Double Burden of Malnutrition Prevalence in Pregnant Women: Systematic Review and Meta-Analysis

The coexistence of undernutrition and overweight, obesity, or diet-related noncommunicable diseases and micronutrient deficiency in pregnant women is defined by the WHO as a double burden of malnutrition (DBM). These coexistences are a critical aspect of maternal and antenatal care, especially in low- and middle-income countries.

To estimate the global prevalence of DBM in pregnant women through a systematic review and meta-analysis.

The systematic review was conducted in accordance with the PRISMA recommendations. Studies that reported prevalence measures of DBM in healthy pregnant women were included. DBM was considered as the coexistence of underweight with gestational diabetes mellitus (GDM), underweight with hypertension, overweight/obesity with anemia, overweight/obesity with vitamin D deficiency, overweight/obesity with vitamin B12 deficiency, and overweight/obesity with folate deficiency. The meta-analysis used a random-effects model with inverse-variance weighting. Risk of bias was assessed using Joanna Briggs Institute tools, and the certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.

The systematic review included 62 articles totaling 1,386,245 pregnant women, at 8-42 gestational weeks and 13-45 years of age. The most common DBMs identified were overweight/obesity and vitamin D deficiency (21%; 95% CI: 14%-27%, n = 10 studies) and overweight/obesity and anemia (9%; 95% CI: 7%-10%, n = 18 studies). A meta-analysis of overweight/obesity and micronutrient deficiency was not conducted due to the small number of eligible studies. Most studies (66.3%) had high methodological quality; however, GRADE rated the overall certainty of evidence as low.

A high prevalence of overweight/obesity with vitamin D deficiency and anemia were observed. These results emphasize the need for stronger public policies to ensure equitable access to healthy diets, evidence-based supplementation, and continuous nutritional monitoring during pregnancy.