Skip to main content Accessibility help
×
Home

Nutrition in transition: historical cohort analysis summarising trends in under- and over-nutrition among pregnant women in a marginalised population along the Thailand–Myanmar border from 1986 to 2016

  • Ahmar H. Hashmi (a1) (a2), Nicola Solomon (a3), Sue J. Lee (a4) (a5), Aung Myat Min (a1), Mary Ellen Gilder (a1), Jacher Wiladphaingern (a1), Nay Win Tun (a1), Emma Plugge (a5), Kremlin Wickramasinghe (a6), Chaisiri Angkurawaranon (a2), Prakaykaew Charunwatthana (a4), François Nosten (a1) (a5), Verena I. Carrara (a1) (a7) and Rose McGready (a1) (a5)...

Abstract

The objective of the present study is to summarise trends in under- and over-nutrition in pregnant women on the Thailand–Myanmar border. Refugees contributed data from 1986 to 2016 and migrants from 1999 to 2016 for weight at first antenatal consultation. BMI and gestational weight gain (GWG) data were available during 2004–2016 when height was routinely measured. Risk factors for low and high BMI were analysed for <18·5 kg/m2 or ≥23 kg/m2, respectively. A total of 48 062 pregnancies over 30 years were available for weight analysis and 14 646 pregnancies over 13 years (2004–2016) had BMI measured in first trimester (<14 weeks’ gestational age). Mean weight at first antenatal consultation in any trimester increased over the 30-year period by 2·0 to 5·2 kg for all women. First trimester BMI has been increasing on average by 0·5 kg/m2 for refugees and 0·6 kg/m2 for migrants, every 5 years. The proportion of women with low BMI in the first trimester decreased from 16·7 to 12·7 % for refugees and 23·1 to 20·2 % for migrants, whereas high BMI increased markedly from 16·9 to 33·2 % for refugees and 12·3 to 28·4 % for migrants. Multivariate analysis demonstrated low BMI as positively associated with being Burman, Muslim, primigravid, having malaria during pregnancy and smoking, and negatively associated with refugee as opposed to migrant status. High BMI was positively associated with being Muslim and literate, and negatively associated with age, primigravida, malaria, anaemia and smoking. Mean GWG was 10·0 (sd 3·4), 9·5 (sd 3·6) and 8·3 (sd 4·3) kg, for low, normal and high WHO BMI categories for Asians, respectively.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Nutrition in transition: historical cohort analysis summarising trends in under- and over-nutrition among pregnant women in a marginalised population along the Thailand–Myanmar border from 1986 to 2016
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Nutrition in transition: historical cohort analysis summarising trends in under- and over-nutrition among pregnant women in a marginalised population along the Thailand–Myanmar border from 1986 to 2016
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Nutrition in transition: historical cohort analysis summarising trends in under- and over-nutrition among pregnant women in a marginalised population along the Thailand–Myanmar border from 1986 to 2016
      Available formats
      ×

Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

*Corresponding authors: Rose McGready, email rose@shoklo-unit.com; Ahmar H. Hashmi, email ahmar.hashmi715@gmail.com

Footnotes

Hide All

Shared first co-authors.

