Gestational Weight Gain and Maternal Immediate Perinatal and Postpartum Outcomes in Low and Middle Income Countries: Individual Participant Data Meta-Analyses
Abstract
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, τ2=0.000) and emergency caesarean delivery (risk ratio 1.22, 1.03 to 1.43, τ2=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, τ2=0.004; risk ratio in women with severely inadequate gestational weight gain 0.82, 0.77 to 0.88, τ2=0.010) and emergency caesarean delivery (risk ratio in moderately inadequate gestational weight gain 0.82, 0.71 to 0.95, τ2=0.004; risk ratio in severely inadequate gestational weight gain 0.73, 0.56 to 0.96, τ2=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, τ2=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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BibTeX
@article{partap2026gestational,
title = {{Gestational Weight Gain and Maternal Immediate Perinatal and Postpartum Outcomes in Low and Middle Income Countries: Individual Participant Data Meta-Analyses}},
author = {Uttara Partap and Janaína Calu Costa and Enju Liu and Ilana Cliffer and Dongqing Wang and Molin Wang and Sudeer Kumar Nookala and Vishak Subramoney and Brittany Briggs and Ajibola Ibraheem Abioye and Manfred Accrombessi and Seth Adu-Afarwuah and Sheraz Ahmed and Hellen Akurut and Hasmot Ali and Asad Ali and Joao Guilherme Alves and Teddy Andra and Carla Adriane Leal de Araújo and Alemayehu Argaw and Shams Arifeen and Rinaldo Artes and Per Ashorn and Ulla Ashorn and Fereidoun Azizi and Bowen Banda and Ahmed Tijani Bawah and Nita Bhandari and Zulfiqar Bhutta and Valerie Briand and Elvira Beatriz Calvo and Marly Augusto Cardoso and Marcia Caldas de Castro and Jose Guilherme Cecatti and Gabriela Chico-Barba and Ranadip Chowdhury and Parul Christian and Shalean Collins and Anthony Costello and Kathryn Dewey and Titus Divala and Jamille Gregório Dombrowski and Michele Drehmer and Christopher Duggan and Pratibha Dwarkanath and Alison Elliott and Davaasambuu Enkhmaa and Daniel Erchick and Guadalupe Estrada-Gutierrez and Frankie Fair and Henrik Friis and Jimena Fritz and Samira Behboudi Gandevani and Davaasumbuu Ganmaa and Armando García-Guerra and Alison Gernand and Exnevia Gomo and Austrida Gondwe and Isabel González-Ludlow and Rebecca Grais},
journal = {BMJ Medicine},
year = {2026},
month = jul,
doi = {10.1136/bmjmed-2025-001558},
url = {https://hal.science/hal-05736257v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Gestational Weight Gain and Maternal Immediate Perinatal and Postpartum Outcomes in Low and Middle Income Countries: Individual Participant Data Meta-Analyses
AU - Uttara Partap
AU - Janaína Calu Costa
AU - Enju Liu
AU - Ilana Cliffer
AU - Dongqing Wang
AU - Molin Wang
AU - Sudeer Kumar Nookala
AU - Vishak Subramoney
AU - Brittany Briggs
AU - Ajibola Ibraheem Abioye
AU - Manfred Accrombessi
AU - Seth Adu-Afarwuah
AU - Sheraz Ahmed
AU - Hellen Akurut
AU - Hasmot Ali
AU - Asad Ali
AU - Joao Guilherme Alves
AU - Teddy Andra
AU - Carla Adriane Leal de Araújo
AU - Alemayehu Argaw
AU - Shams Arifeen
AU - Rinaldo Artes
AU - Per Ashorn
AU - Ulla Ashorn
AU - Fereidoun Azizi
AU - Bowen Banda
AU - Ahmed Tijani Bawah
AU - Nita Bhandari
AU - Zulfiqar Bhutta
AU - Valerie Briand
AU - Elvira Beatriz Calvo
AU - Marly Augusto Cardoso
AU - Marcia Caldas de Castro
AU - Jose Guilherme Cecatti
AU - Gabriela Chico-Barba
AU - Ranadip Chowdhury
AU - Parul Christian
AU - Shalean Collins
AU - Anthony Costello
AU - Kathryn Dewey
AU - Titus Divala
AU - Jamille Gregório Dombrowski
AU - Michele Drehmer
AU - Christopher Duggan
AU - Pratibha Dwarkanath
AU - Alison Elliott
AU - Davaasambuu Enkhmaa
AU - Daniel Erchick
AU - Guadalupe Estrada-Gutierrez
AU - Frankie Fair
AU - Henrik Friis
AU - Jimena Fritz
AU - Samira Behboudi Gandevani
AU - Davaasumbuu Ganmaa
AU - Armando García-Guerra
AU - Alison Gernand
AU - Exnevia Gomo
AU - Austrida Gondwe
AU - Isabel González-Ludlow
AU - Rebecca Grais
PY - 2026
DA - 2026/07/06
JO - BMJ Medicine
DO - 10.1136/bmjmed-2025-001558
UR - https://hal.science/hal-05736257v1
AB - 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, τ2=0.000) and emergency caesarean delivery (risk ratio 1.22, 1.03 to 1.43, τ2=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, τ2=0.004; risk ratio in women with severely inadequate gestational weight gain 0.82, 0.77 to 0.88, τ2=0.010) and emergency caesarean delivery (risk ratio in moderately inadequate gestational weight gain 0.82, 0.71 to 0.95, τ2=0.004; risk ratio in severely inadequate gestational weight gain 0.73, 0.56 to 0.96, τ2=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, τ2=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.
SN - 2754-0413
ER -