Late gestation weight gain and dietary habits as risk factors for hypertension in pregnancy at Naguru hospital

Abstract

Introduction: The prevalence of overweight and obesity in Ugandan women has been reported at 14.6 % and 4.2% respectively showing a heightened risk of excessive gestation weight gain (GWG). Excessive GWG increases the risk of hypertensive disorders of pregnancy (HDP). About 8% of women in Sub-Saharan Africa suffer from HDP. Appropriate diet in pregnancy reduces GWG which in turn can lower the risk of HDP. However, there is inadequate monitoring and management of weight gain during pregnancy in Uganda. This study sought to determine the risk of hypertension in pregnancy associated with excessive late GWG resulting from dietary habits among women attending Naguru hospital. Methods: A prospective cohort study was conducted on 524 systematically sampled pregnant women above 20 weeks of gestation from May to July 2019 attending Naguru hospital. Quantitative data was collected from interviews using pretested semi-structured questionnaire. Modified Poisson generalized linear model were used to determine the risk of hypertension in pregnancy associated with excessive late GWG resulting from dietary habits. The study also conducted an interpretative phenomenological design on 20 purposively sampled pregnant women attending Naguru hospital above 20 weeks of gestation in August 2019. In-depth interviews were conducted using pretested interview guide. Thematic analysis was used to analyse the qualitative data. This study was approved by Makerere University School of Medicine Research and Ethics Committee. Results: Good dietary habits were registered in 241 (46%) which was affirmed qualitatively by women with considerable intake of fruits and vegetables. Good dietary habits were protective against excessive change in pregnancy BMI (aIRR = 0.63, 95% CI: 0.44-0.90, p-value = 0.012) after adjusting for other covariates when compared to poor dietary habits. Excessive change in pregnancy BMI was a risk factor for hypertension in pregnancy (aIRR = 1.78, 95% CI: 1.04-3.04, p-value = 0.035) after adjusting for dietary habits when compared to optimal change in pregnancy BMI. Conclusion: The results in this study highlight that the risk of hypertension in pregnancy may be increased by excessive change in pregnancy BMI. Efforts to consistently monitor excessive change in pregnancy BMI can support healthcare providers to careful manage a plausible risk factor of hypertension in pregnancy. Ministry of health should consider updating the GWG guidelines to include targets on change in pregnancy BMI.