Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
RTI International, Durham, NC, USA.
Am J Clin Nutr. 2021 Aug 2;114(2):804-812. doi: 10.1093/ajcn/nqab086.
Adequate gestational weight gain (GWG) is essential for healthy fetal growth. However, in low- and middle-income countries, where malnutrition is prevalent, little information is available about GWG and how it might be modified by nutritional status and interventions.
We describe GWG and its associations with fetal growth and birth outcomes. We also examined the extent to which prepregnancy BMI, and preconception and early weight gain modify GWG, and its effects on fetal growth.
This was a secondary analysis of the Women First Trial, including 2331 women within the Democratic Republic of Congo (DRC), Guatemala, India, and Pakistan, evaluating weight gain from enrollment to ∼12 weeks of gestation and GWG velocity (kg/wk) between ∼12 and 32 weeks of gestation. Adequacy of GWG velocity was compared with 2009 Institute of Medicine recommendations, according to maternal BMI. Early weight gain (EWG), GWG velocity, and adequacy of GWG were related to birth outcomes using linear and Poisson models.
GWG velocity (mean ± SD) varied by site: 0.22 ± 0.15 kg/wk in DRC, 0.30 ± 0.23 in Pakistan, 0.31 ± 0.14 in Guatemala, and 0.39 ± 0.13 in India, (P <0.0001). An increase of 0.1 kg/wk in maternal GWG was associated with a 0.13 cm (95% CI: 0.07, 0.18, P <0.001) increase in birth length and a 0.032 kg (0.022, 0.042, P <0.001) increase in birth weight. Compared to women with inadequate GWG, women who had adequate GWG delivered newborns with a higher mean length and weight: 47.98 ± 2.04 cm compared with 47.40 ± 2.17 cm (P <0.001) and 2.864 ± 0.425 kg compared with 2.764 ± 0.418 kg (P <0.001). Baseline BMI, EWG, and GWG were all associated with birth length and weight.
These results underscore the importance of adequate maternal nutrition both before and during pregnancy as a potentially modifiable factor to improve fetal growth.
足够的妊娠体重增加（GWG）对胎儿健康生长至关重要。然而，在营养不良普遍存在的中低收入国家，关于 GWG 以及如何通过营养状况和干预措施来改变 GWG 的信息很少。
我们描述了 GWG 及其与胎儿生长和出生结局的关系。我们还研究了孕前 BMI 以及孕前和孕早期体重增加对 GWG 的影响程度，以及它对胎儿生长的影响。
这是对 Women First 试验的二次分析，包括来自刚果民主共和国（DRC）、危地马拉、印度和巴基斯坦的 2331 名女性，评估了从入组到妊娠 12 周左右的体重增加以及妊娠 12 周至 32 周左右的 GWG 速度（kg/wk）。根据母体 BMI，将 GWG 速度与 2009 年医学研究所的建议进行了比较。使用线性和泊松模型，将早期体重增加（EWG）、GWG 速度和 GWG 的充足性与出生结局相关联。
GWG 速度（平均值±标准差）因地点而异：DRC 为 0.22±0.15 kg/wk，巴基斯坦为 0.30±0.23，危地马拉为 0.31±0.14，印度为 0.39±0.13（P<0.0001）。GWG 增加 0.1 kg/wk 与出生长度增加 0.13 cm（95%CI：0.07，0.18，P<0.001）和出生体重增加 0.032 kg（0.022，0.042，P<0.001）相关。与 GWG 不足的女性相比，GWG 充足的女性所生新生儿的平均长度和体重更高：47.98±2.04 cm 与 47.40±2.17 cm（P<0.001）和 2.864±0.425 kg 与 2.764±0.418 kg（P<0.001）。基线 BMI、EWG 和 GWG 均与出生长度和体重相关。
这些结果强调了在妊娠前和妊娠期间获得足够的母体营养的重要性，这是一个潜在可改变的因素，可以改善胎儿生长。
