Background
Methods
Study design, setting, and population
Measurements
At inclusion (at ≤20 weeks of gestation)
In the third trimester (32 to 36 weeks)
Statistical analysis
Results
Characteristics | Gestational weight gain classification based on IOM recommendations | Total (n = 934) | ||||||
---|---|---|---|---|---|---|---|---|
Inadequate (n = 598) | Adequate (n = 332) | Excessive (n = 4) | ||||||
Mean (SD) | Range | Mean (SD) | Range | Mean (SD) | Range | Mean (SD) | Range | |
Height, cm | 157.4 (0.1) | 135.2 to 175.8 | 157.6 (0.1) | 132.6 to 181.2 | 154.4 (0.0) | 150.4 to 160.6 | 157.4 (0.1) | 132.6 to 181.2 |
Pre-pregnancy weight, kg | 47.5 (6.4) | 31.8 to 68.9 | 51.7 (6.2) | 33.3 to 72.9 | 57.0 (7.7) | 47.9 to 66.1 | 49.0 (6.6) | 31.8 to 72.9 |
Pre-pregnancy BMI, kg/m2 | 19.1 (1.9) | 15.0 to 25.4 | 20.8 (1.7) | 15.8 to 25.3 | 23.8 (2.2) | 21.20 to 25.6 | 19.7 (2.0) | 15.0 to 25.7 |
MUAC at inclusion, cm | 22.0 (1.9) | 17.5 to 29.3 | 23.6 (1.7) | 18.1 to 28.3 | 26.6 (2.4) | 23.8 to 29.6 | 22.6 (2.0) | 17.5 to 29.3 |
Weight at inclusion, kg | 49.6 (6.4) | 34.2 to 71.5 | 54.6 (6.3) | 36.6 to 75.7 | 60.0 (8.9) | 49.5 to 70.9 | 51.5 (6.9) | 34.2 to 75.7 |
Weight gain at inclusion, kg (n = 933) | 2.15 (0.9) | 0.6 to 5.3 | 2.9 (1.1) | 1.2 to 6.4 | 3.1 (1.3) | 1.6 to 4.8 | 2.4 (1.0) | 0.6 to 6.4 |
BMI at inclusion, kg/m2 | 20.0 (1.9) | 16.2 to 26.2 | 21.9 (1.7) | 17.3 to 26.1 | 25.1 (2.6) | 21.9 to 27.5 | 20.7 (2.1) | 16.2 to 27.5 |
MUAC at 32 to 36 weeks, cm | 22.2 (1.9) | 17.8 to 29.3 | 23.8 (1.6) | 18.3 to 28.3 | 26.8 (2.3) | 24.20 to 29.8 | 22.8 (2.0) | 17.8 to 29.8 |
Weight at 32 to 36 weeks, kg | 56.8 (6.7) | 39.7 to 78.8 | 64.6 (6.3) | 44.9 to 88.3 | 73.3 (7.8) | 64.3 to 83.1 | 59.6 (7.6) | 39.7 to 88.3 |
Gestational weight gain, kg | 9.3 (1.6) | 5.0 to 14.8 | 13.0 (1.2) | 8.7 to 17.0 | 16.4 (0.8) | 15.3 to 17.0 | 10.6 (2.3) | 5.0 to 17.0 |
Characteristic | Total, n = 934 | Gestational weight gain | P-value | |
---|---|---|---|---|
Adequate, n = 336 | Inadequate, n = 598 | |||
Age in year, mean (SD) | 29.3 (6.5) | 29.1 (6.4) | 29.4 (6.6) | .376 |
Rural residence, n (%) | 607 (65.0) | 202 (60.1) | 403 (67.4) | .031 |
Religion, n (%) | .764 | |||
Orthodox | 922 (98.7) | 331 (98.5) | 591 (98.8) | |
Others (Muslim and Catholic) | 12 (1.3) | 5 (1.5) | 7 (1.2) | |
Educational status of the woman, n (%) | .700 | |||
No formal education | 338 (36.2) | 120 (35.7) | 218 (36.5) | |
Primary education | 307 (32.9) | 109 (32.4) | 198 (33.1) | |
Secondary education or above | 289 (30.9) | 107 (31.9) | 182 (30.4) | |
Occupation of woman, n (%) | .158a | |||
Farmer | 506 (54.1) | 168 (50.0) | 338 (56.5) | |
Housewife | 321 (34.4) | 126 (37.5) | 195 (32.6) | |
Employed | 85 (9.1) | 39 (11.6) | 46 (6.7) | |
Othersb | 22 (2.4) | 3 (0.9) | 19 (3.2) | |
Educational status of husband, n (%) | .495 | |||
No formal education | 300 (32.1) | 104 (31.0) | 196 (32.8) | |
Primary education | 345 (36.9) | 124 (36.9) | 221 (37.0) | |
Secondary education or above | 289 (31.0) | 108 (32.1) | 181 (30.2) | |
Occupation of husband, n (%) | .073 | |||
Farmer | 484 (51.8) | 157 (46.7) | 327 (54.7) | |
