January 12, 2024 | Erin Bluvas, bluvase@sc.edu
Just one semester into her first faculty appointment, Nandita Perumal is already stepping up as a thought leader in gestational weight gain – particularly in a global context. The epidemiology assistant professor recently published a key paper on the topic in the British Medical Journal (BMJ) and joined the World Health Organization’s Technical Advisory Group on Gestational Weight Gain.
Her expertise in these areas stems from a project she led during her time as a postdoctoral fellow in global perinatal epidemiology and nutrition at the Harvard T.H. Chan School of Public Health. Perumal had already been awarded multiple grants from the Canadian Institutes of Health Research during her master’s and doctoral programs at the University of Toronto, where she developed a passion for addressing global health inequities related to perinatal and pediatric health.
Perumal's subsequent work at Harvard – which put her name on the short list of experts in the field – looked at the relationship between gestational weight gain and birth outcomes in low- and middle-income countries. In this BMJ paper, the authors’ meta-analysis of more than 100,000 pregnancies revealed that suboptimal weight gains were more likely to result in adverse neonatal outcomes.
The project looked at more than 53 completed studies in 24 different countries. The researchers found that 55 percent of participants had severely or moderately inadequate gestational weight gain, putting their infants at risk for low birthweight, small/short for gestational age and microcephaly.
Participants who were categorized into the excessive gestational weight gain category (23 percent) faced a higher risk of preterm birth, large for gestational age and macrosomia. Only 12 percent of women in the studies gained the recommended amount of weight during pregnancy. Further, pre-pregnancy BMI influenced outcomes across all groups.
“Optimal maternal nutrition during pregnancy is essential for supporting fetal growth and newborn health, and gestational weight gain is an important measure of maternal nutritional status during pregnancy,” Perumal says. “Our study found that inadequate and excessive gestational weight gain are associated with a higher risk of adverse neonatal outcomes across settings, and we need additional research and interventions to better understand and support optimal weight gain during pregnancy.”
This work caught the attention of the World Health Organization, and they invited Perumal to join their brand-new Technical Advisory Group on Gestational Weight Gain to advise on the development of global gestational weight gain standards. The elite group includes obstetricians, nutrition and public health researchers, epidemiologists and other specialists from around the world (find the report from their first meeting here).
In alignment with conclusions from Perumal’s study, WHO’s antenatal guidelines recommend
that all pregnant women receive counseling about nutrition, healthy diet and physical
activity as well as weight monitoring at antenatal visits. The resulting data will
allow clinicians and researchers to track progress toward improving nutritional status
and inform/measure the impact of public health interventions and policies.
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