Gestational weight gain among women from low income communities: What are the associated factors and what are the subsequent weight status consequences for these women and their children?

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Wiebe, Tracey
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Mount Saint Vincent University
This study explored individual and interpersonal characteristics and demographic factors related to gestational weight gain (GWG) and examined the relationship between GWG and infant birth weight, child weight status at four years of age, and maternal weight status longitudinally. Data come from the Better Beginnings, Better Futures (BBBF) project, a primary prevention project conducted in economically disadvantaged communities in Ontario. A total of 562 participants provided data necessary for the calculation of GWG and were included in the study. Additional data were collected on demographic, physical, mental health and lifestyle topics at approximately three month, 1.5, 2.5, 4 and 8 year intervals. The Social Ecological Model was used as a tool to select variables and to create a framework for examining the interconnectedness of these variables. Between 9.6% and10.8% of the variability in GWG was attributable to the women’s country of birth, age, pre-pregnant BMI and the ability to afford food and living expenses. Being Canadian born significantly increased GWG by 7.17 lbs to 7.99 lbs. Increasing pre-pregnant BMI was associated with lower GWG and women classified as obese prior to pregnancy had a lower GWG by 10.88 lbs on average, compared to women with lower BMIs. Lack of money for food and living expenses was associated with a lower average GWG by 3.43 lbs to 3.59 lbs. Each year of age decreased GWG by an average of 0.22 lbs to 0.28 lbs. Pre-pregnant BMI, country of birth, age, lack of money,taller height and smoking status were predictors of GWG above 2009 Institute of Medicine recommendations (i.e. high GWG). Women overweight or obese prior to pregnancy had more than three times the odds of having high GWG compared to underweight and normal weight women. Taller women were more likely to have high GWG (OR 1.68) as were Canadian born women (OR 2.44), women less than 20 years of age (OR 1.53), and women who were former smokers (1.48). Lack of money for food and living expenses decreased the odds of high GWG (OR 0.641). GWG was a predictor of birth weight after controlling for pre-pregnant BMI, maternal smoking status and infant sex with each one pound increase in GWG associated with an average 0.17 lb increase in infant birth weight. Despite a significant association between GWG classification and average weight-for-height z-score and weight status among the participants’ children at four years of age in bivariate analysis, GWG was not a significant predictor of childhood weight status in multivariate analysis. Over the eight years that the women were followed average weight increased by 16.88 lbs and average BMI increased from 23.29 kg/m2 (normal weight) prior to pregnancy to 25.34 kg/m2 (overweight). GWG was a significant predictor of BMI at four and eight years postpartum when all of the women were examined together. When examined by pre-pregnant BMI status, GWG predicted higher BMI only among normal weight women. In both cases, GWG was attributable to only a small part of the variation in BMI.
Gestational Weight Gain , Better Begginings Better Futures