Background
Methods
Study setting
Sampling strategy
Recruitment
Standard measures
Data analysis
Ethical approval
Results
Maternal characteristics
Maternal characteristics | Participants with delivery data | Participants without delivery data |
P value | ||
---|---|---|---|---|---|
Mean (±standard deviation) | n | Mean (±standard deviation) | n | ||
Height (cm) | 153.4(±5.6) | 581 | 154.2 (±5.4) | 371 | 0.024 |
Pre-pregnancy weight (kg) | 50.2 (±9.1) | 563 | 50.9 (±9.1) | 381 | 0.270 |
Pre-pregnancy BMI (kg/m2) | 21.3 (±3.5) | 548 | 21.3 (±3.5) | 353 | 0.847 |
Gestational weight gain | 10.2 (±6.0) | 544 | 9.3 (±6.5) | 21 | 0.511 |
Gestational age at delivery (weeks) | 39.3 (±2.6) | 217 | – | – | – |
N (%)
|
N (%)
| ||||
Maternal age (years): | |||||
< 20 | 16 (2.7) | 603 | 11 (2.7) | 405 | 0.778 |
20–24 | 132 (21.9) | 77 (19.0) | |||
25–29 | 213 (35.3) | 143 (35.3) | |||
30–34 | 152 (25.2) | 114 (28.1) | |||
> =35 | 90 (14.9) | 60 (14.8) | |||
Nulliparous | 209 (34.5) | 606 | 139 (34.8) | 400 | 0.932 |
Educational level - woman: | |||||
Elementary school | 101 (16.7) | 606 | 40 (9.9) | 404 | 0.013 |
Junior High school | 141 (23.3) | 93 (23.0) | |||
Senior High School | 282 (46.5) | 201 (49.8) | |||
Higher education | 82 (13.5) | 70 (17.3) | |||
Occupationa - woman | |||||
Unemployed, student or housewife | 445 (74.4) | 598 | 302 (75.5) | 400 | 0.054 |
Self-employed, trader, services | 54 (9.0) | 31 (7.8) | |||
Government employee (civil servant, police, army) | 43 (7.2) | 41 (10.3) | |||
Private or state owned enterprise employee | 21 (3.5) | 16 (4.0) | |||
Other - ie services, agriculture, labourer | 35 (5.9) | 10 (2.5) | |||
Occupationa - partner | |||||
Unemployed, student or housewife | 12 (2.0) | 599 | 7 (1.8) | 400 | 0.000 |
Self-employed, trader, services | 412 (68.8) | 299 (74.8) | |||
Government employee (civil servant, police, army) | 47 (7.8) | 37 (9.3) | |||
Private or state owned enterprise employee | 42 (7.0) | 38 (9.5) | |||
Other - ie agriculture, labourer | 86 (14.4) | 19 (4.8) |
Maternal pre-pregnancy BMI and its relation to pregnancy and birth outcomes
International BMI category pre-pregnancy | ASIAN BMI category pre-pregnancy | ||||||
---|---|---|---|---|---|---|---|
