---
title: "Global Prevalence of the Double Burden of Malnutrition in Pregnancy: Systematic Review and Meta-An"
id: "pubmed-42755021"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42755021"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42755021/"
doi: "10.1111/jhn.70347"
published_at: "2026-10-01T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Global Prevalence of the Double Burden of Malnutrition in Pregnancy: Systematic Review and Meta-An
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42755021
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42755021/)
- **DOI:** [10.1111/jhn.70347](https://doi.org/10.1111%2Fjhn.70347)
- **Published At:** 2026-10-01T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The World Health Organization defines the **double burden of malnutrition (DBM)** as coexistence of undernutrition with overweight/obesity or noncommunicable disease risk and micronutrient deficiency; this is important in pregnant women, particularly in low- and middle-income countries. - This study is a systematic review and meta-analysis following PRISMA, including studies that reported prevalence measures of DBM in healthy pregnant women. - DBM combinations evaluated included underweight with gestational diabetes mellitus (GDM), underweight with hypertension, and overweight/obesity with micronutrient deficiencies (anemia, vitamin D, vitamin B12, folate). - A random-effects meta-analysis with inverse-variance weighting was used; risk of bias was assessed with Joanna Briggs Institute tools and evidence certainty with GRADE. - The review included 62 articles comprising 1,386,245 pregnant women across 8–42 weeks' gestation and ages 13–45 years. - The most frequent DBM combinations observed were **overweight/obesity with vitamin D deficiency** (pooled prevalence 21%; 95% CI 14%–27%, n = 10 studies) and **overweight/obesity with anemia** (pooled prevalence 9%; 95% CI 7%–10%, n = 18 studies). - A pooled meta-analysis of overweight/obesity with other micronutrient deficiencies was not performed due to limited eligible studies. - Most included studies (66.3%) were rated as high methodological quality, but the overall certainty of evidence was judged as low by GRADE. - The authors conclude that high prevalences of overweight/obesity coexisting with vitamin D deficiency and anemia underscore the need for reinforced public policies for equitable access to healthy diets, evidence-based supplementation, and ongoing nutritional monitoring in pregnancy. - The paper reports no conflicts of interest and is available as a free PMC article (PMCID PMC13586418); PMID 42755021; DOI 10.1111/jhn.70347.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Graduate Program in Human Nutrition, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF, Brazil. * 2 Graduate Program in Public Health, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF, Brazil. * PMID: **42755021** * PMCID: [ PMC13586418 ](https://pmc.ncbi.nlm.nih.gov/articles/PMC13586418/) * DOI: [ 10.1111/jhn.70347 ](https://doi.org/10.1111/jhn.70347) Item in Clipboard Meta-Analysis # Double Burden of Malnutrition Prevalence in Pregnant Women: Systematic Review and Meta-Analysis Amanda Biete et al. J Hum Nutr Diet. 2026 Oct. Show details Display options Display options Format Abstract PubMed PMID J Hum Nutr Diet Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Hum+Nutr+Diet%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Hum+Nutr+Diet%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42755021/) . 2026 Oct;39(5):e70347. doi: 10.1111/jhn.70347. ### Authors [Amanda Biete](https://pubmed.ncbi.nlm.nih.gov/?term=Biete+A&cauthor_id=42755021)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42755021/#short-view-affiliation-1 "Graduate Program in Human Nutrition, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF, Brazil."), [Camila Biete](https://pubmed.ncbi.nlm.nih.gov/?term=Biete+C&cauthor_id=42755021)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42755021/#short-view-affiliation-1 "Graduate Program in Human Nutrition, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF, Brazil."), [Vivian S S Gonçalves](https://pubmed.ncbi.nlm.nih.gov/?term=Gon%C3%A7alves+VSS&cauthor_id=42755021)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42755021/#short-view-affiliation-2 "Graduate Program in Public Health, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF, Brazil."), [Erika S O Patriota](https://pubmed.ncbi.nlm.nih.gov/?term=Patriota+ESO&cauthor_id=42755021)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42755021/#short-view-affiliation-2 "Graduate Program in Public Health, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF, Brazil."), [Nathalia Pizato](https://pubmed.ncbi.nlm.nih.gov/?term=Pizato+N&cauthor_id=42755021)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42755021/#short-view-affiliation-1 "Graduate Program in Human Nutrition, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF, Brazil.") ### Affiliations * 1 Graduate Program in Human Nutrition, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF, Brazil. * 2 Graduate Program in Public Health, University of Brasilia, Campus Universitário Darcy Ribeiro, Brasília, DF, Brazil. * PMID: **42755021** * PMCID: [ PMC13586418 ](https://pmc.ncbi.nlm.nih.gov/articles/PMC13586418/) * DOI: [ 10.1111/jhn.70347 ](https://doi.org/10.1111/jhn.70347) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Introduction:** The coexistence of undernutrition and overweight, obesity, or diet-related noncommunicable diseases and micronutrient deficiency in pregnant women is defined by the WHO as a double burden of malnutrition (DBM). These coexistences are a critical aspect of maternal and antenatal care, especially in low- and middle-income countries. **Objective:** To estimate the global prevalence of DBM in pregnant women through a systematic review and meta-analysis. **Methods:** The systematic review was conducted in accordance with the PRISMA recommendations. Studies that reported prevalence measures of DBM in healthy pregnant women were included. DBM was considered as the coexistence of underweight with gestational diabetes mellitus (GDM), underweight with hypertension, overweight/obesity with anemia, overweight/obesity with vitamin D deficiency, overweight/obesity with vitamin B12 deficiency, and overweight/obesity with folate deficiency. The meta-analysis used a random-effects model with inverse-variance weighting. Risk of bias was assessed using Joanna Briggs Institute tools, and the certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. **Results:** The systematic review included 62 articles totaling 1,386,245 pregnant women, at 8-42 gestational weeks and 13-45 years of age. The most common DBMs identified were overweight/obesity and vitamin D deficiency (21%; 95% CI: 14%-27%, n = 10 studies) and overweight/obesity and anemia (9%; 95% CI: 7%-10%, n = 18 studies). A meta-analysis of overweight/obesity and micronutrient deficiency was not conducted due to the small number of eligible studies. Most studies (66.3%) had high methodological quality; however, GRADE rated the overall certainty of evidence as low. **Conclusion:** A high prevalence of overweight/obesity with vitamin D deficiency and anemia were observed. These results emphasize the need for stronger public policies to ensure equitable access to healthy diets, evidence-based supplementation, and continuous nutritional monitoring during pregnancy. **Keywords:** double burden of malnutrition; gestational diabetes mellitus; nutritional deficiency; obesity; pregnancy; underweight; vitamin D deficiency. © 2026 The Author(s). Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement The authors declare no conflicts of interest. ## Figures [ ![FIGURE 1](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/845f/13586418/fc72eef63af0/JHN-39-0-g001.gif) ](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/845f/13586418/d3db4e8747de/JHN-39-0-g001.webp) ** FIGURE 1 ** Flow chart of the literature… ** FIGURE 1 ** Flow chart of the literature search, selection criteria, and inclusion of studies (adapted… **FIGURE 1** Flow chart of the literature search, selection criteria, and inclusion of studies (adapted from PRISMA). [ ![FIGURE 2](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/845f/13586418/8a961c4a28a8/JHN-39-0-g002.gif) ](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/845f/13586418/e665ea4a62a5/JHN-39-0-g002.webp) ** FIGURE 2 ** Prevalence of underweight and GDM… ** FIGURE 2 ** Prevalence of underweight and GDM in pregnant women. **FIGURE 2** Prevalence of underweight and GDM in pregnant women. [ ![FIGURE 3](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/845f/13586418/08a1aa5cd6a9/JHN-39-0-g003.gif) ](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/845f/13586418/ffc6ade8d5e7/JHN-39-0-g003.webp) ** FIGURE 3 ** Prevalence of overweight/obesity and anemia… ** FIGURE 3 ** Prevalence of overweight/obesity and anemia in pregnant women. **FIGURE 3** Prevalence of overweight/obesity and anemia in pregnant women. [ ![FIGURE 4](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/845f/13586418/6e5992bab8a2/JHN-39-0-g005.gif) ](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/845f/13586418/560dc897fe4d/JHN-39-0-g005.webp) ** FIGURE 4 ** Prevalence of overweight/obesity and vitamin… ** FIGURE 4 ** Prevalence of overweight/obesity and vitamin D deficiency in pregnant women. **FIGURE 4** Prevalence of overweight/obesity and vitamin D deficiency in pregnant women. [ ![FIGURE 5](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/845f/13586418/c6a4e7dddccc/JHN-39-0-g004.gif) ](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/845f/13586418/d295cf326e4f/JHN-39-0-g004.webp) ** FIGURE 5 ** Funnel graph on the publication… ** FIGURE 5 ** Funnel graph on the publication bias of studies according to each outcome. **FIGURE 5** Funnel graph on the publication bias of studies according to each outcome. [See this image and copyright information in PMC](https://pubmed.ncbi.nlm.nih.gov/42755021/) ## Similar articles * [ Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas. ](https://pubmed.ncbi.nlm.nih.gov/36321557/) Crider K, Williams J, Qi YP, Gutman J, Yeung L, Mai C, Finkelstain J, Mehta S, Pons-Duran C, Menéndez C, Moraleda C, Rogers L, Daniels K, Green P.Crider K, et al.Cochrane Database Syst Rev. 2022 Feb 1;2(2022):CD014217. doi: 10.1002/14651858.CD014217.Cochrane Database Syst Rev. 2022.Update in: [Cochrane Database Syst Rev. 2026 Feb 18;2:CD014217. doi: 10.1002/14651858.CD014217.pub2.](https://pubmed.ncbi.nlm.nih.gov/41705996/)PMID: 36321557Free PMC article.Updated. * [ Spatial Clustering of Malnutrition and Anemia Among Reproductive Women and Its Associated Risk Factors in India: Evidence From National Family Health Survey-5. ](https://pubmed.ncbi.nlm.nih.gov/38439659/) Ghosh K, Chakraborty AS, Haloi B, Zakir S.Ghosh K, et al.Food Nutr Bull. 2024 Mar;45(1):3-11. doi: 10.1177/03795721241234086. Epub 2024 Mar 4.Food Nutr Bull. 2024.PMID: 38439659 * [ Occurrence of Nutritional Deficiencies (Ferritin, Vitamin B12, and D) and Abnormal BMI Among Women of Reproductive Age: Implications for Sustainable Food-Based Interventions. ](https://pubmed.ncbi.nlm.nih.gov/41346037/) Ganie MA, Jabbar PK, Malhotra N, Sahay R, Chowdhury S, Suri V, Bhattacharya PK, Agrawal S, Rozati R, Bashir R, Nisar S, Rashid H, Roshan R, Wani I, Paddar K, Gowhar M, Yousuf A.Ganie MA, et al.Mol Nutr Food Res. 2026 Jan;70(1):e70347. doi: 10.1002/mnfr.70347. Epub 2025 Dec 4.Mol Nutr Food Res. 2026.PMID: 41346037 * [ Prevalence and Determinants of the Co-Occurrence of Overweight or Obesity and Micronutrient Deficiencies among Adults in the Philippines: Results from a National Representative Survey. ](https://pubmed.ncbi.nlm.nih.gov/34371849/) de Juras AR, Hsu WC, Hu SC.de Juras AR, et al.Nutrients. 2021 Jul 8;13(7):2339. doi: 10.3390/nu13072339.Nutrients. 2021.PMID: 34371849Free PMC article. * [ Global prevalence of underweight and overweight/obesity among migrant workers: a systematic review and meta-analysis. ](https://pubmed.ncbi.nlm.nih.gov/42138267/) Nurrahma HA, Arifin H, Pradana AA, Susanto H, Yeh CL, Chen YL, Shirakawa H, Chou KR, Yang SC.Nurrahma HA, et al.J Glob Health. 2026 May 15;16:04154. doi: 10.7189/jogh.16.04154.J Glob Health. 2026.PMID: 42138267Free PMC article. [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42755021) ## References 1. 1. WHO ., “The Double Burden of Malnutrition,” Policy Brief (2017). 2. 1. Double Burden of Malnutrition. Malnutrition in All Its Forms. [Internet]. Geneva: WHO, 2024; [citado 6 de maio de 2025]. Disponível em: . 3. 1. Seferidi P., Hone T., Duran A. C., Bernabe‐Ortiz A., and Millett C., “Global Inequalities in the Double Burden of Malnutrition and Associations With Globalisation: A Multilevel Analysis of Demographic and Health Surveys From 55 Low‐Income and Middle‐Income Countries, 1992–2018,” Lancet Global Health. abril de 10, no. 4 (2022): e482–e490, 10.1016/S2214-109X(21)00594-5. - [DOI](https://doi.org/10.1016/s2214-109x\(21\)00594-5) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC8924053/) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/35148831/) 4. 1. Popkin B. M., Corvalan C., and Grummer‐Strawn L. M., “Dynamics of the Double Burden of Malnutrition and the Changing Nutrition Reality,” Lancet. janeiro de 395, no. 10217 (2020): 65–74, 10.1016/S0140-6736(19)32497-3. - [DOI](https://doi.org/10.1016/s0140-6736\(19\)32497-3) - [PMC](htt
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