ArticleBMJ medicine2026
Gestational weight gain and maternal immediate perinatal and postpartum outcomes in low and middle income countries: individual participant data meta-analyses.
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164 authors.
Uttara PartapDepartment of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.ORCID 0000-0002-2531-1804
Janaína Calu CostaDepartment of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
Enju LiuInstitutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA.
Ilana R ClifferDepartment of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
Dongqing WangDepartment of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia, USA.
Molin WangDepartment of Epidemiology, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA.
Sudeer Kumar NookalaCytel, India, on behalf of the Bill and Melinda Gates Foundation, Seattle, WA, USA.
Vishak SubramoneyDVPL Tech, Dubai, UAE.
Brittany BriggsCertara USA, on behalf of the Bill and Melinda Gates Foundation, Seattle, WA, USA.
Ajibola Ibraheem AbioyeDepartment of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
Manfred AccrombessiInstitut de Recherche Clinique du Benin, Abomey-Calavi, Benin.
Seth Adu-AfarwuahDepartment of Nutrition and Food Science, University of Ghana, Legon, Ghana.
Sheraz AhmedAga Khan University, Karachi, Pakistan.
Hellen AkurutMRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.
Hasmot AliJiVitA Project, Rangpur, Bangladesh.
Asad AliAga Khan University, Karachi, Pakistan.
Joao Guilherme AlvesInstituto de Medicina Integral Prof Fernando Figueira (IMIP), Recife, Brazil.
Teddy AndraInfectious Disease Research Collaboration, Kampala, Uganda.
Carla Adriane Leal de AraújoInstituto de Medicina Integral Prof Fernando Figueira (IMIP), Recife, Brazil.
Alemayehu ArgawDepartment of Food Technology, Safety and Health, Ghent University, Gent, Belgium.
Shams ArifeenMaternal and Child Health Division, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh.
Rinaldo ArtesInstitute of Education and Research (INSPER), Sao Paulo, Brazil.
Per AshornFaculty of Medicine and Health Sciences, Tampere University, Tampere, Finland.
Ulla AshornFaculty of Medicine and Health Sciences, Tampere University, Tampere, Finland.
Fereidoun AziziEndocrine Research Centre, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Bowen BandaUnit of Environmental Sciences and Management, North West University, Potchefstroom Campus, Potchefstroom, South Africa.
Ahmed Tijani BawahDepartment of Medical Laboratory Sciences, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana.
Nita BhandariCentre for Health Research and Development, Society for Applied Studies, New Delhi, India.
Zulfiqar A BhuttaCentre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada.
Valerie BriandResearch Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, National Institute for Health and Medical Research (INSERM) UMR 1219, University of Bordeaux, Bordeaux, France.
Elvira Beatriz CalvoFormer Head, Department of Nutrition, Mother & Child Health Direction, Ministry of Health, Buenos Aires, Argentina.
Marly Augusto CardosoFaculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil.
Marcia Caldas de CastroHarvard T H Chan School of Public Health, Boston, Massachusetts, USA.
Jose Guilherme CecattiUniversity of Campinas, Campinas, Brazil.
Gabriela Chico-BarbaNutrition and Bioprogramming Coordination, Instituto Nacional de Perinatología, Lomas de Virreyes, Mexico City, Mexico.
Ranadip ChowdhuryCentre for Health Research and Development, Society for Applied Studies, New Delhi, India.
Parul ChristianCenter for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Shalean CollinsTulane University, New Orleans, Louisiana, USA.
Anthony CostelloUCL Insitute for Global Health, London, UK.
Kathryn G DeweyDepartment of Nutrition, University of California, Davis, California, USA.
Titus H DivalaBlantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi.
Jamille Gregório DombrowskiDepartment of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.
Michele DrehmerPostgraduate Studies Programme in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
Christopher P DugganDepartment of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
Pratibha DwarkanathDivision of Nutrition, St John's Research Institute, Bangalore, India.
Alison M ElliottMRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.
Davaasambuu EnkhmaaNational Centre for Maternal and Child Health, Ulaanbaatar, Mongolia.
Daniel ErchickDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Guadalupe Estrada-GutierrezDepartment of Immunobiochemistry, Instituto Nacional de Perinatología (Mexico City), Mexico City, Mexico.
Frankie J FairCollege of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK.
Henrik FriisDepartment of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.
Jimena FritzCenter for Research in Nutrition & Health, National Institute of Public Health, Cuernavaca, Mexico.
