ICMR launches national study on gestational weight gain, aims to build India-specific guidelines

The Indian Council of Medical Research (ICMR) has called on researchers and institutions to contribute data for a nationwide study that could redesign guidelines on maternal nutrition and pregnancy care in India.

The initiative seeks to understand how patterns of gestational weight gain (GWG) affect maternal and neonatal outcomes in Indian women, a population whose nutritional and physiological profiles often differ significantly from those in high-income countries where current benchmarks originate.

Globally, inadequate or excessive weight gain during pregnancy has been linked to complications such as preeclampsia, gestational diabetes, preterm delivery, and low birth weight. However, most existing recommendations—including those from the US Institute of Medicine (IOM) and the INTERGROWTH-21st project—are based on non-Indian populations. With limited India-specific data, clinical practice and public health policy rely on standards that may not reflect the unique needs of Indian women.

"Developing evidence rooted in Indian cohorts is crucial," ICMR said in its document, noting that the study will evaluate associations between GWG and outcomes such as maternal hypertension, gestational diabetes, birth weight, stillbirth, and neonatal mortality. Secondary indicators such as anemia, place and mode of delivery, and late neonatal outcomes will also be examined where available.

The council has invited contributions from prospective cohort studies and randomized controlled trials conducted since 2010, with at least 300 participants. Mandatory data include gestational age at delivery, maternal weight measurements, birth outcomes, and maternal complications. Contributing researchers will receive co-authorship in resulting publications and acknowledgment in policy briefs and guideline documents.

The initiative could have far-reaching implications for India’s maternal and child health programmes, influencing clinical guidelines, nutritional supplement use, and the maternal care product pipeline for pharmaceutical and diagnostics companies.

“This ICMR initiative is timely and necessary. For too long, gestational weight gain guidelines developed for Western populations have been applied in India, despite differences in nutritional, socio-economic, and physiological realities. Inadequate or excessive weight gain during pregnancy is not merely a number on a scale—it affects maternal health, raising risks of gestational diabetes, hypertension, and anemia, and influences neonatal outcomes such as low birth weight and preterm delivery,” said Dr Astha Dayal, Director of Obstetrics and Gynaecology, CK Birla Hospital, Gurugram.

A 2023 study in PLOS Global Public Health found that many Indian women gain insufficient weight during pregnancy, posing risks for both mother and newborn. Socio-economic factors, dietary intake, and access to healthcare were key determinants of gestational outcomes.

The Indian Journal of Community Medicine (2021) also reported that many women in India fail to meet ICMR’s recommended weight gain. WHO guidelines (2009) suggest ranges of 12.5–18 kg for underweight women, 11.5–16 kg for normal weight, 7–11.5 kg for overweight, and 5–9 kg for obese women. Together, these findings highlight the urgent need to strengthen nutritional counselling and maternal health programmes across India.

“India carries one of the world’s highest burdens of maternal anemia and low birth weight. India-specific recommendations will allow clinicians to provide tailored nutritional guidance, improve pregnancy care, reduce complications, and give newborns a healthier start,” Dr Dayal added.

NFHS-5 data show that 57% of women aged 15–49 and 59% of adolescent girls are anaemic, with some states, such as Bihar, reporting rates of 63% among pregnant women. Maternal anemia contributes globally to 12% of low birth weight cases, 19% of preterm deliveries, and 18% of perinatal deaths.

Low birth weight remains a pressing concern in India. While rates have fallen from 26% in 1993 to 18% in 2021, nearly half of all low birth weight infants are born in just four states—Uttar Pradesh, Bihar, Maharashtra, and West Bengal. In 2021 alone, India recorded 4.2 million low birth weight infants, underlining stark regional disparities.