Gestational weight gain (GWG) may interfere in perinatal outcomes and also cause future problems throughout woman’s life. The aim of this population-based study is to evaluate the GWG in Campinas city, southeast of Brazil. A total of 1052 women, who delivered in the three major maternity hospitals in Campinas, were interviewed during postpartum period. The general average of GWG was
Obesity is considered as one of the major public health problems in the world and is considered as an epidemic in developed countries and low income countries. Every year at least 2.6 million of deaths by obesity and overweight occur. It is known that a person with obesity or overweight has higher risk of dyslipidemia, diabetes mellitus (DM), and hypertension [
During gestational period some women can exceed the weight gain recommended for pregnancy. It is estimated that 50% of women in infertility age are overweight or obese and 18% of women get pregnant with high body mass index (BMI), overweight, or obese [
Several maternal complications occur due to overweight and obesity, including gestational diabetes, pregnancy induced hypertension and preeclampsia, and high rates of c-section, all of them associated with longer hospitalization [
Pregnancy is a period in which women need a special care. Clinical trials have suggested a lifestyle change such as nutritional adequacy and physical activities programs to be adequate with the weight gain during pregnancy, prevention of excess weight gain, and weight retention in postpartum period [
The aim of this study was to evaluate the gestational weight gain and this association with perinatal outcomes in one of the biggest cities in southeast of Brazil (Campinas city, São Paulo state).
A population-based study was approved by University of Campinas (UNICAMP) ethical committee (by the number 991/2011). Women were interviewed in immediate postpartum period in three major maternity hospitals in Campinas city, São Paulo, Brazil. According to health insurance each maternity hospital was as follows: public health service (Maternity A), private health service (Maternity B), and public and private health service (Maternity C). The data was assessed on immediate postpartum period, so every woman was at least primiparous.
The sample size was calculated in order to obtain a representative population of pregnant women in Campinas city, SP, Brazil. According to DATASUS/SISPRENATAL (
The data collection was from November, 2011, to August, 2013. The inclusion criteria were as follows: women in immediate postpartum with live newborn and habitant in Campinas city. Women with multiple pregnancies, reading and communication difficulties, and any other condition that could interfere in the interview were excluded. Every woman included in this study signed a consent form. For data collection it was used a checklist to verify the inclusion criteria. The women included answered a questionnaire with socio-demographics and biometric characteristics.
The analysis of pregnancy weight gain was based on Institute of Medicine (IOM) recommendations, according to their previous BMI before pregnancy (women with low weight should gain between 12.2 and 18 kg during pregnancy, women with previous adequate weight should gain between 11 and 16 kg, overweight women should gain between 7 and 11.5 kg, and obesity women should gain between 5 and 9 kg [
The adequacy of newborn weight to gestational age was evaluated according to Alexander scale and classified as adequate for gestational age (AGA), small for gestational age (SGA), and large for gestational age (LGA). Prematurity rate was defined based on gestational age and a newborn classified as <37 weeks was considered as preterm [
The variables related to population characteristics, gestational weight gain, and adequacy of gestational weight gain according to BMI were described in absolute and relative frequency. Odds ratio (OR) was used with a confidence interval (CI) of 95% to evaluate the excessive weight gain in accordance with their BMI. The significance level assumed was 5% and the statistical analysis was performed by program Epi-info version 5.1.
A total of 1052 women were included: 238 (22.60%) were from Maternity A, 217 (20.70%) from Maternity B, and 597 (56.69%) from Maternity C. The different percentages for the three hospitals included in the study were in accordance with the proportion of births by maternity in Campinas city in 2010.
Table
Demographic characteristics and prepregnancy weight and BMI data of women in southeast of Brazil.
