Antenatal determinants of maternal weight gain during pregnancy in nulliparous women of urban and suburban parts of Maharashtra

INTRODUCTION

India is home to one sixth of the world's population and one fifth of the world's births. Weight gain in pregnancy remains a matter of great concern for women and health care providers. Women’s knowledge about appropriate gestational weight gain, attitudes and beliefs about weight, and weight gain, as well as healthcare providers advice regarding gestational weight gain can affect the amount of weight women gain during pregnancy. According to the American College of Obstetricians and Gynaecologists (ACOG), components of preconception care should include addressing excess weight gain.¹ In India obesity was reported in about 12.6% of pregnant women, with 21.04% being overweight and 14.79% being underweight in a nationwide study.² Adherence to balanced diet throughout pregnancy, influences maternal body weight as well as health of mother and child.^3-5

In this study we studied the antenatal sociodemographic, maternal obstetric factors and maternal weight gain in the pregnant women nullipara registered in antenatal clinic of tertiary establishment and antenatal clinic of suburban slum area. We compared two groups because in hospital-based population well trained specialists examine and treat the patients while in community-based clinics residential doctors (post graduate students) examine and treat patients on a daily basis. The specialists (assistant professors) are available once a week at community based urban health centers. Hence the preference of pregnant women for hospital based or community-based services is influenced by multiple variable factors directly or indirectly influencing the quality of service.

The present study was planned to assess the validity of correlating antenatal socio-demographic and maternal and obstetric factors with maternal weight gain and the extent to which this can be used as a cost-effective technical tool to be used by grass root level workers and the Medical officers at the primary health centres.

METHODS

Present Study was observational prospective study conducted in two groups; group 1 in King Edward Memorial hospital ANC clinic and group 2 in urban health center ANC clinic for the period of 1year and 6 months from August 2015 to May 2016.

Sample size of Group 1 was 197 and Group 2 was 97.

Inclusion criteria

Nulliparous pregnant women within 12 weeks of pregnancy without high risk attending antenatal OPD who have given their consent were selected by convenient sampling i.e. all women registered in that duration were included in the study.

Exclusion criteria

Primigravida women having complications of pregnancy like twin’s pregnancy, diabetes mellitus, healer disease in pregnancy, pregnancy induced hypertension were excluded from study.

They were weighed and their weight and height were measured during first trimester before 12 weeks of pregnancy using standardized calibrated instrument and the same instrument was used for all study subjects. Body mass index was calculated by using the formula, weight/height in metres.² Maternal weight was measured again during third trimester when the women came for delivery. All of the women were categorized according to the modification for Asian population proposed by WHO, as BMI less than 18.5 kg/m² (underweight), BMI between 18.5 and 24.9 kg/m² (normal weight), BMI between 25 and 29.9 kg/m² (overweight), BMI of 30 kg/m².⁶ Maternal outcomes like mode of delivery, amount of blood lost, maternal complications, duration of hospital stay, time required for resumption of normal routine by mother were assessed after delivery.

All responses were tabulated by the investigator using Microsoft-Excel 2007 Software. Data was analysed by using SPSS Software version 20.0. Statistical tools used were percentages, mean and categorical variables were analysed by chi-square statistics. For small numbers, Fisher exact test was applied wherever required. P<0.05 was considered as statistical significance.

Ethical clearance was obtained from the Institutional Review Board of the College after submitting the protocol and subsequently answering all their queries. Permission was obtained from the Head of department of obstetrics and gynaecology for conducting the study after giving detailed explanation of all the procedures. Preliminary self-introduction was given and rapport building was done with the respondents. The subjects were oriented regarding objectives of the study. During the preparatory phase for formulation of a questionnaire, a pilot study was done on 20 subjects to assess communication needs and contents of the questionnaire. A semi-structured questionnaire was prepared in accordance with the study objectives. In subsequent meetings, informed written consent was taken from the registered pregnant women and then questionnaire was administered to the study subjects.

RESULTS

Socio-demographic and economic characteristics of participants are described in Table 1. Tertiary care hospital respondents belonged predominantly to Hindu religion while in suburban hospital respondents were predominantly Muslim. Majority Primigravida in both the groups were educated till 10th standard, unskilled workers and we’re having per capital income lower than 6000 INR.

Table 2 shows maternal characteristics. Mean age of study subjects in group 1 was 24.38 and 23 in group 2. Majority nullipara in both the groups were below 30 years and were having diet deficient in calories and proteins. Nearly half of the respondents in suburban hospital were underweight (early body mass index less than 18.5kg/m²). Majority respondents in tertiary care hospital gained normal weight (8 to 16 kg) in pregnancy while majority in suburban slum hospital gained less than 8 kg weight during pregnancy.

Table 3 and 4 shows association of socio-demographic, maternal characteristics with maternal weight gain during pregnancy in tertiary care hospital and suburban slum hospital respectively. In both the groups significant association was found between maternal weight gain and maternal education, per capital income, passive smoking, calorie and protein deficient and early pregnancy body mass index indicating that maternal education, per capital income, calorie and protein deficiency, passive smoking and low early pregnancy Body mass index are the antenatal determinants of maternal weight gain during pregnancy.

DISCUSSION

In our study we found that maternal education, per capital income, nutritional calorie and protein deficient, passive smoking and early pregnancy body mass index are found to be the determinants of maternal weight gain during pregnancy.

Education of the women was associated with weight gain. Our results were consistent with the findings of a US based larger study, including secondary data, reported by Howie.31 In contrast, several studies had failed to report any association between educational level and excessive weight gain.^7-9 This may be attributed to the use of different cut-off values for categorizing educational achievements in the studies. Possibly, a low level of education deprives people of access to necessary information on healthy life styles as well as making them less attentive to heeding the advice of experts. Indeed, in Sri Lankan culture, pregnant women are encouraged to consume more food in order to meet with demands of the developing fetus.

According to our study, per capital income was associated with maternal weight gain. Our results were consistent with the findings of the study reported by Hickey and Rodrigues who found that higher income levels were positively associated with weight gain.^9,10 The former study was a review and the latter a cohort study conducted in another developing country.^9,10 In contrast, Chasan-Taber had reported that income was not associated with gestational weigh gain.⁸

Our study revealed that body mass index in early pregnancy, passive smoking during third trimester and low educational level were determinants of weight gain. We could not find any other studies that assessed the effect of passive cigarette smoking for weight gain. All the participants in our study were non-smokers. Several studies assessed the effect of active cigarette smoking for excessive weight gain and found that it had a negative association with gestational weight gain.^9-11 In contrast to the findings of the above studies, two US based cohort studies reported by Brawarsky and Chasan-Taber found that cigarette smoking had no significant association with excessive weight gain.^7,8

In several papers, there were no significant associations reported between age and gestational weight gain which is in agreement with the results of our study.^12-14

Limitations of this study were study included the population living in high-end areas of the city with modern health facilities and others who live in the slums, not being able to access even the basic health facilities. All women (e.g. high-risk pregnancy) were not included in the study. This may present as a limitation in generalizing the results of this study to the whole population.

CONCLUSION

Maternal educational level, per capital income, passive smoking, nutritional caloric and protein deficiency during pregnancy, early pregnancy body mass index determines the weight gain during pregnancy. This implies that for monitoring the maternal weight during antenatal period needs one to monitor and address antenatal factors affecting the same during pregnancy to all pregnant women.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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