Aga Khan University, Karachi, Pakistan.
Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
BMC Pregnancy Childbirth. 2024 Mar 22;24(1):214. doi: 10.1186/s12884-024-06420-3.
Early pregnancy nutritional status can be associated with adverse birth outcomes such as small-for-gestational age (SGA) and low birth weight (LBW). BMI (Body Mass Index) and MUAC (Mid-upper arm circumference) are easy to use assessments and are indicative of the pre-pregnancy nutritional status if obtained in the first trimester. This study primarily assesses the association of maternal nutritional status using BMI and MUAC with SGA in a community-based cohort of Pakistani women. It also aims to determine the predictive ability of MUAC and BMI in predicting SGA. Secondarily, we assessed the association between maternal nutrition and large for gestational age (LGA) and LBW.
This study is a secondary analysis of an ongoing pregnancy cohort "Pregnancy Risk Infant Surveillance and Measurement Alliance (PRISMA)"in Ibrahim Hyderi and Rehri Goth, Karachi. PRISMA participants who were enrolled between January 2021 to August 2022 were included given they had a gestational age < 14 weeks confirmed via ultrasound, MUAC and BMI measurements were available and birth weight was captured within 72 hours. Multivariable logistic regression was used to determine an association between maternal nutritional status and SGA. The PRISMA study was approved by the Aga Khan University Ethics Review Committee (2021-5920-15,518).
Of 926 women included in the analysis, 26.6% (n = 247) had a low MUAC (< 23 cm) while 18.4% (n = 171) were underweight (BMI < 18.5 kg/m2). Nearly one third of low MUAC and underweight women delivered SGA infants (34.4 and 35.1% respectively). Underweight women and women with low MUAC had a statistically significant association with SGA (Underweight: OR 1.49, 95% CI 1.1,2.4; Low MUAC-OR 1.64, 95% CI 1.2,2.3) as well as LBW (Underweight: OR-1.63, 95% CI 1.1,2.4; Low MUAC-OR-1.63, 95% CI 1.2,2.3). ROC curves showed that MUAC and BMI had modest predictability for SGA (AUC < 0.7).
Maternal nutritional status as indicated by BMI and MUAC are strongly associated with adverse pregnancy outcomes including SGA, LGA and LBW. Although MUAC and BMI are widely used to determine maternal nutritional status, they have poor predictive ability for newborn size. Further research is needed to identify other tools or a combination of tools to better predict adverse birth outcomes in resource-limited settings and plan interventions.
早期妊娠营养状况与不良出生结局有关，如小于胎龄儿（SGA）和低出生体重（LBW）。BMI（体重指数）和 MUAC（中上臂围）是易于使用的评估方法，如果在孕早期获得，可反映孕前营养状况。本研究主要评估了巴基斯坦社区妇女基于 BMI 和 MUAC 的孕产妇营养状况与 SGA 的关系。还旨在确定 MUAC 和 BMI 预测 SGA 的能力。其次，我们评估了母体营养与巨大儿（LGA）和 LBW 的关系。
这是在卡拉奇 Ibrahim Hyderi 和 Rehri Goth 进行的正在进行的妊娠队列“妊娠风险婴儿监测和测量联盟（PRISMA）”的二次分析。纳入了 2021 年 1 月至 2022 年 8 月期间入组的 PRISMA 参与者，前提是他们的超声检查证实孕龄<14 周，有 MUAC 和 BMI 测量值，且在 72 小时内记录了出生体重。多变量逻辑回归用于确定母体营养状况与 SGA 之间的关联。PRISMA 研究获得了阿迦汗大学伦理审查委员会的批准（2021-5920-15，518）。
在纳入分析的 926 名妇女中，26.6%（n=247）的 MUAC 较低（<23cm），18.4%（n=171）体重不足（BMI<18.5kg/m2）。近三分之一的 MUAC 较低和体重不足的妇女分娩出 SGA 婴儿（分别为 34.4%和 35.1%）。体重不足的妇女和 MUAC 较低的妇女与 SGA 有统计学显著关联（体重不足：OR 1.49，95%CI 1.1，2.4；MUAC 较低：OR 1.64，95%CI 1.2，2.3）以及 LBW（体重不足：OR-1.63，95%CI 1.1，2.4；MUAC 较低：OR-1.63，95%CI 1.2，2.3）。ROC 曲线显示 MUAC 和 BMI 对 SGA 具有中等预测能力（AUC<0.7）。
BMI 和 MUAC 所示的母体营养状况与不良妊娠结局密切相关，包括 SGA、LGA 和 LBW。尽管 MUAC 和 BMI 广泛用于确定母体营养状况，但它们对新生儿大小的预测能力较差。需要进一步研究以确定其他工具或工具组合，以便在资源有限的环境中更好地预测不良出生结局并计划干预措施。
