Maternal undernutrition and excessive body weight and risk of birth and health outcomes.
BACKGROUND
Overweight and obesity are increasing in low- and middle-income countries, while underweight remains a significant health problems. However, the association between double burden of nutrition and risk of adverse birth and health outcomes is still unclear in Bangladesh. The aim of this study was to determine the effect of maternal undernutrition and excessive body weight on a range of maternal and child health outcomes.


METHODS
In this study, we used Bangladesh Demographic and Health Survey (BDHS) 2011 and 2014 data sets to cover the maternal, child and non-communicable diseases related health outcomes. The study considered a range of outcome variables including pregnancy complication, cesarean delivery, diabetes, hypertension, stunting, and wasting, low birth weight, genital discharge, genital sore/ulcer, stillbirth, early neonatal mortality, perinatal mortality, preterm birth and prolonged labor. The key exposure variable was maternal body mass index. Multilevel regression analysis was performed to examine the association between outcomes and exposure variables.


RESULTS
Maternal overweight and obesity has increased from 10% in 2004 to 24% in 2014, a 240% increase in 10 years. Between 2004 and 2014, maternal undernutrition declined from 33% to 18%, a reduction rate of only 54% in 10 years. Compared to normal-weight women, overweight and obese women were more likely to have experienced pregnancy complication, cesarean delivery, diabetes, and hypertension. Underweight women were 1.3 times more likely to have children with stunting and 1.6 times more likely to experience wasting compared to normal weight women. Maternal BMI was not significantly associated with increased risk of genital sore or ulcer, genital discharge, menstrual irregularities, or low birth weight though in certain cases risk was higher.


CONCLUSIONS
High maternal overweight and obesity were observed to have significant adverse effects on health outcomes, while underweight was a risk factor for newborn health. The findings show that weight management is necessary to prevent adverse birth and health outcomes in Bangladesh.


BACKGROUND
Data related to health was collected by following the guidelines of ICF international and Bangladesh Medical Research Council. The registration number of data collection is 132989.0.000 and the data-request was registered on March 11, 2015.
Department of Population Science and Human Resource Development, University of Rajshahi, 6205 Rajshahi, Bangladesh.
Md Nuruzzaman
MN
Khan
Department of Population Science and Human Resource Development, University of Rajshahi, 6205 Rajshahi, Bangladesh.|Department of Global Health Policy, University of Tokyo, Tokyo, Japan.
Md Mizanur
MM
Rahman
Centre for Foundation Studies in Science, University of Malaya, Malaya, Malaysia.
Asma Ahmad
AA
Shariff
Department of Population Science and Human Resource Development, University of Rajshahi, 6205 Rajshahi, Bangladesh.
Md Mostafizur
MM
Rahman
Department of Global Health Policy, University of Tokyo, Tokyo, Japan.
Md Shafiur
MS
Rahman
Department of Population Science and Human Resource Development, University of Rajshahi, 6205 Rajshahi, Bangladesh.
Md Aminur
MA
Rahman
Bangladesh; Birth and health outcome; Dual nutritional burden; Maternal BMI