Pregnancy Outcome in Undernutrition Mothers: A Multicenter Retrospective Cohort Study


  • Pimjai Maleerat Ban Phue Hospital, UdonThani
  • Metha Songthamwat Department of Obstetrics and Gynecology, AngThong Hospital, AngThong
  • Patinya Saeng-aroon Somdejpraboromrachineenart Natawee Hospital, Songkhla
  • Yaowaret Kittithanesuan Department of Obstetrics and Gynecology, AngThong Hospital, AngThong
  • Srisuda Songthamwat Department of Obstetrics and Gynecology, UdonThani Hospital
  • Ueamporn Summart Faculty of Nursing, Western University, Buriram
  • Koollachart Saejueng Ban Dung Hospital, UdonThani
  • Chatchanawadee Na Nan Phen Hospital, UdonThani


pregnancy, under body mass index, complication, retrospective cohort study


Objective:  To study the percentage of pregnancy with undernutrition (body mass index, BMI < 18.5 kg/m2), compare the complications between undernutrition and normal groups and define the optimum cut-point of undernutrition that affect the pregnancy complications in Thai women.  

Materials and Methods: A multicenter retrospective cohort study in the pregnant women in UdonThani, AngThong, Ban Phue, Ban Dung and Phen Hospitals. The percentage of under BMI group was studied. The maternal and neonatal complications were compared between undernutrition and normal groups using multiple logistic regression analysis. Then each kg/m2 of BMI that less than 21.5 kg/m2 were compared with 21.5-23 kg/m2 group to define the low BMI that increased the pregnancy complications.

Results: From a total 24,068 deliveries, 4,056 cases (16.85 % (95% confidence interval (CI) 16.38 – 17.33)) of undernutrition pregnant women were found. In the undernutrition group, 45.17% had at least one pregnancy complication (adjusted odds ratio (AOR) 1.34 , 95% CI 1.24-1.45). The risk of anemia, small for gestational age, preterm birth and low birthweight under 2,500 g infant were increased significantly in the undernutrition group. The AOR and 95%CI were 1.48 (1.33-1.64), 1.98 (1.78-2.21), 1.12 (1.01-1.26), and 1.54 (1.39-1.71) respectively. The complication risk was increased in case of BMI < 19.5 kg/m2 ( AOR 1.17, 95% CI 1.05-1.32).

Conclusion: From this study’s data, the maternal undernutrition rate was 16.85%. The recommended cut-off BMI for undernutrition diagnosis was 19.5 kg/m2. This group has the risk for anemia, small for gestational age, low birthweight under 2,500 g and preterm birth, therefore the nutritional advice, surveillance and early treatment of complications were important in this maternal group.


Hendrixson DT, Manary MJ, Trehan I, Wall LL. Undernutrition in pregnancy: Evaluation, management, and outcome in resource-limited areas. In: Simpson LL, editor. UpToDate. Waltham, MA: UpToDate; 2021 [Cited Aug 3, 2022]. Available from:

Nahar S, Mascie-Taylor N, Begum HA. Impact of targeted food supplementation on pregnancy weight gain and birth weight in rural Bangladesh: an assessment of the Bangladesh Integrated Nutrition Program (BINP). Public Health Nutr 2009;12:1205-12.

Andert CU, Sanchaisuriya P, Sanchaisuriya K, Schelp FP, Schweigert FJ. Nutritional status of pregnant women in Northeast Thailand. Asia Pac J Clin Nutr 2006;15(3):329-34.

World Health Organization. The Asia-Pacfic Perspective: Redifining Obesity and its treatment 2000. [Cited Aug 3, 2022]. Available from:

United Nation Children's Fund. Maternal Nutrition 2022. [Cited August 9, 2022] Available from:

Belkacemi L, Nelson DM, Desai M, Ross MG. Maternal undernutrition influences placental-fetal development. Biol Reprod 2010;83(3):325-31.

Institute of Medicine. Weight gain during pregnancy: reexamining the guidelines. Washington, D.C: The National Academies Press; 2009.

Brabin BJ, Hakimi M, Pelletier D. An analysis of anemia and pregnancy-related maternal mortality. J Nutr 2001;131(2S-2):604S-14S; discussion 14S-15S.

Rush D. Nutrition and maternal mortality in the developing world. Am J Clin Nutr 2000;72(1 Suppl):212S-40S.

World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience 2016. [Cited Aug 3, 2022]. Available from:

Hofmeyr GJ, Lawrie TA, Atallah AN, Torloni MR. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev 2018;10(10):CD001059.

Jameson S. Zinc status in pregnancy: the effect of zinc therapy on perinatal mortality, prematurity, and placental ablation. Ann N Y Acad Sci 1993;678:178-92.

Caulfield LE, Zavaleta N, Shankar AH, Merialdi M. Potential contribution of maternal zinc supplementation during pregnancy to maternal and child survival. Am J Clin Nutr 1998;68(2 Suppl):499S-508S.

Cunningham F LK, Dashe J, Hoffman B, Spong CY, Casey B. Williams Obstetrics. 26 ed: Mcgraw-hill; 2022.

Han Z, Mulla S, Beyene J, Liao G, McDonald SD, Knowledge Synthesis G. Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses. Int J Epidemiol 2011;40(1):65-101.

Ngamjarus C. Sample Size Calculation for an Epidermiological Study on a Smart Device. Siriraj Med J 2016;68(3):160-70.

Global Nutrition Report: Shining a light to spur action on nutrition, Development Initiatives Bristol2018 [Cited August 6, 2022]. Available from:

Desyibelew HD, Dadi AF. Burden and determinants of malnutrition among pregnant women in Africa: A systematic review and meta-analysis. PloS One 2019;14(9):e0221712.

Girsen AI, Mayo JA, Carmichael SL, Phibbs CS, Shachar BZ, Stevenson DK, et al. Women's prepregnancy underweight as a risk factor for preterm birth: a retrospective study. BJOG: Int J Obstet Gynaecol 2016;123(12):2001-7.



How to Cite

Maleerat P, Songthamwat M, Saeng-aroon P, Kittithanesuan Y, Songthamwat S, Summart U, Saejueng K, Na Nan C. Pregnancy Outcome in Undernutrition Mothers: A Multicenter Retrospective Cohort Study. SRIMEDJ [Internet]. 2022 Dec. 22 [cited 2024 Jul. 24];37(6):565-7. Available from:



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