Impact of Body Mass Index (BMI) and Gestational Weight Gain on Term Pregnancy Outcome in Rwanda

BACKGROUND: There is limited data on the consequences of obesity and gestational weight gain on pregnancy outcomes in developing countries. This study aimed at evaluating BMI and gestational weight gain in Rwanda and their effects on pregnancy outcomes.
METHODS: Prospective cross-sectional study of women with a singleton gestation who entered antenatal care in the 1st trimester and delivered at term. Only patients with accurate gestational age assignments were included. All participants were admitted to 1 of 3 maternity units in Kigali, Rwanda from June to December 2016 and were weighed at the entry to care and at the time of delivery to calculate gestational weight gain.
RESULTS: Of the 1000 participants, 3.1% were underweight, 64.1% had a normal BMI, 26.1% were overweight and 6.7% were obese. Most women (68%) had less weight gain than recommended. Overweight and obese women were at increased risk of hypertension (p<0.0001). Obese women were at increased risk of cesarean section (p<0.0001). Excessive weight gain increased the risk of hypertensive disorders and cesarean section (p<0.0001). Large for gestational age infants were more common in overweight and obese women (OR=3.3, p=0.008 vs OR= 5.3, p=0.007). Underweight women had a 3.5-fold increased risk of low birth weight (p=0.05) and insufficient weight gain significantly increased the risk for a small for gestational age infant (OR=2.5, p<0.0001).
CONCLUSIONS: BMI and gestational weight gain have significant impacts on the term pregnancy outcome in Rwanda. The findings of this study highlight the need for nutritional education and support to improve pregnancy outcomes.