Samira Behboudi GandevaniFaculty of Nursing and Health Sciences, Nord University, Bodø, Nordland, Norway.
Davaasumbuu GanmaaHarvard T H Chan School of Public Health, Boston, Massachusetts, USA.
Armando García-GuerraCentro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico.
Alison D GernandDepartment of Nutritional Sciences, Pennsylvania State University, Philadelphia, PA, USA.
Exnevia GomoFaculty of Medicine & Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
Austrida GondweUNC Project, Tidziwe Centre, Kamuzu Central Hospital, Lilongwe, Central Region, Malawi.
Isabel González-LudlowNutrition and Bioprogramming Coordination, Instituto Nacional de Perinatología, Mexico City, Mexico.
Rebecca GraisEpicentre, Paris, France.
Ousmane GuindoEpicentre Niger, Niamey, Niger.
Lotta HallamaaFaculty of Medicine and Health Sciences, Tampere University, Tampere, Finland.
Davidson H HamerDepartment of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.
Giles Hanley-CookDepartment of Food Technology, Safety and Health, Ghent University, Gent, Belgium.
Alain HienNazi Boni University, Bobo-Dioulasso, Hauts-Bassins, Burkina Faso.
Lieven HuybregtsDepartment of Food Technology, Safety and Health, Ghent University, Gent, Belgium.
Sheila IsanakaEpicentre, Paris, France.
Fyezah JehanDepartment of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
Gilberto KacNutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Richard KajubiInfectious Disease Research Collaboration, Kampala, Uganda.
Abel KakuruInfectious Disease Research Collaboration, Kampala, Uganda.
Margaret P KasaroUNC Global Projects - Zambia, LLC, Lusaka, Zambia.
Joanne KatzDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Subarna K KhatryNepal Nutrition Intervention Project-Sarlahi, Kathmandu, Nepal.
Nancy F KrebsUniversity of Colorado School of Medicine, Aurora, Colorado, USA.
Pratap KumarDepartment of Reproductive Medicine and Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Anura V KurpadDepartment of Physiology, St John's Medical College, Bangalore, India.
Carl LachatDepartment of Food Technology, Safety and Health, Ghent University, Gent, Belgium.
Tsering Pema LamaNepal Nutrition Intervention Project-Sarlahi, Kathmandu, Nepal.
Hector Lamadrid-FigueroaDepartment of Perinatal Health, National Institute of Public Health, Cuernavaca, Mexico.
Hermann LanouInstitut de Recherche en Sciences de la Sante (IRSS), Ouagadougou, Burkina Faso.
Anna LarteyDepartment of Nutrition and Food Science, University of Ghana, Legon, Ghana.
Miriam K LauferCenter for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MA, USA.
See Ling LoyDuke-NUS Medical School, Singapore.
Nur Indrawaty LipoetoDepartment of Nutrition, Andalas University, Padang, Indonesia.
Laura Beatriz LópezFaculty of Medicine, Nutrition School, University of Buenos Aires, Buenos Aires, Argentina.
Liania Alves LuziaSchool of Public Health, University of Sao Paulo, Sao Paulo, Brazil.
Abdullah MahmudNutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh.
G Arun MaiyaDepartment of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.
Kenneth MaletaSchool of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi.
Dharma S ManandharMother and Infant Research Activities (MIRA), Kathmandu, Nepal.
Mark J ManaryDepartment of Pediatrics, Washington University, St. Louis, St. Louis, Missouri, USA.
Charles ManganiSchool of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi.
Claudio Romero Farias MarinhoDepartment of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil.
Hugo Martínez-RojanoEscuela Superior de Medicina del Instituto Politécnico Nacional, Mexico City, Mexico.
Susana L MatiasDepartment of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, California, USA.
Alicia MatijasevichFaculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Elizabeth M McClureRTI International, Durham, NC, USA.
Sotero S MengueUniversidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Joshua D MillerUniversity of North Carolina Chapel Hill, Chapel Hill, NC, USA.
Sophie E MooreDepartment of Women and Children's Health, King's College London, London, UK.
Marhazlina MohamadSchool of Nutrition and Dietetics, Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus, Kuala Nerus, Malaysia.
Hamid Jan Jan MohamedNutrition Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia.
Malay Kanti MridhaCentre for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
Ferdinand M MugusiDepartment of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Ameer MuhammadVITAL Pakistan Trust, Karachi, Pakistan.
Alfa MuhihiAfrica Academy for Public Health, Dar es Salaam, Tanzania.
