TABLE 1.
Research on prevalence, determinants, and consequences of maternal thinness and severe thinness in the last decade (2010–2019) in India
| Study | Author | Year published | Location | Design | Sampling and sample size | Duration | Outcomes |
|---|---|---|---|---|---|---|---|
| 1. | Mukherjee et al. 3 | 2019 | ICDS centers, 3 districts of West Bengal | Community‐based intervention study | 182 pregnant women (first trimester) | 10 months (April 2018–February 2019) | Prevalence (from both groups): 30.3% severely thin (BMI <16) or thin (18.49), 49% anemic |
| Determinants: Not investigated | |||||||
| Consequences: Prevalence of LBW was highest among severely thin and overweight/obese mothers, at 22% and 20% respectively, followed by thin and normal BMI at 15% and 18%, respectively | |||||||
| 2. | Patel et al. 4 | 2018 | Four districts of eastern Maharashtra (Bhandara, Chandrapur, Nagpur, Wardha). Site for NIH's global network for maternal and newborn registry | Prospective observational cohort study | 72 750 women (first trimester pregnant or within 42 days postpartum), actively identified in neighboring areas of primary health centers in 20 study clusters | 7.5 years (June 2009–December 2016) | Prevalence: 35.5% thin or severely thin (BMI <18.5), 91% anemic, 32.8% both underweight and anemic |
| Determinants: Not investigated | |||||||
| Consequences: Maternal deaths: 29 (19 only anemia, 8 both anemia and thin, 1 underweight, and 2 obese). Stillbirths 24 vs 21 per 1000 births, neonatal deaths 21.9 vs 18.3, and LBW 19.9 vs 15.6 (underweight vs normal). LBW significantly higher among thin women (RR 1.21 (1.16–1.25)). Risks for still births 1.47 (RR 1.17–1.85), neonatal deaths (RR 1.74 (1.33–2.26)), and LBW (RR 1.49 (1.37–1.62)) highest among those both anemic and thin | |||||||
| 3. | Short et al. 5 | 2018 | Nagpur and Belagavi, India; Thatta, Pakistan (sites for Maternal Newborn Health Registry, Global network. Also includes sites in Africa and Guatemala) | Prospective observational study | 41 778 of which 30 342 were from India (pregnant women, study clusters constituting areas near government health centers undertaking 300–500 deliveries annually) | 2009 onward (analysis restricted to entries from January 2013 to June 2016, weight recorded at <12 weeks of gestation) | Prevalence: 41% severely thin or thin (<18.5) (India sample) |
| Determinants: Individual variables (age, parity) varied by BMI status, but no difference in education, number of antenatal care checkups, and place of delivery | |||||||
| Consequences: Maternal complications were least prevalent among thin mothers. Adverse maternal outcome: 27.2% underweight mothers vs 47.2% overweight (BMI 25–29) and 56.0% obese (BMI ≥30) | |||||||
| 4. | UNICEF, India 6 | 2017 |
Two states: Andhra Pradesh and Telangana Andhra Pradesh: four districts (Kadapa, Krishna, West Godavari, and Vishakhapatnam) across five ICDS projects (three rural and two tribal) Telangana: three districts of Karimnagar, Khammam, and Warangal covering five ICDS projects (three rural and two tribal) |
Community‐based cross‐sectional |
360 pregnant and lactating women (of infants aged 0–6 months) per state from 60 AWCs 57% pregnant women and 43% lactating MIS records: 520 beneficiaries from 60 AWCs per state per year |
Primary data collection: July 2016 and November 2016 Review of MIS (2014–2016) and April–August 2017 |
Prevalence: Thinness (MUAC <23 cm) 15%–22%; severe thinness (MUAC <21 cm) 4%–12% |
| Determinants: Not investigated | |||||||
| Consequences: Not investigated | |||||||
| 5. | Bhavadharini et al. 7 | 2017 | Three antenatal clinics and private maternity centers in Chennai | Secondary analysis of facility records | 2728 pregnant women (in the first trimester) | 3 years (January 2011–January 2014) | Prevalence: 5.6% (n = 154) severely thin or thin (BMI <18.5), 29% (n = 791) normal weight, 18.5% (n = 504) overweight, and the rest 46.9% (n = 1279) were obese |
