Open Access
Open Peer Review

This article has Open Peer Review reports available.

How does Open Peer Review work?

Gestational weight gain and its associated factors in Harari Regional State: Institution based cross-sectional study, Eastern Ethiopia

Reproductive Health201613:101

https://doi.org/10.1186/s12978-016-0225-x

Received: 30 May 2016

Accepted: 23 August 2016

Published: 30 August 2016

Abstract

Background

Gestational weight gain is an important factor that supports optimal outcome for mothers and their infant. Whereas women who do not gain enough weight during pregnancy have a risk of bearing a baby with low birth weight, those who gain excessive weight are at increased risk of preeclampsia and gestational diabetes. Nonetheless, data on gestational weight gain and its determinants are scarce in developing countries, as it is difficult to collect the information throughout the pregnancy period. Therefore, the aim of the study was to assess weight gain during pregnancy and its associated factors.

Methods

The study employed a health facility based quantitative cross-sectional study design in Harari Regional State. The study included 411 women who had given birth at health institutions from January to July of 2014. The researchers collected both primary and secondary data by using a structured questionnaire and a checklist. Using logistic regression, the factors associated with gestational weight gain were assessed and, based on the United States Institute of Medicine criteria, gestational weight gains were categorized as inadequate, adequate and excessive.

Results

The study revealed that 69.3 %, 28 %, and 2.7 % of the women gained inadequate, adequate and excess gestational weight, respectively. The mean gestational weight gain was 8.96 (SD ±3.27) kg. The factors associated with adequate gestational weight gain were body mass index ≥ 25Kg/m2 at early pregnancy (AOR = 3.2, 95 % CI 1.6, 6.3); engaging in regular physical exercise (AOR = 2.1, 95 % CI 1.2, 3.6); Antenatal care visit of ≥4 times (AOR = 2.9, 95 % CI 1.7, 5.2); consuming fruit and vegetable (AOR = 2.7, 95 % CI 1.2, 6.6), and meat (AOR = 2.7, 95 % CI 1.1, 97.2).

Conclusions

Generally, a small proportion of the women gained adequate gestational weight. The women who were with higher body mass index at early pregnancy, who frequently visited Antenatal care visit, and who consumed diverse food items were more likely to measure adequate gestational weight.

Keywords

Gestational weight gain Early pregnancy BMI Recommended GWG

Plain english summary

Gestational weight gain is an important factor that is  required to support increased metabolic demands, and to enhance positive pregnancy outcomes. A desirable gestational weight gain is essential for a balanced optimal outcome for both the mother and her infant. In contrast, inadequate or excessive weight gain may pose health risks on the mother and/or the fetus.

The study included 411 women who had given birth at health institutions from January to July of 2014. The researchers collected both primary and secondary data by using a structured questionnaire and a checklist. Based on the United States Institute of Medicine criteria, gestational weight gains were categorized as inadequate, adequate and excessive.

The study revealed that 69.3 %, 28 %, and 2.7 % of the women gained inadequate, adequate and excess gestational weight, respectively. The average gestational weight gain was 8.96 kg. The factors associated with adequate gestational weight gain were high body mass index at early pregnancy; engaging in regular physical activity; Antenatal care visit of ≥4 times; consuming fruit and vegetable, and meat.

Generally, a small proportion of the women gained adequate gestational weight. The women who were with higher body mass index at early pregnancy, who frequently visited Antenatal care visit, and who consumed diverse food items were more likely to measure adequate gestational weight.

Background

Gestational weight gain (GWG) is an important factor that is required to support increased metabolic demands, and to enhance positive pregnancy outcomes [1]. A desirable GWG is essential for a balanced optimal outcome for both the mother and her infant [2]. It supports the growth and development of the fetus [3], and reduces the likelihood of morbidity and mortality [2, 4]. In contrast, inadequate or excessive weight gain may pose health risks on the mother and/or the fetus [5].

