There is limited data on the consequences of gestational weight gain (GWG) and obesity on pregnancy outcomes in developing countries. We evaluated body mass index (BMI) and GWG in Rwanda and their effects on pregnancy outcomes.
Prospective cross-sectional study of women with a singleton gestation who entered antenatal care in the 1st trimester and delivered at term. Only patients with accurate gestational age (GA) assignment were included. GA was determined by LMP correlating with 1st trimester examination or by ultrasound before 20 weeks. All participants were admitted to 1 of 3 maternity units in Kigali, Rwanda over a period of 6 months (June to December 2016). The combined annual deliveries at the three hospitals is over 17,000 annually. All women were weighed at entry to care and at the time of delivery to calculate GWG. The World Health Organization classification of BMI and GWG was used to stratify participants. The main outcomes were infant birth weight and percentile, hypertension, diabetes and cesarean section. Data analysis comprised descriptive, linear regression model and multiple logistic regression analyses.
Of the 1000 participants, 31(3.1%) were underweight, 641(64.1%) had a normal BMI, 261(26.1%) were overweight and 67(6.7%) were obese. GWG was normal for 225 (22.5%) participants, less than recommended (LWG) for 680 (68%) and excessive (EWG) for 95 (9.5%). The overall prevalence of diabetes was low in the population studied (1.2%). Overweight and obese women were at increased risk of hypertension (OR 4.2 and 7.2, respectively, p<0.0001). Obese women were at increased risk of cesarean section (OR 3.2, p<0.0001). EWG increased the risk of hypertensive disorders and cesarean section (p<0.0001). The risk of giving birth to a large for gestational age (LGA) infant increased in overweight and obese women (OR=3.3, p=0.008 vs OR= 5.3, p=0.007). Tw enty two percent of the babies of underweight women were SGA. SGA was noted in 23.1 %of women with LWG. Underweight women had a 3.5-fold increased risk of LBW infant (p=0.05) and LWG significantly increased the risk for SGA (OR=2.5, p<0.0001).
BMI and GWG have significant impacts on term pregnancy outcome in Rwanda. The findings of this study highlight the need of nutritional education and support to improve pregnancy outcome.
© 2018 Published by Elsevier Inc.