Academic journal article Journal of Health Population and Nutrition

Is International or Asian Criteria-Based Body Mass Index Associated with Maternal Anaemia, Low Birthweight, and Preterm Births among Thai Population?-An Observational Study

Academic journal article Journal of Health Population and Nutrition

Is International or Asian Criteria-Based Body Mass Index Associated with Maternal Anaemia, Low Birthweight, and Preterm Births among Thai Population?-An Observational Study

Article excerpt

INTRODUCTION

Pregnant women are vulnerable and prone to developing physiological and pathological anaemia. Maternal anaemia is a burden throughout the world, especially in developing countries (1). Maternal anaemia is defined as a haemoglobin (Hb) level of <11g/dL, or haematocrit (Hct) of <33% in all trimesters of pregnancy as defined by the World Health Organization (WHO) (2). A high prevalence of anaemia increases the risk of maternal death in Africa, Asia, and Latin America (1). Anaemia in pregnancy is also associated with malnourishment and low socioeconomic conditions (3,4). Nutritional status can be measured using various parameters, such as weight, height, body mass index (BMI), triceps skinfold, or mid-upper arm circumference. However, BMI is most commonly used in the research field in developing countries. Low maternal BMI has a strong relationship with maternal anaemia (4-8).

The nutritional status of pregnant women is not only related to anaemia but also to the poor pregnancy outcomes in both developing and developed countries. Low maternal BMI results in an increased incidence of newborns with low birth-weight (LBW), an Apgar score of less than 5 at one minute and perinatal mortality in Sudan (5). Underweight, pregnant women in North India had a higher occurrence of anaemia; in contrast, obese pregnant women tend to develop diabetes mellitus, pregnancy-induced hypertension, and are more likely to give birth by caesarean section due to foetal distress and cepahlopelvic disproportion (9). Likewise, underweight women had a significant higher rate of newborns with foetal anaemia, LBW, and preterm delivery but a lower rate of late booking for prenatal care, gestational diabetes mellitus, pre-eclampsia, and postpartum haemorrhage in England (10).

The effects of pre-pregnancy BMI, BMI at the first prenatal visit, or gestational weight gain associated with adverse pregnancy outcomes have been previously reported (11-14). The implication of BMI at the first prenatal visit or gestational weight gain is dependent on the gestational age of pregnancy at the first prenatal visit and gestational age at birth. Similarly, the pre-pregnancy BMI may be affected by recall bias if it is self-reported. In addition, the BMI cut-points for classifying body-weight categories have been found to vary in previous studies.

Underweight has been defined for BMI of less than the 5th percentile for age--18.5 or 19.8. Overweight has been defined for BMI of the [greater than or equal to] 85th percentile for age or [greater than or equal to] 23, [greater than or equal to] 25, or [greater than or equal to] 30 (7,9,15). According to the WHO, the four BMI cut-point categories were defined as follows: underweight (BMI <18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), and obese (BMI [greater than or equal to] 30) (9-11). Recently, the WHO experts addressed the recommended cut-points for BMI categories in Asian populations as follows: <18.5, 18.5-23, 23-27.5, and [greater than or equal to] 27.5 for underweight, normal weight, overweight and obese respectively (16).

There is a lack of evidence showing the association between Asian criteria-based BMI and maternal anaemia, LBW, and preterm delivery among the Asian population. Therefore, this study aimed at determining the risk of anaemia, LBW, and preterm delivery according to the international and Asian criteria-based BMI during pre-pregnancy and pregnancy at the first prenatal visit and the changes in Hb and Hct during pregnancy.

MATERIALS AND METHODS

Study design

The study was a part of the cohort project on epidemiology of infestation of soil-transmitted helminths investigating the effects of treatment, the prevalence of anaemia, and nutritional status in pregnancy. The Institute Ethics Committee of the Faculty of Medicine, Prince of Songkla University (reference no. 49/370-004) approved the study. …

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