Perinatal & Pediatric
Gestational weight gain and child growth and development in low and middle-income countries: an individual participant data meta-analysis Janaina Calu Costa* Janaina Calu Costa Nandita Perumal Uttara Partap Ilana Cliffer Dongqing Wang Enju Liu Molin Wang Wafaie W. Fawzi
Background: Gestational weight gain (GWG) influences maternal and child health with long-term impacts; however, evidence is mainly from high-income settings. We explored the association between GWG and long-term child growth and development in low- and middle-income countries (LMICs). Methods: Systematic literature searches (PubMed, Embase, Web of Science, and Cochrane) identified prospective cohorts and randomized trials from LMICs collecting pregnancy weight and child growth or neurodevelopment data. GWG adequacy was defined as the ratio of the observed over the recommended weight gain based on the Institute of Medicine guidelines. Child anthropometrics were summarized by age (15 days to 6 months, 6-12, 12-24, and 24-36 months). Neurodevelopment z-scores were derived from the 18-month assessment. Two‐stage meta-analyses were used, with study-specific log-binomial or linear regression in the first stage and random-effects models for pooled estimates in the second. Results: Children born to women who had severely inadequate GWG, compared to those with adequate GWG, presented lower mean anthropometric z-scores at every age (27 studies, 86,540 mother-child pairs). Significant mean differences (MD) ranged from -0.14 to -0.30 standard deviations (SD) across different age groups for height-for-age, weight-for-age, and weight-for-height; and between -0.11 and -0.21SD for body mass index (BMI)-for-age. Children of women with severely inadequate GWG also showed lower neurodevelopment z-scores (7 studies): fine motor [MD = -0.08SD (95%CI -0.16, -0.01)], gross motor [-0.12SD (-0.19, -0.05)], receptive language [-0.10SD (-0.19, -0.01)], and socioemotional domains [-0.10SD (-0.20, -0.01)]. Pre-pregnancy BMI modified associations between GWG and child growth at up to 12 months. Conclusion: Suboptimal GWG was associated with short- and long-term child growth and development and support the need for interventions to improve women’s nutrition before and during pregnancy.