GWG is highly influenced by a range of biological, metabolic, and social factors, which include maternal pre-pregnancy body mass index (BMI) [6], multi-parity [6, 7], maternal age, smoking, educational status [3], healthy eating, physical activity [2], and adequate counseling of mothers on weight gain during pregnancy [8]. However, in developing countries, there is very little information about GWG and its determinants. This is most likely due to the difficulties associated with collecting the data throughout the pregnancy period in these settings [9], and as such GWG remains a neglected public health issue in the developing world. Therefore, the aim of this study was to assess GWG and its associated factors in the health care facilities in Harari Regional State, Eastern Ethiopia.

Methods

Study setting

The study was conducted in Harari Regional State, whose capital, Harar, lies 526 km to the East of Addis Ababa. According to 2015 Ethiopian Central Statistical Agency population projection, the region has a population of 232,000, of whom 127,600 (55 %) are urban dwellers. According to the Regional Health Bureau, the health service coverage of the region is 100 %. There are two public hospitals, one Federal Police Hospital, one Federal Defense Hospital, two private General hospitals, one Fistula Hospital, eight government health centers, 16 health posts, and one nongovernmental organization clinic. The health worker per 1,000-population ratio is 2.8.

Subjects

We employed a health facility based quantitative cross-sectional study from January to July of 2014. The study included Hiwot Fana Hospital, Jugal Hospital, Harar Federal Police Hospital, Family Guidance Association Harar Model Clinic, and Arategna Health Centre. The pregnant women who attended antenatal care (ANC) clinic during first trimester (started their ANC visit at ≤16 weeks of gestation) and who gave live birth in the health care facilities were included in the study. Women with twin pregnancy were excluded. The target sample size was determined by Open Epi Version 2.3, by taking the proportion of the women who gained adequate gestational weight (p = 0.55) [10], 5 % margin of error, 95 % confidence level, and 10 % non-response rate. The final sample size was 418. All the women who gave birth and fulfilled the inclusion criteria were included in the study until the required sample size was achieved.

Measurements

We collected both the primary and the secondary data through interview and checklists. Secondary data like initial maternal weight, gestational age, number of ANC visit, and parity were extracted from antenatal follow up registration card. The last maternal weight (just before delivery) was measured by digital weight scale with minimum clothing. A participants’ first measured weight (before or at 16 weeks’ gestation) was used as the proxy for her weight at conception. GWG is the difference between the last and the first measured maternal weight. The United States Institute of Medicine (IOM) classifies a healthy GWG of 12.5–18 kg, 11.5–16 kg, 7–11 kg and 5–9 kg for underweight, normal, overweight and obese women respectively. Accordingly, weight gains below and above these recommendations are considered inadequate and excessive [3]. Variables, which collected through interviewing, were socio-demographic and economic characteristics, dietary pattern/dietary habit and physical exercise. Women were asked for their average dietary habit and physical activity throughout pregnancy.

Data quality control

The questionnaire was pre-tested on 20 women in Dilchora Hospital at Dire Dawa (outside of the study area) and feedback was used to guide the modifications necessary to optimise the questionnaire. The data collectors (midwives) and the supervisors (health officers) were selected from the health facilities based on their qualifications and field data collection experience. They were given training on the objectives of the study, data collection methods, and field supervision. The supervisors and principal investigator checked data for completeness on daily basis.

Data processing and analyses

Data were entered into Epi-data Version 3.0 and analysed using SPSS 20 statistical packages. Frequencies, proportions, measures of central tendency, and dispersions were estimated to describe the variables. Crude odds ratios (COR) and adjusted odds ratios (AOR) were calculated to determine the association between the explanatory variables and GWG. The variables associated with the dependent variable in the bivariate analyses at p ≤0.2 were entered into multivariable logistic regression model. The total GWG was taken as the difference between the last measured weight (recorded just before delivery) and the first measured weight at early pregnancy (before or at first trimester). Based on the IOM criteria, GWG was categorised as inadequate, adequate and excessive. Eleven (2.7 %) respondents who gained excessive weight were excluded from the logistic regression analyses.

