Gestational weight gain status and body satisfaction among Kurdish women: A cohort study

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While excessive GWG is a concern in high- income countries, the prevalence of obesity and inadequate GWG remains unclear among Kurdish women. This study aimed to assess the status of gestational weight gain and body satisfaction among Kurdish pregnant women. Methods A prospective cohort study was conducted among pregnant women attending antenatal care in two randomly selected primary health care centers in Erbil City. A purposive sample of 152 pregnant women was enrolled. Data were collected at four time points: on pregnancy diagnosis, 13 weeks, 26 weeks, and 37 weeks of gestation. Data were collected on sociodemographic, obstetrical history, physical measurements, and the Body Understanding Measure for pregnancy scale (BUMPs). Statistical analysis, including descriptive statistics, Fisher-Freeman-Halton Exact Test, and simple linear regression, was performed using SPSS version 27. Results Obesity increased dramatically from 23.7% by 1st visit on pregnancy diagnosis to 74.3% by the 4th visit (37 weeks) among the total sample. A highly significant association was found between pre- pregnancy body mass index (BMI) and total weight gain in the third trimester (p < 0.001). The majority of women who started pregnancy as overweight (79.7%) or obese (88.9%) experienced excessive weight gain compared to those who had a normal BMI. A highly significant association was found between overall body understanding at the 4th visit and total GWG (p < 0.001). A significant association was found between socioeconomic status and weight gain (p = 0.027), with women in the middle socioeconomic group showing the highest proportion of high weight gain (64.9%). Conclusions Pre-pregnancy BMI is a strong predictor of total GWG, with overweight and obese women being highly prone to excessive gain. Furthermore, lower levels of body understanding satisfaction are significantly associated with high total weight gain. Gestational weight gain Body understanding Pregnancy Antenatal care Figures Figure 1 Background Appropriate weight is one of the key elements of health. Obesity and overweight are considered a principal public health concern and ranked as the fifth foremost reason for death globally ( 1 ). Weight gain during pregnancy is an important indicator in the prediction of morbidity and mortality in the infant and mother ( 2 ). Worldwide, the rate of Gestational weight gain within the recommended range has become a key indicator in monitoring maternal and child health status and the effectiveness of health services and programs ( 3 ). Gestational weight gain (GWG) is usually defined as a change in maternal weight measured before pregnancy and before delivery, which is crucial to fetal growth and subsequent breastfeeding ( 4 ). Gestational weight gain is an important factor that is required to support increased metabolic demands and to enhance positive pregnancy outcomes ( 5 ). The recommended amount of GWG varies based on the pre-pregnancy body mass index (BMI) of the women ( 6 ). Based on BMI, the recommended weight gains during pregnancy for lean women with a BMI of less than 18.5 is 13–18 kg, for those with a BMI of 18.5–24.9 is 11 to 16 kg. Moreover, the suggested weight gains for overweight women with a BMI of 25– 29.9 is considered to be 7 to 11 kg, while weight gain of 5 to 9 kg is recommended for obese women with a BMI over 30 ( 7 ). The objective of the new guidelines was to reduce the unfavorable health effects of inadequate or excessive gestational weight gain on the mother, pregnancy, and infant ( 8 ). Most studies have reported that fewer than a third of pregnant women gain adequate gestational weight. The majority of women in high-income countries such as the United States (73%) and Canada (71%) gain an excessive amount of gestational weight. In contrast, inadequate GWG is a major public health concern in low-income Sub-Saharan African countries, where studies showed that 69% of pregnant women from eastern Ethiopia, Harar, and 62.7% of pregnant women from low-income settings such as urban Uganda, Kampala gained inadequate gestational weight ( 6 ). A study done in Iran in 2020 indicated that 28.7% of pregnant women were underweight, 49.6% of them gained adequate weight, while 21.7% of the pregnant women gained excessive weight ( 7 ). According to a study carried out in Baghdad in 2022, it shows that 73% of the pregnant women gained excessive weight, 11% of them gained insufficient weight during pregnancy, and 17% of them had adequate weight gain ( 2 ). Another study in Duhok city in 2019 shows that less than half of the pregnant women (46.3%) were within normal weight, while (52%) of them were overweight or obese ( 9 ). In Erbil city, a small pilot by Mirkhan et al in 2012, suggested that 29% of pregnant women were obese ( 10 ). GWG is highly influenced by a range of biological, metabolic, and social factors, which include maternal pre-pregnancy body mass index (BMI), multi-parity, maternal age, smoking, educational status, healthy eating, physical activity, and adequate counseling of mothers on weight gain during pregnancy ( 5 ) ( 6 ). Weight gain and changes in physical appearance are parts of a healthy pregnancy. Some women do not mind or even welcome these changes, whereas other women can be distressed and concerned about their body images ( 11 ). Some authors have found increasing satisfaction throughout pregnancy. However, studies have shown that a high percentage of pregnant women are dissatisfied with their appearance , achieving levels of 45%. These discrepancies may be explained by the different methods of body image evaluation ( 12 ). Since few studies and limited data have focused on assessing gestational weight gain and obesity among Kurdish women and related predictors, the prevalence of obesity remains unclear; the researcher is interested in determining this status in Kurdish society. Methods Aim The present study aimed to assess the status of gestational weight gain and body satisfaction among Kurdish pregnant women during pregnancy, examine their association with sociodemographic and obstetrical characteristics, and the relationship between gestational weight gain and body satisfaction among the study sample. Study design A prospective cohort study was carried out among pregnant women who attended antenatal care in primary health care centers (PHCC) in Erbil City, Kurdistan region, Iraq. Twenty-one primary health centers are in Erbil City, of which nineteen primary health centers provide maternal and child health care services. Two primary health care centers were randomly selected according to geographic area: Mala Afande from the east, and Nafea Akraee from the west. Sample and sampling method A purposive sampling of 284 pregnant women was calculated to be included in the study; a sample of 166 cases was selected, and 152 cases completed the study. All participants were enrolled from the first antenatal visit for pregnancy diagnosis, and then with follow-up assessments conducted once in each trimester. Sample size was estimated using the general formula for targeted population size, an allowed error 5%, and using the 95% confidence interval. The sample size of each primary health care center was according to their ratio in the targeted population. The sample size from Mala afande PHCC was 64, and from Nafea akraee was 88. All the women were taken to the urban area. Tools and methods of data collection Data presented in this study is a part of a larger study. Data collection was performed between 1st September 2024 and 15th August 2025. Before data collection, the official permission was obtained from the College of Nursing, Erbil General Directorate of Health, and primary health care centers for carrying out the study in Erbil City, and ethical approval was obtained from Hawler Medical University/ College of Nursing (Dated: 13/6/2024, Ethics Approval no.: 2417). Informed consent was taken from the study participants before data collection. They were informed about the objectives of the study and that