Employed | 212 (22.7) | 83 (24.7) | 129 (21.6) | |
Daily laborer | 148 (15.9) | 64 (19.1) | 84 (14.0) | |
Othersc | 90 (9.6) | 32 (9.5) | 58 (9.7) | |
Household size, mean (SD) | 4.5 (2.0) | 4.6 (2.1) | 4.3 (1.9) | .042 |
Model household, n (%) | 229 (24.5) | 101 (30.1) | 128 (21.4) | .004 |
Access to health facility in minutes, median (IQR) | 32.5 (25-75) | 40 (25-80) | 30 (20-70) | .070d |
Access to improved source of water, n (%) | 835 (89.4) | 302 (89.9) | 533 (89.1) | .805 |
Time needed to fetch water not exceed 30 min, n (%) | 745 (79.8) | 266 (79.2) | 479 (80.1) | .734 |
Access to improved sanitation facility, n (%) | 132 (14.1) | 46 (13.7) | 86 (14.4) | .847 |
Household own < 0.5 ha farmland, n (%) | 635 (68.0) | 232 (69.0) | 403 (67.4) | .654 |
Wealth index, n (%) | .483 | |||
Poorest | 189 (20.2) | 67 (20.0) | 122 (20.4) | |
Second poor | 185 (19.8) | 70 (20.8) | 115 (19.2) | |
Middle | 190 (20.3) | 73 (21.7) | 117 (19.6) | |
Second rich | 186 (20.0) | 70 (20.8) | 116 (19.4) | |
Rich | 184 (19.7) | 56 (16.7) | 128 (21.4) | |
Physical activity, n (%) | <.001 | |||
Low | 497 (53.2) | 208 (61.9) | 289 (48.3) | |
Moderate | 404 (43.3) | 122 (36.3) | 282 (47.2) | |
High | 33 (3.5) | 6 (1.8) | 27 (4.5) | |
Perceived work burden, n (%) | ||||
Easy | 383 (41.0) | 146 (43.4) | 237 (39.6) | .407 |
Moderate | 414 (44.3) | 141 (42.0) | 273 (45.7) | |
Difficult | 137 (14.7) | 49 (14.6) | 88 (14.7) | |
Low support from partner and others, n (%) | 72 (7.7) | 17 (5.1) | 55 (9.2) | <.001 |
At least one stressful life event, n (%) | 343 (36.7) | 104 (30.9) | 239 (40.0) | .002 |
Distress, n (%) | .006 | |||
Not distressed at all | 518 (55.5) | 207 (61.6) | 311 (52.0) | |
Distressed in one domain | 206 (22.1) | 75 (22.3) | 131 (21.9) | |
Distressed in two domains | 122 (13.0) | 36 (10.7) | 86 (14.4) | |
Distressed in three domains | 88 (9.4) | 18 (5.4) | 70 (11.7) | |
History of pre-pregnancy illness, n (%) | 128 (13.7) | 41 (12.2) | 87 (14.5) | .317 |
Reproductive and obstetric conditions | Total, n = 934 | Gestational weight gain | P-value | |
---|---|---|---|---|
Adequate, n = 336 | Inadequate, n = 598 | |||
Age at first marriage in year, median (IQR) | 18 (17-20) | 18 (17-20) | 18 (17-20) | .131a |
Nulliparous before the index pregnancy, n (%) | 181 (19.4) | 112 (18.7) | 69 (20.5) | .559 |
Parity (n = 753), mean (SD) | 3.3 (2.1) | 3.9 (1.8) | 4.1 (1.9) | .113 |
Age at first birth in year (n = 747), median (IQR) | 19 (18-21) | 19 (18-21) | 19 (18-20) | .176a |
Previous birth interval in months (n = 558), median (IQR) | 38 (30-48) | 39 (33-48) | 37 (30-47) | .085a |
History of adverse birth outcome, n (%) | 187 (24.8) | 65 (19.3) | 122 (20.4) | .887 |
Ever used modern contraceptive, n (%) | 725 (77.6) | 262 (78.0) | 463 (77.4) | .911 |
Women empowerment score, mean (SD) | 5.6 (1.5) | 5.9 (1.5) | 5.4 (1.4) | <.001 |
Intimate partner violence score, mean (SD) | 6.9 (3.0) | 6.2 (2.6) | 7.3 (3.1) | <.001 |
Unplanned index pregnancy, n (%) | 379 (40.6) | 122 (36.3) | 257 (43.0) | .055 |
Adequacy of prenatal care utilization, n (%) | .006 | |||
