Body mass index and gestational weight gain in migrant women by birth regions compared with Swedish-born women: A registry linkage study of 0.5 million pregnancies

• Published in: PloS one 2020-10, Vol.15 (10), p.e0241319-e0241319
• Main Authors: Henriksson, Pontus, Sandborg, Johanna, Blomberg, Marie, Nowicka, Paulina, Petersson, Kerstin, Bendtsen, Marcus, Rosell, Magdalena, Löf, Marie
• Format: Article
• Language: English
• Subjects: Adult; Birth; Body mass; Body Mass Index; Body size; Body weight; Body weight gain; Childbirth & labor; Country of birth; Demographic aspects; Educational attainment; Female; Food, Nutrition and Dietetics; Gestational age; Gestational Weight Gain; Gynecology; Health aspects; health inequalities; Humans; Kostvetenskap; Maternal & child health; Maternal child nursing; Medicine; migration; Nutrition; Obesity; Obesity - epidemiology; Obesity - ethnology; Obesity - physiopathology; Obstetrics; Overweight; Population; Population studies; Pregnancy; Pregnancy Complications - epidemiology; Pregnancy Complications - ethnology; Pregnancy Complications - physiopathology; Pregnant women; Prenatal care; Public health; Regions; Registries; self-perceived health; self-rated health; self-reported health; Sweden - epidemiology; Sweden - ethnology; Thinness - epidemiology; Thinness - ethnology; Thinness - physiopathology; Transients and Migrants; Underweight; Weight gain; Women immigrants; Womens health
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0241319

Women migrating to high-income countries may have increased risks of adverse pregnancy outcomes as compared with native-born women. However, little is known whether migrant women are more likely to have unhealthy body mass index (BMI) or gestational weight gain (GWG), which is of importance considering the well-established links between unhealthy BMI and GWG with adverse pregnancy outcomes. Hence, the aim of the study was to examine the prevalence and estimate odds ratios (ORs) of underweight and obesity in the first trimester as well as inadequate and excessive GWG across birth regions in migrant (first-generation) and Swedish-born women in a population-based sample of pregnant women in Sweden. This population-based study included 535 609 pregnancies from the Swedish Pregnancy Register between the years 2010-2018. This register has a coverage of approximately 90% and includes data on body weight, height, birth country and educational attainment. BMI in the first trimester of pregnancy was classified as underweight, normal weight, overweight and obesity whereas GWG was classified as inadequate, adequate and excessive according to the recommendations from the National Academy of Medicine, USA. BMI and GWG were examined according to 7 birth regions and the 100 individual birth countries. Adjusted ORs of underweight, obesity as well as inadequate or excessive GWG by birth regions were estimated using multinomial logistic regression. There were large disparities in unhealthy BMI and GWG across birth regions. For instance, women born in North Africa and Middle East and Sub-Saharan Africa had 1.40 (95% CI 1.35-1.44) and 2.13 (95% CI 2.03-2.23) higher odds of obesity compared with women born in Sweden. However, women born in Sub-Saharan Africa had also considerably higher odds of underweight (OR, 2.93 [95% CI 2.70-3.18]) and inadequate GWG (OR, 1.97 [95% CI 1.87-2.07]). The limitations of the study include the lack of a validated measure of acculturation and that the study only had data on first-generation migration. The large differences across the 7 regions and 100 countries highlights the importance of considering birth region and country-specific risks of unhealthy BMI and GWG in first-generation migrant women. Furthermore, inadequate GWG was common among pregnant first-generation migrant women, especially in women born in Sub-Saharan Africa, which demonstrates the need to promote adequate GWG, not only the avoidance of excessive GWG. Thus, our findings also