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Gestational weight gain and maternal immediate perinatal and postpartum outcomes in low and middle income countries: individual participant data meta-analyses

Article scientifique 2026 Anglais

Résumé

Objective To estimate the associations between gestational weight gain and maternal immediate perinatal and postpartum outcomes by pooling data from low and middle income countries. Design Individual participant data meta-analyses. Data sources PubMed, Embase, Web of Science, and Cochrane Library, based on three searches (Search 1: all prospective studies published from January 2000 to May 2021; Search 2: randomized controlled trials of balanced energy and protein supplementation published until June 2021; Search 3: randomized controlled trials of anti-infectious agents published until August 2021). Eligibility criteria for selecting studies Prospective studies (randomised controlled trials or observational cohort studies) with measured maternal weight during pregnancy and data available on maternal height, based in populations from low and middle income countries with no underlying conditions. Results The analyses included 156 300 women from 61 studies and 23 countries, with most participants based in South Asia (n=78 454, 50.2%) and sub-Saharan Africa (n=36 327, 23.2%). Compared with women with adequate (90-125%) gestational weight gain, women with excessive (>125%) gestational weight gain had a higher risk of caesarean delivery (risk ratio 1.10, 95% confidence interval 1.06 to 1.13, τ 2 =0.000) and emergency caesarean delivery (risk ratio 1.22, 1.03 to 1.43, τ 2 =0.000). Women with moderately (70% to <90%) or severely inadequate (<70%) versus adequate gestational weight gain had lower risks for caesarean delivery (risk ratio in women with moderately inadequate gestational weight gain 0.88, 95% confidence interval 0.84 to 0.92, τ 2 =0.004; risk ratio in women with severely inadequate gestational weight gain 0.82, 0.77 to 0.88, τ 2 =0.010) and emergency caesarean delivery (risk ratio in moderately inadequate gestational weight gain 0.82, 0.71 to 0.95, τ 2 =0.004; risk ratio in severely inadequate gestational weight gain 0.73, 0.56 to 0.96, τ 2 =0.103). Excessive versus adequate gestational weight gain was associated with higher postpartum weight retained at any time point (mean difference 2.00 kg, 95% confidence interval 1.49 to 2.50, τ 2 =1.317), whereas moderately and severely inadequate gestational weight gain were associated with lower retained weight compared with adequate gestational weight gain. Similar trends were found for postpartum body mass index. Severely inadequate gestational weight gain was associated with lower systolic and diastolic blood pressure at any time point post partum than adequate gestational weight gain. No associations were observed for other outcomes including postpartum depressive symptoms or breastfeeding. Evidence indicating an interaction between gestational weight gain and body mass index before pregnancy was found when examining the risk of caesarean delivery and postpartum weight retention, body mass index, and systolic blood pressure as outcomes. Conclusions These findings support the association between suboptimal gestational weight gain and adverse maternal outcomes in the immediate perinatal and postpartum periods. Further research examining the consequences of suboptimal gestational weight gain in low and middle income countries would be valuable to inform potential strategies to improve long term maternal health. Review registration PROSPERO CRD42023432836

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Partap, U., Costa, J., Liu, E., Cliffer, I., Wang, D., Wang, M., Nookala, S., Subramoney, V., Briggs, B., Abioye, A., Accrombessi, M., Adu‐Afarwuah, S., Ahmed, S., Akurut, H., Ali, H., Ali, A., Alves, J., Andra, T., Araújo, C., Argaw, A., Arifeen, S., Artes, R., Ashorn, P., Ashorn, U., Azizi, F., Banda, B., Bawah, A., Bhandari, N., Bhutta, Z., Briand, V., Calvo, E., Cardoso, M., Castro, M., Cecatti, J., Chico‐Barba, G., Chowdhury, R., Christian, P., Collins, S., Costello, A., Dewey, K., Divala, T., Dombrowski, J., Drehmer, M., Duggan, C., Dwarkanath, P., Elliott, A., Enkhmaa, D., Erchick, D., Estrada‐Gutiérrez, G., Fair, F., Friis, H., Fritz, J., Behboudi‐Gandevani, S., Ganmaa, D., García‐Guerra, A., Gernand, A., Gomo, E., Gondwe, A., González-Ludlow, I., Grais, R., Guindo, O., Hallamaa, L., Hamer, D., Hanley‐Cook, G., Hien, A., Huybregts, L., Isanaka, S., Jehan, F., Kac, G., Kajubi, R., Kakuru, A., Kasaro, M., Katz, J., Khatry, S., Krebs, N., Kumar, P., Kurpad, A., Lachat, C., Lama, T., Lamadrid‐Figueroa, H., Lanou, H., Lartey, A., Laufer, M., Loy, S., Lipoeto, N., López, D., Luzia, L., Mahmud, A., Maiya, G., Maleta, K., Manandhar, D., Manary, M., Mangani, C., Marinho, C., Martínez‐Rojano, H., Matias, S., Matijasevich, A., McClure, E., Mengue, S., Miller, J. (2026). Gestational weight gain and maternal immediate perinatal and postpartum outcomes in low and middle income countries: individual participant data meta-analyses. https://doi.org/10.1136/bmjmed-2025-001558

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Auteur(s)

Uttara Partap Janaína Calu Costa Enju Liu Ilana Rachel Cliffer Dongqing Wang Molin Wang Sudeer Kumar Nookala Vishak Subramoney Brittany Briggs Ajibola Ibraheem Abioye Manfred Accrombessi Seth Adu‐Afarwuah S Haroon Ahmed Hellen Akurut Hasmot Ali Asad Ali João GB Alves Teddy Ochieng Andra Carla Adriane Leal de Araújo Alemayehu Argaw Shams Arifeen Rinaldo Artes Per Ashorn Ulla Ashorn Fereidoun Azizi Bowen Banda Ahmed Tijani Bawah Nita Bhandari Zulfiqar A Bhutta V Briand Elvira Beatriz Calvo Marly Augusto Cardoso Márcia Caldas de Castro José Guilherme Cecatti Gabriela Chico‐Barba Ranadip Chowdhury Parul Christian Shalean Collins Anthony Costello Kathryn G. Dewey Titus Divala Jamille Gregório Dombrowski Michele Drehmer Christopher Duggan Pratibha Dwarkanath Alison M. Elliott Davaasambuu Enkhmaa Daniel Erchick Guadalupe Estrada‐Gutiérrez Frankie Fair Henrik Friis Jimena Fritz Samira Behboudi‐Gandevani Davaasumbuu Ganmaa Armando García‐Guerra Alison D. Gernand Exnevia Gomo Austrida Gondwe Isabel González-Ludlow Rebecca Grais Ousmane Guindo Lotta Hallamaa Davidson H. Hamer Giles Hanley‐Cook Alain Hien Lieven Huybregts Sheila Isanaka Fyezah Jehan Gilberto Kac Richard Kajubi Abel Kakuru Margaret P. Kasaro Joanne Katz Subarna K. Khatry Nancy F. Krebs P U Kumar A V Kurpad Carl Lachat Tsering Pema Lama Héctor Lamadrid‐Figueroa Hermann Lanou Anna Lartey Miriam K. Laufer See Ling Loy Nur Indrawaty Lipoeto Dra. Laura Beatriz López Liania Alves Luzia Abdullah Mahmud G Arun Maiya Kenneth Maleta Dharma Sharna Manandhar Mark Manary Charles Mangani Cláudio Romero Farias Marinho Hugo Martínez‐Rojano Susana L Matias Alicia Matijasevich Elizabeth M. McClure Sotero Serrate Mengue Joshua D Miller

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