Inadequate | 385 (41.2) | 114 (33.9) | 271 (45.3) | |
Intermediate | 112 (12.0) | 41 (12.2) | 71 (11.9) | |
Adequate | 380 (40.7) | 156 (46.4) | 224 (37.5) | |
Adequate plus | 57 (6.1) | 25 (7.5) | 32 (5.3) | |
Iron-folic-acid tablets taken in two weeks, mean (SD) | 10.2 (3.6) | 10.6 (3.2) | 10.4 (3.2) | .218 |
Haemoglobin (n = 882), mean (SD) | 11.9 (1.6) | 12.9 (1.3) | 11.4 (1.5) | <.001 |
Anaemic (n = 882), n (%) | 271 (30.7) | 24 (7.5) | 247 (43.8) | <.001 |
Number of pregnancy complications, median (IQR) | 1 (0-2) | 1 (0-2) | 1 (0-2) | .177a |
Number of pregnancy complications, n (%) | .098 | |||
None | 428 (45.8) | 139 (41.4) | 289 (48.3) | |
One | 335 (17.6) | 67 (19.9) | 97 (16.2) | |
Two or more | 342 (36.6) | 130 (38.7) | 212 (35.5) | |
History of diarrhea during pregnancy, n (%) | 45 (4.8) | 20 (6.0) | 25 (4.2) | .292 |
Negative rhesus factor, n (%) | 23 (2.5) | 9 (2.8) | 14 (2.3) | .900 |
Urine analysis positive result, n (%) | 174 (18.6) | 48 (14.3) | 126 (21.1) | .014 |
Stool examination positive result, n (%) | 30 (3.2) | 14 (4.2) | 16 (2.7) | .295 |
History of illness during pregnancyb, n (%) | 210 (22.5) | 21 (6.3) | 36 (6.0) | 1.000 |
Food and dietary characteristics | ||||
Harvest volume in quintals, median (IQR) | 0.75 (0-6) | 0 (0-6.1) | 3 (0-6) | .217a |
Agrobiodiversity score, median (IQR) | 2 (0-4) | 1 (0-4) | 2 (0-4) | .027a |
Food insecure, n (%) | 361 (38.7) | 93 (27.7) | 268 (44.8) | <.001 |
Adequate dietary diversity score, n (%) | 493 (52.8) | 216 (64.3) | 277 (46.3) | <.001 |
Number of meals ≥3 times per day, n (%) | 886 (94.9) | 325 (93.8) | 561 (96.7) | .075 |
Fruits intake ≥3 times per week, n (%) | 53 (5.7) | 21 (6.3) | 32 (5.4) | .673 |
Vegetables intake ≥3 times per week, n (%) | 86 (9.2) | 34 (10.1) | 52 (8.7) | .546 |
Animal-source food intake ≥3 times per week, n (%) | 230 (24.6) | 83 (24.7) | 147 (24.6) | .967 |
Fasting, n (%) | 650 (69.6) | 209 (62.2) | 441 (73.7) | <.001 |
Alcohol intake ≥1 times per week, n (%) | 221 (23.7) | 75 (22.3) | 146 (24.4) | .521 |
Coffee intake ≥1 times per day, n (%) | 738 (79.0) | 266 (79.2) | 472 (78.9) | .999 |
Characteristics | Effect on gestational weight gain in kg (95% CI) | |||
---|---|---|---|---|
Unadjusted | P-value | Adjustedb | P-value | |
Model 1 | ||||
Women empowerment score below 4 | −0.53 (−1.09, 0.02) | .060 | − 0.48 (− 1.00, 0.04) | .069 |
Women empowerment score above 4 | 0.96 (0.39, 1.53) | .001 | 0.60 (0.06, 1.14) | .028 |
Dietary diversity score below 5 | −0.20 (− 0.52, 0.11) | .208 | − 0.32 (− 0.62, − 0.03) | .030 |
Dietary diversity score above 5 | 0.40 (0.01, 0.80) | .047 | 0.39 (0.03, 0.76) | .035 |
Food insecurity score | −0.10 (− 0.13, − 0.07) | <.001 | − 0.01(− 0.05, 0.02) | .438 |
Number of meals per daya | 2.39 (0.67, 4.13) | .007 | 1.16 (− 0.57, 2.88) | .189 |
Fruits intake (times per month)a | 0.82 (0.39, 1.24) | <.001 | 0.24 (−0.28, 0.77) | .364 |
Alcohol intake (times per month)a | −0.71 (−1.18, − 0.23) | .004 | −0.27 (− 0.73, 0.19) | .256 |
Fasting, yes | −0.59 (− 0.91, − 0.26) | <.001 | − 0.13 (− 0.43, 0.16) | .379 |
Perceived work burden | ||||
Easy | Reference | – | Reference | – |