Footnotes

References

Hide All
1.Black, RE, Victora, CG, Walker, SP, et al. (2013) Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382, 427451.
2.Grantham-McGregor, S, Cheung, Y, Cueto, S, et al. (2007) Developmental potential in the first 5 years for children in developing countries. Lancet 369, 6070.
3.Victora, C, Adair, L, Fall, C, et al. (2008) Maternal and child undernutrition: consequences for adult health and human capital. Lancet 371, 340357.
4.Asia Pacific Cohort Studies Collaboration (2007) The burden of overweight and obesity in the Asia-Pacific region. Obes Rev 8, 191196.
5.Dans, A, Ng, N, Varghese, C, et al. (2011) The rise of chronic non-communicable diseases in southeast Asia: time for action. Lancet 377, 680689.
6.Popkin, BM (2006) Global nutrition dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases. Am J Clin Nutr 84, 289298.
7.Stevens, GA, Singh, GM, Lu, Y, et al. (2012) National, regional, and global trends in adult overweight and obesity prevalences. Popul Health Metr 10, 22.
8.World Health Organization Expert Consultation (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363, 157163.
9.Woodward, M, Huxley, R, Ueshima, H, et al. (2012) The Asia pacific cohort studies collaboration: a decade of achievements. Glob Heart 7, 343351.
10.Aune, D, Saugstad, OD, Henriksen, T, et al. (2014) Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis. JAMA 311, 15361546.
11.Ee, TX, Allen, JC Jr., Malhotra, R, et al. (2014) Determining optimal gestational weight gain in a multiethnic Asian population. J Obstet Gynaecol Res 40, 10021008.
12.Kiel, DW, Dodson, EA, Artal, R, et al. (2007) Gestational weight gain and pregnancy outcomes in obese women: how much is enough? Obstet Gynecol 110, 752758.
13.Liu, Y, Dai, W, Dai, X, et al. (2012) Prepregnancy body mass index and gestational weight gain with the outcome of pregnancy: a 13-year study of 292,568 cases in China. Arch Gynecol Obstet 286, 905911.
14.Nohr, EA, Vaeth, M, Baker, JL, et al. (2009) Pregnancy outcomes related to gestational weight gain in women defined by their body mass index, parity, height, and smoking status. Am J Clin Nutr 90, 12881294.
15.Ota, E, Haruna, M, Suzuki, M, et al. (2011) Maternal body mass index and gestational weight gain and their association with perinatal outcomes in Viet Nam. Bull World Health Organ 89, 127136.
16.Wells, J (2017) The new “obstetrical dilemma”: stunting, obesity and the risk of obstructed labour. Anat Rec (Hoboken) 300, 716731.
17.Hanson, M & Gluckman, P (2011) Developmental origins of noncommunicable disease: population and public health implications. Am J Clin Nutr 94, 1754S8S.
18.Aekplakorn, W (2014) Thai National Health Examination Survey, NHES V. Nontaburi: Health Systems Research Institute.
19.Kosulwat, V (2002) The nutrition and health transition in Thailand. Public Health Nutr 5, 183189.
20.Saito, M, Keereevijit, A, San, T, et al. (2018) Challenges to primary healthcare services in the management of non-communicable diseases in marginalised populations on the Thailand–Myanmar border: a pilot survey. Trop Doct 48, 273277.
21.Berkowitz, SA, Fabreau, GE, Raghavan, S, et al. (2016) Risk of developing diabetes among refugees and immigrants: a longitudinal analysis. J Community Health 41, 12741281.
22.Dawson-Hahn, E, Pak-Gorstein, S, Matheson, J, et al. (2016) Growth trajectories of refugee and nonrefugee children in the United States. Pediatrics 138, e20160953.
23.Huguet, JW & Chamratrithirong, A (2011) Thailand Migration Report 2011. Bangkok: International Organization for Migration.
24.The Burma Border Consortium (2007) Programme Report: July to December 2006 Including Revised Funding Appeal for 2007. Bangkok: The Burma Border Consortium.
25.The Border Consortium (2017) 2016 Annual Report. Bangkok: The Border Consortium.
26.Fellmeth, G, Plugge, E, Paw, MK, et al. (2015) Pregnant migrant and refugee women’s perceptions of mental illness on the Thai–Myanmar border: a qualitative study. BMC Pregnancy Childbirth 15, 93.
27.Gilder, ME, Zin, TW, Wai, NS, et al. (2014) Gestational diabetes mellitus prevalence in Maela refugee camp on the Thai–Myanmar border: a clinical report. Glob Health Action 7, 23887.
28.Luxemburger, C, McGready, R, Kham, A, et al. (2001) Effects of malaria during pregnancy on infant mortality in an area of low malaria transmission. Am J Epidemiol 154, 459465.
29.Carrara, VI, Hogan, C, Pree, CD, et al. (2011) Improved pregnancy outcome in refugees and migrants despite low literacy on the Thai–Burmese border: results of three cross-sectional surveys. BMC Pregnancy Childbirth 11, 45.
30.Boel, M, Carrara, V, Rijken, M, et al. (2010) Complex interactions between soil-transmitted helminths and malaria in pregnant women on the Thai-Burmese border. PLoS Negl Trop Dis 4, e887.
31.Mullany, L, Lee, C, Yone, L, et al. (2008) Access to essential maternal health interventions and human rights violations among vulnerable communities in Eastern Burma. PLoS Med 5, 16891690.
32.Parker, DM, Carrara, VI, Pukrittayakamee, S, et al. (2015) Malaria ecology along the Thailand–Myanmar border. Malar J 14, 388.
33.Amnesty International (2005) Thailand: The Plight of Burmese Migrant Workers. Bangkok: Amnesty International.
34.Carrara, VI, Lwin, KM, Phyo, AP, et al. (2013) Malaria burden and artemisinin resistance in the mobile and migrant population on the Thai–Myanmar border, 1999–2011: an observational study. PLoS Med 10, e1001398.
