(P07-027-23) Maternal Morbidity and Risk of Malnutrition by Mid-Upper Arm Circumference (MUAC) in Early Pregnancy in Rural Bangladesh

Objectives: Assess morbidity and risk of malnutrition evaluated in first trimester pregnancy in rural Bangladesh.

Methods: This was a retrospective study of morbidity and nutritional status, assessed by MUAC, in 26,224 rural Bangladeshi women in the 1^st trimester of pregnancy at time of recruitment into an antenatal multiple micronutrient vs iron-folic acid supplementation trial (2008-12). Thirty-day and 7-day histories of 32 symptoms were obtained during home interviews at 5-12 weeks’ gestation. “Illnesses” were further constructed from combining symptoms in the previous 7-days that aligned most closely with ICD-10 diagnoses and WHO definitions (see Kim et a IJGO 2012). Prevalence, duration and treatment-seeking behavior for each symptom and illness were summarized. Odds ratios (OR) with 95% confidence intervals (CI) of undernutrition, defined as a MUAC < 21.5 cm, were computed by logistic regression to assess risk of thinness among women reporting any days of individual symptoms vs not in the previous (a) 30 days, (b) 7 days, and (c) illness of composite symptoms in the previous week. Statistical analyses were performed using STATA version 17.

Results: Most common symptoms reported in the previous 30 days were nausea (48%), low-grade fever (47%), poor appetite (42%), lower abdominal pain (28%), vomiting (28%), cough (19%), incontinence (14%) and painful urination (9%). In the past 7 days, rates were 40%, 28%, 35%, 21%, 19%, 12%, 8% and 6%, respectively. Treatment was most often sought for high fever, hand swelling, diarrhea, bloody or mucoid stool, and ‘yellow eyes’ (proxy for jaundice). For 30-day histories, ORs (95% CI) of thinness were higher for yellow eyes, 1.90 (1.23–2.92); night blindness, 1.47 (1.06–2.03); vaginal discharge, 1.34 (1.03–1.75); high fever, 1.32 (1.14–1.53); low fever 1.27 (1.17–1.37); watery stools, 1.25 (0.98–1.61); severe headache, 1.22 (1.10–1.36) and poor appetite, 1.18 (1.09-1.27). ORs generally remained but were slightly weaker for 7-day histories. Most prevalent illnesses in the previous week were morning sickness (25%), excessive vomiting (6%), and urinary tract infections (6%).

Conclusions: Rural Bangladeshi gravida report substantial morbidity in the 1^st trimester, a period that often precedes registering for routine antenatal care, accompanied by increased risk of undernutrition.

Funding Sources: Bill & Melinda Gates Foundation