Maternal Adiposity in Eastern Libya: Prevalence and Associations with Socioeconomic Characteristics, Unhealthy Eating...

Background/Objectives: Maternal overweight and obesity are increasing in Libya, yet multicity evidence among pregnant women remains limited, particularly regarding central adiposity and associations with socioeconomic characteristics, unhealthy eating behaviours (UEBs), physical inactivity, and sedentary behaviour. This study estimated the prevalence of women meeting standard WHO BMI cut-offs for overweight/obesity at antenatal assessment and examined associated socioeconomic, dietary, and lifestyle characteristics among women attending participating public antenatal clinics in six Eastern Libyan cities. Methods: This cross-sectional study included 3000 pregnant women attending participating public antenatal clinics in six Eastern Libyan cities. A multistage, city-stratified sampling strategy was used. Participants completed a structured Arabic questionnaire assessing socioeconomic characteristics, dietary intake, physical inactivity, and sedentary behaviour. Trained female nurses obtained standardised anthropometric measurements during antenatal assessment using the TANITA RD-545HR Smart Segmental Body Composition Analyser. Body mass index (BMI) was evaluated as an indicator of general pregnancy-period adiposity, while WC and BIA-derived visceral fat rating (VFR) were treated as complementary epidemiological indicators rather than precise or diagnostic measures of visceral adiposity. For each participant, BMI, WC, and VFR were obtained during the same antenatal assessment; however, participants were recruited across different gestational stages. Multivariable linear regression examined associations between the specified exposures and continuous adiposity measures, while modified Poisson regression with robust variance estimated adjusted prevalence ratios (aPRs) for overweight/obesity after adjustment for age, parity, gestational stage, and relevant covariates. Results: Among the recruited antenatal clinic sample, 60.6% had BMI-defined overweight/obesity (95% CI: 58.9-62.3); using prespecified descriptive thresholds, 58.9% had WC ≥ 88 cm (95% CI: 57.1-60.7) and 52.1% had BIA-derived VFR ≥ 10 (95% CI: 50.3-53.9). Lower educational attainment (aPR = 1.24, 95% CI: 1.15-1.35, p < 0.001) and lower household income (aPR = 1.18, 95% CI: 1.09-1.27, p = 0.004) were independently associated with a higher prevalence of overweight/obesity. In the primary scale-level analyses, higher physical inactivity sedentary lifestyle scores (aPR = 1.04, 95% CI: 1.03-1.05, p < 0.001) and higher UEBs scores (aPR = 1.07, 95% CI: 1.05-1.09, p < 0.001) were associated with a higher prevalence of BMI-defined overweight/obesity. In secondary exploratory item-level analyses, prolonged mobile phone use showed the strongest lifestyle association (aPR = 1.30, 95% CI: 1.20-1.41, p < 0.001), while consuming fewer than five daily portions of fruit and vegetables demonstrated the strongest dietary association (aPR = 1.36, 95% CI: 1.24-1.49, p = 0.003). The full adjusted models accounted for 6.4-17.6% of variance in the continuous adiposity measures, indicating limited-to-modest explanatory power. Conclusions: BMI-defined weight status and elevated pregnancy-period adiposity indicators were common among women attending participating public antenatal services across six Eastern Libyan cities and were associated with socioeconomic disadvantage, sedentary behaviour, and poorer diet quality. The BMI-based classification reflects weight status at antenatal assessment and should not be interpreted as pre-pregnancy overweight/obesity prevalence.