



































Prevalence of obesity among Bangladeshi pregnant women at their first trimester of pregnancy


 

 

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Prevalence of obesity among 

Bangladeshi pregnant women at 

their first trimester of pregnancy 
 

 

Shatabdi Goon 
 
Nutrition and Food Engineering 
Department, Daffodil International 
University, Dhanmondi, Dhaka, 
Bangladesh 

 

 

Vol. 2, No. 2 (2013)   |   ISSN 2166-7403 (online)    

DOI 10.5195/cajgh.2013.70   |   http://cajgh.pitt.edu 

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Volume 2, No. 2 (2013)  |  ISSN 2166-7403 (online)   |  DOI 10.5195/cajgh.2013.70  |  http://cajgh.pitt.edu 

  

 

Abstract 

BACKGROUND: Paradoxically, the escalating global epidemic of maternal obesity coexists with malnutrion in many areas of 

Bangladesh. This proves a major challenge to obstetric practice from preconception to postpartum due to related comorbid 

conditions including: maternal death or severe morbidity, gestational diabetes and hypertension, increased risk of early and 

recurrent miscarriage, pre-eclampsia, thromboembolism, post-caesarean wound infection, postpartum haemorrhage, and low 

breastfeeding rates. A dramatic increase in birth defects and other pregnancy-induced disorders related to maternal obesity has 

added millions of dollars to health care costs leading great economical loss to the country.  

OBJECTIVE: The study was designed to determine the prevalence of obesity among Bangladeshi pregnant women in their 1st 

trimester of pregnancy.  

STUDY DESIGN: 426 pregnant women presenting to the antenatal care until of Azimpur maternity hospital of Dhaka, 

Bangladesh were randomly selected for this cross sectional study to determine their weight status using body mass index (BMI, 

kg/m2).  

RESULT: 90 (21.2%) pregnant women were reported as obese with pregnancy BMI of >30 kg/m2. 171 (40.1%) and 140 (32.8%) 

pregnant women were reported as overweight and healthy with pregnancy BMI of 25-29.9 kg/m2 and 18.5-24.9 kg/ m2, 

respectively. Statistical analysis revealed obesity and overweight status were found to be significantly associated with age; 

women aged 31 or above were more likely to be obese (OR=2.5; 95% CI 1.53–3.96) and overweight (OR=3.3; 95% CI 2.15–

4.99).  

CONCLUSION: This study provides evidence of increasing trends in obesity among Bangladeshi pregnant women, which poses 

possible health risks both for mother and child. The findings of this study may act as baseline data for monitoring the 

effectiveness of national programs for the prevention and control of maternal obesity.  

Keywords: obese pregnant, first trimester, adverse pregnancy outcome, body mass index, neonatal health, 

maternal health 

 

Prevalence of obesity among 

Bangladeshi pregnant women at 

their first trimester of pregnancy 

Shatabdi Goon 
 
Nutrition and Food Engineering Department, 
Daffodil International University, 
Dhanmondi, Dhaka, Bangladesh 

Research 

Maternal obesity and related comorbid 

conditions have serious impact on the health and 

development of obese women's offspring. The incidence 

of maternal obesity at the start of pregnancy is 

increasing worldwide.
1 

International studies show a 

prevalence of maternal obesity ranging from 1.8% to 

25.3% across countries.
2 

Approximately 50% of 

pregnant women have a body mass index (BMI) >25 

kg/m.
2,3

 Nearly two-thirds of reproductive-age women 

in the United States (U.S.) are currently overweight or 

obese, placing them at elevated risk for adverse health 

outcomes.
4
 The recent National Health and Nutrition 

Examination Survey (NHANES) found that in the 

United States, more than 50% of pregnant women are 

overweight or obese and 8% of reproductive-aged 

women are extremely obese.
5
 In 2009, 26% of adult, 

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reproductive-age, U.S. women were classified with a 