they have the right to withdraw from the study at any time they want. Data were collected at four time points: pregnancy diagnosis, 13 weeks, 26 weeks, and 37 weeks of gestation. A specially designed questionnaire was prepared by the researcher after extensive review of relevant literatures, which consists of questions regarding age, residency, level of education and occupation for wife and husband, with socioeconomic status, and obstetrical history which include parity and gravida, these questions were obtained one times which is on pregnancy diagnosis, while the other questions like physical measurement which include (Height in cm, and weight in kg) were obtained at each trimesters (follow up), the Height was measured used a mechanical stadiometers, and the weight was recorded using an electronic weighing scale, BMI was computed using the formula: BMI (kg/m2)= weight 9kg)/ height (m)2. The Body Understanding Measure for Pregnancy Scale (BUMPs) questions were obtained three times in each trimester. This part consists of questions regarding weight gain concerns, which contains six questions. A Likert scale was used on a 5-point (1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, 5 = strongly agree) ( 13 ). Statistical analysis The statistical analyses were performed using SPSS version 27 and GraphPad Prism 10. In SPSS, descriptive statistics including frequency, percentage, mean, and standard deviation (SD) were calculated. Inferential analyses were conducted using P-Values for significance testing and the Fisher–Freeman–Halton Exact Test for multi-dimensional categorical comparisons. Simple linear regression analysis was applied, and both unstandardized (B) and standardized (Beta) coefficients were reported. Results Participants' distribution of BMI categories across pregnancy visits The study involved 152 pregnant women. The distribution of BMI categories of the study participants across pregnancy visits is shown in Table 1 . The initial BMI assessment at the time of pregnancy diagnosis revealed that the majority of women were overweight (45.4%, N = 69). As the pregnancy progressed, this distribution shifted notably towards higher weight; Normal weight significantly decreased from 30.9% by the 1st visit on pregnancy diagnosis to just 2.6% at the 4th visit (37 weeks). Obesity increased dramatically from 23.7% by the 1st visit on pregnancy diagnosis to 74.3% by the 4th visit. The mean BMI levels increased from 27.04 ± 3.78 by the 1st visit on pregnancy diagnosis to 32.26 ± 3.64 at the 4th visit. Table 1 Distribution of BMI Categories Across Pregnancy Visits (N = 152) Items Frequency % BMI Levels at the 1st visit on pregnancy diagnosis Normal weight 47 30.9% Overweight 69 45.4% Obesity 36 23.7% Mean ± SD 27.04 ± 3.78 BMI 2nd visit (13 weeks) Normal weight 40 26.3 Overweight 74 48.7 Obesity 38 25.0 Mean ± SD 27.36 ± 3.80 BMI 3rd visit (26 weeks) Normal weight 14 9.2 Overweight 62 40.8 Obesity 76 50.0 Mean ± SD 30.05 ± 3.73 BMI 4th visit (37 weeks) Normal weight 4 2.6 Overweight 35 23.0 Obesity 113 74.3 Mean ± SD 32.26 ± 3.64 Association between BMI at the start of pregnancy and total weight gain A highly significant association was found between Body Mass Index (BMI) at the start of pregnancy and the total weight gain groups (p < 0.001). The distribution across the total weight gain groups (low, normal, and high weight) is shown in Table 2 . Among women who began pregnancy with a normal BMI, most experienced normal weight gain (66%), while 27.7% gained less than recommended, and only 6.4% gained excessively. In contrast, the majority of overweight women had excessive weight gain (79.7%), with only 18.8% gaining within the normal range and 1.4% gaining below recommended levels. Similarly, women classified as obese at the start of pregnancy showed a very high proportion of excessive weight gain (88.9%), whereas 11.1% achieved normal weight gain, and none had low gain. Table 2 Association Between BMI at Start of Pregnancy and total Weight gain Categories (N = 152) BMI at start Low Weight Normal Weight High Weight Total Wt. gain during pregnancy P-Value Fisher-Freeman-Halton Exact Test Normal weight 13 (27.7) 31 (66) 3 (6.4) 47 < 0.001 (HS) Over weight 1 (1.4) 13 (18.8) 55 (79.7) 69 Obese 0 (0) 4 (11.1) 32 (88.9) 36 Total 14 48 90 152 Association between total weight gain and socioeconomic and obstetrical characteristics The findings presented in Table 3 demonstrate the association between total gestational weight gain and selected sociodemographic and obstetric characteristics. Regarding age, high total weight gain was the predominant pattern across all age groups. Women aged 27–31 years accounted for the largest proportion of high weight gain (60%), followed by those aged 32–36 years (80%). Lower weight gain was relatively uncommon in all age categories. However, the association between age and total weight gain did not reach statistical significance (p = 0.099). A significant association was observed between socioeconomic status and weight-gain categories (p = 0.027). Women with middle socioeconomic scores exhibited a higher proportion of high weight gain (64.9%) compared with those in higher socioeconomic groups (56%). Conversely, low weight gain appeared more frequently among women with higher socioeconomic scores. In relation to gravidity, high weight gain was most apparent among women with five or more pregnancies (63%). Nevertheless, the overall association between gravida and total weight gain was not statistically significant (p = 0.246). Similarly, parity showed a predominance of high weight gain across all categories. Women with three or more previous births had the highest proportion of high weight gain (78.6%). Despite this pattern, the relationship between parity and total weight gain was not statistically significant (p = 0.181). Table 3 Association Between total weight gain and Sociodemographic and Obstetrical characteristics Items Total Weight Gain Groups Low Weight Normal Weight High Weight P-Value (Sig.) Fisher-Freeman-Halton Exact Test F % F % F % Age 17–21 6 22.2 11 40.7 10 37.0 0.099 (NS) 22–26 4 8.3 16 33.3 28 58.3 27–31 2 4.3 16 34.8 28 60.9 32–36 1 6.7 2 13.3 12 80.0 37+ 1 6.3 3 18.8 12 75.0 Socioeconomic Status Low score 9 18.0 17 34.0 24 48.0 0.027 (S) Middle score 2 2.6 25 32.5 50 64.9 High score 3 12.0 6 24.0 16 64.0 Gravida 1–2 12 11.9 33 32.7 56 55.4 0.246 (NS) 3–4 1 2.3 14 32.6 28 65.1 5+ 1 12.5 1 12.5 6 75.0 Para 0 11 13.3 26 31.3 46 55.4 0.181 (NS) 1–2 2 3.6 20 36.4 33 60.0 3+ 1 7.1 2 14.3 11 78.6 Association between overall body understanding at the 4th visit and total weight gain Figure 1 shows the association between overall body understanding during the 4th antenatal visit and total gestational weight gain categories. A statistically significant association was observed between them (p < 0.001). Among women who were satisfied with their body understanding, the distribution of weight gain was relatively balanced, with 9 women (34.6%) having low weight gain, 9 (34.6%) normal weight gain, and 8 (30.8%) high weight gain. For those who reported a neutral level of body understanding, 2 women (12.5%) had low weight gain, 6 (37.5%) had normal weight gain, and 8 (50%) experienced high weight gain. A contrasting pattern was observed among women who were not satisfied with their body image. In this group, the vast majority, 74 women (67.3%) experienced high weight gain, compared with 33 (30%) who had normal weight gain and only 3 (2.7%) who had low weight gain. Linear Regression Model for the Body understanding at 4th Visit and socioeconomic status with Total Weight Gain during pregnancy A simple linear regression model was used in Table 4 to examine the association between overall body understanding at 4th Visit as the independent variable and total gestational weight gain groups as the dependent variable, and to assess the effect of socioeconomic status on total gestational weight gain groups. The model revealed that body understanding at the 4th Visit was a significant positive predictor of total weight gain (B = 0.297, SE = 0.074). The standardized coefficient indicated a moderate effect size (Beta = 0.346). This