title: Maternal body mass index and risk of birth and maternal health outcomes in low- and middle-income countries: a systematic review and meta-analysis.
abstract: We conducted a systematic review and meta-analysis of population-based cohort studies of maternal body mass index (BMI) and risk of adverse birth and health outcomes in low- and middle-income countries. PubMed, Embase, CINAHL and the British Nursing Index were searched from inception to February 2014. Forty-two studies were included. Our study found that maternal underweight was significantly associated with higher risk of preterm birth (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01-1.27), low birthweight (OR, 1.66; 95% CI, 1.50-1.84) and small for gestational age (OR, 1.85; 95% CI, 1.69-2.02). Compared with mothers with normal BMI, overweight or obese mothers were at increased odds of gestational diabetes, pregnancy-induced hypertension, pre-eclampsia, caesarean delivery and post-partum haemorrhage. The population-attributable risk (PAR) indicated that if women were entirely unexposed to overweight or obesity during the pre-pregnancy or early pregnancy period, 14% to 35% fewer women would develop gestational diabetes, pre-eclampsia or pregnancy-induced hypertension in Brazil, China, India, Iran or Thailand. The highest PAR of low birthweight attributable to maternal underweight was found in Iran (20%), followed by India (18%), Thailand (10%) and China (8%). Treatment and prevention of maternal underweight, overweight or obesity may help reduce the burden on maternal and child health in developing countries.
authors.affiliation: Department of Global Health Policy, The University of Tokyo, Tokyo, Japan.|Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh.
authors.forename: M M
authors.initials: MM
authors.lastname: Rahman
authors.affiliation: Department of Global Health Policy, The University of Tokyo, Tokyo, Japan.
authors.forename: S K
authors.initials: SK
authors.lastname: Abe
authors.affiliation: Department of Global Health Policy, The University of Tokyo, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kanda
authors.affiliation: Department of Global Health Policy, The University of Tokyo, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Narita
authors.affiliation: Department of Global Health Policy, The University of Tokyo, Tokyo, Japan.
authors.forename: M S
authors.initials: MS
authors.lastname: Rahman
authors.affiliation: Department of Global Health Policy, The University of Tokyo, Tokyo, Japan.
authors.forename: V
authors.initials: V
authors.lastname: Bilano
authors.affiliation: Department of Health Policy, National Centre for Child Health and Development, Tokyo, Japan.
authors.forename: E
authors.initials: E
authors.lastname: Ota
authors.affiliation: Department of Global Health Policy, The University of Tokyo, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Gilmour
authors.affiliation: Department of Global Health Policy, The University of Tokyo, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Shibuya
mesh_terms: D000328:Adult; D015992:Body Mass Index; D001938:Brazil / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data*; D002681:China / Q000453:epidemiology; D016640:Diabetes, Gestational / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology / Q000209:etiology*; D007194:India / Q000453:epidemiology; D007231:Infant, Newborn; D007492:Iran / Q000453:epidemiology; D000068097:Maternal Health; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology; D013785:Thailand / Q000453:epidemiology; D013851:Thinness / Q000150:complications* / Q000453:epidemiology
keywords: Low- and middle-income countries; maternal BMI; population-attributable risk; pregnancy and health outcomes