BMI ≥30 kg/m
2
.
6  

Compared to developed countries, maternal 

obesity is less of an epidemic in developing ones; 

however, Bangladeshi women of reproductive age have 

shown a trend of increasing BMI.
7
 A survey conducted 

among this subpopulation found obesity prevalence 

increased from 2.7% to 8.9% between 1996 and 2006.
7
 

In comparison, the prevalence of maternal obesity in the 

United States ranged from 13.9% to 25.1% between 

2004 and 2005.
8
 Current Institute of Medicine 

guidelines, published in 1990, recommend that all 

women can expect to gain one or two kilograms in their 

first trimester of pregnancy, but additional weight gain 

above is considered excessive.
9 

In recent years, 

excessive weight gain has led to increased obesity 

prevalence among pregnant women, resulting in 

maternal and fetal health complications. Maternal 

obesity carries significant risks for the mother and fetus 

with increased health risks to the mother during the 

antenatal, intrapartum, and postnatal periods.
10-13 

Excess 

accumulation of adipose tissue within the abdominal 

cavity, or visceral obesity, among obese, pregnant 

women has been associated with a cluster of metabolic 

alterations, which includes: insulin resistance, 

hyperinsulinemia, elevated triglyceride levels, low HDL 

cholesterol, and hypertension.
14,15

 Evidence from both 

animal and human studies indicates that maternal 

obesity 1) increases the risk for offspring to develop 

obesity, 2) alters body composition in child- and 

adulthood, and 3) impacts the offspring's cardio-

metabolic health with dysregulation of metabolism, 

including: insulin homoeostasis, development of 

hypertension, and vascular dysfunction.
16

  

Maternal obesity is associated with increased 

odds of neural tube defects,
17-22

 spina bifida,
17

 

cardiovascular anomalies,
23

 and high mortality rate. 

Reynolds et al. found that offspring of obese mothers 

have an increased risk of hospital admission for a 

cardiovascular event (OR=1.29; 95% CI 1.06-1.57) 

compared with offspring of mothers with normal BMI.
24

 

First trimester maternal obesity has significantly 

increased over time, having more than doubled from 

7.6% to 15.6% since 1994,
25

 resulting in lost pregancies 

and birth defects
26

 that occur during embryogenesis. 

Overweight and obese women have larger anatomic 

depots of adipose tissue in all compartments, resulting 

in different metabolic adaptations.
27

 Obese women are 

more likely to develop gestational diabetes,
28,29

 high 

blood pressure,
30-33

 and proteinuria
34-37 

after 20 weeks of 

pregnancy, which promote preeclampsia.
38,39

 Compared 

with normal weight women (BMI < 25 kg/m
2
), a recent 

meta-analysis of 20 studies demonstrated that the OR of 

developing gestational diabetes was 2.14 (95% CI 1.82–

2.53), 3.56 (95% CI 3.05–4.21), and 8.56 (95% CI 

5.07–16.04) among overweight (BMI: 25-30 kg/m
2
), 

obese (BMI > 30 kg/m
2
), and severely obese women 

(BMI > 40 kg/m
2
), respectively.

29
 Obesity among 

pregnant women has also been linked to poorer 

cognitive performance, higher incidence of autism 

spectrum disorders, and more attention deficit-

hyperactivity disorder (ADHD) in their children. 

Increased BMI is associated with increased rates of 

midline vertical incision, longer operative time, urinary 

tract infections,
40 

stillbirths and fetal death,
41-44 

lower 

rates of subcuticular skin closure,
45 

and caesarean 

delivery.
46 

A meta-analysis of 33 studies showed that 

the odd ratio (OR) of cesarean delivery were 1.46 (95% 

CI 1.34–1.60), 2.05 (95% CI 1.86–2.27), and 2.89 (95% 

CI 2.28–3.79) among overweight, obese, and severely 

obese women, respectively, compared with normal 

weight pregnant women.
10,11,47,48 

Also in a recent meta-

analysis, a BMI ≥ 25 was found to be associated with 

miscarriage, regardless of mode of conception 

(OR=1.67; 95% CI 1.25–2.25).
49

 Obesity increases the 

risk of preterm delivery,
50

 (a leading cause of infant 

mortality, morbidity, and long-term disability).
51

  These 

risks increase with decreasing gestational age.
52

 Obese 

women are at increased risk of thrombosis as well as 

delivering an infant significantly larger than average 

(macrosomia).
46,53,54

  

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Evidence shows that a child of an obese mother 

may suffer from exposure to a suboptimal in utero 

environment and that early life adversities may extend 

into adulthood.
55 

Being obese during pregnancy might 

increase the risk that the baby will develop heart disease 

or diabetes as an adult. Research suggests that obesity 

during pregnancy slightly increases the risk of having a 

baby who's born with a birth defect,
3
 such as heart 

problems or conditions affecting the brain or spinal 

cord.
19

 Higher maternal BMI at first prenatal hospital 

visit is associated with increased risk of prolonged 

pregnancy and increased rate of induction of labor.
56  

Maternal obesity offers an altered genetic, 

hormonal, and biochemical environment for the 

developing fetus/embryo and influences fetal growth 

and organ development.
57

 Compared with neonates born 

to women of normal weight, neonates born to women 

with BMIs ≥40 (severely obese) were at increased risk 

of birth injury to the peripheral nervous system, birth 

injury to the skeleton, respiratory distress syndrome, 

bacterial sepsis, convulsions, and hypoglycemia.
58

 