Moderate | −0.43 (− 0.75, − 0.11) | .008 | − 0.26 (− 0.57, 0.05) | .097 |
Difficult | − 0.36 (− 0.79, 0.07) | .100 | 0.09 (− 0.37, 0.55) | .700 |
Physical activity | ||||
Low | Reference | – | Reference | – |
Moderate | −0.66 (− 0.96, − 0.36) | <.001 | − 0.28 (− 0.60, 0.04) | .085 |
High | − 0.76 (−1.51, − 0.01) | .046 | − 0.24 (− 1.00, 0.51) | .529 |
Total distress score | − 0.17 (− 0.23, − 0.12) | <.001 | −0.003 (− 0.08, 0.07) | .916 |
Total support score | 0.11 (0.07, 0.15) | <.001 | 0.02 (−0.03, 0.07) | .384 |
Intimate partner violence score | −0.12 (− 0.16, − 0.07) | <.001 | −0.02 (− 0.07, 0.04) | .559 |
Pre-pregnancy BMI in kg/m2 | 0.43 (0.35, 0.51) | <.001 | 0.13 (0.05, 0.22) | .003 |
Husband occupation | ||||
Farmer | Reference | – | Reference | – |
Employed | 0.39 (0.04, 0.74) | .028 | −0.17 (−0.69, 0.36) | .533 |
Daily laborer | 0.52 (0.09, 0.96) | .019 | 0.24 (− 0.27, 0.74) | .353 |
Others | 0.03 (−0.49, 0.54) | .915 | −0.27 (− 0.88, 0.34) | .383 |
Household size | −0.08 (− 0.16, − 0.01) | .032 | − 0.003 (− 0.09, 0.08) | .932 |
Model household, yes | 0.56 (0.22, 0.90) | .001 | 0.06 (− 0.26, 0.38) | .701 |
Agrobiodiversity scorea | −0.49 (− 0.94, − 0.03) | .036 | 0.04 (− 0.76, 0.84) | .924 |
Number of stressful life events | − 0.27 (− 0.42, − 0.11) | .001 | − 0.10 (− 0.24, 0.05) | .184 |
Adequacy of prenatal care utilization | ||||
Inadequate | Reference | – | Reference | – |
Intermediate | 0.21 (−0.27, 0.70) | .387 | 0.07 (−0.35, 0.49) | .743 |
Adequate | 0.80 (0.48, 1.12) | <.001 | 0.58 (0.28, 0.88) | <.001 |
Adequate plus | 0.87 (0.22, 1.51) | .009 | 0.28 (−0.29, 0.86) | .334 |
Haemoglobin in g/dL | 0.73 (0.65, 0.81) | <.001 | 0.54 (0.45, 0.64) | <.001 |
Model 2 | ||||
Quartiles of pre-pregnancy BMI | ||||
First quartile (≤ 18.31) | Reference | – | Reference | – |
Second quartile (18.32-19.48) | 0.67 (0.26, 1.07) | .001 | 0.13 (−0.27, 0.53) | .517 |
Third quartile (19.49-20.99) | 1.95 (1.54, 2.35) | <.001 | 0.71 (0.24, 1.17) | .003 |
Fourth quartile (≥ 21.00) | 2.28 (1.88, 2.67) | <.001 | 0.77 (0.27, 1.27) | .003 |
Characteristics | Probability, % (95% CI) |
---|---|
Economic empowerment score | |
≤ 3rd quartile | 43.1 (37.5, 48.6) |
4th quartile | 50.1 (45.6, 54.7) |
Socioeconomic empowerment score | |
≤ 3rd quartile | 46.7 (41.8, 51.6) |
4th quartile | 46.9 (42.0, 51.7) |
Experiencing intimate partner violence | |
Yes | 20.3 (14.7, 25.9) |
No | 26.6 (22.3, 30.9) |
Dietary diversity score | |
≤ 3rd quartile | 44.2 (39.8, 48.7) |
4th quartile | 55.2 (45.3, 65.2) |
Fasting for religious purposes | |
Yes | 32.2 (29.1, 35.3) |
No | 37.4 (32.9, 42.8) |
Pre-pregnancy body mass index | |
Underweight | 17.7 (11.1, 24.2) |
Normal weight | 51.6 (47.8, 55.4) |
Haemoglobin at prenatal care booking | |
< 11 g/dL | 8.9 (5.5, 12.2) |
≥ 11 g/dL | 28.5 (24.3, 32.6) |
Adequate prenatal care utilization | |
Yes | 41.4 (37.3, 45.6) |
No | 36.5 (32.8, 40.2) |
Illness during the index pregnancy | |
Yes | 30.1 (24.5, 35.6) |
No | 38.7 (35.3, 42.0) |
Experiencing at least one stressful life event | |
Yes | 30.2 (25.9, 34.6) |
No | 34.3 (30.3, 38.2) |