<18.5 | 25.0–29.9 | ≥30.0 | <18.5 | 23.0–27.4 | ≥27.5 | ||
Numbers in each category (%) | 110 (20.1) | 74 (13.5) | 6 (1.1) | 110 (20.1) | 119 (21.7) | 29 (5.3) | |
GWG (kg) | MD (95% CI) | 2.67 (1.43, 3.92)*** | −2.47 (−3.90, −1.04)** | −4.63 (−9.22, −0.03)* | 2.21 (0.95, 3.48)** | −2.76 (−3.99, −1.54)*** | −3.04 (−5.20, −0.88)** |
aMD (95% CI)‡ | 2.48 (1.24, 3.73)*** | −2.58 (−4.03, −1.13)** | −5.35 (−9.93, −0.78)* | 2.07 (0.80, 3.33)** | −2.79 (−4.04, −1.55)*** | −3.32 (−5.54, −1.10)** | |
Birthweight (g) | MD (95% CI) | −19 (−105, 67) | 63 (−37, 164) | 524 (204, 844)** | 11 (−77, 99) | 129 (43, 214)** | 196 (42, 350)* |
aMD (95% CI)‡ | −15 (−102, 72) | 53 (−50, 156) | 556 (234, 878)** | 10 (−79, 99) | 117 (29, 205)** | 205 (46, 365)* | |
Number of antenatal visits | MD (95% CI) | 0.27 (−0.52, 1.05) | 1.06 (0.13, 2.00)* | −1.23 (−4.13, 1.68) | 0.44 (−0.37, 1.25) | 1.14 (0.34, 1.94)** | 0.51 (−0.94, 1.96) |
aMD (95% CI)‡ | 0.30 (−0.48, 1.08) | 0.81 (−0.13, 1.74) | −1.83 (−4.69, 1.04) | 0.49 (−0.31, 1.28) | 1.10 (0.30, 1.90)** | 0.20 (−1.27, 1.67) | |
Gestation at delivery (weeks) | MD (95% CI) | 0.24 (−0.69, 1.17) | 0.55 (−0.53, 1.63) | 1.17 (−1.87, 4.21) | 0.18 (−0.77, 1.12) | 0.13 (−0.91, 1.17) | 0.39 (−1.10, 1.87) |
aMD (95% CI)‡ | 0.15 (−0.82, 1.11) | 0.71 (−0.42, 1.85) | 1.04 (−2.12, 4.19) | 0.90 (−0.89, 1.07) | 0.25 (−0.82, 1.32) | 0.55 (−1.04, 2.13) | |
Inadequate weight gain | OR (95% CI) | 0.53 (0.34, 0.83)** | 0.36 (0.21, 0.60)*** | 0.29 (0.05, 1.62) | 0.58 (0.37, 0.91)* | 0.32 (0.20, 0.50)*** | 0.29 (0.13, 0.65)** |
aOR (95% CI)‡ | 0.56 (0.36, 0.88)* | 0.37 (0.22, 0.63)*** | 0.33 (0.06, 1.86) | 0.61 (0.39, 0.96)* | 0.31 (0.20, 0.50)*** | 0.31 (0.13, 0.72)** | |
Trimester 2 Haemoglobin <11.0g/dl | OR (95% CI) | 1.27 (0.78, 2.05) | 0.54 (0.29, 1.01) | 0.84 (0.14, 5.02) | 1.17 (0.71, 1.91) | 0.55 (0.33, 0.92)* | 0.61 (0.24, 1.60) |
aOR (95% CI)‡ | 1.32 (0.80, 2.17) | 0.47 (0.24, 0.90)* | 0.89 (0.14, 5.79) | 1.18 (0.71, 1.97) | 0.45 (0.26, 0.79)** | 0.55 (0.19, 1.54) | |
Trimester 3 Haemoglobin <11.0 g/dl | OR (95% CI) | 1.11 (0.66, 1.86) | 0.71 (0.38, 1.36) | 1.27 (0.21, 7.73) | 1.08 (0.63, 1.84) | 0.84 (0.50, 1.41) | 0.62 (0.22, 1.77) |
aOR (95% CI)‡ | 1.18 (0.69, 2.00) | 0.75 (0.38, 1.45) | 1.60 (0.25, 9.99) | 1.12 (0.65, 1.93) | 0.75 (0.43, 1.29) | 0.76 (0.25, 2.27) | |