Variables |
|
---|---|
Age (years)—mean |
|
<19— |
122 (11.6) |
20–34— |
771 (73.4) |
>35— |
158 (15) |
Race— |
|
Caucasian | 519 (49.5) |
Black/brown | 518 (49.4) |
Others | 12 (1.1) |
Educational attainment— |
|
Up to grade school | 225 (21.5) |
Up to high school | 615 (58.8) |
College university or advanced degree | 206 (19.9) |
Married or common law— |
989 (94.0) |
Planned pregnancy— |
524 (49.8) |
Parity— |
|
1 | 498 (47.4) |
|
553 (52.6) |
Gestational age at first prenatal visits—mean |
|
Number of prenatal visits—mean |
|
Prenatal at public health system— |
676 (64.6) |
Smoking during pregnancy— |
85 (8.1) |
Diabetes mellitus— |
62 (5.9) |
Hypertension— |
92 (8.8) |
Prepregnancy weight—mean |
|
Prepregnancy BMI**—mean |
|
BMI < 18.5— |
63 (6.16) |
BMI ≥ 18.5 < 25— |
568 (55.58) |
BMI ≥ 25 < 30— |
252 (24.66) |
BMI ≥ 30— |
139 (13.6) |
BMI: body mass index; SD: standard deviation; *5 missing data, **29 missing data.
The average weight gain was
Adequacy ranges of weight gain by BMI category according to the recommendations of the Institute of Medicine, 2009, of women in southeast of Brazil.
The overweight and obese pregnant women showed higher risk to weight gain during pregnancy; otherwise women that started the prenatal care with lower weight had lower risk to an excessive weight gain (Table
Weight gain and risk of excessive weight gain according to BMI category (IOM, 2009) of women in southeast of Brazil.
BMI | Mean WG |
|
WG excessive (%) | OR | CI 95% |
|
---|---|---|---|---|---|---|
Total sample |
|
|||||
BMI < 18.5 |
|
<0.0001 | 14.5 | 0.37 | 0.17–0.80 | 0.009 |
BMI ≥ 18.5 < 25 |
|
30.5 | Reference | — | — | |
BMI ≥ 25 < 30 |
|
55.9 | 2.7 | 1.05–4.01 | <0.0001 | |
BMI ≥ 30 |
|
53.7 | 2.62 | 1.67–4.12 | <0.0001 |
The rate of prematurity was higher in obese pregnant women as well as in the underweight pregnant women. However, the newborn weight was correlated to prepregnancy maternal BMI and the newborn weight increases according to maternal weight. Overweight and obese women showed newborns with higher weight at birth (4.5% and 6.9%); on the other hand underweight women showed newborns with <2500 g. The rate of c-section in this population was 58.9% and increases according to GWG (Table
Pregnancy outcomes according to BMI category of women in southeast of Brazil.
Gestational outcomes | Total sample | BMI < 18.5 | BMI ≥ 18.5 < 25 | BMI ≥ 25 < 30 | BMI ≥ 30 |
|
---|---|---|---|---|---|---|
Final weight (kg)—mean |
|
|
|
|
|
<0.0001** |
C-section rate— |
619 (58.9) | 31 (49.21) | 318 (55.99) | 159 (63.35) | 101 (72.66) | <0.0001* |
Gestational age at birth—weeks—mean |
|
|
|
|
|
0.1183** |
Prematurity rate <37 weeks— |
58 (5.9) | 4 (6.67) | 30 (5.55) | 9 (3.70) | 10 (8.20) | 0.0498* |
Newborn weight (g)—mean |
|
|
|
|
|
0.0003** |
Newborn weight (g)— |
||||||
<2500 | 59 (5.8) | 6 (9.68) | 34 (6.10) | 9 (3.70) | 9 (6.98) | <0.0001* |
2500–3999 | 923 (90.7) | 56 (90.32) | 507 (91.02) | 223 (91.77) | 111 (86.05) | |
≥4000 | 36 (3.5) | — | 16 (2.87) | 11 (4.53) | 9 (6.98) |
According to their prepregnancy BMI, women with excessive weight gain and obese women had higher chance to have LGA newborn (Table
Association between excessive weight gain and LGA and between prepregnancy BMI and LGA of women in southeast of Brazil.