| Determinants: Not investigated | |||||||
|
Consequences: Thin women gaining less weight than recommended were at higher odds of having LBW babies compared with normal and overweight gaining less weight (underweight OR 2.4; 95% CI, 0.72–8.1, P = 0.15; normal weight OR 1.5; 95% CI, 0.8–2.7, P = 0.2; overweight OR 0.7; 95% CI, 0.3–1.3, P = 0.2) Underweight women gaining more than recommended weight were at higher odds for having LBW babies compared with normal, overweight, and obese women (underweight OR 2.7; 95% CI, 0.2–3.21, P = 0.42; normal weight OR 1.4; 95% CI, 0.4–3.1, P = 0.5; overweight OR 0.6; 95% CI, 0.2–1.8, P = 0.3; obese OR 0.9; 95% CI, 0.6–1.5, P = 0.8) | |||||||
| 6. | Tellapragada et al. 9 | 2016 | Manipal (Kasturba Medical College) | Prospective observational cohort study | 790 (pregnant women, ≤24 weeks of gestation) | 3 years (May 2011–April 2014) | Prevalence: 25% severely thin or thin (BMI cut‐off ≤19.9) |
| Determinants: Not investigated | |||||||
| Consequences: Not investigated | |||||||
| 7. | Sebastian et al. 10 | 2015 | Labor room register, The Christian Medical College and Hospital, Vellore, Tamil Nadu | Prospective observational study | 36 674 babies and their mothers, rotational sampling (four quarters of 1 year from 1990 to 2010) | 15 years (1990–2010) (weight at delivery taken for calculating BMI) | Prevalence: Thinness (BMI <18.5) 2.51% and 1.41% prior to and after 2004 |
| Determinants: Not investigated for maternal underweight | |||||||
|
Consequences: Thin women were 1.71 (1.38–2.13) times at higher odds for having SGA babies compared with women who were of normal weight (P < 0.001) Anemic mothers had 1.29 (1.01–1.6) times higher odds. Incidence of SGA was 11.4% in 1996 and 8.4% in 2010 | |||||||
| 8. | Agarwal et al. 8 | 2016 | Antenatal clinics, Pt. J.N.M Medical College, Raipur, Chhattisgarh | Prospective, observational study | 1000 pregnant women (at/before 16 weeks of gestation) | 3 years (2011–2014) | Prevalence: 18% (514) severely thin or thin (≤19.9) |
| Determinants: Not investigated | |||||||
| Consequences: Anemia more common in thin women compared with obese (14.9% vs 9.5%, P = 0.008) | |||||||
| 9. | Jain et al. 11 | 2012 | Department of Obstetrics and Gynecology, SMS Medical College, Jaipur | Observational study | 300 pregnant women (nulliparous women with singleton term pregnancies who were in early labor) | 1 year and 3 months (June 2009–September 2010) | Prevalence: 10 (3.3%) were severely thin or thin (BMI ≤19.9), 193 (61%) had normal BMI, 71 (24%) were overweight, and 17 (6%) were obese |
| Determinants: Not investigated | |||||||
| Consequences: LBW more prevalent among thin women (80%) compared with women with BMI 20–25 (21.21%) (OR 0.32; 0.180–0.568) | |||||||
| 10. | Kumar et al. 12 | 2010 | Antenatal clinics, Maulana Azad Medical College, New Delhi | Prospective observational study | 2027 pregnant women (before 8 weeks of gestation) | 1 year (July 2005–July 2006) | Prevalence: 7.2% had very low BMI (<18.5), 9.7% had low BMI (18.5–19.8), 25.8% high BMI (>26), underweight (weight <40 kg) 2.6% |
| Determinants: Not investigated | |||||||
|
Consequences: LBW babies delivered: 35.4% with very low BMI and 33.7% with low BMI compared with 24% in normal BMI group (r = 28.1, P = 0.001). The risk of having LBW babies in the low BMI group was found to be 1.9 times that of normal BMI (OR 1.950; 95% CI, 1.108–3.431). 37.7% women with weight <40 kg delivered LBW babies compared with normal weight women 26.5% (n = 402/1514) (r = 25.4, P < 0.05) |
Abbreviations: AWC, Anganwadi Centre; BMI, body mass index (calculated as weight in kilograms divided by height in meters squared); ICDS, Integrated Child Development Service; LBW, low birthweight; MIS, Management Information System; MUAC, mid‐upper arm circumference; NIH, National Institute of Health; SGA, small for gestational age.