Induction | OR (95% CI) | 1.17 (0.50, 2.69) | 1.86 (0.82, 4.22) | 2.95 (0.32, 27.43) | 1.24 (0.52, 2.95) | 1.50 (0.70, 3.23) | 2.63 (0.81, 8.57) |
aOR (95% CI)‡ | 1.06 (0.45, 2.51) | 1.92 (0.81, 4.58) | 1.71 (0.18, 16.53) | 1.17 (0.48, 2.86) | 1.78 (0.79, 4.02) | 2.31 (0.65, 8.12) | |
Spontaneous vaginal delivery | OR (95% CI) | 1.32 (0.71, 2.48) | 0.55 (0.30, 0.99)* | 0.40 (0.07, 2.25) | 1.33 (0.70, 2.53) | 0.77 (0.45, 1.33) | 0.53 (0.22, 1.27) |
aOR (95% CI)‡ | 1.55 (0.81, 2.99) | 0.53 (0.28, 1.02) | 0.51 (0.09, 3.00) | 1.51 (0.78, 2.95) | 0.63 (0.35, 1.14) | 0.64 (0.24, 1.68) | |
Caesarean section | OR (95% CI) | 0.76 (0.38, 1.52) | 1.70 (0.89, 3.23) | 3.28 (0.58, 18.39) | 0.79 (0.39, 1.60) | 1.32 (0.72, 2.40) | 2.58 (1.07, 6.26)* |
aOR (95% CI)‡ | 0.68 (0.33, 1.41) | 1.55 (0.77, 3.11) | 2.61 (0.43, 15.98) | 0.72 (0.34, 1.50) | 1.43 (0.75, 2.72) | 2.05 (0.77, 5.51) | |
LBW <2.5 kg | OR (95% CI) | 1.89 (0.54, 6.57) | 2.86 (0.81, 10.03) | – | 1.52 (0.44, 5.30) | 1.04 (0.26, 4.09) | 1.45 (0.17, 12.23) |
aOR (95% CI)‡ | 1.77 (0.98, 6.27) | 3.14 (0.84, 11.65) | – | 1.47 (0.42, 5.21) | 1.19 (0.29, 4.89) | 1.29 (0.14, 11.89) | |
Macrosomia >4.0 kg | OR (95% CI) | 0.65 (0.08, 5.58) | 1.95 (0.37, 10.28) | 34.20 (5.05, 231.71)*** | 0.87 (0.09, 8.50) | 2.46 (0.49, 12.37) | 11.12 (2.13, 58.01)** |
aOR (95% CI)‡ | 0.66 (0.07, 5.80) | 1.67 (0.30, 9.11) | 104.84 (6.15, 1788.21)** | 0.91 (0.09, 8.91) | 2.54 (0.48, 13.47) | 13.46 (2.32, 77.99)** | |
SGA | OR (95% CI) | 0.88 (0.30, 2.60) | 0.75 (0.20, 2.80) | – | 0.76 (0.26, 2.24) | 0.18 (0.02, 1.43) | 0.93 (0.19, 4.60) |
aOR (95% CI)‡ | 0.68 (0.21, 2.18) | 0.62 (0.14, 2.69) | – | 0.62 (0.20, 2.00) | 0.23 (0.03, 1.87) | 0.60 (0.09, 3.88) | |
LGA | OR (95% CI) | 0.89 (0.09, 8.84) | 5.87 (1.23, 27.88)* | – | 1.18 (0.10, 13.41) | 5.02 (0.80, 31.49) | 8.08 (1.04, 62.77)* |
aOR (95% CI)‡ | 1.56 (0.13, 18.48) | 5.50 (0.96, 31.50) | – | 2.07 (0.15, 27.89) | 4.81 (0.72, 32.07) | 7.10 (0.65, 77.93) | |
Born <37 + 0 weeks | OR (95% CI) | 0.69 (0.27, 1.73) | 0.26 (0.06, 1.18) | – | 0.68 (0.27, 1.72) | 0.48 (0.15, 1.51) | 0.27 (0.03, 2.16) |
aOR (95% CI)‡ | 0.73 (0.28, 1.89) | 0.22 (0.05, 1.01) | – | 0.72 (0.28, 1.90) | 0.44 (0.14, 1.40) | 0.23 (0.03, 2.01) | |
