THE EFFECTS OF GESTATIONAL WEIGHT GAIN ON THE OUTCOME OF DELIVERY AT THE CENTRAL MATERNITY OF THE YAOUNDE CENTRAL HOSPITAL.

Background: Obesity rates are increasing in Cameroon and pregnant women constitute an important subpopulation with elevated risk of obesity due to excess weight gain during pregnancy. Obstetric literature has recently focused on the rising incidence of complications with increases in weight gain in pregnancy. The increased background risks of gestational diabetes, and preeclampsia associated with weight gain also elevate the estimated risks of delivery complications and cesarean delivery; therefore, examining the effects of excess weight gain among pregnant women could help identify weight gain limits during pregnancy. Because of these, the Institute of Medicine (IOM) was recommended by the World Health organization (WHO) to develop guidelines for weight gain during pregnancy and we carried out this study in order to evaluate delivery outcomes when weight is gained above these guidelines and to know if these guidelines are applicable in our environment. Methods: We determined maternal and neonatal delivery outcomes based on gestational weight gain in women who delivered at the Central Maternity of the Yaounde Central Hospital. The study was a cross sectional analytic study which involved 220 women with singleton term pregnancies, who came to deliver during the period from 1st March 2012 to 1st march 2013. After explaining the study to these women and obtaining a written consent, they were grouped into two groups, normal (110 women) and excess (110 women) weight gain groups, with respect to their prepregnancy BMI. The normal group was defined as; women with BMI 30kg/m² gained 5-9kg. Those who gained weight above these ranges were the abnormal group or exposed group. These women were equally followed up during labor and delivery and the outcomes of delivery were recorded in a predesigned and pretested questionnaire. We then calculated odds ratios (ORs) and 95% confidence intervals and compared them in the two groups. Results: Our study showed that, 47.3% of the women were overweight or obese before pregnancy, 41.6% had normal BMI. Primiparity was strongly associated to excess weight gain (OR 3.0, 95%CI 1.7-5.2, P=0.0002), while multiparity was protective against excess weight gain (OR 0.3, 95%CI 0.1-0.5, P=0.0002). Underweight (BMI <18.5), was strongly associated to excessive weight gain (OR 2.5, 95%CI 1-6 and P=0.048) while obese women were found more in the normal weight group (OR 0.3, 95%CI 0.1-0.7, P=0.004). Women who gained weight above the recommended range suffered from preeclampsia 18.2% vs. 6.4%in the normal group ( OR 3.2, 95%CI 1.3-8.0, p=0.014), cesarean section 27.3% vs.10% OR 3.3, 95%CI 1.5-7.1, p=0.002), induced labour 19.1% vs. 9.0% (OR 2.4, 95%CI 1.0-5.2, p=0.05), prolonged labor 43.6%vs. 16.4% (OR 4.0, 95%CI 2.1-7.4, p=0.000), postpartum hemorrhage 10% vs. 1.8% (OR 6.2, 95%CI 1.3-9.2, p=0.002), malpresentation 11.8% vs. 3.6% (OR 4.0, 95%CI 1.31-11.9, p=0.004), macrosomia 30.9% vs. 6.4% (OR 7.0, 95%CI 2.7-15.6, p<0.0001), large for age babies 32.7% vs.15. 5% (OR 2.6, 95%CI 1.3-5.1, p=0.0045) and birth trauma 10% vs. 1.8%. (OR6.2, 95%CI 1.3-9.2, p=0.023). Conclusion: Almost half of the women were overweight or obese before pregnancy. Close to half had normal BMI. Weight gain decreased with increase in Body Mass Index. Primiparous women gained weight above the recommended guidelines while multiparous women gained weight within guidelines. Women whose weight gain during pregnancy was out of the recommended ranges had an increased risk of adverse obstetric and neonatal outcome. This also suggests that the Institute of Medicine weight gain guidelines can be applicable to our population. Recommendations We would like to recommend to: Antenatal care attendants, to include counseling on weight gain during pregnancy in their health education package. Pregnant women, to make every effort to attain a normal BMI before getting pregnant and gain the appropriate weight of 11.5 to 16kg. Faculty of medicine/Researchers, to carry out prospective cohort studies to better show the relationship between the exposure and outcome.