Maternal body composition near term and birth weight.

OBJECTIVE: To assess the relative influence of maternal body composition at late gestation on birth weight. METHODS: Maternal body composition was estimated in 224 women near term using a deuterium dilution technique. Using a stepwise multiple linear regression analysis, we studied the association with birth weight of eight factors, including maternal fat-free mass and fat mass. RESULTS: Maternal fat-free-mass was the most important variable influencing birth weight (R2 = .144, P < .001), followed by maternal fat mass (R2 = .051, P < .001). Gestational age at delivery was the third strongest influence on birth weight (R2 = .047, P < .001). CONCLUSION: In late pregnancy, fat-free mass was the most important maternal body component associated with birth weight. The implementation of longitudinal studies could shed more light on the influence of maternal body composition on birth weight.

Breast-feeding determinants in Chile.

PIP: In Chile in low income populations, research shows that the longer infants breast feed the lower the incidence of malnutrition (p.05) in these infants. Yet mothers with 9 years of formal education and often members of the low income group are at the highest risk of giving birth to infants 3000 g who are at highest risk of death. Indeed, it is among these groups that infant malnutrition rates are the highest. Therefore, to reduce infant mortality in these groups, more women should breast feed longer. Other determinants of women choosing to not breast feed or not breast feeding for a long period of time in Chile include work, poor nutritional status, smoking, and poor health team attitudes and practices. To counteract the negative trend in breast feeding and thereby increase the duration of breast feeding in low income mothers in Chile, the Ministry of Health (MOH) initiated its National Program for Breast-feeding Promotion (NPBP) in 1980. The educational component included training primary health care and maternity hospital health teams and distribution of educational brochures to pregnant women. If pregnant women weighed less than what the new 1980 standard recommended, they received nutritional supplements as part of the Supplementary Food Program (SPF). A study revealed that in an area where pregnant mothers received educational materials and support from the health team and food supplements, the proportion of 6 month olds exclusively breast fed rose 61.4% (p.001) in 2 years while it rose 40.7% in the area where only the SPF had been implemented. In Santiago, the percentage of breast fed 3 month olds also increased after introduction of NPBP (46%-63% [1977-1982]). The Ministries of Education and Labor could also contribute to healthier babies by preparing a family life curriculum and sponsoring legislation to extend maternity leave for working mothers.^ieng

Growth failure prediction in Chile.

The purpose of this investigation was to develop screening instruments for the prediction of infants' growth failure. Biological and social variables of subjects attending public clinics in Santiago, Chile, were prospectively collected and screened as possible risk factors of being underweight/age at the end of the first year of life using three methodologies. Methodologies used were: simple relative risk, logistic regression, and classification and regression trees. As judged by sensitivity and specificity properties, the screening instrument developed by the latter methodology is much better than the other two.

Effect of a milk-based food supplement on maternal nutritional status and fetal growth in underweight Chilean women.

The effects on pregnancy outcome and maternal iron status of powdered milk (PUR) and a milk-based fortified product (V-N) were compared in a group of underweight gravidas. These take-home products were distributed during regular prenatal visits. Women in the V-N group had greater weight gain (12.29 vs 11.31 kg, p less than 0.05) and mean birth weights (3178 vs 3105 g, p less than 0.05) than those in the PUR group. Values for various indicators of maternal Fe status were also higher in the V-N group. Compared with self-selected noncompliers, similar in all control variables to compliers, children of women who consumed powdered milk or the milk-based fortified product had mean birth weights that were higher by 258 and 335 g, respectively. Data indicate a beneficial effect of the fortified product on both maternal nutritional status and fetal growth.

PIP: The effects on maternal and infant weight gain and maternal iron status of powdered milk (PUR) and a milk-based fortified product (V-N) were compared in underweight women attending prenatal clinics in Santiago, Chile. All pregnant women attending 9 prenatal clinics of the Southeast Health Area, over 18 years old, parity 0-5, nonsmoking, nonalcohol-consuming and underweight (95% of standard) joined the study. They were given either the PUR, powdered milk with 26% milkfat, or V-N, (Vita-Nova Mother-food, Melkunie Holland, Woerden) which contained micronutrients and added vegetable fat, as mandated by law. Those who failed to consume supplements were relegated to the control group. The V-N group had greater weight gain (12.29 vs 11.31 kg, p0.05), mean birth weights (3178 vs 3105 g, p0.05) than the PUR group. Iron status, shown by significantly higher mean hematocrit, hemoglobin, mean corpuscular volume, transferrin saturation and plasma ferritin levels near term, was also better in the V-N group than in the PUR. Other significant differences in favor of the V-N supplement were number of intrauterine growth retarded infants and birth weights under 3001 g. The V-N group had greater fluid retention: the import of this is unknown. The infants of non-compliers had birthweights 258 and 335 g lower than the women consuming PUR and V-N, respectively. The babies of V-N mothers gained 74 g/kg maternal weight gain, higher than many previously reported increments, perhaps due to the micronutrients in the supplement.

Validation of the deuterium dilution technique for the measurement of fluid intake in infants.

The validity of the deuterium dilution technique as a method of measuring fluid intake was investigated by comparing values obtained with this technique and direct measurements of milk intake in 10 exclusively bottle-fed infants recovering from protein-energy malnutrition. Values for total body water were derived from body weight and length using Friis-Hansen's formula. During a 15-d period, average daily milk intake, measured with the deuterium technique, ranged between 519 and 963 ml and was similar to values obtained by direct measurement (range 531-1002 ml). Correlation between both sets of values was highly significant (r = 0.97; P less than 0.001). The data indicate that the deuterium dilution method provides good estimates of daily fluid intake in young infants.

Marco historico para el analisis de las causas del descenso en la practica de la lactancia materna. / Historycal background on the causes of diminution in the practice of breast-feeding

La modernizacion de las sociedades en el mundo ha producido diversos cambios que se asocian con el descenso en la practica de la lactancia materna. Esta modernizacion tendria caracteristicas especiales en los paises en vias de desarrollo. Para America Latina, donde se observa un intenso proceso de urbanizacion acompanado en algunos paises por una desaceleracion del crecimiento de la poblacion, se senalan algunas de estas caracteristicas. En particular se discute el caso de Chile, describiendose las acciones realizadas para revertir el descenso historico en la practica de la lactancia materna