LGA— |
OR (CI 95%) | |
---|---|---|
Adequacy of weight gain | ||
Excessive weight gain | 21 (5.7%) | 2.83 (1.19–6.76) |
Insufficient weight gain | 4 (1.6%) | 0.75 (0.22–2.58) |
Adequate weight gain | 7 (2.1%) | Reference |
Prepregnancy BMI | ||
BMI < 18.5 | 0 (0%) | — |
BMI ≥ 18.5 < 25 | 15 (2.7%) | Reference |
BMI ≥ 25 < 30 | 10 (4.3%) | 1.58 (0.70–3.56) |
BMI ≥ 30 | 9 (7.2%) | 2.75 (1.18–6.44) |
This study has shown that, in Campinas, Brazil, the excessive gestational weight gain rate was higher among those women who were overweight (55.9%) and obese (53.7%).
In the USA, more than a quarter of women are overweight and one-third are obese [
The high inadequate weight gain percentage during gestational period (35.5% of low weight had insufficient gain and 55.9% and 53.7% among women with overweight and obesity, resp., put on weight excessively) was pretty much similar to those found in study done with 204 pregnant women where 45.5% of those exceeded the gain [
The level of education is a factor that may be associated with gestational weight gain, reflecting the socioeconomic status of women, because women with lower purchasing power consume more high-calorie food because of its low cost, leading to excess weight gain in pregnancy. In Brazil two studies conducted in southeast and in northeast showed that 46% and 51.8% of women, respectively, had completed more than eight years studied, corresponding to more than grade school [
Among those women interviewed in this study 56.2% worked during pregnancy, and according to another study conducted in Brazil, 45% of women had job/occupation outside their home [
The relation between multiparity and excessive weight gain in pregnancy is discussed in which 47.4% of women were primiparous. In a study conducted in São Paulo, the authors observed similar data, where 46.2% of women in the sample were primigravidae [
Adequate prenatal care should rely on monitoring all stages of pregnancy, such as interventions and counseling about the various phases and complications that pregnancy can cause. However, the quality of prenatal is difficult to measure and evaluate, especially when it is not the central purpose of the study. In this population the average gestational age at initiation of prenatal care was
These data are suitable for those recommended by WHO, which suggests that the first visits should be held between eight and 12 weeks of gestation and the minimum number of visits is at least four times, and in this study the average number of visits was
In a study conducted in four basic healthcare facilities in the state of Rio de Janeiro, Brazil, it was found that despite the fact that 98.8% of pregnant women received prenatal care, they had high rates of excessive gestational weight gain during pregnancy (39.5) [
c-section prevalence was 58.9% in the study population, far from the ideal rate which is 15% recommended by the World Health Organization (WHO). In a survey conducted by WHO in 2009, with the countries of Latin America, Brazil took the last position in the practice of c-section, where the country that had the highest rate was Paraguay [
A meta-analysis of 33 studies found that the risk of c-section increases proportionally with the increase of BMI (overweight and obesity) [
This study aimed to describe the gestational weight gain and the characteristics of pregnant women who went to the major maternity hospitals in southeast of Brazil and identify risks associated with prenatal. The main finding of this study was the high rate of overweight and obese BMI pregnancy and exceed GWG in these groups. Both overweight and obesity are considered problems not only in the Brazilian population but also in different regions of the world; it represented a worldwide problem in the obstetric population. Lack of knowledge about the limits of weight gain during pregnancy is limiting factor for women to achieve appropriate weight gain during this phase [
Pregnancy is a phase of women’s life where they need special health care and so studies show that strategies to promote public health are important to provide changes in lifestyle, mothers diet adjustment, and physical exercises during the prenatal, in an attempt to adjust the weight gain during pregnancy and prevent obstetric risks and retention of postpartum weight, thus improving women’s health in the long term [
The authors declare that there is no conflict of interests regarding the publication of this paper.