A baseline study on diet, physical activity, mental health, and related socio-cultural factors associated with gestational weight gain and pregnancy complications among a cohort of pregnant women in Kathmandu, Nepal

Abstract

Introduction: Pregnancy is a critical period for both maternal and child health, as it involves physiological, psychological and behavioral changes that can affect the well-being of the mother and the offspring. Diet, physical activity (PA), overweight and mental health are important factors that influence pregnancy outcomes, such as gestational weight gain and the risk of gestational diabetes or gestational hypertension. However, there is limited evidence on the patterns and determinants of these factors and their associations with pregnancy outcomes among women in low- and middle-income countries (LMICs), where the burden of maternal and child morbidity and mortality is high. Nepal is one such country, where maternal undernutrition, micronutrient deficiencies, anemia, obesity, and mental health problems are prevalent among pregnant women. Moreover, urbanization, globalization, and socio-cultural factors may have an impact on the dietary and PA behaviors of Nepalese women during pregnancy. There is an increasing trend of overweight and obesity globally and women are more affected than man (WHO 2018). Similar trend has now been seen in low- and middle-income countries, particularly in urban setting. With this increasing trend, the risks related to pregnancy and childbirth increase1,2 Therefore, there is a need to conduct a comprehensive study that examines these factors and their relationships with pregnancy outcomes in urban Nepal. This is a baseline study of a cohort design. The aim of this study was to examine diet, PA, overweight and mental health, among a cohort of 500 pregnant women in urban Kathmandu, Nepal. This study used a quantitative approach for data collection and analysis. The study had three main objectives: (1) to assess food intake, energy and nutrient intakes; sedentary time, time spent at different intensity levels and PA habits; and (2) symptoms of depression and anxiety in early pregnancy; (2) to explore the sociodemographic factors of pregnant women regarding diet, PA, and mental health during pregnancy. The study employed various tools to measure these factors, such as Axivity AX3 devices for objective PA assessment, 24-hour recalls for dietary assessment, Beck anxiety inventory (BAI) and Edinburg postnatal depression scale (EPDS) for mental health assessment, and maternity cards for weight gain and pregnancy outcome data. The quantitative data were analyzed through descriptive and multivariate analysis using SPSS. The study provides information that is necessary for promoting healthy diet and PA, mental health, and prevention of overweight among Nepalese women as well as the development of maternity care in Nepal. The study also contribute to the existing literature on maternal nutrition, PA, overweight and mental health in LMICs. The findings of the study will have implications for policy makers, health professionals, researchers, and stakeholders who are involved in maternal and child health programs in Nepal. The study will also identify gaps and challenges that need to be addressed in future research and interventions on these issues. Methods: This is a baseline of a cohort study of 500 pregnant women in Kathmandu, Nepal. We collected data on diet, physical activity, mental health, and weight at baseline. We used accelerometers, questionnaires, 24-hour recalls, and maternity cards to measure the variables. We analyzed the data using SPSS. We examined how diet, physical activity, overweight and mental health affect weight gain and pregnancy complications. The quantitative research methods were applied for this study. Results: The mean age of the pregnant women was 27.6 years and most of them were obese according to Asian-specific BMI classification. The majority of the pregnant women belonged to Brahmin and Chhetri ethnic groups, Hinduism, were married or cohabiting, had a nuclear family type, and had one or zero children. Most of the pregnant women and their husbands had completed higher secondary education, but more husbands had a bachelor's or higher degree. Most of the working pregnant women had an occupation in the service sector. The majority of the pregnant women and their families had a low yearly income, less than 100,000. Many of the pregnant women’s families had a history of hypertension and diabetes, but the pregnant women themselves had few chronic diseases. Mental health problems were rare among both groups. Very few pregnant women consumed tobacco or alcohol during pregnancy. The majority of the pregnant women had minimal anxiety and depression during pregnancy, as measured by the BAI and EPDS questionnaires. There was a significant association between ethnicity and BMI, but not with education level, income, anxiety, or depression. Most of the pregnant women did not add salt to food frequently, were not vegetarian, used nutrition supplements, used sunflower oil, and cooked by themselves. Conclusion: The study population of pregnant women in urban Kathmandu, Nepal, had a high prevalence of obesity, low income, and a family history of hypertension and diabetes. The study population also had a high level of education, especially among husbands, and a low level of tobacco and alcohol consumption during pregnancy. The study findings suggest that there is a need for interventions to promote healthy weight management, dietary quality, and physical activity among pregnant women in Nepal, as well as to prevent and manage chronic diseases and their complications. The study population of pregnant women in urban Kathmandu, Nepal, had a low prevalence of anxiety and depression during pregnancy, but a high prevalence of obesity, especially among certain ethnic groups. The study population also had a low intake of salt, a high intake of animal products, a high use of nutrition supplements, and a preference for sunflower oil and self-cooking. The study findings suggest that there is a need for interventions to promote mental health awareness, dietary diversity, and healthy cooking practices among pregnant women in Nepal, as well as to address the ethnic disparities in obesity and its consequences.