Born >41 + 6 weeks | OR (95% CI) | 0.65 (0.21, 2.08) | 0.74 (0.20, 2.72) | – | 0.60 (0.19, 1.93) | 0.59 (0.16, 2.17) | 0.45 (0.06, 3.71) |
aOR (95% CI)‡ | 0.59 (0.18, 1.96) | 0.80 (0.21, 3.14) | – | 0.56 (0.17, 1.85) | 0.60 (0.16, 2.29) | 0.51 (0.06, 4.56) | |
Postpartum haemorrhage | OR (95% CI) | 0.86 (0.32, 2.36) | 1.73 (0.70, 4.28) | 3.07 (0.34, 27.55) | 1.00 (0.35, 2.84) | 2.11 (0.94, 4.71) | 1.42 (0.31, 6.60) |
aOR (95% CI)‡ | 0.87 (0.31, 2.42) | 1.89 (0.74, 4.85) | 3.35 (0.36, 31.61) | 0.97 (0.34, 2.80) | 1.93 (0.84, 4.47) | 1.81 (0.37, 8.92) | |
Perineal sutures | OR (95% CI) | 1.47 (0.92, 2.37) | 0.79 (0.45, 1.41) | 3.17 (0.33, 30.81) | 1.27 (0.78, 2.07) | 0.57 (0.35, 0.93)* | 0.66 (0.26, 1.71) |
aOR (95% CI)‡ | 1.11 (0.66, 1.89) | 1.13 (0.59, 2.19) | 1.88 (0.19, 18.87) | 1.07 (0.62, 1.83) | 0.95 (0.55, 1.65) | 0.91 (0.30, 2.74) | |
Initial feed at breast | OR (95% CI) | 1.31 (0.43, 3.98) | 0.22 (0.10, 0.46)*** | 0.08(0.01, 0.49)** | 1.24 (0.39, 3.88) | 0.33 (0.15, 0.72)** | 0.22 (0.07, 0.68)** |
aOR (95% CI)‡ | 1.34 (0.43, 4.15) | 0.25 (0.12, 0.56)** | 0.15 (0.02, 1.00) | 1.26 (0.40, 4.04) | 0.31 (0.14, 0.70)** | 0.33 (0.10, 1.08) | |
Breastfeeding at discharge | OR (95% CI) | 1.07 (0.61, 1.89) | 0.49 (0.28, 0.85)* | 0.37 (0.06, 2.27) | 1.06 (0.59, 1.89) | 0.66 (0.40, 1.10) | 0.52 (0.22, 1.20) |
aOR (95% CI)‡ | 1.04 (0.59, 1.85) | 0.52 (0.29, 0.92)* | 0.47 (0.08, 2.95) | 1.03 (0.57, 1.85) | 0.67 (0.39, 1.13) | 0.58 (0.24, 1.39) | |
Back pain | OR (95% CI) | 1.15 (0.36, 3.65) | 1.24 (0.34, 4.51) | – | 1.11 (0.34, 3.62) | 1.20 (0.40, 3.60) | – |
aOR (95% CI)‡ | 1.21 (0.36, 4.07) | 1.06 (0.28, 4.07) | – | 1.16 (0.34, 3.97) | 1.02 (0.31, 3.34) | – | |
Neonatal intensive care admission | OR (95% CI) | – | 2.55 (0.46, 14.22) | 19.75 (1.79, 218.36)* | – | 0.59 (0.07, 5.30) | 6.02 (1.04, 34.83)* |
aOR (95% CI)‡ | – | 1.89 (0.31, 11.74) | 12.90 (1.01, 164.98)* | – | 0.53 (0.06, 5.21) | 3.93 (0.53, 29.19) |
Gestational weight gain based on IOM recommendations and its relationship with pregnancy and birth outcomes
IOM weight gain recommendations applied to international BMI classification | IOM weight gain recommendations applied to Asian BMI classification | ||||
