Gestational Weight Gain in Central Ethiopia: Patterns, Predictors, Birth Weight, Women’s and Care Providers’ Views. A Mixed Method Study

Abstract

Background: Adequate weight gain is needed to support a number of physiological changes during pregnancy. Gaining inadequate or excess gestational weight poses a health risk to the mother and baby. Inadequate gestational weight gain (GWG) increases the risk of fetal growth restriction, pre-term birth, and low birth weight. In contrast, women who gain excessive gestational weight are at an increased risk of hypertension in pregnancy, caesarean sections, postpartum weight retention, and development of long-term obesity. Given the scarcity of evidence that focuses on GWG in low-income countries including Ethiopia, it is necessary to undertake studies to understand the issue.

Aim: The aim of this study was to assess GWG status of the women, and examine the effect of GWG on a baby’s birth weight, and explore pregnant women’s and care providers’ views on GWG in Central Ethiopia.

Method: A concurrent mixed method study was carried out in 16 public health facilities (four tertiary hospitals and 12 health centres) in Addis Ababa, Ethiopia. A total of 395 pregnant women enrolled into the quantitative study before or at 16 weeks of gestation and were prospectively followed until they gave birth. Eight focus group discussions with pregnant women, and 36 in-depth interviews (15 with pregnant women, 11 with midwives and 10 with obstetricians) were conducted. The quantitative data were analysed using multinomial logistic regression and linear regression. The qualitative data were analysed using thematic analyses.

Results: Of the total of 395 pregnant women enrolled into the quantitative study, GWG was assessed for 369 (93%) women. More than two thirds of the pregnant women (67.2%) gained inadequate gestational weight. Pre-pregnancy weight and employment status were statistically significant predictors of GWG. Infants whose mothers had inadequate weight gain were 245.8 gm lighter compared to those who gained adequate weight. Almost all pregnant women, midwives and obstetricians had limited knowledge of the recommended amount of GWG. Counselling about GWG and postpartum weight was lacking. Midwives and obstetricians did not consider gestational weight gain counselling as a priority issue. Most pregnant women did not want to gain weight during pregnancy; but did want to gain weight after birth.

Conclusions: Inadequate GWG and women’s widespread misconception about GWG is a public health concern in Ethiopia. The limited knowledge of and low attention to pregnancy related weight management by midwives and obstetricians in Ethiopia needs appropriate intervention. Adapting a guideline for pregnancy weight management and integrating it into antenatal care is essential.