Increased maternal BMI is associated with categorical 

and continuous reductions in the proliferative index and 

a continuous reduction in the apoptotic index.
59 

Obese 

women are also less likely to initiate and sustain 

breastfeeding.
60

 Women who are obese during 

pregnancy might be at increased risk of a potentially 

serious sleep disorder in which breathing repeatedly 

stops and starts. Sleep apnea occurring in this group of 

women may further complicate anesthetic management 

and postoperative care.
61

 
 

Helping women understand the risks associated 

with obesity and working with them to develop 

strategies to decrease their risk is a challenge for both 

the patient and the healthcare provider. The objective of 

this study was to evaluate the prevalence of maternal 

obesity among Bangladeshi pregnant women. 
 

Methods 

Study design 

This cross-sectional study was carried out at 

Azimpur maternity hospital, Dhaka, Bangladesh 

between May and June 2013. A total of 450 urban, 

pregnant women in their first trimester of pregnancy 

were selected by systemic random process by 

approaching every 2
nd

 woman attending to prenatal care 

clinic. After approaching potential participants, 426 

pregnant women (94.6%) agreed to participate. 24 

pregnant women refused consent. Verbal, informed 

consent was obtained from all study subjects per the 

Bangladesh Medical Research Council.  

 

Inclusion/ Exclusion Criteria 

Women were approached to participate in this 

investigation if they were currently in their first 

trimester of pregnancy and attending the prenatal care 

clinic of Azimpur maternity hospital. Women were 

exluded from analysis if they had a history of 

hypertension, diabetes, or spontaneous abortions. Thus, 

426 pregnant women were enrolled and included in 

analysis. 

 

Data Collection 

Participants completed questionnaires 

providing information about age, month of pregnancy, 

and education status. Age was stratified into 4-year 

categories: <20 years, 21-25 years, 26–30 years, and 

>30 years. 

All demographic information was collected via 

face-to-face interview. Body mass index (BMI) (kg/m
2
) 

was calculated based on clinically assessed weight (kg) 

and height (m) at baseline. The current analysis 

considered only the baseline measurements, as there 

was no notable change with regard to BMI during the 

follow up across the trials.  WHO definitions were used 

to categorize women as normal weight (BMI: 18.5–

24.9), overweight (BMI: 25–29.9), and obese (BMI: 

30+).  Substantial weight gain typically does not occur 

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during the first trimester of pregnancy, therefore 

anthropometric measurements taken at baseline were 

compared to prepregnancy measurements found in the 

patients’ medical records. No significant differences 

were found between the two measurements therefore no 

patients were excluded. Weight and height were 

measured by pre-defined procedure using a standard 

weight scale and measuring tape. 

 

Statistical analysis 

Considering an expected obesity prevalence of 

50% and using a confidence level of 95% the sample 

size of the cross-sectional study was calculated as 450 

using the following formula: 

n = t² * p(1-p) 

 m² 

 

 Data were analyzed using IBM SPSS
®
 

statistics version 15.0.
62

 Descriptive statistics were used 

for demographic information and Chi-squared tests were 

used to test significance of associations between age and 

BMI. 

 

Results  

This paper presents the weight status 

(determined by BMI) in a sample of Bangladeshi 

pregnant women at their first trimester of pregnancy.  

426 women were interviewed and examined. The mean 

age of the selected pregnant women was 27.13 ± 

5.38(Mean ± SD). 66 (15.5%) pregnant women were 

<20 years of age, 114 (26.8%) 21-25 years of age. 108 

(25.4%), 26-30 years of age, and 138 (32.3%) were >30 

years. 90 (21.2%) and 171 (40.1%) pregnant women 

were classified as obese or overweight with pregnancy.
 

140 (32.8%) pregnant women were normal weight. 

Table 1 shows the distribution of this sample by age and 

BMI level. 

 

Table 1. Distribution of respondents by age and BMI 

level. 

 

Figure one illustrates the prevalence of 

overweight (40.1%) and obese (21.2%) participants in 

this sample.  

 

Figure 1: Distribution of respondents by BMI level. 