---|---|---|---|---|---|
Inadequate | Excessive | Inadequate | Excessive | ||
Number in each category (%) | 297 (56.1%) | 62 (11.7%) | 268 (50.7%) | 80 (15.1%) | |
Mean birthweight (g) | MD (95% CI) | −98 (−173, −22)* | 131 (14, 248)* | −139 (−215, −64)*** | 83 (−23, 188) |
aMD (95% CI)‡ | −104 (−180, −29)** | 128 (12, 245)* | −139 (−215, −64)*** | 63 (−43, 169) | |
Number of antenatal visits | MD (95% CI) | −0.27 (−0.97, 0.44) | 0.62 (−0.46, 1.71) | −0.48 (−1.18, 0.23) | 0.62 (−0.37, 1.60) |
aMD (95% CI)‡ | −0.20 (−0.89, 0.50) | 0.45 (−0.63, 1.52) | −0.43 (−1.13, 0.27) | 0.43 (−0.64, 1.41) | |
Gestation at delivery | MD (95% CI) | −1.22 (−2.03, −0.42)** | −0.45 (−1.77, 0.88) | −1.13 (−1.95, −0.31)** | −0.38 (−1.56, 0.80) |
aMD (95% CI)‡ | −1.28 (−2.10, −0.45)** | −0.42 (−1.78, 0.94) | −1.18 (−2.02, −0.35)** | −0.37 (−1.63, 0.89) | |
Haemoglobin <11.0 g/dl in trimester 2 | OR (95% CI) | 1.26 (0.82, 1.94) | 1.09 (0.56, 2.10) | 1.23 (0.80, 1.90) | 0.98 (0.54, 1.80) |
aOR (95% CI) ‡ | 1.28 (0.81, 2.01) | 1.39 (0.69, 2.79) | 1.22 (0.77, 1.93) | 1.23 (0.65, 2.35) | |
Haemoglobin <11.0 g/dl in trimester 3 | OR (95% CI) | 1.42 (0.90, 2.25) | 1.19 (0.59, 2.42) | 1.46 (0.92, 2.32) | 1.17 (0.61, 2.23) |
aOR (95% CI) ‡ | 1.41 (0.88, 2.26) | 1.32 (0.64, 2.74) | 1.45 (0.91, 2.32) | 1.31 (0.67, 2.56) | |
Induction | OR (95% CI) | 0.69 (0.35, 1.40) | 1.34 (0.52, 3.48) | 0.81 (0.39, 1.66) | 1.75 (0.74, 4.12) |
aOR (95% CI) ‡ | 0.73 (0.35, 1.50) | 1.13 (0.42, 3.06) | 0.85 (0.40, 1.79) | 1.60 (0.65,3.92) | |
Spontaneous vaginal delivery | OR (95% CI) | 1.20 (0.73, 1.97) | 0.98 (0.47, 2.04) | 1.23 (0.74, 2.02) | 0.92 (0.47, 1.78) |
aOR (95% CI)‡ | 1.13 (0.67, 1.91) | 1.15 (0.52, 2.51) | 1.10 (0.65, 1.85) | 1.06 (0.52, 2.17) | |
Caesarean section | OR (95% CI) | 0.67 (0.39, 1.13) | 0.72 (0.31, 1.67) | 0.66 (0.38, 1.14) | 0.90 (0.44, 1.87) |
aOR (95% CI)‡ | 0.69 (0.39, 1.20) | 0.59 (0.24, 1.43) | 0.72 (0.41, 1.27) | 0.75 (0.34, 1.67) | |
LBW <2.5 kg | OR (95% CI) | 0.89 (0.31, 2.53) | – | 1.24 (0.41, 3.76) | 0.45 (0.05, 3.89) |
aOR (95% CI)‡ | 0.87 (0.30, 2.51) | – | 1.25 (0.41, 3.86) | 0.47 (0.05, 4.21) | |
Macrosomia >4.0 kg | OR (95% CI) | 0.19 (0.04, 0.96)* | 0.94 (0.18, 4.77) | 0.11 (0.01, 0.93)* | 1.14 (0.28, 4.68) |