association was statistically significant (t = 4.039, p < 0.001), and the intercept of the model was also statistically significant (B = 1.339, p = 0.005). Regarding socioeconomic status, the models showed that socioeconomic status had a positive but non-significant association with Total Weight Gain Groups (B = 0.148, SE = 0.078, Beta = 0.154), with a t-value of 1.903 and a P-value of 0.059. The regression constant was 2.228 (P < 0.001), representing the expected Total Weight Gain Group value when socioeconomic status is zero. Overall, while the trend suggests a positive relationship, socioeconomic status was not a statistically significant predictor of Total Weight Gain Groups in this sample. Table 4 Linear Regression Model for the Body understanding at 4th Visit and socioeconomic status with Total Weight Gain during pregnancy Model Unstandardized Coefficients Standardized Coefficients t-test P-Value Sig. B SE Beta (Constant) 1.339 0.466 2.871 < 0.005 HS Body understanding 4th visit Groups (Constant) Socioeconomic status 0.297 2.228 0.148 0.074 0.152 0.078 0.346 0.154 4.039 14.614 1.903 < 0.001 < 0.001 0.059 HS HS NS Dependent Variable: Total Weight Gain Groups Discussion The findings of this cohort study underscore a significant public health challenge regarding GWG and obesity among Kurdish women in Erbil City. The most striking finding is the dramatic increase in the prevalence of obesity from the 1st visit on pregnancy diagnosis (23.7%) to (74.3%) in the 3rd trimester. Similarly, the mean BMI rose substantially. This highlights a widespread issue of excessive total weight gain in this population. Similar findings were reported in the study done by Ikola et al ., who found the high prevalence of obesity ( 14 ). By contrast, a study done by Austrida et al . highlighted the low prevalence of obesity ( 15 ). The highly significant association between BMI at the start of pregnancy and total GWG (p < 0.001) reaffirms pre-pregnancy BMI as the most critical predictor of appropriate GWG. With the similarity of a study by Zhijie et al ., who found a highly significant association of BMI with GWG ( 16 ). And Kambiz et al . indicated in their findings the association between maternal BMI and GWG ( 17 ). Women who began as overweight (79.7%) or obese (88.9%) were highly likely to experience excessive weight gain. This demonstrates that the problem often begins before conception, making pre-conception or early antenatal interventions essential for women in these categories. The fact that only those starting at a normal weight (66%) mostly achieved normal GWG confirms the importance of maintaining a healthy BMI before pregnancy. These results confirm a study done by Cara et al ., who observed that excessive GWG was found among women who were overweight and obese before pregnancy ( 18 ). And a study done by K Cheney et al . also validates our cohort study, which states that the women who were overweight and obese pre-pregnancy were more likely to gain excess weight, suggesting that there is a lack of knowledge regarding healthy GWG by women, especially those most at risk, the overweight and the obese ( 19 ). The highly significant association between overall body understanding and total GWG is a crucial psychological finding (p < 0.001). The vast majority of women who reported being "Not Satisfied" (67.3%) experienced high weight gain. The linear regression model further supported this, showing a positive relationship between higher dissatisfaction and greater total weight gain. This suggests that psychological factors, such as body image concerns and distress, may influence weight gain behaviors. This discrepancy (high dissatisfaction concurrent with high weight gain) may indicate a complex relationship where dissatisfaction does not necessarily motivate healthy weight management and may instead be associated with unhealthy coping mechanisms or poor health behaviors. However, studies carried out by Eduardo et al . have shown high levels of pregnant women dissatisfied with their appearance ( 12 ). In contrast to a study by Tuba et al., who found no statistically significant association between body image and GWG ( 11 ). The study identified a significant association between socioeconomic status (SES) and GWG (p = 0.027). The results of our study suggest differences from a study by Rebeca et al ., who observed that there was no statistically significant difference in the distribution of socioeconomic and GWG categories ( 20 ). While socioeconomic status was found to play a crucial role in modulating GWG in a cohort study of Mugdha et al . ( 21 ), women with a middle SES exhibited the highest proportion of high weight gain (64.9%). This is an important finding for targeting public health campaigns, suggesting that financial or educational resources are not solely responsible, and women in the middle-income bracket may face unique lifestyle or dietary challenges contributing to excessive weight gain. Factors like age, gravida, and parity showed a predominance of high weight gain but did not reach statistical significance. Our cohort study is not without its limitations; these results strongly imply a need for a shift in antenatal care focus. Health care providers must emphasize Pre-conception and early pregnancy counseling on achieving and maintaining a healthy weight, especially for women with overweight/obese pre-pregnancy BMI. Psychosocial support to address body image concerns and dissatisfaction, which is significantly linked to excessive GWG. Conclusions The study confirms an alarming rate of excessive gestational weight gain and increasing obesity among Kurdish women. Pre-pregnancy BMI during pregnancy is a highly significant predictor of total GWG. Furthermore, lower levels of body understanding satisfaction are significantly associated with high total weight gain. Targeted interventions, including early weight management counseling and addressing body image concerns, are urgently required within the local healthcare system to improve maternal and child health outcomes in this population. Abbreviations GWG: Gestational Weight Gain BUMPs: Body Understanding Measure for pregnancy scale BMI: Body Mass Index PHCC: Primary Health Care Center SES: Socio-Economic Status Declarations Ethics approval and consent to participate : Declaration of Helsinki as ethical principles for medical research involving human participants were followed in the present study. Before data collection, the official permission was obtained from the College of Nursing, Erbil General Directorate of Health, and primary health care centers for carrying out the study in Erbil City, and ethical approval was obtained from Hawler Medical University/ College of Nursing (Dated: 13/6/2024, Ethics Approval no.: 2417). Informed consent was taken from the study participants before data collection. They were informed about the objectives of the study and that they have the right to withdraw from the study at any time they want. Consent for publication : Not applicable. Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: There are no competing interests. Funding: No funds allocated for this research by any side. The authors were totally responsible. Authors' contributions: RGA were responsible for data collection, data analysis, and writing the first draft of the manuscript. HMA proposed the idea of the research, guiding the research process, and interpreting the data. All authors approved the final version of the manuscript. Acknowledgements: The authors thank all study participants for their valuable contribution and the antenatal clinic staff for their support during data collection. References Golawski K, Giermaziak W, Ciebiera M, Wojtyla C. Excessive Gestational Weight Gain and Pregnancy Outcomes. J Clin Med. 2023;12(9). Kufa Medical Journal. 2023;19(1). Nunnery D, Ammerman A, Dharod J. Predictors and outcomes of excess gestational weight gain among low-income pregnant women. Health Care Women Int. 2018;39(1):19-33. Zhou YB, Liu JM. Optimal gestational weight gain. Lancet Reg Health West Pac. 2021;13:100207. Asefa F, Nemomsa D. 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Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 12 May, 2026 Reviews received at journal 10 May, 2026 Reviewers agreed at journal 26 Apr, 2026 Reviews received at journal 22 Apr, 2026 Reviewers agreed at journal 10 Apr, 2026 Reviewers agreed at journal 02 Apr, 2026 Reviewers invited by journal 31 Mar, 2026 Editor assigned by journal 31 Mar, 2026 Editor invited by journal 31 Mar, 2026 Submission checks completed at journal 27 Mar, 2026 First submitted to journal 27 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9219765","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":616528402,"identity":"fc765d48-17fd-4510-81c1-c891ccd7a897","order_by":0,"name":"Rushna Ghazy Abdulwahid","email":"","orcid":"","institution":"Erbil General Directorate of Health","correspondingAuthor":false,"prefix":"","firstName":"Rushna","middleName":"Ghazy","lastName":"Abdulwahid","suffix":""},{"id":616528403,"identity":"fd63946a-0765-418b-a497-b7c6b03c5c6a","order_by":1,"name":"Hamdia Mirkhan Ahmed","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYBACAyCWSIAxPjbABA8wMDYQo0VyJtFaYAxpXmK0mLOfTrzxoIZB3lzs8MHbtju2JTawN2+TYDhzTxaXFsue3M0WCccYDHfOTku2zj1zO7GB51iZBMONYmOcDjuQu00igY2BccPtHDPp3DagFokcMwmGDwmJOLWcfwvU8o/BfsPt/G/SliAt8m8IaLkBtCWxjSERaAubNCPYFh6glhv4tLzdbJHYJ5G84XaasWVv223jNp60YouEMwm4/XI+d+PNH99sbDfcTn5442fbbdl+9sMbb3w4loAzxKBAAsFkAxEJ+JWPglEwCkbBKCAAAHirYy6STi6TAAAAAElFTkSuQmCC","orcid":"","institution":"Hawler Medical University","correspondingAuthor":true,"prefix":"","firstName":"Hamdia","middleName":"Mirkhan","lastName":"Ahmed","suffix":""}],"badges":[],"createdAt":"2026-03-25 07:41:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9219765/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9219765/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106307272,"identity":"df364b27-cf02-4050-b0b9-ab7c40f3bae6","added_by":"auto","created_at":"2026-04-07 10:04:13","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":40914,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCluster Bar Chart Between Overall Body Understanding 4\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003eth\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e visit and Total Weight Gain\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9219765/v1/da9084ef8247419c19eab087.jpg"},{"id":106403182,"identity":"4eba78d8-3859-4060-bd63-c10e211e632b","added_by":"auto","created_at":"2026-04-08 09:13:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":943508,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9219765/v1/e4af1543-d0fa-4c4b-97d1-20d8e2675dfb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Gestational weight gain status and body satisfaction among Kurdish women: A cohort study","fulltext":[{"header":"Background","content":"\u003cp\u003eAppropriate weight is one of the key elements of health. Obesity and overweight are considered a principal public health concern and ranked as the fifth foremost reason for death globally (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWeight gain during pregnancy is an important indicator in the prediction of morbidity and mortality in the infant and mother (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Worldwide, the rate of Gestational weight gain within the recommended range has become a key indicator in monitoring maternal and child health status and the effectiveness of health services and programs (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGestational weight gain (GWG) is usually defined as a change in maternal weight measured before pregnancy and before delivery, which is crucial to fetal growth and subsequent breastfeeding (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Gestational weight gain is an important factor that is required to support increased metabolic demands and to enhance positive pregnancy outcomes (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The recommended amount of GWG varies based on the pre-pregnancy body mass index (BMI) of the women (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBased on BMI, the recommended weight gains during pregnancy for lean women with a BMI of less than 18.5 is 13\u0026ndash;18 kg, for those with a BMI of 18.5\u0026ndash;24.9 is 11 to 16 kg. Moreover, the suggested weight gains for overweight women with a BMI of 25\u0026ndash; 29.9 is considered to be 7 to 11 kg, while weight gain of 5 to 9 kg is recommended for obese women with a BMI over 30 (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The objective of the new guidelines was to reduce the unfavorable health effects of inadequate or excessive gestational weight gain on the mother, pregnancy, and infant (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMost studies have reported that fewer than a third of pregnant women gain adequate gestational weight. The majority of women in high-income countries such as the United States (73%) and Canada (71%) gain an excessive amount of gestational weight. In contrast, inadequate GWG is a major public health concern in low-income Sub-Saharan African countries, where studies showed that 69% of pregnant women from eastern Ethiopia, Harar, and 62.7% of pregnant women from low-income settings such as urban Uganda, Kampala gained inadequate gestational weight (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). A study done in Iran in 2020 indicated that 28.7% of pregnant women were underweight, 49.6% of them gained adequate weight, while 21.7% of the pregnant women gained excessive weight (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). According to a study carried out in Baghdad in 2022, it shows that 73% of the pregnant women gained excessive weight, 11% of them gained insufficient weight during pregnancy, and 17% of them had adequate weight gain (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Another study in Duhok city in 2019 shows that less than half of the pregnant women (46.3%) were within normal weight, while (52%) of them were overweight or obese (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In Erbil city, a small pilot by Mirkhan et al in 2012, suggested that 29% of pregnant women were obese (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGWG is highly influenced by a range of biological, metabolic, and social factors, which include maternal pre-pregnancy body mass index (BMI), multi-parity, maternal age, smoking, educational status, healthy eating, physical activity, and adequate counseling of mothers on weight gain during pregnancy (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWeight gain and changes in physical appearance are parts of a healthy pregnancy. Some women do not mind or even welcome these changes, whereas other women can be distressed and concerned about their body images (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSome authors have found increasing satisfaction throughout pregnancy. However, studies have shown that a high percentage of pregnant women are dissatisfied with their appearance\u003c/p\u003e \u003cp\u003e, achieving levels of 45%. These discrepancies may be explained by the different methods of body image evaluation (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSince few studies and limited data have focused on assessing gestational weight gain and obesity among Kurdish women and related predictors, the prevalence of obesity remains unclear; the researcher is interested in determining this status in Kurdish society.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThe present study aimed to assess the status of gestational weight gain and body satisfaction among Kurdish pregnant women during pregnancy, examine their association with sociodemographic and obstetrical characteristics, and the relationship between gestational weight gain and body satisfaction among the study sample.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy design\u003c/h3\u003e\n\u003cp\u003eA prospective cohort study was carried out among pregnant women who attended antenatal care in primary health care centers (PHCC) in Erbil City, Kurdistan region, Iraq. Twenty-one primary health centers are in Erbil City, of which nineteen primary health centers provide maternal and child health care services. Two primary health care centers were randomly selected according to geographic area: Mala Afande from the east, and Nafea Akraee from the west.\u003c/p\u003e\n\u003ch3\u003eSample and sampling method\u003c/h3\u003e\n\u003cp\u003eA purposive sampling of 284 pregnant women was calculated to be included in the study; a sample of 166 cases was selected, and 152 cases completed the study. All participants were enrolled from the first antenatal visit for pregnancy diagnosis, and then with follow-up assessments conducted once in each trimester. Sample size was estimated using the general formula for targeted population size, an allowed error 5%, and using the 95% confidence interval. The sample size of each primary health care center was according to their ratio in the targeted population. The sample size from Mala afande PHCC was 64, and from Nafea akraee was 88. All the women were taken to the urban area.\u003c/p\u003e\n\u003ch3\u003eTools and methods of data collection\u003c/h3\u003e\n\u003cp\u003eData presented in this study is a part of a larger study. Data collection was performed between 1st September 2024 and 15th August 2025. Before data collection, the official permission was obtained from the College of Nursing, Erbil General Directorate of Health, and primary health care centers for carrying out the study in Erbil City, and ethical approval was obtained from Hawler Medical University/ College of Nursing (Dated: 13/6/2024, Ethics Approval no.: 2417). Informed consent was taken from the study participants before data collection. They were informed about the objectives of the study and that they have the right to withdraw from the study at any time they want. Data were collected at four time points: pregnancy diagnosis, 13 weeks, 26 weeks, and 37 weeks of gestation. A specially designed questionnaire was prepared by the researcher after extensive review of relevant literatures, which consists of questions regarding age, residency, level of education and occupation for wife and husband, with socioeconomic status, and obstetrical history which include parity and gravida, these questions were obtained one times which is on pregnancy diagnosis, while the other questions like physical measurement which include (Height in cm, and weight in kg) were obtained at each trimesters (follow up), the Height was measured used a mechanical stadiometers, and the weight was recorded using an electronic weighing scale, BMI was computed using the formula: BMI (kg/m2)= weight 9kg)/ height (m)2.\u003c/p\u003e \u003cp\u003eThe Body Understanding Measure for Pregnancy Scale (BUMPs) questions were obtained three times in each trimester. This part consists of questions regarding weight gain concerns, which contains six questions. A Likert scale was used on a 5-point (1\u0026thinsp;=\u0026thinsp;strongly disagree, 2\u0026thinsp;=\u0026thinsp;disagree, 3\u0026thinsp;=\u0026thinsp;neither agree nor disagree, 4\u0026thinsp;=\u0026thinsp;agree, 5\u0026thinsp;=\u0026thinsp;strongly agree) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe statistical analyses were performed using \u003cb\u003eSPSS version 27\u003c/b\u003e and GraphPad Prism 10. In SPSS, descriptive statistics including frequency, percentage, mean, and standard deviation (SD) were calculated. Inferential analyses were conducted using P-Values for significance testing and the Fisher\u0026ndash;Freeman\u0026ndash;Halton Exact Test for multi-dimensional categorical comparisons. Simple linear regression analysis was applied, and both unstandardized (B) and standardized (Beta) coefficients were reported.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eParticipants' distribution of BMI categories across pregnancy visits\u003c/h2\u003e \u003cp\u003eThe study involved 152 pregnant women. The distribution of BMI categories of the study participants across pregnancy visits is shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The initial BMI assessment at the time of pregnancy diagnosis revealed that the majority of women were overweight (45.4%, N\u0026thinsp;=\u0026thinsp;69). As the pregnancy progressed, this distribution shifted notably towards higher weight; Normal weight significantly decreased from 30.9% by the 1st visit on pregnancy diagnosis to just 2.6% at the 4th visit (37 weeks). Obesity increased dramatically from 23.7% by the 1st visit on pregnancy diagnosis to 74.3% by the 4th visit. The mean BMI levels increased from 27.04\u0026thinsp;\u0026plusmn;\u0026thinsp;3.78 by the 1st visit on pregnancy diagnosis to 32.26\u0026thinsp;\u0026plusmn;\u0026thinsp;3.64 at the 4th visit.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of BMI Categories Across Pregnancy Visits (N\u0026thinsp;=\u0026thinsp;152)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBMI Levels at the 1st visit on pregnancy diagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e30.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e45.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e23.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003e27.04\u0026thinsp;\u0026plusmn;\u0026thinsp;3.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBMI 2nd visit (13 weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e26.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e48.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003e27.36\u0026thinsp;\u0026plusmn;\u0026thinsp;3.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBMI 3rd visit (26 weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e40.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003e30.05\u0026thinsp;\u0026plusmn;\u0026thinsp;3.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBMI 4th visit (37 weeks)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e23.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e74.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003e32.26\u0026thinsp;\u0026plusmn;\u0026thinsp;3.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAssociation between BMI at the start of pregnancy and total weight gain\u003c/h3\u003e\n\u003cp\u003eA highly significant association was found between Body Mass Index (BMI) at the start of pregnancy and the total weight gain groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The distribution across the total weight gain groups (low, normal, and high weight) is shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Among women who began pregnancy with a normal BMI, most experienced normal weight gain (66%), while 27.7% gained less than recommended, and only 6.4% gained excessively. In contrast, the majority of overweight women had excessive weight gain (79.7%), with only 18.8% gaining within the normal range and 1.4% gaining below recommended levels. Similarly, women classified as obese at the start of pregnancy showed a very high proportion of excessive weight gain (88.9%), whereas 11.1% achieved normal weight gain, and none had low gain.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation Between BMI at Start of Pregnancy and total Weight gain Categories (N\u0026thinsp;=\u0026thinsp;152)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI at start\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003cp\u003eWeight\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003cp\u003eWeight\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003cp\u003eWeight\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal Wt. gain during pregnancy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003cp\u003eFisher-Freeman-Halton Exact Test\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (27.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001 (HS)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOver weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (79.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eAssociation between total weight gain and socioeconomic and obstetrical characteristics\u003c/h2\u003e \u003cp\u003eThe findings presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e demonstrate the association between total gestational weight gain and selected sociodemographic and obstetric characteristics. Regarding age, high total weight gain was the predominant pattern across all age groups. Women aged 27\u0026ndash;31 years accounted for the largest proportion of high weight gain (60%), followed by those aged 32\u0026ndash;36 years (80%). Lower weight gain was relatively uncommon in all age categories. However, the association between age and total weight gain did not reach statistical significance (p\u0026thinsp;=\u0026thinsp;0.099). A significant association was observed between socioeconomic status and weight-gain categories (p\u0026thinsp;=\u0026thinsp;0.027). Women with middle socioeconomic scores exhibited a higher proportion of high weight gain (64.9%) compared with those in higher socioeconomic groups (56%). Conversely, low weight gain appeared more frequently among women with higher socioeconomic scores. In relation to gravidity, high weight gain was most apparent among women with five or more pregnancies (63%). Nevertheless, the overall association between gravida and total weight gain was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.246). Similarly, parity showed a predominance of high weight gain across all categories. Women with three or more previous births had the highest proportion of high weight gain (78.6%). Despite this pattern, the relationship between parity and total weight gain was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.181).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation Between total weight gain and Sociodemographic and Obstetrical characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c9\" namest=\"c3\"\u003e \u003cp\u003eTotal Weight Gain Groups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003cp\u003eWeight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003cp\u003eWeight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003cp\u003eWeight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eP-Value (Sig.)\u003c/p\u003e \u003cp\u003eFisher-Freeman-Halton Exact Test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u0026ndash;21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e37.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.099 (NS)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u0026ndash;26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e58.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u0026ndash;31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e60.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32\u0026ndash;36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e80.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e75.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSocioeconomic Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e48.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.027 (S)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e64.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e64.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eGravida\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e55.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.246 (NS)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e65.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e75.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePara\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e55.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.181 (NS)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e60.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e78.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eAssociation between overall body understanding at the 4th visit and total weight gain\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the association between overall body understanding during the 4th antenatal visit and total gestational weight gain categories. A statistically significant association was observed between them (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Among women who were satisfied with their body understanding, the distribution of weight gain was relatively balanced, with 9 women (34.6%) having low weight gain, 9 (34.6%) normal weight gain, and 8 (30.8%) high weight gain. For those who reported a neutral level of body understanding, 2 women (12.5%) had low weight gain, 6 (37.5%) had normal weight gain, and 8 (50%) experienced high weight gain. A contrasting pattern was observed among women who were not satisfied with their body image. In this group, the vast majority, 74 women (67.3%) experienced high weight gain, compared with 33 (30%) who had normal weight gain and only 3 (2.7%) who had low weight gain.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eLinear Regression Model for the Body understanding at 4th Visit and socioeconomic status with Total Weight Gain during pregnancy\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA simple linear regression model was used in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e to examine the association between overall body understanding at 4th Visit as the independent variable and total gestational weight gain groups as the dependent variable, and to assess the effect of socioeconomic status on total gestational weight gain groups. The model revealed that body understanding at the 4th Visit was a significant positive predictor of total weight gain (B\u0026thinsp;=\u0026thinsp;0.297, SE\u0026thinsp;=\u0026thinsp;0.074). The standardized coefficient indicated a moderate effect size (Beta\u0026thinsp;=\u0026thinsp;0.346). This association was statistically significant (t\u0026thinsp;=\u0026thinsp;4.039, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the intercept of the model was also statistically significant (B\u0026thinsp;=\u0026thinsp;1.339, p\u0026thinsp;=\u0026thinsp;0.005). Regarding socioeconomic status, the models showed that socioeconomic status had a positive but non-significant association with Total Weight Gain Groups (B\u0026thinsp;=\u0026thinsp;0.148, SE\u0026thinsp;=\u0026thinsp;0.078, Beta\u0026thinsp;=\u0026thinsp;0.154), with a t-value of 1.903 and a P-value of 0.059. The regression constant was 2.228 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), representing the expected Total Weight Gain Group value when socioeconomic status is zero. Overall, while the trend suggests a positive relationship, socioeconomic status was not a statistically significant predictor of Total Weight Gain Groups in this sample.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLinear Regression Model for the Body understanding at 4th Visit and socioeconomic status with Total Weight Gain during pregnancy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eModel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnstandardized Coefficients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStandardized Coefficients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et-test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBeta\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Constant)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.871\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody understanding 4th visit Groups\u003c/p\u003e \u003cp\u003e(Constant)\u003c/p\u003e \u003cp\u003eSocioeconomic status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.297\u003c/p\u003e \u003cp\u003e2.228\u003c/p\u003e \u003cp\u003e0.148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003cp\u003e0.152\u003c/p\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.346\u003c/p\u003e \u003cp\u003e0.154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.039\u003c/p\u003e \u003cp\u003e14.614\u003c/p\u003e \u003cp\u003e1.903\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHS\u003c/p\u003e \u003cp\u003eHS\u003c/p\u003e \u003cp\u003eNS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eDependent Variable: Total Weight Gain Groups\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this cohort study underscore a significant public health challenge regarding GWG and obesity among Kurdish women in Erbil City. The most striking finding is the dramatic increase in the prevalence of obesity from the 1st visit on pregnancy diagnosis (23.7%) to (74.3%) in the 3rd trimester. Similarly, the mean BMI rose substantially. This