The relative influence of maternal nutritional status before and during pregnancy on birth outcomes in Vietnam

Melissa F Young; Phuong Hong Nguyen; O Yaw Addo; Wei Hao; Hieu Nguyen; Hoa Pham; Reynaldo Martorell; Usha Ramakrishnan

doi:10.1016/j.ejogrb.2015.09.018

The relative influence of maternal nutritional status before and during pregnancy on birth outcomes in Vietnam

Eur J Obstet Gynecol Reprod Biol. 2015 Nov:194:223-7. doi: 10.1016/j.ejogrb.2015.09.018. Epub 2015 Sep 28.

Authors

Melissa F Young¹, Phuong Hong Nguyen², O Yaw Addo¹, Wei Hao¹, Hieu Nguyen³, Hoa Pham³, Reynaldo Martorell¹, Usha Ramakrishnan⁴

Affiliations

¹ The Hubert Department of Global Health and the Doctoral Program in Nutrition and Health Sciences, Emory University, Atlanta, GA, United States.
² Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam; International Food Policy Research Institute, Hanoi, Vietnam.
³ Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam.
⁴ The Hubert Department of Global Health and the Doctoral Program in Nutrition and Health Sciences, Emory University, Atlanta, GA, United States. Electronic address: uramakr@emory.edu.

PMID: 26454228
DOI: 10.1016/j.ejogrb.2015.09.018

Abstract

Objective: This study aimed to: (1) examine the role of multiple measures of prepregnancy nutritional status (weight, height, body composition) on birth outcomes (low birth weight (LBW), small for gestational age (SGA), preterm, birth weight, birth length, infant head circumference and mid-upper arm circumference (MUAC)); (2) assess relative influence of maternal nutritional status before and during (gestational weight gain) pregnancy on birth outcomes.

Study design: We used prospective data on maternal body size and composition collected from women who participated in a randomized controlled trial evaluating the impact of preconceptional micronutrient supplements (PRECONCEPT) on birth outcomes in Thai Nguyen province, Vietnam (n=1436). Anthropometric measurements were obtained before conception through delivery by trained health workers. The relationship between prepregnancy nutritional status indicators, gestational weight gain (GWG) and birth outcomes were examined using generalized linear models, adjusting for potential confounding factors.

Results: Maternal prepregnancy weight (PPW) was the strongest anthropometric indicator predicting infant birth size. A 1 standard deviation (SD) increase in PPW (5.4kg) was associated with a 283g (95%CI: 279-286) increase in birthweight. A similar and independent association was observed with birthweight for an increase of 1 SD in gestational weight gain (4kg) (250g; 95% CI: 245-255). Women with a PPW <43kg or who gained <8kg during their pregnancy were more likely to give birth to a SGA (OR 2.9: 95%CI 1.9-4.5, OR 3.3: 95%CI 2.2-5.1) or LBW infant (OR 3.1: 95%CI 1.5-6.2, OR 3.4: 95%CI 1.6-7.2), respectively.

Conclusions: These findings indicate that clinical care and programs aimed at improving birth outcomes will have the greatest impact if they address maternal nutrition both before and during pregnancy. Women with a PPW <43kg or a GWG <8kg are at greatest risk for poor birth outcomes in this setting. Preconception counseling and clinical care to obtain a healthy weight prior to pregnancy along with routine obstetric care on gestational weight gain is critical to improve birth outcomes.

Trial registration: NCT01665378 (https://clinicaltrials.gov/show/NCT01665378).

Keywords: Birth outcomes; Nutrition; Preconception; Pregnancy; Women.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Arm / anatomy & histology*
Birth Weight*
Body Composition
Body Height
Body Weight
Female
Head / anatomy & histology*
Humans
Infant, Newborn
Infant, Small for Gestational Age
Nutritional Status*
Organ Size
Preconception Care
Pregnancy
Premature Birth / epidemiology
Prenatal Care
Prospective Studies
Vietnam / epidemiology
Weight Gain*

Associated data

ClinicalTrials.gov/NCT01665378