(P37-04-26) Early Pregnancy Morbidity Validated by Mid-Upper Arm Circumference Among Rural Bangladeshi Gravidae

Objectives: Early pregnancy maternal morbidity is likely common but poorly assessed in low- and middle-income countries where antenatal care often starts in the 2nd trimester (TM). We assessed 1st TM prevalences of reported morbidity symptoms and their association with maternal thinness in rural Bangladesh.

Methods: Among 22,720 pregnant Bangladeshi women in their 1st TM (5-12 wks) baseline 30-day histories of 33 morbidity symptoms, including number of days and treatments sought, were obtained while enrolling into a multiple micronutrient vs iron-folic acid supplementation trial. The median of >3 mid-upper arm circumferences (MUAC), measured to the nearest 0.1 cm at the time of interview, served as an indicator of maternal nutritional status. Prevalence risk ratios (PRR) of maternal MUAC < 21.5 cm by symptom were generated via log binomial regression analysis, adjusted for age, parity, gestational age at interview, and socioeconomic status, with 95% confidence intervals (CI). Bonferroni adjusted p values provided inferential guidance.

Results: Histories were obtained at a median (IQR) of 8 (7-10) wks’ gestation. The most prevalent symptoms were nausea (57%), poor appetite (49%), low-grade fever (47%), lower abdominal pain (33%) and vomiting (32%), which lasted medians of 4-15 days (except poor appetite lasting for 28 days). Among all 33 symptoms, higher PRRs (95% CI) for a thin maternal MUAC were observed with positive histories of poor appetite 1.12 (1.06, 1.19), white dysentery 1.22 (1.11, 1.34), yellow eyes 1.58 (1.20, 2.08), foul-smelling vaginal discharge 1.24 (1.03, 1.49), low-grade 1.19 (1.12, 1.36) and high-grade 1.21 (1.10, 1.34) fevers, severe headache 1.15 (1.07, 1.24) and night blindness 1.32 (1.06-1.64). Lower PRRs were observed for lower abdominal pain 0.91 (0.86, 0.97) and vaginal bleeding 0.78 (0.62, 0.97). Poor appetite, white dysentery, fevers, and severe headache were significantly associated with maternal thinness after Bonferroni correction.

Conclusions: Bangladeshi gravidae in their 1st TM report a high burden of morbidity, generally lasting up to 2 weeks in a month. Symptoms of infection or that disturb appetite may increase the risk of maternal wasting. Further, a decrement in maternal MUAC may offer indirect evidence of a valid morbidity history.

Funding Sources: Cancer Prevention Fellowship Program, NCI; Bill and Melinda Gates Foundation