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Title: Pre-conceptional and gestational weight trajectories and risk of delivering a small-for-gestational age baby in rural Gambia
Authors: Johnson, William O.
Elmrayed, Seham A.A.
Sosseh, Fatou
Prentice, A.M.
Moore, Sophie E.
Keywords: Maternal nutrition
Small-for-gestational age
Pre-pregnancy weight
Gestational weight gain
Age-related trajectories
Issue Date: 2017
Publisher: American Society for Nutrition
Citation: JOHNSON, W.O. ...et al., 2017. Pre-conceptional and gestational weight trajectories and risk of delivering a small-for-gestational age baby in rural Gambia. American Journal of Clinical Nutrition, 105(6), pp.1474-1482.
Abstract: Background: Maternal nutritional status is a key determinant of small-for-gestational age (SGA), but there remain some knowledge gaps, particularly regarding the role of energy balance entering pregnancy. Objective: This study investigates how pre-conceptional and gestational weight trajectories (summarized by individual-level traits) are associated with SGA risk in rural Gambia. Design: The sample comprised 670 women in a trial (ISRCTN49285450), with serial weight data (7,310 observations) available before and during pregnancy. Individual trajectories from six months pre-conception to 30 weeks gestation were produced using multilevel modelling. Summary traits were expressed as weight Z-scores (Zwt-3 months pre-conception, Zwt0 months (i.e., conception), Zwt+3 months post-conception, Zwt+7 months post-conception, and conditional measures representing change from the preceding time) and related to SGA risk using Poisson regression with confounder adjustment; linear splines were used to account for non-linearity. Results: Maternal weight at each time had a consistent non-linear relationship with SGA risk. For example, the Zwt-3 months estimate was stronger in women with values ≤ 0.5 Z-scores (relative risk 0.736; 95% confidence interval 0.594, 0.910) than in women with values > 0.5 Z-scores (0.920; 0.682, 1.241). The former group had the highest observed SGA prevalence. Focusing on weight change, only Conditional Zwt+7 months was associated with SGA, and only in women with values > -0.5 Z-scores (0.579; 0.463, 0.724). Conclusions: Protection against delivering an SGA neonate offered by greater pre-conceptional or gestational weight may be most pronounced among more undernourished and vulnerable women. Independently of this, greater second/third trimester weight gain beyond a threshold may be protective.
Description: This is an open access article distributed under the CC-BY license (http:// creativecommons.org/licenses/by/3.0/
Sponsor: Supported by the United Kingdom Medical Research Council (MRC) (MC-A760-5QX00) and the United Kingdom Department for International Development (DFID) under the MRC/DFID Concordat agreement. WJ and SEM are funded by the United Kingdom MRC program MC_UP_1005/1
Version: Published
DOI: 10.3945/ajcn.116.144196
URI: https://dspace.lboro.ac.uk/2134/24741
Publisher Link: https://doi.org/10.3945/ajcn.116.144196
Related Resource: http://ajcn.nutrition.org/content/early/2017/05/10/ajcn.116.144196/suppl/DCSupplemental
ISSN: 1938-3207
Appears in Collections:Published Articles (Sport, Exercise and Health Sciences)

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