Role of Maternal Nutrition in the Health Outcomes of Mothers and Their Children: A Retrospective Analysis.

BACKGROUND Low nutrition status of mothers plays an important role in increasing the prevalence of poor pregnancy outcomes. Poor pregnancy outcomes are the most common in the Guangzhou region of China. The objective of the study was to evaluate the role of maternal nutrition in the improvement of health outcomes for mothers and their children in the Guangzhou region of China. MATERIAL AND METHODS In this study, pregnancy medical records of women were analyzed. Data related to questionnaires which had been provided during hospital stays for nutritional consumption were gathered. Demographic characteristics and health outcomes of mothers and their children were recorded. Correlations of health outcomes with maternal nutrition were tested with respect to Z-scores at 95% confidence level. RESULTS Based on the health outcomes of mothers and their children, the study divided participants into 2 groups. The first group was mothers and their children with good health outcomes (live births with weighing ≥2.5 kg; the GHO group, n=130) and the second group was mothers and their children with poor health outcomes (miscarriage or premature birth with weighing less than 2.5 kg; the PHO group, n=70). These results showed positive correlation between financial status of the mother (salaried, P<0.001), maternal body mass index (P=0.001), maternal nutrition (P<0.001), maternal education (in years, P<0.001), and maternal age (P=0.004)) with health outcomes of mothers and their children. CONCLUSIONS The financial status of the mother, maternal nutrition, maternal age, and maternal education were the key determinants for predicting health outcomes of mothers and their children.

Nutritional assessment of pregnant adolescents: comparison of two popular classification systems.

The objective of this study was to assess the degree of concordance between two popular classification systems [the Centers for Disease Control and Prevention (CDC)-2000 and the Institute of Medicine (IOM)-2009] used to categorise the nutritional status of pregnant adolescents. This cross-sectional study involved 327 pregnant adolescents (10-19 years) booking for antenatal care at a single public maternity in São Paulo, Brazil. Participants were classified into one of four categories, by both systems according to their pre-pregnancy body mass index and age. The CDC-2000 system classified significantly fewer pregnant adolescents as underweight (3.7% vs. 12.5%, P < 0.0001) and significantly more adolescents as normal-weight (86.8% vs. 75.6%, P = 0.0003) than the IOM-2009 system. The distribution of the adolescents in the two systems differed significantly. The global rate of discordance was 13.5%. The overall concordance between the two systems was marginally good (K = 0.63), being moderate for younger (<16 years) adolescents (K = 0.52). Approximately one in every seven pregnant adolescent would be classified in a non-corresponding category if the IOM-2009 classification was used instead of the CDC-2000 classification. The IOM-2009 nutritional classification, which does not take into account age and gender, tends to overestimate the proportion of underweight adolescents, especially in the younger-age group. The use of this classification system can lead to recommendations of higher gestational weight gain in a substantial proportion of pregnant adolescents, which could predispose to post-partum weight retention and future obesity.

Early invitation to food and/or multiple micronutrient supplementation in pregnancy does not affect body composition in offspring at 54 months: follow-up of the MINIMat randomised trial, Bangladesh.

Growth patterns in early life are associated with later health. The effect of nutrition during in utero development on later body composition is unclear. We evaluated whether prenatal early invitation to food and/or multiple micronutrient supplementation (MMS) in pregnancy has an effect on offspring body composition at 54 months of age. In Maternal and Infant Nutrition Interventions in Matlab trial (ISRCTN16581394) in Bangladesh, 4436 pregnant women were randomised into six equally sized groups: double-masked supplementation with capsules of either 30 mg Fe and 400 µg folic acid, or 60 mg Fe and 400 µg folic acid, or MMS (15 micronutrients), was combined with a randomised early invitation (around 9 weeks) or a usual invitation (around 20 weeks) to start food supplementation (608 kcal 6 days per week). At 54 months, the body composition of the offspring was assessed by leg-to-leg bioelectrical impedance analysis. Of the 3267 live singletons with birth anthropometry, 2290 children were measured at 54 months, representing 70% of the live births. There was no interaction between the food and micronutrient supplementation on body composition outcomes. There were no significant differences in a range of anthropometric and body composition measurements, including weight, height, mid-upper arm circumference, head circumference, skinfold thickness, and fat mass and fat-free mass between the different prenatal food and micronutrient groups using an intention-to-treat analysis. This analysis shows that early invitation to food supplementation and MMS provided to rural Bangladeshi women during pregnancy did not affect offspring body composition at 54 months of age.

Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?

Maternal undernutrition contributes to 800,000 neonatal deaths annually through small for gestational age births; stunting, wasting, and micronutrient deficiencies are estimated to underlie nearly 3·1 million child deaths annually. Progress has been made with many interventions implemented at scale and the evidence for effectiveness of nutrition interventions and delivery strategies has grown since The Lancet Series on Maternal and Child Undernutrition in 2008. We did a comprehensive update of interventions to address undernutrition and micronutrient deficiencies in women and children and used standard methods to assess emerging new evidence for delivery platforms. We modelled the effect on lives saved and cost of these interventions in the 34 countries that have 90% of the world's children with stunted growth. We also examined the effect of various delivery platforms and delivery options using community health workers to engage poor populations and promote behaviour change, access and uptake of interventions. Our analysis suggests the current total of deaths in children younger than 5 years can be reduced by 15% if populations can access ten evidence-based nutrition interventions at 90% coverage. Additionally, access to and uptake of iodised salt can alleviate iodine deficiency and improve health outcomes. Accelerated gains are possible and about a fifth of the existing burden of stunting can be averted using these approaches, if access is improved in this way. The estimated total additional annual cost involved for scaling up access to these ten direct nutrition interventions in the 34 focus countries is Int$9·6 billion per year. Continued investments in nutrition-specific interventions to avert maternal and child undernutrition and micronutrient deficiencies through community engagement and delivery strategies that can reach poor segments of the population at greatest risk can make a great difference. If this improved access is linked to nutrition-sensitive approaches--ie, women's empowerment, agriculture, food systems, education, employment, social protection, and safety nets--they can greatly accelerate progress in countries with the highest burden of maternal and child undernutrition and mortality.

Socioeconomic, demographic and nutritional factors associated with maternal weight gain in general practices in Southern Brazil.

In order to describe adequacy of weight gain during pregnancy and its association with pre-pregnancy nutritional status and other factors, a cohort study of pregnant women enrolled at 16-36 weeks of gestation and followed up until delivery was carried out in prenatal care in primary care services in Rio Grande do Sul State, Brazil. Maternal weight was recorded at each prenatal care visit. Weight gain was classified as "adequate," "insufficient" or "excessive" (Institute of Medicine). Poisson regression was used to measure the associations. The sample was comprised of 667 women, and insufficient and excessive weight gain incidences were 25.8% and 44.8%, respectively. Overweight and obese before pregnancy had a significant increased risk of excessive weight gain in pregnancy (RR: 1.75; 95%CI: 1.48-2.07, RR: 1.55; 95%CI: 1.23-1.96, respectively). Women with fewer than six prenatal visits had a 52% increased risk for weight gain below recommended values. Although insufficient weight gain may still be a public health problem, excessive gain is becoming a concern that needs immediate attention in prenatal care.