Results

Socio-demographic characteristics

Out of the 418 participants identified for the study, 411 were included in the study, which gives a response rate of 98.3 %. Their mean age was 25.2 (SD ±5.01) years, and 65.2 % of them were between 20 and 29 years of age. Most of the respondents (94.6 %) were married, 25.8 % were illiterate, 16.5 % attended tertiary education, 44 % were Oromo in ethnic, 55.2 % were Muslim, 81 % were urban residents, and 52.6 % were homemakers. Eighty four percent of the respondents started ANC follow up between 8 and 12 weeks of gestational age (Table 1).
Table 1

Socio-demographic characteristics of the respondents in Harari Regional state, 2014 (n = 411)

Variable

Frequency

percent

Age group (year)

 less than 20

49

11.9

 20–29

268

65.2

  > 29

94

22.9

Marital status

 Single

18

4.4

 Married

389

94.6

 Divorced

2

0.5

 Widowed

2

0.5

Educational status

 No formal education

106

25.8

 Primary and secondary

237

57.7

 Tertiary education

68

16.5

Ethnicity

 Amhara

128

31.1

 Oromo

181

44

 Gurage

42

10.2

 Harari

35

8.5

 Tigrai

15

3.6

 Others a

10

2.4

Religion

 Muslim

227

55.2

 Christian

181

44

 Others

3

0.7

Residence

 Rural

78

19

 Urban

333

81

Occupational status

 Homemaker

216

52.6

 Government employee

80

19.5

 Merchant

49

11.9

 Private employee

28

6.8

 Farmer

23

5.6

 Student

7

1.7

 Daily laborer

8

1.9

Estimated income (USD)

 Less than $50

88

21.5

 $50–$100

157

38.2

  > $100

166

40.3

Gestation age at ANC initiation

 Less than 8 weeks

39

9.5

 8–12 weeks

345

83.9

 13–16 weeks

27

6.6

a Others - Somali, Walayita, Argoba

Eating habit and physical exercise of the respondents

Only 16.5 % of the women ate food at least three times a day during their current pregnancy, and 81.5 %, 79.1 %, and 91.7 % of them consumed fruits and vegetables, meat, and egg at least once a week, respectively. During their current pregnancy, 65.2 % were not engaged in any physical activities (Table 2).
Table 2

Eating habit and physical exercise  of the respondents during their current pregnancy in Harari Regional State, 2014 (n = 411)

Variable

Frequency

Percept

Frequency of eating per day

  < 3 times

343

83.5

  ≥ 3 times

68

16.5

Frequency of eating vegetables and fruit at least once per week

 Yes

335

81.5

 No

76

18.5

Frequency of eating meat at least once per week

 Yes

325

79.1

 No

86

20.9

Frequency of eating egg at least once per week

 Yes

377

91.7

 No

34

8.3

Physical exercise at least once per week

 Yes

143

34.8

 No

268

65.2

Early pregnancy BMI and GWG of the study participants

The mean BMI of the respondents at early pregnancy was 22.39 (SD ± 3.84 kg/m2), and 72 % of them had a normal body weight (BMI 18–24.9 kg/m2), whereas 14.6 % were overweight (BMI 25–29.9 kg/m2). The mean weight gain during their pregnancy was 8.96 (SD ±3.27 kg) kg. Underweight and obese women gained 9.14 (SD ±3.46 kg) and 6.44 (SD ±3.46 kg), respectively (Table 3). Many of the women (69.3 %) gained inadequate gestational weight, but only 11 (2.7 %) respondents gained excessive gestational weight. Based on early pregnancy BMI, only 7.7 % of the underweight women, 24 % of the women with normal BMI, 51.7 % of the overweight women, and 62.5 % of the obese women gained adequate gestational weight (Table 4).
Table 3

BMI at early pregnancy and mean gestational weight gain in Harari Regional state, 2014 (n = 411)

Early pregnancy BMI

Frequency (%)

Mean GWG

SD

<18.5 kg/m2

39 (9.5)

9.14 kg

±3.46 kg

18.5–24.9 kg/m2

296 (72)

9.26 kg

±3.14 kg

25–29.9 kg/m2

60 (14.6)

8.03 kg

±3. 64 kg

≥30/m2

16 (3.9)

6.44 kg

±3.46 kg

Total

411 (100)

8.96 kg

±3.27 kg

Table 4

Proportion of gestational weight gain of the women based on early pregnancy BMI in Harari Regional state, 2014 (n = 411)

