Are women in Uganda gaining adequate gestational weight? A prospective study in low income urban Kampala

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Abstract

Background

Pre-pregnancy weight and weight gained during pregnancy significantly influence maternal and infant health. Little information is available regarding optimal gestational weight gain (GWG) in relation to pre-pregnancy body mass index (BMI) in Uganda. The study aimed at determining gestational weight gain (GWG) in women pregnant for the first and second time.

Methods

The study was prospective cohort study which included 221 HIV negative women pregnant for the first or second time. It was conducted in the antenatal clinic of the directorate of gynecology and obstetrics, Mulago hospital and women were recruited at ≤18 weeks of gestation by dates. Follow up measurements were done at 26 and 36 weeks gestation. Measured maternal height and reported pre-pregnancy weight were used to calculate BMI. Depending on BMI category, GWG was categorized as inadequate, adequate and excessive based on the Uganda Ministry of Health guidelines.

Results

The participants’ mean ± standard deviation (Sd) age was 20.9 ± 2.7 years and mean ± Sd BMI was 21.40 ± 2.73 kg/m ². None of the participants was obese and 68.8% ( n = 132) were pregnant for the first time. The mean ± Sd GWG at time of delivery was 10.58 ± 2.44 kg. Inadequate GWG was recorded in 62.5% ( n = 120/192) while only 3.1% ( n = 6/192) of the participants gained excessive weight during pregnancy.

Conclusion

About 62% of pregnant women in Kampala did not gain adequate weight during their first/second pregnancy. We recommend that studies be carried out to assess whether the Uganda Ministry of Health recommendations for weight gain during are appropriate for preventing adverse pregnancy outcomes across populations in Uganda.

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Most cited references 24

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Maternal and child undernutrition and overweight in low-income and middle-income countries

Robert E Black, Cesar G Victora, Susan P. Walker … (2013)

The Lancet, 382(9890), 427-451

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Maternal and fetal risk factors for stillbirth: population based study

Jason Gardosi, Vichithranie Madurasinghe, Mandy Williams … (2013)

Objective To assess the main risk factors associated with stillbirth in a multiethnic English maternity population. Design Cohort study. Setting National Health Service region in England. Population 92 218 normally formed singletons including 389 stillbirths from 24 weeks of gestation, delivered during 2009-11. Main outcome measure Risk of stillbirth. Results Multivariable analysis identified a significant risk of stillbirth for parity (para 0 and para ≥3), ethnicity (African, African-Caribbean, Indian, and Pakistani), maternal obesity (body mass index ≥30), smoking, pre-existing diabetes, and history of mental health problems, antepartum haemorrhage, and fetal growth restriction (birth weight below 10th customised birthweight centile). As potentially modifiable risk factors, maternal obesity, smoking in pregnancy, and fetal growth restriction together accounted for 56.1% of the stillbirths. Presence of fetal growth restriction constituted the highest risk, and this applied to pregnancies where mothers did not smoke (adjusted relative risk 7.8, 95% confidence interval 6.6 to 10.9), did smoke (5.7, 3.6 to 10.9), and were exposed to passive smoke only (10.0, 6.6 to 15.8). Fetal growth restriction also had the largest population attributable risk for stillbirth and was fivefold greater if it was not detected antenatally than when it was (32.0% v 6.2%). In total, 195 of the 389 stillbirths in this cohort had fetal growth restriction, but in 160 (82%) it had not been detected antenatally. Antenatal recognition of fetal growth restriction resulted in delivery 10 days earlier than when it was not detected: median 270 (interquartile range 261-279) days v 280 (interquartile range 273-287) days. The overall stillbirth rate (per 1000 births) was 4.2, but only 2.4 in pregnancies without fetal growth restriction, increasing to 9.7 with antenatally detected fetal growth restriction and 19.8 when it was not detected. Conclusion Most normally formed singleton stillbirths are potentially avoidable. The single largest risk factor is unrecognised fetal growth restriction, and preventive strategies need to focus on improving antenatal detection.

