A Comprehensive Exploration of the Relationships between Structural Vulnerability Factors and Gestational Weight Gain Pre-COVID-19: A Scoping Review (preprint)

ABSTRACT

Background:Insufficient and excessive gestational weight gain (GWG) have emerged as rising public health concerns affecting the majority of pregnant women in high-income countries, and are associated with a multitude of adverse maternal and infant health outcomes. The goal of this scoping review was to identify key structural vulnerability factors related to GWG and to examine the extent, range, and nature of research examining associations between those factors and GWG before the advent of the COVID-19 pandemic. Methods: Electronic searches were performed in October 2018, and updated in August 2019 in the databases MEDLINE(R) ALL, EMBASE, PsycINFO, CINAHL, and Sociological Abstracts. Studies included needed to be set in high-income countries, have pregnant participants and an observational methodological design with inferential statistics performed between one or more structural vulnerability factors and GWG. Results: Of the 11,382 citations identified through database searches, 157 articles were included in the review. The structural vulnerability factors most commonly studied in association with GWG were race and ethnicity (n=91 articles), age (n=87), parity (n=48), education (n=44), income (n=39), marital status (n=28), immigration (n=19) and abuse (n=12). Moststudies were conducted in the USA (77%), a majority reported significant associations between these factors and GWG and 34% were specific to a population where all individuals were affected by one of more structural vulnerability factors. Race and ethnicity stood out as the most extensively studied factor; i.e., for the longest period (since 1976), with the highest number of published articles, the largest sample size (n=7,966,573) and the second highest (79%) proportion of studies reporting a significant relationship with GWG, with immigration status having the highest proportion (95%). Conclusions: To advance knowledge on the causes and consequences of excessive and insufficient GWG, research should extend beyond the USA and adopt an intersectional approach to unravel the complex interplay between social context, interacting structural vulnerability factors and specific measures of GWG. Such knowledge is required for the prevention of detrimental impacts on both maternal and offspring health.