Improving gestational weight gain among urban Bangladeshi women living in resource-poor settings: effects of home-based nutritional counselling and micronutrient supplementation

Inadequate gestational weight gain (GWG) is a recognised public health concern associated with adverse birth outcomes in low- and middle-income countries. This study examined whether a home-based nutrition counselling and supplementation intervention was associated with GWG and birth outcomes in an urban slum in Dhaka, Bangladesh. This quasi-experimental study was conducted among 362 pregnant women (≤ 16 weeks’ gestation). Participants were allocated to an intervention group ( n = 216), receiving home-based nutritional counselling by trained peer-counsellors alongside micronutrient supplementation, or a comparison group ( n = 146) receiving standard care. Maternal weight was measured longitudinally from early pregnancy to delivery. Outcomes included total GWG, rate of weight gain (RWG) during the second and third trimesters, and attainment of optimal GWG based on Institute of Medicine guidelines. Multiple linear regression and mixed-effects models assessed GWG trajectories, while propensity score matching evaluated intervention effects on optimal GWG and birth outcomes. A p-value of < 0.05 was considered statistically significant. Participants had a median age of 23.1 years (IQR: 19.9–28.3); 16.9% were underweight. The mean (SD) total GWG was 8.6 (3.9) kg, with a weekly gain of 0.40 (SD 0.2) kg. Only 22.6% achieved optimal GWG, based on pre-pregnancy BMI. The intervention and comparison groups differed significantly in total GWG (9.0 vs. 7.9 kg; p = 0.007). Across BMI categories, the RWG among intervention participants was more consistent with IOM-recommended ranges. Mixed-effects modelling indicated a steeper RWG among intervention participants (β = 0.04; 95% CI: 0.01, 0.08). Maternal education ( p < 0.001), husband’s age ( p < 0.001), and being overweight or obese ( p < 0.001) were positively associated with GWG, while being underweight was inversely related ( p < 0.001). Home-based nutrition counselling with micronutrient supplementation improved total and weekly gestational weight gain but did not significantly increase the likelihood of achieving optimal gestational weight gain. Peer-led community-based interventions may help improve maternal nutrition in similar resource-constrained settings. This study is registered at ClinicalTrials.gov (identifier: NCT05311436; url: https://clinicaltrials.gov/study/NCT05311436 ; Registration date: 27.03.2022).