Socioeconomic, demographic and nutritional factors associated with maternal weight gain in general practices in Southern Brazil / Fatores socioeconômicos, demográficos e nutricionais associados com ganho de peso gestacional em unidades básicas de saúde no Sul do Brasil

In order to describe adequacy of weight gain during pregnancy and its association with pre-pregnancy nutritional status and other factors, a cohort study of pregnant women enrolled at 16-36 weeks of gestation and followed up until delivery was carried out in prenatal care in primary care services in Rio Grande do Sul State, Brazil. Maternal weight was recorded at each prenatal care visit. Weight gain was classified as "adequate," "insufficient" or "excessive" (Institute of Medicine). Poisson regression was used to measure the associations. The sample was comprised of 667 women, and insufficient and excessive weight gain incidences were 25.8 percent and 44.8 percent, respectively. Overweight and obese before pregnancy had a significant increased risk of excessive weight gain in pregnancy (RR: 1.75; 95 percentCI: 1.48-2.07, RR: 1.55; 95 percentCI: 1.23-1.96, respectively). Women with fewer than six prenatal visits had a 52 percent increased risk for weight gain below recommended values. Although insufficient weight gain may still be a public health problem, excessive gain is becoming a concern that needs immediate attention in prenatal care.

Para caracterizar o ganho ponderal gestacional e sua associação com estado nutricional pré-gestacional e fatores relacionados à gravidez, realizou-se estudo de coorte com gestantes arroladas consecutivamente entre a 16ª e a 36ª semanas, e seguidas até o parto em serviços da rede básica de saúde do Estado do Rio Grande do Sul, Brasil. Informações do peso da gestante em cada consulta de pré-natal foram obtidas. Ganho de peso foi classificado conforme o Instituto de Medicina dos Estados Unidos. Regressão de Poisson com variância robusta foi utilizada. Incidências de ganho de peso insuficiente e excessivo das 667 gestantes foram de 25,8 por cento e 44,8 por cento, respectivamente. Gestantes com sobrepeso e obesidade pré-gestacional apresentaram risco para ganho ponderal excessivo (RR: 1,75; IC95 por cento: 1,48-2,07 e RR: 1,55; IC95 por cento: 1,23-1,96). Gestantes com menos de seis consultas de pré-natal tiveram risco de 52 por cento de ganhar peso insuficiente. Embora o ganho ponderal insuficiente persista como um problema de saúde pública, o ganho excessivo está se configurando como uma questão que precisa de atenção imediata nos serviços de pré-natal.

Determinants of compliance to antenatal micronutrient supplementation and women's perceptions of supplement use in rural Nepal.

OBJECTIVE: We examined factors affecting compliance to antenatal micronutrient supplementation and women's perceptions of supplement use. DESIGN: Randomized controlled supplementation trial of four alternative combinations of micronutrients given during pregnancy through to 3 months postpartum. Women were visited twice weekly to monitor compliance and to replenish tablets by female study workers. At 6 weeks postpartum women with live births (n 4096) were interviewed regarding their perceptions of the supplement. Median compliance calculated as percentage of total eligible doses received by women was high (84 %). SETTING: Rural southern Nepal. SUBJECTS: Pregnant women. RESULTS: Women with high compliance (above the median of 84 %) were likely to be older, less educated, poorer, undernourished, belong to lower caste and of Pahadi (hill) ethnicity compared with women with low compliance (at or below the median of 84 %). Smoking and drinking alcohol in the past week during pregnancy were strongly associated with low compliance. The major reason for irregular intake was forgetting to take supplements. A higher proportion of the high compliers liked taking the supplements but only half of them were willing to purchase them in the future. A large proportion of women (91 %) perceived a benefit from taking the supplement such as improved strength and health, whereas only about 10 % perceived any side-effects which were not a major barrier to compliance. CONCLUSIONS: The present analysis highlights that poor, undernourished, uneducated women can have high compliance to antenatal supplementation if they are supplied with the tablets and reminded to take them regularly, and counselled about side-effects.

[Pregnancy and eating behavior in pregnant women from a low-income neighborhood in Rio de Janeiro, Brazil]. / Gravidez e comportamento alimentar em gestantes de uma comunidade urbana de baixa renda no Município do Rio de Janeiro, Brasil.

The aim of this study was to understand the meanings of acceptance attributed to pregnancy and their influence on the eating behavior of pregnant women attending a health unit located in a low-income neighborhood in the city of Rio de Janeiro, Brazil. The methodology involved a qualitative approach with social representations as the analytical category. Data were collected through semi-structured interviews with adolescent and adult pregnant women (primiparous or multiparous) in different stages of pregnancy. Discourse analysis drew on in-depth hermeneutics, using thematic analysis as the main technical resource. Two representational categories emerged from the set of discourses, namely accepting versus not accepting the pregnancy, which involved different eating behaviors. In the former, women tended to either eat adequately or overeat. For the latter, not accepting the pregnancy was associated with denial of eating, temporarily or throughout the pregnancy.

The elimination of child poverty and the pivotal significance of the mother.

The child poverty not an independent condition: it is intimately related to the ecology of the family. It elimination will involve the elimination poor maternal nutrition, low birthweight and its life long consequences in chronic ill health and poor learning. Maternal nutrition and health is a prime determinant of the future of the child and also of her own health, mental state and ability to manage child care. Maternal nutrition and health is also relevant to the future employment opportunities, health, skills and literacy and social behaviour of the new born. Poor maternal nutrition and adverse outcomes conspire to maintain the state of poverty. Children need to be empowered by knowledge. Nutrition, health and home economics should be introduced from pre-school to advanced levels in the school curriculum. It makes little sense to educate children with everything they need to know except how to take charge of their own health, reproductive capacity, cognitive development and that of their own children that they are likely bear. Today non-communicable diseases account for more deaths than all the HIV-AIDS, Malaria, and Tuberculosis combined. The Global Forum for Health predicts that the top three burdens of ill health world-wide will by 2020 be heart disease, perinatal conditions (adverse pregnancy outcomes) and mental ill-health. Unfavourable nutritional conditions contribute substantially to the cause of these three conditions and other non-communicable diseases. Yet children today grow up in ignorance of the science of nutrition and health and become leaders in industry and government with little understanding of nutritional science which could, if taught properly, lead to large scale reductions in chronic disorders, substantial cost savings in the health services and especially in the enhancement of population skills and prosperity. It is also evident that education alone will not suffice. The priority in human development is vested in the brain. Nutrition and food policies last century were based on protein and growth. This century they should be re-aligned to take the human priority of the brain nutrition into account.

Dietary patterns in pregnancy and associations with socio-demographic and lifestyle factors.

OBJECTIVE: To obtain distinct dietary patterns in the third trimester of pregnancy using principal components analysis (PCA); to determine associations with socio-demographic and lifestyle factors. DESIGN AND METHODS: A total of 12 053 pregnant women partaking in a population-based cohort study recorded current frequency of food consumption via questionnaire in 1991-1992. Dietary patterns identified using PCA were related to social and demographic characteristics and lifestyle factors. RESULTS: Five dietary patterns were established and labelled to best describe the types of diet being consumed in pregnancy. The 'health conscious' component described a diet based on salad, fruit, rice, pasta, breakfast cereals, fish, eggs, pulses, fruit juices, white meat and non-white bread. The 'traditional' component loaded highly on all types of vegetables, red meat and poultry. The 'processed' component was associated with high-fat processed foods. The 'confectionery' component was characterized by snack foods with high sugar content and the final 'vegetarian' component loaded highly on meat substitutes, pulses, nuts and herbal tea and high negative loadings were seen with red meat and poultry. There were strong associations between various socio-demographic variables and all dietary components; in particular, a 'health conscious' diet was positively associated with increasing education and age and non-white women. There was a negative association with increased parity, single, non-working women, those who smoked and who were overweight pre-pregnancy. Opposite associations were seen with the 'processed' component. CONCLUSIONS: Distinct dietary patterns in pregnancy have been identified. There is clear evidence of social patterning associated with the dietary patterns, these social factors need to be accounted for in future studies using dietary patterns. This study will form the basis for further work investigating pregnancy outcome.

Intensifying efforts to reduce child malnutrition in India: an evaluation of the Dular program in Jharkhand, India.