Early Pregnancy BMI

Inadequate GWG

Adequate GWG

Excess GWG

N (%)

N (%)

N (%)

Under weight

35 (89.7)

3 (7.7)

1 (2.6)

Normal

222 (75)

71 (24)

3 (1)

Overweight

23 (38.3)

31 (51.7)

6 (10)

Obese

5 (3.25)

10 (62.5)

1 (6.25)

Total

285 (69.3)

115 (28)

11 (2.7)

Factors associated with weight gain during pregnancy

In a logistic regression model, the women who had higher early pregnancy BMI (overweight and obese) were more likely to gain adequate gestational weight as compared to the underweight mothers (AOR = 3.2,95 % CI 1.6,6.3). The women who fed on fruit and vegetables (AOR =2.7, 95 % CI 1.16, 6.6), or meat (AOR = 2.7,95 % CI 1.1,7.2) at least once a week were more likely to gain adequate gestational weight than their counter parts, as were women who engaged in different physical activities (AOR = 2.1, 95 % CI 1.2, 3.6). Likewise, women who gave birth at or after 37 weeks (AOR = 4.5, 95 % CI1.1, 20.7), or who had ANC follow up of ≥4 times (AOR = 2.9, 95 % CI 1.7, 5.1) were more likely to gain adequate gestational weight compared to their counterparts (Table 5).
Table 5

Factors associated with gestational weight gain during pregnancy of Harari Regional State, 2014 (N = 400)

Variable

Adequate GWG

Inadequate GWG

COR (95 %,CI)

AOR (95 % CI)

Early pregnancy BMI

 Underweight

3 (7.9)

35 (92.3)

1.00

1.00

 Normal

71 (24.2)

222 (75.8)

17 (4.7–61)*

7.9 (1.9–34)***

 Overweight& obese

41 (59.4)

28 (41.6)

4.6 (2.6–7.9)***

3.2 (1.6–6.3)*

Gestational age

 <37 weeks

2 (3.7)

52 (96.3)

1.00

1.00

 ≥37 weeks

113 (32.7)

233 (67.3)

12.6 (3–52)**

4.5 (1.1–20.7)*

ANC visit

 ≤3

29 (14.9)

166 (85.1)

1.00

1.00

 ≥4

86 (42)

119 (58)

4 (2.5–6.7)***

2.9 (1.7–5.2)***

Physical exercise per week

 Not at all

57 (21.9)

203 (78.1)

1.00

1.00

 At least once

58 (41.4)

82 (58.6)

2.5 (1.6–3.9)***

2.1 (1.2–3.6)*

Monthly Income status

  < $50

17 (19.3)

71 (80.7)

1.00

1.00

 $50–$100

17 (11.2)

135 (88.8)

0.5 (0.3–1.1)

1.5 (0.7–3.3)

  > $100

81 (50.6)

79 (49.4)

2.7 (1.4–5.2)**

5.2 (2.7–9.9)

Frequency of eating a day

 <3times/day

85 (25.2)

252 (74.8)

1.00

1.00

 ≥3 times/day

30 (47.6)

33 (52.4)

2.6 (1.6,4–68)**

2.5 (0.9–2.4)

Fruit and vegetables consumption per week

 Not at all

9 (12.2)

65 (87.8)

1.00

1.00

 At least once

106 (32.5)

220 (67.5)

3.5 (1.7–7.3)**

2.7 (1.2–6.6)*

Eggs consumption per week

 Not at all

5 (15.2)

28 (84.8)

1.00

1.00

 At least once

110 (30)

257 (70)

2.4 (0.9,6.37)

0.4 (0.1,1.5)

Meat consumption per week

 Not at all

9 (10.7)

75 (89.3)

1.00

1.00

 At least once

106 (33.5)

210 (66.5)

4 (2.0–8.7)***

2.7 (1.1–7.2)*

Residence

 Rural

15 (21.4)

55 (78.6)

1.00

1.00

 Urban

100 (30.3)

230 (69.7)

1.6 (0.9–2.9)

0.8 (0.4–1.8)

Parity

 primipara

54 (25.5)

158 (74.5)

1.00

1.00

 Multi para

61 (32.4)

127 (67.6)

1.4 (0.9–2.2)

0.9 (0.5–1.7)

*,p=,0.05,** p <0.01.*** p <0.001

Discussion

Adequate gestational weight gain is required for optimal pregnancy outcome. Less than one-third (28 %) of the pregnant women in this study gained adequate gestational weight. The factors positively associated with the adequate gain of the weight were having high BMI at early pregnancy (≥25 kg/m2), engaging in regular physical exercise, visiting ANC frequently, and eating fruit, vegetables and meat.

