Structural Vulnerability Factors Influence Gestational Weight Gain in a Broad Range of Contexts: A Scoping Review

Abstract

Background: Insufficient and excessive gestational weight gain (GWG) are rising epidemiological health concerns, affecting the majority of pregnant women in high-income countries and contributing to a multitude of adverse maternal and infant health outcomes. Objective: The aim of this scoping review was to identify key structural vulnerability factors related to GWG in order to examine the extent, scope and nature of this body of research and to inform future methodological approaches. Data sources: Electronic searches were performed in October 2018 (updated in August 2019) in MEDLINE(R) ALL, EMBASE, PsycINFO, CINAHL, and Sociological Abstracts databases. Study selection: Studies had to be conducted before COVID-19, in a high-income country, have pregnant participants, have an observational design, and perform inferential statistics between a structural vulnerability factor 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/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%) and reported significant associations between structural vulnerability factors and GWG; 34% of studies were specific to a population where all individuals were affected by one of more structural vulnerability factors. Race/ethnicity was the most extensively studied factor, covering the longest time period (since 1976), being assessed in the highest number of articles (n=91) with the largest sample size (n=7,966,573), and having a high proportion (79%) of studies reporting a significant relationship with GWG. Conclusions: Adopting an intersectional approach may enhance our understanding of the complex interplay between social context, structural vulnerability factors, and GWG. Recognizing their long-term health consequences during pregnancy, increased social, structural, and policy efforts should support pregnant women in achieving optimal GWG.