aOR (95% CI)‡ | 0.19 (0.04, 1.02) | 1.04 (0.18, 5.95) | 0.10 (0.01, 0.87)* | 0.85 (0.19, 3.86) | |
SGA | OR (95% CI) | 2.79 (0.89, 8.69) | 0.77 (0.08, 7.32) | 3.87 (1.09, 13.82)* | 1.48 (0.23, 9.46) |
aOR (95% CI)‡ | 4.52 (1.26, 16.24)* | 0.72 (0.07, 7.78) | 5.44 (1.36, 21.77)* | 1.22 (0.14, 10.31) | |
LGA | OR (95% CI) | 0.35 (0.06, 2.18) | 2.21 (0.34, 14.39) | 1.12 (0.10, 12.60) | 10.10 (1.07, 95.70)* |
aOR (95% CI)‡ | 0.29 (0.04, 2.27) | 2.25 (0.29, 17.50) | 0.68 (0.05, 8.97) | 5.66 (0.48, 66.64) | |
Born <37 weeks | OR (95% CI) | 3.17 (1.14, 8.80)* | 2.03 (0.44, 9.41) | 3.18 (1.14, 8.88)* | 1.94 (0.48, 7.95) |
aOR (95% CI)‡ | 3.38 (1.17, 9.73)* | 2.76 (0.55, 13.69) | 3.55 (1.23, 10.21)* | 3.14 (0.70, 14.19) | |
Born ≥42 weeks | OR (95% CI) | 0.30 (0.12, 0.79)* | 0.47 (0.09, 2.33) | 0.35 (0.13, 0.94)* | 0.56 (0.14, 2.21) |
aOR (95% CI)‡ | 0.27 (0.10, 0.73)* | 0.58 (0.11, 3.02) | 0.34 (0.13, 0.93)* | 0.82 (0.19, 3.55) | |
Postpartum Haemorrhage | OR (95% CI) | 1.00 (0.43, 2.33) | 2.26 (0.80, 6.37) | 1.03 (0.43, 2.47) | 2.45 (0.93, 6.44) |
aOR (95% CI)‡ | 0.98 (0.41, 2.34) | 2.11 (0.72, 6.17) | 1.13 (0.47, 2.77) | 2.40 (0.88, 6.51) | |
Perineal sutures | OR (95% CI) | 0.60 (0.39, 0.91)* | 0.85 (0.44, 1.64) | 0.60 (0.39, 0.91)* | 0.63 (0.34, 1.14) |
aOR (95% CI)‡ | 0.56 (0.34, 0.91)* | 0.72 (0.34, 1.50) | 0.51 (0.31, 0.83)** | 0.57 (0.29, 1.14) | |
Initial feed at breast | OR (95% CI) | 1.89 (0.91, 3.93) | 0.97 (0.36, 2.59) | 1.59 (0.75, 3.38) | 0.82 (0.33, 2.01) |
aOR (95% CI)‡ | 1.68 (0.78, 3.62) | 1.16 (0.41, 3.32) | 1.33 (0.61, 2.92) | 1.05 (0.40, 2.78) | |
Breastfeeding at discharge | OR (95% CI) | 0.86 (0.54, 1.38) | 0.95 (0.46,1.94) | 0.83 (0.52, 1.32) | 1.02 (0.53, 1.96) |
aOR (95% CI)‡ | 0.86 (0.54, 1.39) | 1.02 (0.49, 2.13) | 0.83 (0.51, 1.33) | 1.20 (0.61, 2.36) | |
Back pain | OR (95% CI) | 0.05 (0.01, 0.37)** | 1.43 (0.51, 4.01) | 0.07 (0.01, 0.54)* | 1.96 (0.74, 5.16) |
aOR (95% CI)‡ | 0.06 (0.01, 0.43)** | 1.29 (0.42, 3.96) | 0.07 (0.10, 0.60)* | 2.10 (0.70, 6.25) | |
Neonatal intensive care admission | OR (95% CI) | 0.41 (0.07, 2.49) | 1.94 (0.32, 11.91) | 0.74 (0.10, 5.28) | 3.64 (0.60, 22.27) |
aOR (95% CI)‡ | 0.50 (0.08, 3.19) | 1.44 (0.22, 9.65) | 0.89 (0.12, 6.68) | 2.40 (0.35, 16.33) |