Academic journal article Bulletin of the World Health Organization

Maternal Body Mass Index and Gestational Weight Gain and Their Association with Perinatal Outcomes in Viet Nam/ Indice Maternel De Masse Corporelle et Augmentation Du Poids En Gestation et Leur Association Avec Les Observations Perinatales Au Viet Nam/Relacion Entre Los Resultados Perinatales En Viet Nam Y El Indice De Masa Corporal De la Madre Y El Aumento De Peso Durante El Embarazo

Academic journal article Bulletin of the World Health Organization

Maternal Body Mass Index and Gestational Weight Gain and Their Association with Perinatal Outcomes in Viet Nam/ Indice Maternel De Masse Corporelle et Augmentation Du Poids En Gestation et Leur Association Avec Les Observations Perinatales Au Viet Nam/Relacion Entre Los Resultados Perinatales En Viet Nam Y El Indice De Masa Corporal De la Madre Y El Aumento De Peso Durante El Embarazo

Article excerpt

Introduction

The Global Safe Motherhood Initiative, launched in 1987, is designed to improve antenatal care and counselling throughout the world. Nutrient intake and weight gain during pregnancy are the two main modifiable factors influencing maternal and infant outcomes. (1) Indeed, a low body mass index (BMI) and suboptimal weight gain during pregnancy are long-recognized risk factors for the delivery of infants too small for gestational age. (2)

Being born small for gestational age is a major predictor of neonatal mortality and morbidity, (2) failure to grow, slow cognitive development and chronic diseases in adulthood. (3) Infants too large for gestational age also experience higher perinatal and long-term health risks. (4-7) In addition, both groups of infants are more likely to be delivered by Caesarean section. Thus, reducing the delivery of excessively small or large infants translates into fewer surgical risks for women. (8) Appropriate antenatal management of maternal nutrition, as dictated by scientific evidence, is critical in reducing the delivery of these babies for whom both the intrauterine environment and the birth process can be life-threatening. (8,9)

Maternal anthropometry differs across populations. (10) Women belonging to ethnic groups characterized by a small body size have been reported to gain less weight on average during pregnancy than larger women. In less-developed Asian countries, including Viet Nam, women generally have a lower BMI and/or a smaller gestational weight gain than in developed countries. (11,12) In the United States of America, for example, 2% of pregnant women have a BMI < 18.5 and more than 50% have a BMI > 25. (13) There is a need to assess whether the current anthropometric recommendations for pregnant women of the United States National Academy of Sciences Institute of Medicine (IOM), which are based on data from western countries, are appropriate for preventing adverse pregnancy outcomes across populations everywhere, including south-east Asia.

The objectives of this study were: (i) to determine the prevalence of small and large size for gestational age among infants of Vietnamese women, and (ii) to estimate the risk of giving birth to an infant too small or too large for gestational age as a function of maternal gestational weight gain and BMI in Viet Nam.

Methods

Study setting and population

Viet Nam is a low-income country with an estimated total population of 87 million. According to data from the United Nations Children's Fund, from 2003 to 2008 the average annual number of births in the country was 1494 000 and the average annual prevalence of low birth weight was 7%. In 2008, the maternal mortality ratio was 150 per 100 000 live births, and the infant mortality rate was 12 per 1000 live births. (14,15) We conducted a prospective health-facility-based study in Nha Trang city, in the province of Khanh Hoa. The study included women from eight community health centres and one provincial hospital in the catchment area of Nha Trang, whose total population is approximately 400 000. (16)

Trained midwives conducted semi-Structured interviews with women residents of the study catchment area with singleton pregnancies who were admitted to the aforementioned health institutions for delivery from 3 July 2007 to 15 June 2008. Women who delivered a stillborn or who gave birth before the 22nd week of gestation were excluded from the study. A stillborn was defined as a fetus with a gestational age of at least 22 full weeks that did not breathe, cry or show minimal movement of the chest or limbs at birth.

Ethical approval

The institutional review boards of the University of Tokyo (Tokyo, Japan) and the National Institute of Hygiene and Epidemiology (Hanoi, Viet Nam) approved the study. All participants received detailed information about the study and were asked to give written informed consent. …

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