 

Among obese women, 48.9% were aged 31 or 

above. Additionally, approximately 48% of overweight 

women were aged of 31 or above. Women aged 31 

years or above were more likely to be obese (OR=2.5; 

95% CI 1.53–3.96) and overweight (OR=3.3; 95% CI 

2.15–4.99). The correlation between age and BMI level 

was found to be significant, as shown in Table 2 

(p=0.01).  

 

Table 2: Unadjusted OR for selected age (30 or above) 

by BMI category. 

 

Obesity was detected among 21.2% of 

participants. Those aged 31 years or above showed 

significantly higher prevalence (X
2
=14.18, p<0.05). 

Overweight was detected among 40.1% of participants 

and those aged 31 years or above showed significantly 

higher prevalence (X
2
=31.58, p<0.05). Table 3 

illustrates the distribution of respondents according to 

weight status. 

Table 3: Distribution of respondents according to the 

presence or absence of specific weight status.  

 

Discussion 

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We determined the prevalence of obesity 

among a sample of 426 pregnant, Bangladeshi women 

who visited Azimpur maternity hospital in Dhaka, 

Bangladesh between May and June 2013. 

Approximately 40% of pregnant women were identified 

as overweight in their first trimester of pregnancy, 

whereas 21.2% were identified as obese. These findings 

mirror those of other literature. For example, Fattah et 

al. showed an obesity prevalence of 19% in a study of 

1,000 Caucasian pregnant women.
63

 Another study, 

conducted on pregnant women receiving maternal care 

in Bangladesh, showed an obesity prevalence of 23%.
64

 

Furthermore, A retrospective cohort study including 

8,176 pregnant women showed an obesity prevalence of 

17.7%,
35

 Lastly, a cohort study of 4,830 patients with 

gestational diabetes (GDM) showed an obesity 

prevalence of 15.7%,
65

 Flegal et al. showed the 

prevalence of obesity among US women of 35.8% in 

2009-2010.
5
 While the Centre for Maternal and Child 

Enquiries published that more than 1 in 20 pregnant 

women in US are severely obese,
66

 this is one of the 

first studies that has been conducted in Bangladesh to 

evaluate the current data on maternal obesity.  

In most cases, Bangladeshi women are 

considered malnourished during their gestational period, 

but this study has revealed pregnant, Bangladeshi 

women have relatively high prevalence of 

overweightness and obesity. Though this study was 

conducted only among Bangladeshi urban women, 

weight status of rural pregnant women could be 

different considering socio-demographical condition. As 

a developing country, Bangladesh has struggled with the 

burden of malnutrition; however, these new findings of 

obesity prevalence among pregnant Bangladesh women 

point to the possibility that obesity point to the 

possibility of obesity becoming an increasing problem 

to the Bangladeshi healthcare system. Previously, 

pregnant, Bangladeshi women typically participated in 

moderate household work, but with the extension of 

civilization, women are becoming dependent on modern 

technologies to cope with their daily work needs, 

decreasing their amount of daily, physical activity. As a 

result, obesity has more prevalent among this group. 

Economic, technologic, and lifestyle changes have 

created an abundance of cheap, high-calorie food 

coupled with a decrease in required physical activity, 

promoting excessive weight gain among this group.  

Research suggests that as age increases, 

hormonal changes and decreased physical activity 

increases the risk of obesity. In this study, obesity was 

more prevalent among women aged 31 or more. 

Approximately 48.9% of obesity cases were found in 

women aged 31 years or higher. Overweightness was 

also higher among women aged 31 years or higher (48% 

of the sample). Other investigators showed that BMI 

increases with increasing maternal age.
50 

Our study 

corroborates these findings, with a positive correlation 

between maternal age and BMI status (p=0.01). The 

risks of obesity in the first trimester are primarly 

pregnancy loss and birthday defects that occur during 

embryogenesis. Studies show that the risks of early 

miscarriage, and recurrent early miscarriage were 

significantly higher among obese patients.
67

 The 

evidence is fairly clear that obesity is significantly 

associated with increased risk of pregnancy 

complications, ranging from miscarriage to problems 

later in pregnancy. Studies in genetically identical 

rodents convincingly show that maternal obesity, as 

well as elements of a hypercaloric diet, can permanently 

influence offspring risk of obesity, and these findings 

are also supported by studies in larger mammals.
68 

Our 

findings highlight overweight and obesity as an 

important public health issue. 

This study had several limitations. First, we 

only evaluated the weight status of Bangladeshi 

pregnant women corresponding to find out the 

prevalence of maternal obesity, not the maternal and 

fetal outcome associated with the prevalence of obesity 

among those pregnant women. Unless evaluating the 

pregnancy outcome, it will not be able to determine the 

overall risk associated with maternal obesity. 

