Patterns and predictors of gestational weight gain in Addis Ababa, Central Ethiopia: a prospective cohort study

IntroductionGaining excessive or inadequate gestational weight is associated with many adverse maternal and fetal outcomes. Inadequate gestational weight gain (GWG) increases the risk of fetal growth restriction, pre-term birth, and low birth weight. It is a public health concern in sub-Saharan Africa. The aim of this study was to assess the patterns and predictors of GWG in Addis Ababa, Ethiopia.MethodsWe conducted a prospective cohort study among pregnant women who attended antenatal care in health centres in Addis Ababa, from January to September 2019. Data were collected by a structured questionnaire and checklists and analysed using Stata version-14. Weight at or before 16 weeks gestation was used as a proxy for pre-pregnancy weight. Women's height and baseline weight were measured by data collectors, and we obtained weight at the end of the 24th and 36th weeks of gestation from women's medical records. GWG was categorized as inadequate, adequate and excessive based on the United States Institute of Medicine criteria. Predictors of GWG were identified using multinomial logistic regression.ResultsA total of 395 pregnant women were enrolled in the study. GWG was assessed for 369 (93%) women. The median GWG was 8.7 kg with inter quartile ranges (25th, 75th percentiles) of 7.0 kg and 11.6 kg. More than two-third of the participants, 248 (67.2% [95% CI: 62.2, 72.0%]), gained inadequate weight; 103 (27.9% [95% CI: 23.4, 32.8%]) gained adequate weight; and 18 (4.9% [95% CI: 2.9%, 7.6%]) gained excessive weight. Three quarters (75%) of underweight women gained inadequate gestational weight, whereas 43% of overweight or obese women gained inadequate gestational weight. Being underweight (AOR=3.30 [95% CI: 1.32, 8.24]) or normal weight (AOR=2.68 [95% CI: 1.37, 5.24]) before pregnancy increased the odds of gaining inadequate gestational weight compared to overweight or obese women. Not having paid employment was associated with higher odds of gaining inadequate gestational weight compared to women employed outside the home (AOR=2.17 [95% CI: 1.16, 4.07]).ConclusionsMost pregnant women in Addis Ababa gain inadequate gestational weight. In particular, three quarters of underweight women gained inadequate gestational weight. Being underweight, normal weight or having no paid employment were associated with higher odds of inadequate GWG. Promoting adequate GWG in Addis Ababa among underweight and normal weight women may be an important public health initiative. Plain language summaryPregnant women are expected to gain weight due to various biological changes. Gaining inadequate or excessive weight during pregnancy poses a health risk to the mother and baby. Inadequate weight gain is a public health concern in low-income countries, including Ethiopia. This study assessed patterns and predictors of weight gain during pregnancy in Addis Ababa, Central Ethiopia. The study was conducted from January to September 2019. Women attending public health facilities were followed from before or at 16 weeks of gestation until 36 weeks of pregnancy. A total of 395 pregnant women enrolled in the study. Weight gain was assessed for 369 (93%) women. More than two-third of the participants (67.2%) gained inadequate weight during pregnancy. Three quarters (75%) of underweight women gained inadequate weight, whereas 43% of overweight or obese women gained inadequate weight during pregnancy. Promoting adequate weight gain during pregnancy for underweight and normal weight women in Addis Ababa is an important public health initiative.