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Factors Affecting Antenatal Care Attendance: Results from Qualitative Studies in Ghana, Kenya and Malawi

Christopher Pell, Arantza Meñaca, Florence Were … (2013)

Background Antenatal care (ANC) is a key strategy to improve maternal and infant health. However, survey data from sub-Saharan Africa indicate that women often only initiate ANC after the first trimester and do not achieve the recommended number of ANC visits. Drawing on qualitative data, this article comparatively explores the factors that influence ANC attendance across four sub-Saharan African sites in three countries (Ghana, Kenya and Malawi) with varying levels of ANC attendance. Methods Data were collected as part of a programme of qualitative research investigating the social and cultural context of malaria in pregnancy. A range of methods was employed interviews, focus groups with diverse respondents and observations in local communities and health facilities. Results Across the sites, women attended ANC at least once. However, their descriptions of ANC were often vague. General ideas about pregnancy care – checking the foetus’ position or monitoring its progress – motivated women to attend ANC; as did, especially in Kenya, obtaining the ANC card to avoid reprimands from health workers. Women’s timing of ANC initiation was influenced by reproductive concerns and pregnancy uncertainties, particularly during the first trimester, and how ANC services responded to this uncertainty; age, parity and the associated implications for pregnancy disclosure; interactions with healthcare workers, particularly messages about timing of ANC; and the cost of ANC, including charges levied for ANC procedures – in spite of policies of free ANC – combined with ideas about the compulsory nature of follow-up appointments. Conclusion In these socially and culturally diverse sites, the findings suggest that ‘supply’ side factors have an important influence on ANC attendance: the design of ANC and particularly how ANC deals with the needs and concerns of women during the first trimester has implications for timing of initiation.

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Author and article information

Contributors

Ronald Wanyama: +256 772 330638 , rwanyama@gmail.com

Gerald Obai: lakobai@gmail.com

Pancras Odongo: odongpancras@gmail.com

Mike N. Kagawa: kagawanm@yahoo.com

Rhona K. Baingana: rbaingana@gmail.com

Journal

Journal ID (nlm-ta): Reprod Health

Journal ID (iso-abbrev): Reprod Health

Title: Reproductive Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1742-4755

Publication date (Electronic): 24 September 2018

Publication date PMC-release: 24 September 2018

Publication date Collection: 2018

Volume: 15

Electronic Location Identifier: 160

Affiliations

[1 ]GRID grid.442626.0, Lecturer, Biochemistry Department, Faculty of Medicine, , Gulu University, ; P.O. Box 166, Gulu, Uganda

[2 ]GRID grid.442626.0, Lecturer, Physiology Department, Faculty of Medicine, , Gulu University, ; P.O. Box 166, Gulu, Uganda

[3 ]GRID grid.442626.0, Lecturer, Internal Medicine Department, Faculty of Medicine, , Gulu University, ; P.O. Box 166, Gulu, Uganda

[4 ]ISNI 0000 0004 0620 0548, GRID grid.11194.3c, Lecturer, Obstetrics & Gynecology Department, College of Health Sciences, , Makerere University, ; P.O. Box 7062, Kampala, Uganda

[5 ]ISNI 0000 0004 0620 0548, GRID grid.11194.3c, Lecturer, Biochemistry and Sports Science Department, School of Biological Sciences, , Makerere University, ; P.O. Box 7062, Kampala, Uganda

Article

Publisher ID: 608

DOI: 10.1186/s12978-018-0608-2

PMC ID: 6154409

SO-VID: 0b18bb8e-734d-4099-8658-81ec99304b58

License:

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.

History

Date received : 10 July 2018

Date accepted : 19 September 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100004493, International Atomic Energy Agency;

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: pregnancy,body mass index,gestational weight gain,maternal,uganda

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: pregnancy, body mass index, gestational weight gain, maternal, uganda

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Are women in Uganda gaining adequate gestational weight? A prospective study in low income urban Kampala

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Karger: Nutrition and Dietetics

Most cited references 24

Maternal and child undernutrition and overweight in low-income and middle-income countries

Maternal and fetal risk factors for stillbirth: population based study

Factors Affecting Antenatal Care Attendance: Results from Qualitative Studies in Ghana, Kenya and Malawi

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