Shahrir, Nurul Farehah
(2022)
Factors associated with suboptimal gestational weight gain (GWG) among pregnant women in Selangor : a mixed method study.
PhD thesis, Universiti Sains Malaysia.
Abstract
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.
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