T Verenice Muñoz-RochaCenter for Research in Nutrition & Health, National Institute of Public Health, Cuernavaca, Mexico.
Wilbroad MutaleUniversity of Zambia School of Public Health, Lusaka, Zambia.
Lynnette M NeufeldFood and Agriculture Organization of the United Nations (FAO), Rome, Italy.
Phuong Hong NguyenInternational Food Policy Research Institute, Washington, DC, USA.
Maria Angélica Antunes NunesPostgraduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
Maria Ome-KaiusPapua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
David OsrinUCL Insitute for Global Health, London, UK.
Noel PatsonMalaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi.
Andrea B PembeDepartment of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Otilia Perichart-PereraNutrition and Bioprogramming Coordination, Instituto Nacional de Perinatología (Mexico City), Mexico City, Mexico.
Karen E PetersonNutritional Sciences Department, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
Zul PremjiDepartment of Parasitology/Medical Entomology, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Andrew M PrenticeMRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia.
Amado D Quezada-SánchezCentro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico.
Najeeb RahmanAga Khan University, Karachi, Pakistan.
Preetha RamachandraDepartment of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Usha RamakrishnanHubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Arjumand RizviInstitute for Global Health & Development, Aga Khan University, Karachi, Pakistan.
Dominique RoberfroidDepartment of Medicine, Namur University, Namur, Belgium.
Patricia Lima RodriguesInstituto de Puericultura e Pediatria Martagão Gesteira, Divisão de Nutrição, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Stephen J RogersonDepartment of Infectious Diseases, University of Melbourne, Doherty Institute, Melbourne, VIC, Australia.
Patricia Hc RondóSchool of Public Health, University of Sao Paulo, Sao Paulo, Brazil.
Daniel E RothDepartment of Pediatrics and the Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.
Reyna SámanoNutrition and Bioprogramming Coordination, Instituto Nacional de Perinatología (Mexico City), Mexico City, Mexico.
Naomi M SavilleUniversity College London Institute for Global Health, London, UK.
Maria Inês SchmidtUniversidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Katherine Ea SemrauHarvard Medical School, Boston, Massachusetts, USA.
Yasir ShafiqHarvard T H Chan School of Public Health, Boston, Massachusetts, USA.
Saijuddin ShaikhJiVitA Project, Rangpur, Bangladesh.
Bhim P ShresthaHealth Research & Develop Forum (HRDF), Kathmandu, Nepal.
José Roberto Da SilvaInstituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil.
Hora SoltaniCollege of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK.
Sajid SoofiCentre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
Rodrigo Medeiros MartoranoMultidisciplinary Centre, Federal University of Acre, Cruzeiro do Sul, Brazil.
Renato Teixeira SouzaUniversity of Campinas, Campinas, Brazil.
Dan J SteinDepartment of Psychiatry and Mental Health and SA-MRC Unit on Risk and Resilience, University of Cape Town, Cape Town, South Africa.
Jeffrey Sa StringerDepartment of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Christopher R SudfeldDepartment of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
Sunita TanejaCentre for Health Research and Development, Society for Applied Studies, New Delhi, India.
Fahimeh Ramezani TehraniReproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Tinku ThomasDepartment of Biostatistics, St John's Medical College, Bangalore, India.
James M TielschDepartment of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Laéticia Céline ToeDepartment of Food Technology, Safety and Health, Ghent University, Gent, Belgium.
Holger W UngerGlobal and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.
Willy UrassaDepartment of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Juliana Dos Santos VazFaculty of Nutrition, Universidade Federal de Pelotas, Pelotas, Brazil.
Audêncio VictorSchool of Public Health, University of Sao Paulo, Sao Paulo, Brazil.
Emily L WebbLondon School of Hygiene and Tropical Medicine, London, UK.
Keith P WestDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Elizabeth WidenSchool of Human Ecology, University of Texas at Austin, Austin, TX, USA.
Lesley WorkmanDepartment of Paediatrics and Child Health and SA-MRC unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa.
Robert O WrightDepartment of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Lee Shu Fune WuDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Sera L YoungNorthwestern University, Evanston, IL, USA.
Heather ZarDepartment of Paediatrics and Child Health and SA-MRC unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa.
Lingxia ZengDepartment of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, People's Republic of China.
Wafaie W FawziDepartment of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
Funding
No grant is acknowledged in the PubMed record.
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, τ 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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EpidemiologyNutritional sciencesObstetricsPublic health
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