Proceedings of the Peradeniya University Research Sessions, Sri Lanka, Vol.

12, Part I, 30thNovember 2007

Development of an Antenatal Growth Chart using Maternal BMI in the Second Half of Pregnancy for Sri-Lankan Mothers S.B.A. Dissanayake1*, U.B. Dissanayake1 and W.I. Amarasinghe2
1

Faculty of Dental Sciences, 2Faculty of Medicine, University of Peradeniya

Introduction Taller and heavier mothers have larger babies than smaller and thinner mothers. This relationship of birth weight to maternal size was observed by Thomson et al., in 1968. Investigators in the past considered maternal body weight as an important indicator of nutritional status of the mother. Upper (UK85Kg, USA-66Kg) and lower limits (UK45Kg, USA-48Kg) for underweight and overweight pregnant women have also been defined for Western countries.(Abrams and Laros, 1986; Brown et al., 1990; Allen, 1994, Doyle et al., 1990; Gardorsi et al., 1992). However, no reference values have been established for the Sri-Lankan mothers (Dissanayake et al., 2001). Despite the fact the weighing mothers has become a routine practice in antenatal care, surprisingly little is known about the effectiveness of weighing as a screening procedure for predicting maternal and foetal outcomes. Maternal weight and height are influenced by environmental (nutrition) and genetic factors. Perhaps the most appropriate approach in assessing nutritional status of the mother would be to use an index that minimizes the effect of height on weight. Maternal BMI satisfies this need and it has been widely used in the west and is recommended for assessing antenatal nutritional status. The aim of the present study is to define the mean BMI values for different gestational ages and to develop an Antenatal Percentile Chart for maternal BMI in the second half of the pregnancy to be used in antenatal care. Method A total of 316 mothers were randomly selected from those who completed their confinement at the Teaching Hospital, Peradeniya over a period of two years. After excluding 82 mothers with various pregnancy complications, 234 were available for the present study. The age range of the mothers varied from 17 to 41 years and the mean was 28 5 years. The weight and height data of the mothers in 122

different stages of pregnancy were extracted from the antenatal records and the data were converted to BMI using the formula given below: BMI = Weight in kilograms / Height in meters2 The mean, 10th and 90th percentile values for the maternal BMI in different stages of pregnancy were calculated using SPSS. The 10th percentile of the second half of the pregnancy was estimated as the cut off point for defining nutritionally compromised mothers. The 90th percentile sample was chosen as the cut off point for overweight mothers. (Tenth and 90th percentiles are generally utilized as cut off points in Growth Charts). Using the calculated percentile data a Percentile Chart was developed for the second half of pregnancy. The relationship of maternal BMI at the time of delivery to birth weight was assessed by using a scatter diagram. Results The mean BMI, 10th and 90th percentiles in the second half of pregnancy were 23.76 3.48, 20.09 and 28.88 respectively. The scatter diagram did not display a linear relationship of birth weight to maternal BMI at the time of delivery. There was linear increase of mean birth weight from maternal BMI 20 to 27 but it tended to plateau thereafter from 28 to 33. Discussion The absence of uniformity in the definition for upper and lower limits of antenatal maternal weight, the wide variation of weight during pregnancy and the influence of height on weight were the reasons for using maternal BMI in the present analysis. The cut off point defined at 10th percentile for BMI was 20.09. The cut of point for 90th percentile was 28.88. These values approximate the BMI values (21, 30) reported for Western countries (Naeye, 1990). The approximation of BMI values in the two different population groups which vary in stature indicates that the influence of height on

Proceedings of the Peradeniya University Research Sessions, Sri Lanka, Vol.12, Part I, 30thNovember 2007

weight has been negated to a considerable degree. As such, BMI could be a valuable index in comparing maternal nutritional status of different population groups. However, further studies with larger sample size including different population groups are needed to confirm the findings in the present study.
Percentile Chart for Maternal BMI
32 31 30 29 28 27 26 25

findings are consistent with internationally reported studies. The Percentile Chart developed (Chart 1) in the present study could be utilized as a clinical tool. References Abrams, B.F. and Laros, R.K. (1986) Pregnancy weight, weight gain and birth weight, Amer J of Obstect and Gynae, 15, 503-509. Allen, A.H. (1994) Recent developments in maternal nutrition and their implication for practitioners, American J Clinical Nutrition, 59(2) suppli, 439-541. Brown, J.E., Abrams, B.F. and Lederman, S.A. (1990) Report of a special panel on desired Prenatal weight gain for underweight and normal weight women, Public Health Reports, 105, 24-28. Dissanayke, S.B.A., Amarasinghe, W.I. and Ratnatunge, N. (2001) Maternal parameters associated with birth weight and placental weight in Sri-Lankan mothers, Annual Research Sessions, University of Peradeniya, 6, 56. Doyle, W., Crawford, M.A., Wynn, A.H.A. and Wynn, S.W. (1990) The association between maternal diet and birth dimensions, J Nutritional Medicine, 1, 917, Gardorsi, J., Chang, A., Kalyan, B., Sahota, D. and Symmonds, E.N. (1992) Customized antenatal growth charts, Lancet, 339,283287. Naeye, R.L. (1990) Maternal body weight and pregnancy outcome, American Journal of Clinical Nutrition, 52, 273-279. Thomson, A.M., Billewitz, W.Z. and Hytten, F.E. (1968) The assessment of foetal growth, J.Obstect Gynae Brit Cwlth, 75, 903-916.

BMI

24 23 22 21 20 19 18 17 16
20 wks 21 wks 22 wks 23 wks 24 wks 25 wks 26 wks 27 wks 28 wks 29 wks 30 wks 31 wks 32 wks 33 wks 34 wks 35 wks 36 wks 37 wks 38 wks 39 wks 40 wks 41 wks 42 wks

Series2 18.49 17.96 18.1 18.42 18.54 18.64 19.01 18.4 18.34 18.79 19.29 20.01 19.49 19.09 19.91 20.28 20.04 19.74 20.92 20.24 20.82 20.72 21.38 22 22.16 22.07 22.95 23.11 22.45 23.16 22.51 23.03 23.53 24.14 24.25 24.71 25.05 23.87 Series3 20.47 21.46 20.69 21.48 21.48 21.86 22.06 22 27 27.34 27.22 27.48 27.52 28.7 28.1 27.89 28.73 28.84 29.5 29.29 29.97 29.43 30.62 30.46 Series4 24.78 25.58 24.92 26.06 25.66 26.31 26.5

Gestation in Weeks

Chart 1. Percentile Chart for Maternal BMI from 20 to 42 weeks of gestation

Chart 2. Relationship of Birth Weight to Maternal BMI Conclusions The cut off points defined for 10th and 90th percentile were 20 and 29 respectively. These

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