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Pre-conceptional and gestational weight trajectories and risk of delivering a small-for-gestational age baby in rural Gambia

journal contribution
posted on 20.04.2017 by Will Johnson, Seham A.A. Elmrayed, Fatou Sosseh, A.M. Prentice, Sophie E. Moore
Background: Maternal nutritional status is a key determinant of small-for-gestational age (SGA), but there remain some knowledge gaps, particularly regarding the role of energy balance entering pregnancy. Objective: This study investigates how pre-conceptional and gestational weight trajectories (summarized by individual-level traits) are associated with SGA risk in rural Gambia. Design: The sample comprised 670 women in a trial (ISRCTN49285450), with serial weight data (7,310 observations) available before and during pregnancy. Individual trajectories from six months pre-conception to 30 weeks gestation were produced using multilevel modelling. Summary traits were expressed as weight Z-scores (Zwt-3 months pre-conception, Zwt0 months (i.e., conception), Zwt+3 months post-conception, Zwt+7 months post-conception, and conditional measures representing change from the preceding time) and related to SGA risk using Poisson regression with confounder adjustment; linear splines were used to account for non-linearity. Results: Maternal weight at each time had a consistent non-linear relationship with SGA risk. For example, the Zwt-3 months estimate was stronger in women with values ≤ 0.5 Z-scores (relative risk 0.736; 95% confidence interval 0.594, 0.910) than in women with values > 0.5 Z-scores (0.920; 0.682, 1.241). The former group had the highest observed SGA prevalence. Focusing on weight change, only Conditional Zwt+7 months was associated with SGA, and only in women with values > -0.5 Z-scores (0.579; 0.463, 0.724). Conclusions: Protection against delivering an SGA neonate offered by greater pre-conceptional or gestational weight may be most pronounced among more undernourished and vulnerable women. Independently of this, greater second/third trimester weight gain beyond a threshold may be protective.

Funding

Supported by the United Kingdom Medical Research Council (MRC) (MC-A760-5QX00) and the United Kingdom Department for International Development (DFID) under the MRC/DFID Concordat agreement. WJ and SEM are funded by the United Kingdom MRC program MC_UP_1005/1

History

School

  • Sport, Exercise and Health Sciences

Published in

American Journal of Clinical Nutrition

Volume

105

Issue

6

Pages

1474-1482

Citation

JOHNSON, W.O. ...et al., 2017. Pre-conceptional and gestational weight trajectories and risk of delivering a small-for-gestational age baby in rural Gambia. American Journal of Clinical Nutrition, 105(6), pp.1474-1482.

Publisher

American Society for Nutrition

Version

VoR (Version of Record)

Publisher statement

This work is made available according to the conditions of the Creative Commons Attribution 3.0 Unported (CC BY 3.0) licence. Full details of this licence are available at: http://creativecommons.org/licenses/by/3.0/

Acceptance date

29/03/2017

Publication date

2017-05-10

Copyright date

2017

Notes

This is an open access article distributed under the CC-BY license (http:// creativecommons.org/licenses/by/3.0/

ISSN

1938-3207

Language

en

Licence

Exports