MATERNAL BODY MASS INDEX IN EARLY PREGNANCY AND THE RISK OF ADVERSE PREGNANCY OUT COMES IN THE TAMALE METROPOLITAN AREA OF THE NORTHERN REGION

Abstract

Background: Adverse pregnancy outcomes are part of the leading causes of infant mortality in the world. LBW contributes 60% to 80% of all neonatal deaths in the developing countries. Sub Saharan Africa has made less progress than any other region in the globe in lowering newborn deaths. Body mass index (BMI) is a major determining factor of the outcome of pregnancy. The different groups of BMI have been found to have different effects on pregnancy outcomes. These groups are underweight, normal, overweight and obese. High maternal BMI has been linked to adverse pregnancy outcomes, especially in developed countries. The rising prevalence of obesity in developing countries such as Ghana have however shown that this could not be related only to the increase incidence of adverse pregnancy outcomes, but due also to other factors such as the double burden of diseases. The main aim of this study was to examine the influence of BMI in early pregnancy and the risk of Preterm birth (PTB) and Low Birth Weight (LBW) as key adverse pregnancy outcomes among women within the Tamale Metropolitan Area. Methodology: Data from 411 women who gave birth within the last 6–12 months in five (5) public healthcare facilities in the Tamale Metropolis were collected using a facility-based cross-sectional survey methodology. Two (2) health facilities were purposively selected and three (3) were randomly selected. Systematic random sampling was used to select participants from the health facilities, and structured questionnaire was used to collect data. The main exposure variable assessed was BMI status in early pregnancy, and the outcome variable was LBW (a birthweight of less than 2500g). Analysis were performed in SPSS version 21. Chi-squared tests was used to assess associations between variables and multivariate logistic regression test was used to examine the degree of association between variables while adjusting for confounders. Results: PTB prevalence was 19.5% (95% CI: 15.6-23.4) and LBW prevalence was 9.2% (95% CI: 6.6-12.4). Mothers who were not overweight or obese during the early stages of pregnancy had 2.8(AOR = 2.78, 95% Cl: 1.24 - 6.25, p = 0. 001) and 5.4(AOR = 5.40, 95% Cl: 2.67 - 10.91, p = 0. 001) fold higher odds of having LBW babies and PTB respectively. Lower than four ANC visits by mothers increased the likelihood of PTB and LBW birth by 2.6 (AOR = 5.06, 95% Cl: 2.36 – 10.87, p = 0.001) and 5(AOR = 2.62, 95% CI: 1.09 – 6.30, p = 0.03) times than those with more visits. In comparison to male babies, female babies had a 4.4 (AOR = 4.36, 95% CI: 2.08 – 9.15, p = 0.001) times higher likelihood of being born LBW. When compared to mothers aged 35 and above, mothers under the age of 25 had 3.2 (AOR=3.22, 95% CI: 1.30 - 8.04, p=0.012), and 14.5 (AOR=14.53, 95% Cl: 4.28 - 49.30, p =0.001) times higher the likelihood of having PTB and LBW newborns. Women with less education had a 3.9 (AOR 3.93, p = 0.03) times higher risk of PTB than those with at least Senior high school degree. Conclusion: Low prevalence of LBW and PTB is associated with high maternal BMI in early pregnancy. Low LBW and PTB are associated with high maternal age and more ANC visits. Low education, high gravidity and parity independently predicted PTB, and the female gender independently predicted LBW