35.McGready, R, Boel, M, Rijken, M, et al. (2012) Effect of early detection and treatment on malaria related maternal mortality on the north-western border of Thailand 1986–2010. PLOS ONE 7, e40244.
36.Rijken, MJ, De Livera, AM, Lee, SJ, et al. (2014) Quantifying low birth weight, preterm birth and small-for-gestational-age effects of malaria in pregnancy: a population cohort study. PLOS ONE 9, e100247.
37.Rijken, MJ, Lee, SJ, Boel, ME, et al. (2009) Obstetric ultrasound scanning by local health workers in a refugee camp on the Thai–Burmese border. Ultrasound Obstet Gynecol 34, 395403.
38.Centers for Disease Control and Prevention (2007) National Health and Nutrition Examination Survey (NHANES): Anthropometry Procedures Manual. Atlanta: CDC.
39.Krukowski, RA, West, DS, DiCarlo, M, et al. (2016) Are early first trimester weights valid proxies for preconception weight? BMC Pregnancy Childbirth 16, 357.
40.Institute of Medicine (2009) Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: Institute of Medicine.
41.Dubowitz, L & Dubowitz, V (1977) Gestational Age of the Newborn: A Clinical Manual. ed. Reading: Addison-Wesley.
42.Moore, K, Simpson, J, Thomas, K, et al. (2015) Estimating gestational age in late presenters to antenatal care in a resource-limited setting on the Thai-Myanmar border. PLOS ONE 10, e0131025.
43.Razak, F, Corsi, DJ & Subramanian, SV (2013) Change in the body mass index distribution for women: analysis of surveys from 37 low- and middle-income countries. PLoS Med 10, e1001367.
44.Koh, H, Ee, TX, Malhotra, R, et al. (2013) Predictors and adverse outcomes of inadequate or excessive gestational weight gain in an Asian population. J Obstet Gynaecol Res 39, 905913.
45.Koyanagi, A, Zhang, J, Dagvadorj, A, et al. (2013) Macrosomia in 23 developing countries: an analysis of a multicountry, facility-based, cross-sectional survey. Lancet 381, 476483.
46.Gluckman, PD, Hanson, MA, Cooper, C, et al. (2008) Effect of in utero and early-life conditions on adult health and disease. N Engl J Med 359, 6173.
47.Hales, C & Barker, D (2013) Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis. Int J Epidemiol 42, 12151222.
48.Li, Y, Ley, S, Tobias, D, et al. (2015) Birth weight and later life adherence to unhealthy lifestyles in predicting type 2 diabetes: prospective cohort study. BMJ 351, h3672.
49.Wells, J, Pomeroy, E, Walimbe, S, et al. (2016) The elevated susceptibility to diabetes in India: an evolutionary perspective. Front Public Health 4, 145.
50.Hashmi, A, Paw, M, Nosten, S, et al. (2018) “Because the baby asks for it”: a mixed methods study on local perceptions of nutrition during pregnancy among marginalized migrant women along the Myanmar–Thailand border. Glob Health Action 11, 1473104.
51.Aung, MN, Lorga, T, Srikrajang, J, et al. (2012) Assessing awareness and knowledge of hypertension in an at-risk population in the Karen ethnic rural community, Thasongyang, Thailand. Int J Gen Med 5, 553561.
52.Lorga, T, Aung, MN, Naunboonruang, P, et al. (2012) Predicting prediabetes in a rural community: a survey among the Karen ethnic community, Thasongyang, Thailand. Int J Gen Med 5, 219225.
53.Lorga, T, Srithong, K, Manokulanan, P, et al. (2012) Public knowledge of diabetes in Karen Ethnic rural residents: a community-based questionnaires study in the far north-west of Thailand. Int J Gen Med 5, 799804.
54.Parmar, PK, Barina, CC, Low, S, et al. (2015) Health and human rights in eastern Myanmar after the political transition: a population-based assessment using multistaged household cluster sampling. PLOS ONE 10, e0121212.
55.Srikanok, S, Parker, DM, Parker, AL, et al. (2017) Empirical lessons regarding contraception in a protracted refugee setting: a descriptive study from Maela camp on the Thai–Myanmar border 1996–2015. PLOS ONE 12, e0172007.
56.Cates, JE, Unger, HW, Briand, V, et al. (2017) Malaria, malnutrition, and birthweight: a meta-analysis using individual participant data. PLoS Med 14, e1002373.
57.Parker, DM, Landier, J, Thu, AM, et al. (2017) Scale up of a Plasmodium falciparum elimination program and surveillance system in Kayin State, Myanmar. Wellcome Open Res 2, 98.
58.Luxemburger, C, Ricci, F, Nosten, F, et al. (1997) The epidemiology of severe malaria in an area of low transmission in Thailand. Trans R Soc Trop Med Hyg 91, 256262.
59.Banjong, O, Menefee, A, Sranacharoenpong, K, et al. (2003) Dietary assessment of refugees living in camps: a case study of Mae La camp, Thailand. Food Nutr Bull 24, 360367.
60.Carrara, VI, Stuetz, W, Lee, SJ, et al. (2017) Longer exposure to a new refugee food ration is associated with reduced prevalence of small for gestational age: results from 2 cross-sectional surveys on the Thailand-Myanmar border. Am J Clin Nutr 105, 13821390.
61.Stuetz, W, Carrara, VI, McGready, R, et al. (2012) Micronutrient status in lactating mothers before and after introduction of fortified flour: cross-sectional surveys in Maela refugee camp. Eur J Nutr 51, 425434.
62.Stuetz, W, Carrara, VI, Mc Gready, R, et al. (2016) Impact of food rations and supplements on micronutrient status by Trimester of pregnancy: cross-sectional studies in the Maela Refugee Camp in Thailand. Nutrients 8, 66.
63.Parker, AL, Parker, DM, Zan, BN, et al. (2018) Trends and birth outcomes in adolescent refugees and migrants on the Thailand–Myanmar border, 1986–2016: an observational study. Wellcome Open Res 3, 62.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed