High burden of maternal morbidity in early pregnancy in rural Bangladesh

OBJECTIVE: In response to a dearth of data on morbidity in early pregnancy in developing countries, we investigated the burden of first trimester maternal morbidity in rural, northern Bangladesh. METHODS: We analyzed morbidity data obtained in the first trimester from 42,896 women during their enrollment into a population-based vitamin A or beta-carotene supplementation trial (JiVitA Trial). One-week histories for 34 symptoms were collected between 5-12 weeks gestation. Morbidities were defined by combining symptoms, compatible with the ICD-10 classification system, or with World Health Organization or other published definitions. We determined the prevalence of morbidities in the first trimester and their associations with maternal malnutrition by mid-upper arm circumference (MUAC, <21.5 cm) using adjusted logistic regression analysis. RESULTS: The most frequent symptoms were fatigue (58%), poor appetite (53%), nausea (48%), vaginal discharge (49%), difficulty breathing (44%), low-grade fever (38%), and lower abdominal pain (24%). The most frequent morbidities were anemia (36%), morning sickness (17%), genitourinary infections (7%), excessive vomiting (7%) and gastroenteritis (5%). The following symptoms were significantly associated with low MUAC scores: fever, cough, poor appetite, vomiting, diarrhea, vaginal discharge, and night blindness. We will further analyze the relationship of these morbidities to maternal and infant outcomes including fetal loss, fetal growth restriction and preterm birth. CONCLUSIONS: This is the largest known study of first trimester maternal morbidities in a developing country. Women in rural Bangladesh incur substantial morbidity in early pregnancy. Further study is needed to determine early risk factors for adverse pregnancy outcomes in this population.