Association of Gestational Weight Trajectories With Neonatal Outcomes Among Pregnant Slum-Dwelling Women, India

Abstract

The influence of early pregnancy weight and gestational weight gain (GWG) on neonatal outcomes among Indian slum-dwellers remains understudied. A prospective cohort study summarised maternal weight trajectories using the longitudinal clustering technique and explored associations between these clusters and neonatal outcomes (low birthweight, small for gestational age [SGA] and preterm births) among 423 pregnant slum-dwelling women in Pune, India. Sociodemographic data, height and weight were measured at enrolment (< 12 weeks, ‘early pregnancy’). Weight was additionally measured at 23 ± 1 (‘mid-pregnancy’), 33 ± 1 (‘late pregnancy’), 36–37 and 39–40 weeks. The mean age was 24.7 (95% CI, 23.3, 25.1) years and the mean BMI at enrolment was 22.3 (95% CI, 21.9, 22.7) kg/m². Underweight women had the highest GWG rates and total GWG, while obese women had the lowest. Four clusters were identified: Cluster 1 (n = 124, 97% normal and overweight women, GWG rate: 0.27 (95% CI, 0.24, 0.30) kg/week early-late pregnancy) was the reference group. Women in Cluster 2 (n = 146, 93% underweight and normal weight women, GWG rate: 0.31 (95% CI, 0.28, 0.34) kg/week early-late pregnancy) had a higher risk of having SGA and preterm newborns and women in Cluster 3 (n = 68, 100% overweight and obese women, GWG rate: 0.17, 95% CI, 0.12, 0.22 kg/week early-late pregnancy) had a higher risk of having preterm newborns than Cluster 1. The women in Cluster 4 (n = 85, 100% underweight and normal weight, mean early-late pregnancy GWG rate of 0.47, 95% CI, 0.44, 0.50 kg/week) showed no higher risk of adverse neonatal outcomes. This study highlights the need to monitor both pre-pregnancy BMI and weight throughout pregnancy to enhance the possibility of favourable neonatal outcomes.