BACKGROUND: The Dular strategy is a unique nutrition initiative initiated by UNICEF India in collaboration with the states of Bihar and Jharkhand. Designed to complement the government's Integrated Child Development Services (ICDS) and build upon its infrastructure, one of the major goals of the Dular program is to capitalize and develop community resources at the grassroots level. The emphasis of the Dular program is on establishing a community-based tracking system of the health status of women and of children 0 to 36 months of age by neighborhood-based local resource persons (LRPs). The main objectives of the Dular program include increased prenatal attendance, improvement in breastfeeding and colostrum delivery, improved nutritional practices, and decreased malnutrition. OBJECTIVES AND METHOD: An impact evaluation of 744 women and children in Jharkhand examined antenatal and birthing practices, colostrum delivery, delivery of breastmilk as first food, reported use of iodized salt, measured iodized salt status, immunization and weight-for-age z-scores (WAZ) of children 0 to 36 months of age, controlling for various measures of socioeconomic status. RESULTS: Differences were found between Dular and non-Dular villages in all major outcomes. Particularly noteworthy is that young children in Dular areas had a 45% lower prevalence of severe malnutrition and were four times more likely to receive colostrum than those in non-Dular villages. CONCLUSIONS: Our evaluation results indicate that programmatic overlays to the ICDS program, which focus primary attention on children 0 to 36 months of age and on women, have the potential to transform into a cost-effective instrument for reducing child malnutrition in India, with implications for women and children in India.

Relación entre los niveles de ácido todo trans-retinoico en sangre de cordón umbilical y medidas antropométricas del recién nacido / Retinoic acid levels in the serum of blood from umbilical cord and their relation to anthropometric measures in newborn

Antecedentes: La vitamina A, principalmente en su forma de ácido todo trans-retinoico, desempeña una función de vital importancia durante el desarrollo gestacional en todos los tejidos y órganos del cuerpo. Objetivo: Determinar los niveles de ácido retinoico en el suero de sangre de cordón umbilical y relacionarlos con el peso/edad gestacional del recién nacido y el consumo materno de vitamina A, conjuntamente con variables socio-económicas y nutricionales. Método: Estudio descriptivo de corte transversal, analizando un total de 62 neonatos y sus madres, provenientes de las maternidades de los Hospitales San José y Barros Luco-Trudeau, Santiago de Chile. Resultados: En la población en estudio se observó una relación directa entre el peso/edad gestacional del neonato y el consumo materno de vitamina A, pero no con los niveles de esa vitamina en el suero de sangre de cordón umbilical. Se encontró que el consumo medio de vitamina A en las embarazadas fue sólo de 2298 +/- 1416,8 Ul, siendo la dosis recomendada por OMS de 8000 Ul. Conclusión: Existe asociación entre la ingesta de vitamina A y el estado nutricional materno en relación con el peso/edad gestacional del neonato. Debido a que los requerimientos nutricionales del feto están privilegiados por sobre los maternos, no se observaron diferencias en las características antropométricas del neonato asociadas a la ingesta materna de vitamina A.

Background: Vitamin A, mainly in their form of retinoic acid, it carries out a function of vital importance during the gestational development, in all the tissues and organs of the body. Objective: To evaluate the levels of retinoic acid in the serum of blood from umbilical cord and to relate them with the weight/gestational age ratio of the newborns and the maternal intake of vitamin A, jointly with socioeconomic and nutritional variables. Method: A descriptive study of traverse court, in the maternities of the Hospitals San José and Barros Luco-Trudeau of Santiago, Chile, studying a total of 62 cases. Results: In the population in study a direct relationship was observed between the newborn ratio weight/gestational age and the maternal consumption of vitamin A, but no relationship was found among the same weight/gestational age ratio and the levels of this vitamin in the serum of blood of umbilical cord. On the other hand, it was found that the average consumption of vitamin A in the maternities it was of 2298 +/- 1416.8 IU, being the dose recommended by WHO for pregnant of 8000 IU, therefore, the whole population in study had a faulty consumption of vitamin A. Conclusion: Exists association among the intake of vitamin A and the maternal nutritional state with the weight/gestational age ratio of the newborn and the concentration of trans-retinoic acid in the umbilical cord. Because the nutritional requirements of the fetus are privileged over the maternal ones, differences were not observed in the newborn anthropometries features associated to the maternal vitamin A intake.