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Considering this issue, the next step of this study will be 

to follow up respondents up to their delivery, and 

further research should evaluate the adverse pregnancy 

outcome associated with the maternal obesity. Second, 

data other than anthropometric measurements were self-

reported, and the study is cross-sectional, which does 

not infer causal relationships. Lastly, we examined only 

one maternity hospital located in Dhaka, Bangladesh, so 

caution should be taken to generalize the data for other 

maternity hospitals and locations. 

 

Conclusion 

The current study presented evidence for high 

rates of obesity among pregnant, Bangladeshi women in 

their first trimester of pregnancy. Babies born to obese 

mothers are more likely to be obese, develop diabetes, 

and have high blood pressure later in life, indicating that 

this issue not only affects the current generation, but 

may have long term implications in terms of quality of 

life and healthcare costs, among others. New strategies 

are needed to re-formulate existing obesity prevention 

and treatment programs by incorporating information on 

a healthy diet and lifestyle to produce holistic health and 

wellness interventions. Considering the high prevalence 

of obesity in females of reproductive age group in 

Bangladesh, this study emphasizes a strong need for 

pre-pregnancy advice about weight loss in these women 

before conception as even minimal weight loss can lead 

to better perinatal outcomes.  

 

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Table 1: Distribution of respondents by age and BMI level. 

 
 

Age Total 

Under 

weight 

 

Normal  

(Healthy weight) 
Overweight Obesity 

 426 25(5.9%) 140(32.8%) 171(40.1%) 90(21.2%) 

<20 66(15.5%) 25(100%) 24(17.1%) 10(5.8%) 7(7.8%) 

21-25 114(26.8%) 0 79(56.4%) 23(13.5%) 12(13.3%) 

26-30 108(25.4%) 0 25(17.8%) 56(32.7%) 27(30%) 

≥31 138(32.3%) 0 12(8.7%) 82(48%) 44(48.9%) 

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This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 2, No. 2 (2013)  |  ISSN 2166-7403 (online)   |  DOI 10.5195/cajgh.2013.70  |  http://cajgh.pitt.edu 

  

 

Table 2: Unadjusted OR for selected age (≥30) by BMI category. 

Total Overweight 

(BMI 25-29.9 kg/m
2
) 

Obese  

(BMI >30 kg/m
2
) 

  OR(95% CI)  OR(95% CI) 

261 n=171 3.3; 2.15-4.99 n=90 2.5 ;1.53-3.96 

 

  

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GOON 

 

 

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This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 2, No. 2 (2013)  |  ISSN 2166-7403 (online)   |  DOI 10.5195/cajgh.2013.70  |  http://cajgh.pitt.edu 

  

 

Table 3: Distribution of respondents according to the presence or absence of specific weight 

status. 

Character Present/ 

absent 

<20 years 21-25 26-30 ≥31 Statistical values 

Obesity Present 7 (7.8%) 12 (13.3%) 27 (30%) 44 (48.9%) X
2
=14.18, p<0.05 

Absent 59 (17.5%) 102 (30.4%) 81 (24.1%) 94 (28%) 

Overweight Present 10 (5.8%) 23 (13.5%) 56 (32.7%) 82 (48%) X
2
=31.58, p<0.05 

Absent 56 (21.9%) 91 (35.7%) 52 (20.4%) 56 (22%) 

Normal weight Present 24 (17.1%) 79 (56.4%) 25 (17.9%) 12 (8.6%) X
2
=54.03, p<0.05 

Absent 42 (14.7%) 35 (12.2%) 83 (29.0%) 126 (44.1%) 

Underweight Present 25 (100%) 0 0 0 X
2
=12.73, p<0.05 

Absent 0 117 (29.2%) 108 (26.9%) 138 (43.9%) 

 

  

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of its D-Scribe Digital Publishing Program, and is cosponsored by the University of Pittsburgh Press. 

 

Central Asian Journal of Global Health 

Volume 2, No. 2 (2013)  |  ISSN 2166-7403 (online)   |  DOI 10.5195/cajgh.2013.70  |  http://cajgh.pitt.edu 

 

 

Figure 1: Distribution of respondents by BMI level. 

 

 

0

20

40

60

80

100

Underweight Normal Overweight Obesity

5.9 

32.8 
40.1 

21.2 

Underweight

Normal

Overweight

Obesity

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