In the study, the mean weight gain during pregnancy was 8.96 kg. This is consistent with the findings from a study in Pakistan (8.5 kg) [11], but less than the findings from research in Brazil, in which the mean GWG ranged from 11.7 to 13.9 kg depending on BMI at early pregnancy [1214]. Although the proportion of the women who gained inadequate (69.3 %) and adequate (28 %) gestational weight in our study is similar to those found in studies conducted in other countries [15, 16], it is smaller than the findings of similar studies conducted in other areas [11, 14, 17, 18]. The inadequate gestational weight gain in our study is most likely related to the nutritional condition of the women, given that 84 % of the women had less than three meals per day. In addition, a significant proportion of women were underweight at the conception. Moreover, while IOM recommendations may be well suited to high-income countries, there may be a number of contextual factors that limit the applicability of these guidelines to low or middle income-countries such as Ethiopia. It is, therefore, important to consider GWG in the context of all the factors in a woman’s life and to develop a GWG guideline that could address the context of developing countries.

This study also indicated that the women with higher early pregnancy BMI were more likely to gain adequate gestational weight when compared to underweight women. This is consistent with previous research in Pakistan [11]. Women who are underweight at early pregnancy are required to gain more weight than their overweight or obese counterparts do in order to achieve a healthy GWG. It may be difficult for these women to gain a significant amount of weight during pregnancy, particularly if they tend to be underweight due to metabolic or food security factors. Overweight and obese women, on the other hand, are required to gain comparatively little weight to achieve adequate GWG as they are able to use a portion of their stored energy to support the growth of the fetus. As such, adequate GWG may be attained easily for these women.

At least a half-an- hour of physical exercise per day is believed to be vital during pregnancy for a healthy lifestyle and for weight management for both the mother and the fetus [19]. In the study, the mothers who undertook physical exercise at least once a week were 2.1 times more likely to gain adequate gestational weight compared to those that did not. This finding is in line with other studies conducted in the United states [20] and China [21].

The women who frequently visited ANC (≥4 times) were 2.9 times more likely to gain adequate gestational weight. This result supports the findings of the study in southern Brazil [15]. This may be explained by the fact that during ANC visits, women are likely to receive advice on weight management, the importance of maintaining a balanced diet, the need for proper nutrition during pregnancy. The women who gave birth at or after 37 weeks of gestation were 4.5 times more likely to have gained adequate gestational weight compared to than those who gave birth before 37 weeks. This is supported by research in Thailand [6], and may be attributed to an increased opportunity to gain weight by virtue of having an increase gestational period.

Women who eat fruit and vegetable for at least once per week were 2.7 times more likely to gain adequate gestational weight. This contrasts with finding of another study [20] in which fruit and vegetable consumption during pregnancy has no association with weight gain. The difference might be due to a small number of subjects (105) in the indicated study. However, in this study, 81.5 % of the women consumed fruit and vegetable most of the day during their current pregnancy.

The women from good family income (family income of > $100 per month) were 5 times more likely to gain adequate gestational weight than their counter parts, a finding supported by research in Southern Brazil [15]. It is likely that a good family income enhances household food security. In which case, pregnant women with a high family income are more likely to have consistent access to a varied diet and thus could gain appropriate weight during pregnancy.

This study has some limitations. Since the weight gain recommendation is the recommendation of developed countries, it may underestimate the proportion of gestational weight gain in developing countries such as Ethiopia, where this study was conducted. Moreover, early pregnancy BMI was taken before or at 16 weeks of gestation, at which time there may already have been an increase or decrease of gestational weight. Since variables like physical excersise and dietary habits were asked retrospectively, and they are qualitative in nature; it is difficult to measure objectively and does not indicate any specific trimester. Findings are also generalizable only for women who attended at least one ANC visit and gave birth at a health facility.

