Factors associated with suboptimal gestational weight gain (GWG) among pregnant women in Selangor : a mixed method study

• Main Author: Shahrir, Nurul Farehah
• Format: Thesis
• Language: English
• Published: 2022
• Subjects: R Medicine
• Online Access: http://eprints.usm.my/53313/1/Nurul%20Farehah%20Shahrir-24%20PAGES..pdf; http://eprints.usm.my/53313/
• Institution: Universiti Sains Malaysia

Background: The increasing prevalence of suboptimal gestational weight gain (GWG) worldwide is a public health concern. It is well recognized that suboptimal GWG was associated with adverse foetal and maternal outcomes both in short and long terms. There is limited information available regarding modifiable risk factors contributing to suboptimal GWG. This study aims to determine the proportion, associated factors with GWG, and to explain the factors associated with suboptimal GWG among pregnant women attending antenatal care in Selangor. Materials and Methods: A mixed method study with sequential explanatory design was conducted between January 2020 and June 2021. The two-phase design started with a cross-sectional quantitative survey, followed by qualitative using phenomenology approach. The survey was conducted from January 2020 to March 2020, while the qualitative phase was followed consequently in August 2020 to June 2021. A multistage sampling was applied. There were 475 pregnant women in second or third trimester that fulfilled the inclusion and exclusion criteria, selected from 18 health clinics in Selangor. Multinomial logistic regression was used for analysis. The Phase two study used in-depth interview, exploring the factors influence suboptimal GWG based on the findings derived in the quantitative survey. Thematic analysis was used to identify recurring themes. The participants consisted of 20 purposively selected samples from the phase one study. Results: The proportion of inadequate, adequate and excessive GWG was 47.2% (95% CI; 45.7, 48.3), 29.9% (95% CI; 28.7.0, 31.3) and 22.9% (95% CI; 21.7, 24.3), respectively. Diabetes in pregnancy (AdjOR 2.24,95%CI:1.31, 3.83, p=0.003); middle (M40) monthly household income (AdjOR 2.33,95%CI:1.09, 4.96, p=0.029), low (B40) monthly household income (AdjOR 2.22,95%CI: 1.07, 4.72, p=0.039), and pre-pregnancy BMI obese (AdjOR 2.77,95%CI: 1.43, 5.35, p=0.002) were significantly associated with inadequate GWG. Pre-pregnancy BMI overweight (AdjOR 5.18, 95%CI: 2.52, 10.62, p<0.001) and obese (AdjOR 17.95, 95%CI: 8.13, 36.95, p <0.001) were significantly associated with excessive GWG. Through indepth- interview, pre-pregnancy overweight and obese influenced excessive GWG through continuation and exaggeration of an unhealthy pre-pregnancy lifestyle, compounded by belief and knowledge, social network pressure, health care provider interaction, and accessibility to foods and physical activity during pregnancy. Prepregnancy obesity and diabetes in pregnancy influenced inadequate GWG through diagnosis of diabetes as a wake-up call, emotional impact of the diagnosis, extreme dietary restriction-coping strategies, prioritisation of foetal health over maternal health, healthcare provider prioritisation of diabetic control over maternal nutritional status, and a long waiting period for dietitian appointments. Middle (M40) and low (B40) monthly household income influence inadequate GWG through multiple commitment, high living cost and limited disposable income for food; quitting work due to pregnancy and constrained household finance; and no saving, acute financial crisis, and household food insecurity with hunger. Conclusion: The identification of risk factors for suboptimal GWG enables the scale up the intervention programme focusing on high-risk group women to lower the risk of adverse maternal and foetal outcomes.