% of those with low weight, 41.5% of normal weight women, 67.3% of those who were overweight, and 64.7% of women with obesity gained more weight than the recommended limits (p 30 kg/m2 who were randomly selected between 15-19 gestational weeks, conceived of a broad socioeconomic and racial spectrum were included in the study. Behavioral training was given to the study group once per week and only antenatal follow-up was performed in the control group. However, a behavioral intervention that addressed diet and physical activity did not improve obstetric and perinatal outcomes, did not prevent development of gestational diabetes, and did not reduce the frequency of LGA or macrosomic babies.18 In another study, duration of stay in hospital, frequency of diseases such as respiratory distress syndrome (RDS) and macrosomia in the newborns of pregnant women with BMI > 25 kg/m2 were evaluated. Statistically significant results were obtained in all parameters in the diet group in which behavioral training was added.19

In randomized controlled studies, by adding diet and exercise to behavioral interventions before pregnancy, BMI was reduced in 12-month follow-up and it was shown that decreasing BMI by increasing physical activity positively affected the prognosis of pregnancy.20,21 In a review that investigated factors other than BMI before pregnancy that affected GWG, it was found that GWG was not associated with negative emotions such as depression, anxiety and stress, but negative body image of the pregnant woman, inability to enjoy her own body, and her attitude towards weight gain were associated with excessive GWG.22 Pregnancy is the most appropriate period to investigate this international problem and to find a solution.23 It has been shown that patients want to receive information from their healthcare workers and they trust them.24 In addition, it seems effective to take advantage of technology.

In a study, it was observed that pregnant women who were delivered warnings about GWG, beginning from the 16th gestational week by telephone, webinar, SMS, e-mail or application gained statistically less weight.25

Limitations of the study: This study was conducted in a single university hospital and in a relatively small sample group. More effective results could be obtained if a prospective cohort study was performed with a larger number of pregnant women. Although the weight of the patients was measured by a single, fixed and accurate weightier, the height of the patients recorded according to their own statements. These statements can cause problems even if they correctly measured their height. More demographic data and emotional and behavioral parameters could be added to the study design.

CONCLUSION

Excessive weight is a major and neglected public health burden. Women in reproductive age are both at high risk for complications and are also target groups in terms for interventions. Ethnicity and BMI affect the range of weight that should be gained during pregnancy. The efficacy of individualized behavioral training, diet, and exercise is still not clear but should be investigated. It is thought that those who are overweight and obese before pregnancy should be brought to the ideal weight and lifestyle with a complex intervention, and those who are low weight should be protected by state policy and reach the ideal care conditions, which will improve antenatal and postnatal outcomes.

Conflict of interest: None.

Financial disclosure: The financial support of this work has been covered by the authors.

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Author:Resmiye Ozdilek, Yilda Arzu Aba, Sena Dilek Aksoy, Bulat Aytek Sik and Yasam Kemal Akpak
Publication:Pakistan Journal of Medical Sciences
Date:Oct 16, 2019
Words:3059
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