Conclusions

A considerable proportion of women in this study (69.3 %) gained inadequate gestational weight, while less than one-third (28 %) gained adequate gestational weight. Women with higher BMI at early pregnancy, who frequently visited ANC, or who consumed diverse food items during pregnancy have higher likelihood of gaining recommended gestational weight. Therefore, women of childbearing age should be informed about the importance of conceiving at a normal BMI, maintaining a balanced diet, engaging in physical activity during pregnancy, and achieving a healthy gestational weight gain. There is also a need to develop guidelines on gestational weight gain to optimize pregnancy and birth outcomes in low- and middle-income countries.

Abbreviations

ANC: 

Antenatal care

AOR: 

Adjusted odds ratio

BMI: 

Body mass index

CI: 

Confidence interval

COR: 

Crude odds ratio

GWG: 

Gestational weight gain

IOM: 

Institute of medicine

IRERC: 

Institutional Research and Ethical Review Committee

SD: 

Standard deviation

SPSS: 

Statistical package for social science

Declarations

Acknowledgment

The authors would like to acknowledge Haramaya University for providing some technical support and ethically reviewing the paper. Next, we would like to thank the data collectors and the study participants. Our heartfelt thanks goes to Victoria Oliver (PhD) for reviewing the manuscript prior to submission. Finally, yet importantly, our thanks go to those individuals who directly or indirectly contributed their skills and knowledge toward the accomplishment of this study.

Availability of data and materials

All important data and materials have already been included in the manuscript.

Authors’ contribution

FA has critically revised the design of the study, data collection techniques, involved in the statistical analysis, and drafted the manuscript. DN has conceived the study, overall design and execution, performed data collection and statistical analysis. Both authors read this manuscript and finally approved for submission.

Authors’ information

FA has Master of Public Health in Epidemiology, and currently serves as a lecturer and Head, Department of Public Health, Haramaya University. DN has Master of Public Health in Nutrition and currently working in Federal Police Hospital, Harar, Ethiopia.

Competing interests

The authors declare that they have no competing interests.

Ethics approval and consent to participate

The Institutional Research and Ethical Review Committee (IRERC) of the College of Health and Medical Sciences of Haramaya University approved the study protocol. Official letter of co-operation was written to each health institution. The participants were informed about the purposes and procedures of the data collection, and the potential risks and benefits of the study. It was explained that participation would be voluntary, and that private information would be protected. A written informed consent was obtained from each participant. To strengthen confidentiality, the participants’ names were excluded from the questionnaires, and participants were identified only through numerical codes.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Department of public Health, College of Health and Medical Sciences, Haranmaya University
(2)
Federal Police Hospital