Factors influencing antenatal and postnatal diets of primigravid women.

This article disseminates research on the self-reported perceived factors influencing antenatal and postnatal diets of a sample of primigravid women. Participants (n = 39) were recruited from general medical practices during the first trimester of pregnancy, with 37 participants remaining in the study until six months post-partum. Self-reported diet diaries at the first trimester, third trimester and six months post-partum generated information on food consumption, using estimated portions. In-depth interviews at the same three time points identified environmental, physical, social and emotional barriers to healthy eating during pregnancy. Findings from the interviews indicate that the key influences on dietary choices change over the three time periods. Conclusions relate to the key influencing factors and a number of recommendations are made for health promotion interventions to ensure women are informed and able to choose a healthy eating plan during pregnancy and post-partum.

Tracking of food choices across the transition to motherhood.

OBJECTIVE: This research addresses 2 questions: What are the patterns in selected food choice behaviors across the transition to motherhood? and Do the patterns vary by mothers' social location, particularly parity, family income, and breast-feeding behavior? DESIGN: A prospective cohort study with healthy, adult women followed from midpregnancy until 2 years postpartum. Data were collected through mailed questionnaires for prepregnancy and pregnancy, at 6 months, at 1 and 2 years postpartum, and through an audit of the women's medical records. SETTING: A hospital and primary care clinic system serving a 10-county area of rural upstate New York. PARTICIPANTS: 360 women of the 622 in the cohort provided data for all time points. VARIABLES MEASURED: Three food choice behaviors served as categorical dependent variables at each of the 5 time points: drinking > or = 2 cups of milk per day, consuming > or = 3 servings of fruits and vegetables per day, and eating breakfast every day. Three social location variables were used as independent variables for the second research question: parity (nulliparous vs primi- and multiparous), family income (low [< or = 185% of federal poverty level] vs higher), and breast-feeding (> or = 1 year vs less). ANALYSIS: McNemar's test was used to compare proportions of women at or above the cutoff value for each food choice behavior across time, and the Fisher exact test was used to compare proportions between groups for each social location variable at each time point. P < or = .05 was considered significant. RESULTS: The proportion of women drinking 2 or more cups of milk per day at 2 years postpartum was not different from prepregnancy, but the proportions consuming 3 or more fruits and vegetables and eating breakfast every day were significantly higher at 2 years postpartum than prior to pregnancy. The pattern of change varied by categories within the social location variables and differed by food choice behavior. CONCLUSIONS AND IMPLICATIONS: The transition to motherhood was associated with a positive change in some food choice behaviors. Women making this transition for the first time showed the most consistent positive changes and should be a target audience for nutrition education.

Nutrition before birth, programming and the perpetuation of social inequalities in health.

The need to explain social inequalities in health has led to the theory that chronic disease is due, in part, to a legacy of adverse experiences in early life. Epidemiological studies show consistently that individuals who are small at birth have an increased risk of cardiovascular disease in adulthood. There is growing consensus that this association reflects a causal relationship and is not simply the product of bias or confounding. The concept of programming is invoked as the biological mechanism; birth size is thus a proxy for fetal programming. Recent findings suggest that fetal programming interacts with the post-birth environment. The adverse exposures that are thought to underlie and potentiate programming cluster in socially patterned ways, thus creating substantial inequalities in health. Experiments in animals demonstrate that nutritional interventions before or during pregnancy can produce programming phenomena in the offspring, sometimes without an impact on birth size. However, the extent to which maternal nutrition contributes to programming in contemporary developed countries is uncertain.