highlights a widespread issue of excessive total weight gain in this population. Similar findings were reported in the study done by Ikola \u003cem\u003eet al\u003c/em\u003e., who found the high prevalence of obesity (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). By contrast, a study done by Austrida \u003cem\u003eet al\u003c/em\u003e. highlighted the low prevalence of obesity (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe highly significant association between BMI at the start of pregnancy and total GWG (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) reaffirms pre-pregnancy BMI as the most critical predictor of appropriate GWG. With the similarity of a study by Zhijie \u003cem\u003eet al\u003c/em\u003e., who found a highly significant association of BMI with GWG (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). And Kambiz \u003cem\u003eet al\u003c/em\u003e. indicated in their findings the association between maternal BMI and GWG (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWomen who began as overweight (79.7%) or obese (88.9%) were highly likely to experience excessive weight gain. This demonstrates that the problem often begins before conception, making pre-conception or early antenatal interventions essential for women in these categories. The fact that only those starting at a normal weight (66%) mostly achieved normal GWG confirms the importance of maintaining a healthy BMI before pregnancy. These results confirm a study done by \u003cem\u003eCara et al\u003c/em\u003e., who observed that excessive GWG was found among women who were overweight and obese before pregnancy (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). And a study done by K Cheney \u003cem\u003eet al\u003c/em\u003e. also validates our cohort study, which states that the women who were overweight and obese pre-pregnancy were more likely to gain excess weight, suggesting that there is a lack of knowledge regarding healthy GWG by women, especially those most at risk, the overweight and the obese (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe highly significant association between overall body understanding and total GWG is a crucial psychological finding (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The vast majority of women who reported being \"Not Satisfied\" (67.3%) experienced high weight gain. The linear regression model further supported this, showing a positive relationship between higher dissatisfaction and greater total weight gain. This suggests that psychological factors, such as body image concerns and distress, may influence weight gain behaviors. This discrepancy (high dissatisfaction concurrent with high weight gain) may indicate a complex relationship where dissatisfaction does not necessarily motivate healthy weight management and may instead be associated with unhealthy coping mechanisms or poor health behaviors. However, studies carried out by Eduardo \u003cem\u003eet al\u003c/em\u003e. have shown high levels of pregnant women dissatisfied with their appearance (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In contrast to a study by Tuba et al., who found no statistically significant association between body image and GWG (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe study identified a significant association between socioeconomic status (SES) and GWG (p\u0026thinsp;=\u0026thinsp;0.027). The results of our study suggest differences from a study by Rebeca \u003cem\u003eet al\u003c/em\u003e., who observed that there was no statistically significant difference in the distribution of socioeconomic and GWG categories (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). While socioeconomic status was found to play a crucial role in modulating GWG in a cohort study of Mugdha \u003cem\u003eet al\u003c/em\u003e. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), women with a middle SES exhibited the highest proportion of high weight gain (64.9%). This is an important finding for targeting public health campaigns, suggesting that financial or educational resources are not solely responsible, and women in the middle-income bracket may face unique lifestyle or dietary challenges contributing to excessive weight gain. Factors like age, gravida, and parity showed a predominance of high weight gain but did not reach statistical significance.\u003c/p\u003e \u003cp\u003eOur cohort study is not without its limitations; these results strongly imply a need for a shift in antenatal care focus. Health care providers must emphasize Pre-conception and early pregnancy counseling on achieving and maintaining a healthy weight, especially for women with overweight/obese pre-pregnancy BMI. Psychosocial support to address body image concerns and dissatisfaction, which is significantly linked to excessive GWG.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe study confirms an alarming rate of excessive gestational weight gain and increasing obesity among Kurdish women. Pre-pregnancy BMI during pregnancy is a highly significant predictor of total GWG. Furthermore, lower levels of body understanding satisfaction are significantly associated with high total weight gain. Targeted interventions, including early weight management counseling and addressing body image concerns, are urgently required within the local healthcare system to improve maternal and child health outcomes in this population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eGWG: Gestational Weight Gain\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBUMPs: Body Understanding Measure for pregnancy scale\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBMI: Body Mass Index\u003c/p\u003e\n\u003cp\u003ePHCC: Primary Health Care Center \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSES: Socio-Economic Status\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e: Declaration of Helsinki as ethical principles for medical research involving human participants were followed in the present study.\u0026nbsp;Before data collection, the official permission was obtained from the College of Nursing, Erbil General Directorate of Health, and primary health care centers for carrying out the study in Erbil City, and ethical approval was obtained from Hawler Medical University/ College of Nursing (Dated: 13/6/2024, Ethics Approval no.: 2417). Informed consent was taken from the study participants before data collection. They were informed about the objectives of the study and that they have the right to withdraw from the study at any time they want.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: Not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThere are no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNo funds allocated for this research by any side. The authors were totally responsible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions:\u0026nbsp;\u003c/strong\u003eRGA were responsible for data collection, data analysis, and writing the first draft of the manuscript. HMA proposed the idea of the research, guiding the research process, and interpreting the data. All authors approved the final version of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eThe authors thank all study participants for their valuable contribution and the antenatal clinic staff for their support during data collection.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGolawski K, Giermaziak W, Ciebiera M, Wojtyla C. Excessive Gestational Weight Gain and Pregnancy Outcomes. J Clin Med. 2023;12(9).\u003c/li\u003e\n\u003cli\u003eKufa Medical Journal. 2023;19(1).\u003c/li\u003e\n\u003cli\u003eNunnery D, Ammerman A, Dharod J. Predictors and outcomes of excess gestational weight gain among low-income pregnant women. Health Care Women Int. 2018;39(1):19-33.\u003c/li\u003e\n\u003cli\u003eZhou YB, Liu JM. Optimal gestational weight gain. Lancet Reg Health West Pac. 2021;13:100207.\u003c/li\u003e\n\u003cli\u003eAsefa F, Nemomsa D. Gestational weight gain and its associated factors in Harari Regional State: Institution-based cross-sectional study, Eastern Ethiopia. Reprod Health. 2016;13(1):101.