References

  1. Raatikainen K, Heiskanen N, Heinonen S. Transition from overweight to obesity worsens pregnancy outcome in a BMI-dependent manner. Obesity. 2006;14:165–71.View ArticlePubMedGoogle Scholar
  2. Nancy F, Janet C. Energy requirements during pregnancy and lactation. Public Health Nutr. 2005;8:1010–27.Google Scholar
  3. Institute of Medicine. Weight gain during pregnancy: reexamining the guideline. Washington DC: National Academy Press; 2009.Google Scholar
  4. WHO. Physical Status: The Use and Interpretation of Anthropometry. Geneva: WHO; 1995.Google Scholar
  5. Rhodes JR, Schoendorf KC, JD P. Maternal influences on child health: preconception, prenatal, and early childhood. Pediatrics. 2003;111:1181–5.PubMedGoogle Scholar
  6. Lertbunnaphong T, Talungjit P, Titapant V. Does Gestational Weight Gain in Normal Pre-Pregnancy BMI Pregnant Women Re fl ect Fetal Weight Gain? J Med Assoc Thai. 2012;95:853–8.PubMedGoogle Scholar
  7. Thame MM, Jackson MD, Manswell IP, Osmond C, Antoine MG. Weight retention within the puerperium in adolescents: a risk factor for obesity? Public Health Nutr. 2010;13:283–8.View ArticlePubMedGoogle Scholar
  8. Stotland NJ, Haas JS, Brawarsky P, Jackso RA, Fuentes-Afflick E, Escobar GJ. Body mass index, provider advice, and target gestational weight gain. Obstet Gynecol. 2005;105:633–8.View ArticlePubMedGoogle Scholar
  9. WINKVIST A, STENLUND H, IIAKIMI M, DS M, DIBLEY MJ. Weight-gain patterns from prepregnancy until delivery among women in Central Java, Indonesia. Am J Clin Nutr. 2002;75:1072–7.PubMedGoogle Scholar
  10. Latifa M, Rachid R, Jalal K, Mariam K, Amina B. Body Mass Index, Gestational Weight Gain, and Obstetric Complications in Moroccan Population. J Pregnancy. 2013;2013:1-6.Google Scholar
  11. Munim S, Maheen H. Association of Gestational Weight Gain and Pre-Pregnancy Body Mass Index with Adverse Pregnancy Outcome. J Coll Physicians Surgeons Pakistan. 2012;22:694–8.Google Scholar
  12. Rodrigues PL, Lacerda EMA, Schlüssel MM, Spyrides MHC, Ka G. Determinants of weight gain in pregnant women attending a public prenatal care facility in Rio de Janeiro, Brazil: a prospective study, 2005–2007. Cad Saúde Pública. 2008;24:272–84.View ArticleGoogle Scholar
  13. Fraga ACSA, Filha MMT. Factors associated with gestational weight gain in pregnant women in Rio de Janeiro, Brazil, 2008. Cad Saúde Pública, Rio de Janeiro. 2014;30:633–44.View ArticleGoogle Scholar
  14. Maria I, Maria T, Anselmo O, Andressa G, Caroline B, Cristiane M, Juliana H, Patricia M, Rafael M, Silvia O. Socioeconomic, demographic and nutritional factors associated with maternal weight gain in general practices in Southern Brazil. Cad Saúde Pública, Rio de Janeiro. 2010;26:1024–34.View ArticleGoogle Scholar
  15. Michele D, Bruce B, Gilberto K, Maria I. Association of Second and Third Trimester Weight Gain in Pregnancy with Maternal and Foetal Outcome. Plos one. 2013;8:1–8.Google Scholar
  16. Sharon J, Deborah B, Adam D, Alicia A, LaVette D, Emily O, and Gary D. Determinants of excessive gestational weight gain in urban, low income Women. Women’s Health Issues. 2012;22:e439–e446.Google Scholar
  17. Mei-Yueh C, Chun-Hua K, Kuei-Feng C. The effects of pre-pregnancy body mass index and gestational weight gain on neonatal birth weight in Taiwan. Int J Nurs Midwifery. 2010;2:28–34.Google Scholar
  18. Mamu AA, Callaway LK, O’Callaghan MJ, William GM, Najman JM, Rosa A, Clavarino A, Lawlor DA. Associations of maternal pre-pregnancy obesity and excess pregnancy weight gains with adverse pregnancy outcomes and length of hospital stay. BMC Pregnancy Childbirth. 2011;11:62.View ArticleGoogle Scholar
  19. Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Macera CA, Castaneda-Sceppa C. Physical Activity and Public Health in Older Adults Recommendation From the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116:1094–105.View ArticlePubMedGoogle Scholar
  20. Weisman CS, Hillemeier MM, Downs DS, Chuang CH, Dyer A-M. PRECONCEPTION PREDICTORS OF WEIGHT GAIN DURING PREGNANCY. Womens Health Issues. 2010;20:126–32.View ArticlePubMedPubMed CentralGoogle Scholar
  21. Jiang H, Qian X, Li M, Lynn H, Fan Y, Jiang H, He F, He G. Can physical activity reduce excessive gestational weight gain? Findings from a Chinese urban pregnant women cohort study. Int J Behav Nutr Phys Act. 2012;9:12.View ArticlePubMedPubMed CentralGoogle Scholar

Copyright

© The Author(s). 2016