Gestational weight gain in sub-Saharan Africa: Estimation based on pseudo-cohort design

Background: Inadequate or excess gestational weight gain (GWG) leads to multiple undesirable birth outcomes. Yet, in sub-Saharan Africa (SSA) little is known about the weight gain pattern in pregnancy. The purpose of the study is to estimate the average gestational weight gain (GWG) in sub-Saharan Africa (SSA) and to examined whether there had been recent improvements or not. Methods: Based on cross-sectional anthropometric data extracted from multiple Demographic and Health Surveys conducted in SSA, we estimated the average GWG in the region. Pseudo-cohort design was used to reconstruct GWG trajectories based on aggregated data of 110,482 women extracted from 30 recent surveys. Trend in GWG between 2000 and 2015 was determined using the data of 11 SSA countries. Pre-pregnancy weight was estimated based on the weight of non-pregnant women at risk of conception. Results: On average, women in SSA gain inadequate weight (6.6 kg, 95% confidence interval, 6.0–7.2) over pregnancy. No meaningful gain was observed in the first trimester; whereas, women in the second and third trimesters put on 2.2 and 3.2 kg, respectively. The highest weight gain (10.5, 8.2–12.9 kg) was observed in Southern African sub-region and the lowest in Western Africa (5.8, 5.0–6.6 kg). The GWG among women who had secondary or above education (9.5, 8.2–10.9 kg) was higher than women with lower education (5.0, 4.3–5.8 kg). Likewise, GWG in women from richest households (9.0, 7.2–10.7 kg) was superior to those from poorest households (6.1, 5.3–7.0 kg). The estimated recent (2015–20) mean GWG (6.6, 5.8–7.4 kg) was not significantly different from what had been at beginning of the new millennium (6.7, 5.9–7.5 kg). Conclusion: In SSA GWG is extremely low and is not showing improvements.