1. Gestational weight gain and haemoglobin status among pregnant women in Mangochi, Malawi
Shyreen Emmaculate Taoloka Chithambo (Mphil) Trondheim,

2. Introduction Gestational weight gain(GWG)
Amount of weight gained in pregnancy
Important determinant of maternal and neonatal outcome
Inadequate GWG - associated with low birth weight, neonatal morbidity and mortality
Excessive GWG - a risk factor for gestational diabetes, dyslipidemia, postpartum weight retention

3. Institute of Medicine(IOM) 2009 Gestational Weight Gain Guidelines
Weight categories
Pregestational BMI
(kg/m2)
Weight gain rate/week
(kg)
Weight Gain
Under weight
< 18.5
0.51 (0.44, 0.58)
Normal weight
18.5 – 24.9
0.42 (0.35, 0.50)
Over weight
25.0 – 29.9
0.28 (0.23, 0.33)
Obese
≥ 30
0.22 (0.17, 0.27)
Source: IOM 2009 GWG Report

4. Introduction Anemia Low hemoglobin(Hb) level
Several types of anemia can develop during pregnancy: Iron-deficiency, Folate-deficiency & vitamin B12 deficiency
Maternal anemia - a common problem in pregnancy, particularly in developing countries (Chowdhury et al., 2015)
Anemia

5. The Mangochi study
257 pregnant women were recruited from 19 villages in this clustered longitudinal study
The women were either in the first or second trimester (≥ 8 but ≤ 24 weeks)
Inclusion criteria;
Would reside in the study area in the next 6 months
Would give birth at one of the health facilities
Consented to participate
Exclusion criteria;
Severe illness including mental illness
Twin pregnancy

6. Justification
GWG - an important determinant of maternal and neonatal outcomes
Pregnancy maternal weight gains are not properly monitored in Malawi – Thus posing a risk for unfavourable birth outcomes
Thus the rationale was two-fold:
Are IOM guidelines being met in rural Malawi? What is the prevalence of pregnancy anemia?
What are the factors that are associated with GWG in rural Malawi? Can dietary counselling improve GWG and Hb status?

7. Objectives
To find the prevalence of women meeting the IOM GWG guidelines
To find the prevalence of anemia
To identify factors associated with gestational weight gain and haemoglobin status in a rural setting in Malawi

8. Methods
Anthropometric measurements (standard anthropometric procedures)
Weight: Seca analog scale, measured at baseline, mid-point and endpoint
Skinfold thickness measurements (biceps, triceps, suprailliac and subscapular): measured at baseline and endpoint with Harpenden skinfold calliper
Mid Upper Arm circumference:measured at baseline and endpoint using Seca tape measure

9. Methods cont/…
Haemoglobin(Hb) status: Tests done on baseline and endpoint(g/dl), Hemocue Hb 301 machine used

10. Methods GWGs categories - inadequate, adequate and excessive
Hb status was categorized as anemia (mild, moderate, severe) based on WHO cut-offs
A linear mixed effects regression model identified factors associated with gestational weight gain
A Generalized Linear Regression Model (GLM) was used to identify factors associated with Hb status

11. The prevalence of women who met the IOM GWG guidelines was 14.4%

12. The prevalence of women who met the IOM GWG guidelines in different categories of maternal BMI. For example, 11.1% of the under weight women met the IOM guideline

13. Comparison of GWG (IOM Guidelines vs Study Results) by
maternal BMI (Results for 11 week follow-up)
Weight categories
Preconception BMI
(kg/m2)
IOM Weight Gain
(kg)
Study Weight Gain
Under weight
< 18.5
5.61
3.77
Normal weight
18.5 – 24.9
4.62
2.91
Over weight
25.0 – 29.9
3.08
2.40
In all BMI categories, the study participants gained lesser than the IOM guidelines

14. ***Maternal factors associated with GWG
Covariates
β (95% CI)
P-value
Baseline BMI (Ref: Normal)
Underweight
-7.54 (-4.92, )
< 0.01
Overweight
11.45 (9.59, 13.31)
Marital status (ref: unmarried)
Married
2.53 (0.13, 4.93)
0.04
SES (ref: Well off)
Very poor
-2.83(-4.82, -0.83)
Poor
-2.27 (-4.01,-0.52)
0.01
Underweight women gained kg lesser than women who had normal BMI at baseline
Married women gained 2.53 kg more than unmarried women
Women from very poor families gained 2.83 kg lesser than women who were well-off
***Model results also adjusted for gestation age at recruitment, clinical measurements and other socio-demographics

15. Haemoglobin status Mean Haemoglobin: 11.40 ± 1.52
Prevalence of anemia (severe,
moderate and mild) was
37.8%
**Factors associated with Hb:
Gestation age at baseline (in weeks)
was negatively associated with
Hb status [-0.06 (-0.11, -0.01)]
Malaria was also negatively associated
with Hb status [-0.45 (-0.91, -0.00)]
**Model results also adjusted for gestation age at recruitment, clinical measurements and other socio-demographics

16. Conclusions and recommendations
Pregnant women from the study area are failing to comply to IOM GWG guidelines
Although the reasons maybe multi-facet, BMI at baseline, marital status and SES significantly predicted GWG
The study also revealed a high prevalence of anemia (37.8%) at baseline
There is a need to monitor GWG in Malawi; currently this is a challenge. Health workers have limited knowledge on how this can be done
Nutrition interventions may be imperative for low income women