\u003c/li\u003e\n\u003cli\u003eAsefa F, Cummins A, Dessie Y, Foureur M, Hayen A. Patterns and predictors of gestational weight gain in Addis Ababa, Central Ethiopia: a prospective cohort study. Reprod Health. 2021;18(1):159.\u003c/li\u003e\n\u003cli\u003eDolatian M, Sharifi N, Mahmoodi Z, Fathnezhad-Kazemi A, Bahrami-Vazir E, Rashidian T. Weight gain during pregnancy and its associated factors: A Path analysis. Nurs Open. 2020;7(5):1568-77.\u003c/li\u003e\n\u003cli\u003eMestrovic Z, Roje D, Relja A, Kosovic I, Aracic N, Vulic M, et al. Maternal body mass index change as a new optimal gestational weight gain predictor in overweight women. Croat Med J. 2019;60(6):508-14.\u003c/li\u003e\n\u003cli\u003eAbdulmalek I, Amian S. The Knowledge toward Obesity and Gestational Weight Gain of Pregnant Women in Duhok City. The Journal of the University of Duhok. 2019;22(1):75-89.\u003c/li\u003e\n\u003cli\u003eHajimam A, Harris T. Does an Antenatal Educational Program Improve Maternal Outcomes among Obese Pregnant Women in the Kurdistan Region of Iraq? Journal of Sulaimani Medical College. 2017;7(2):159-67.\u003c/li\u003e\n\u003cli\u003eUcar T, Guney E, Cesur B, Yurtsal ZB. The scale for body image concerns during pregnancy: Development and validation. Perspect Psychiatr Care. 2018;54(3):416-21.\u003c/li\u003e\n\u003cli\u003eSalzer EB, Meireles JFF, Toledo AFA, de Siqueira MR, Ferreira MEC, Neves CM. Body Image Assessment Tools in Pregnant Women: A Systematic Review. Int J Environ Res Public Health. 2023;20(3).\u003c/li\u003e\n\u003cli\u003eKirk E, Preston C. Development and validation of the Body Understanding Measure for Pregnancy Scale (BUMPS) and its role in antenatal attachment. Psychol Assess. 2019;31(9):1092-106.\u003c/li\u003e\n\u003cli\u003eAdeoye IA, Bamgboye EA, Omigbodun AO. Gestational weight gain among pregnant women in Ibadan, Nigeria: Pattern, predictors and pregnancy outcomes. PLoS One. 2023;18(8):e0290102.\u003c/li\u003e\n\u003cli\u003eGondwe A, Ashorn P, Ashorn U, Dewey KG, Maleta K, Nkhoma M, et al. Pre-pregnancy body mass index (BMI) and maternal gestational weight gain are positively associated with birth outcomes in rural Malawi. PLoS One. 2018;13(10):e0206035.\u003c/li\u003e\n\u003cli\u003eYu ZM, Van Blyderveen S, Schmidt L, Lu C, Vanstone M, Biringer A, et al. Predictors of Gestational Weight Gain Examined As a Continuous Outcome: A Prospective Analysis. J Womens Health (Larchmt). 2021;30(7):1006-15.\u003c/li\u003e\n\u003cli\u003eAhmadi Angali K, Azhdari M, Cheraghi M, Shahri P, Salmanzadeh S, Borazjani F. The Association Between Pre-Pregnancy Body Mass Index and Gestational Weight Gain on Pregnancy Outcomes: A Retrospective Cohort Study. Journal of Holistic Nursing And Midwifery. 2023;33(2):95-104.\u003c/li\u003e\n\u003cli\u003eDolin CD, Gross RS, Deierlein AL, Berube LT, Katzow M, Yaghoubian Y, et al. Predictors of Gestational Weight Gain in a Low-Income Hispanic Population: Sociodemographic Characteristics, Health Behaviors, and Psychosocial Stressors. Int J Environ Res Public Health. 2020;17(1).\u003c/li\u003e\n\u003cli\u003eCheney K, Berkemeier S, Sim KA, Gordon A, Black K. Prevalence and predictors of early gestational weight gain associated with obesity risk in a diverse Australian antenatal population: a cross-sectional study. BMC Pregnancy Childbirth. 2017;17(1):296.\u003c/li\u003e\n\u003cli\u003eBenito-Villena R, Cano-Ibanez N, Roman-Galvez RM, Martin-Pelaez S, Khan KS, Martinez-Galiano JM, et al. Gestational weight gain and daily life impact of pregnancy symptoms in healthy women: A multivariable analysis. Eur J Obstet Gynecol Reprod Biol. 2024;303:85-90.\u003c/li\u003e\n\u003cli\u003eDeshpande M, Kajale N, Shah N, Gondhalekar K, Patwardhan V, Raiturker AP, et al. Predictors of gestational weight gain in western India: Findings from a longitudinal study across rural and urban cohorts. PLoS One. 2025;20(7):e0328081.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Gestational weight gain, Body understanding, Pregnancy, Antenatal care","lastPublishedDoi":"10.21203/rs.3.rs-9219765/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9219765/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAppropriate gestational weight gain (GWG) is crucial for predicting maternal and infant morbidity and mortality, and is considered a key indicator of maternal and child health status worldwide. While excessive GWG is a concern in high- income countries, the prevalence of obesity and inadequate GWG remains unclear among Kurdish women. This study aimed to assess the status of gestational weight gain and body satisfaction among Kurdish pregnant women.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA prospective cohort study was conducted among pregnant women attending antenatal care in two randomly selected primary health care centers in Erbil City. A purposive sample of 152 pregnant women was enrolled. Data were collected at four time points: on pregnancy diagnosis, 13 weeks, 26 weeks, and 37 weeks of gestation. Data were collected on sociodemographic, obstetrical history, physical measurements, and the Body Understanding Measure for pregnancy scale (BUMPs). Statistical analysis, including descriptive statistics, Fisher-Freeman-Halton Exact Test, and simple linear regression, was performed using SPSS version 27.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eObesity increased dramatically from 23.7% by 1st visit on pregnancy diagnosis to 74.3% by the 4th visit (37 weeks) among the total sample. A highly significant association was found between pre- pregnancy body mass index (BMI) and total weight gain in the third trimester (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The majority of women who started pregnancy as overweight (79.7%) or obese (88.9%) experienced excessive weight gain compared to those who had a normal BMI. A highly significant association was found between overall body understanding at the 4th visit and total GWG (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). A significant association was found between socioeconomic status and weight gain (p\u0026thinsp;=\u0026thinsp;0.027), with women in the middle socioeconomic group showing the highest proportion of high weight gain (64.9%).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003ePre-pregnancy BMI is a strong predictor of total GWG, with overweight and obese women being highly prone to excessive gain. Furthermore, lower levels of body understanding satisfaction are significantly associated with high total weight gain.\u003c/p\u003e","manuscriptTitle":"Gestational weight gain status and body satisfaction among Kurdish women: A cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-07 10:04:09","doi":"10.21203/rs.3.rs-9219765/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-12T07:57:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-10T12:40:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"242122975481657000566368469717314662144","date":"2026-04-26T13:19:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-22T13:15:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"327867469602596120215662694660639954782","date":"2026-04-10T14:22:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"283793283356763156538288632493904885815","date":"2026-04-02T10:32:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-01T03:26:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-01T02:56:53+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-31T18:25:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-27T17:01:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2026-03-27T16:56:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b532b0b4-fa92-42b8-9f97-1e2c4461629a","owner":[],"postedDate":"April 7th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-12T07:57:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-10T12:40:31+00:00","index":36,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-12T08:09:55+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-07 10:04:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9219765","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9219765","identity":"rs-9219765","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}