Maternal nutritional status in pregnancy and blood pressure in childhood.

OBJECTIVE: To examine the relation between indices of maternal nutrition during pregnancy, including haemoglobin concentration, skinfold thickness and body weight, and the child's blood pressure at 10 to 12 years of age. DESIGN: Follow up study of children whose mothers had haemoglobin estimations, weights and skinfold thicknesses recorded during pregnancy. SETTING: Kingston, Jamaica. SUBJECTS: Seventy-seven children whose mothers took part in a prospective study of nutrition during pregnancy in relation to fetal growth. MAIN OUTCOME MEASURE: Blood pressure at 10 to 12 years of age. RESULTS: The child's mean systolic pressure adjusted for current weight rose by 2.6 mmHg (95% CI 0.5-4.6, P = 0.01) for each 1 g/dl fall in the mother's lowest haemoglobin during pregnancy. Mothers with a lower haemoglobin had thinner skinfold thicknesses, especially over the triceps (P = 0.005). In multiple regression analyses, taking account of the child's sex and current weight, there was a strong association between thin maternal triceps skinfold thickness at 15 weeks of gestation and raised blood pressure in the offspring. Taking account of the mother's triceps skinfold thickness abolished the relation between lower haemoglobin and raised blood pressure in the child. Lower weight gain between 15 and 35 weeks of gestation was independently associated with raised children's blood pressure. Systolic pressure rose by 10.7 mmHg (95% CI 5.7 to 15.6, P = 0.0001) for each log mm decrease in the mother's triceps skinfold thickness, and by 0.6 mmHg (95% CI 0.1 to 1.0, P = 0.02) for each 1 kg decrease in the mother's weight gain during pregnancy. CONCLUSIONS: These results parallel animal experiments suggesting that impaired maternal nutrition may underlie the programming of adult hypertension during fetal life.

PIP: In the early 1990s, researchers followed up on 77 children, 10.4-12.2 years old, who had attended the outpatient clinic at the University Hospital of the West Indies in Kingston, Jamaica, as infants during 1979-1981 to determine whether maternal nutrition during pregnancy sets the stage for adult hypertension. The mothers had received prenatal care early in the pregnancy. The overall mean systolic pressure was 94.8 mmHg. For each log mm decrease in the mother's triceps skinfold thickness at 15 weeks gestation, the child's systolic pressure increased by 10.7 mmHg (p = 0.0001). For each 1 kg reduction in maternal weight gain between 15 and 35 weeks gestation, child's systolic pressure increased by 0.6 mmHg (p = 0.02). Mothers with a lower hemoglobin level had thinner skinfold thicknesses, particularly of the triceps (p = 0.005). The child's systolic blood pressure increased by 2.6 mmHg for each 1 g/dl decline in the mother's hemoglobin (p = 0.01), but this effect was not consistent or strong. Nevertheless, it adds more credence to the theory that poor maternal nutrition status is linked to the programming of hypertension in fetuses. These findings correspond to findings of experiments with rats. Further research is needed to confirm these findings. These findings illustrate the need to expand our knowledge about how maternal nutrition affects the fetus and how the fetus responds to poor maternal nutrition.

Dietary patterns and nutrition in pregnancy in Jamaica.

During a study of nutrition in pregnancy, the diets of 108 Jamaican pregnant women were assessed by single 24-hour recalls. The women were 16-45 years old, of mixed parity (0-9), attended private (23 per cent) and public (77 per cent) antenatal clinics and differed in stage of pregnancy at interview. Mean energy intake (2110 +/- 739 kcal/d) was low, 83 per cent of the average Recommended Dietary Allowance for the Caribbean (CFNI 1976). Most (76 per cent) women had low energy and dietary iron (75 per cent) intakes. Fewer women had low riboflavin (42 per cent) or protein intakes (29 per cent). Maternal age, parity, obstetric performance, and unusual cravings influenced maternal nutrition to some extent. Dietary assessments overestimated the risk of maternal malnutrition.

Parasitism and nutritional status of poor suburban Jamaican toddlers.

PIP: A survey was conducted on 145 toddlers, 6-36 months of age, in a suburb in Kingston, Jamaica. The aim of the study was to measure the prevalence of and association between parasitism and nutritional status. 42% were malnourished (80% of standard weight for age), most commonly (76%) in the 12-17 month age group. 34% had 1 or more parasites, particularly Trichuris trichuria (21%) or Ascaris lumbricoides (63%). Peak prevalence of parasitism was among the 30-36 month old children (63%). Nutritional status did not differ between children with and without parasites. Most of them had light intensities of infection. Therefore, in this sample, there was no association between parasitism and nutritional status.^ieng

Parasitism and nutritional status of poor suburban jamaican toddlers

A survey was conducted on 145 toddlers, 6-36 months of age, in a suburb in Kingston, Jamica. The aim of the study was to measure the prevalence of and association between parasitism and nutritional status. Forty-two per cent were malnourished ( <80% of standard weight for age), most commonly (76%) in the 12-17 month age group. Thirty-four per cent hada one or more parasites, particularly Trichuris trichuria (21%) or Ascaris lumbricoides (19%). The peak prevalence of parasitism was among the 30-36 month old children (63%). Nutritional status did not differ between children with and without parasites. Most of them had light of infection. Therefore, in this sample, there was no association between parasitism and nutritional status

Urea kinetics in adults with homozygous sickle cell disease.

The kinetics of urea metabolism were measured in four adults with homozygous sickle cell disease (HbSS). On a dietary intake of 1.2 to 2.7 g protein/kg/d the rate of urea production was 188 to 277 mg nitrogen/kg/d. A relatively small proportion of the urea was excreted in the urine (40 per cent), with a high fixed rate of hydrolysis in the bowel, 145 mg nitrogen/kg/d. Although 50 per cent of the nitrogen from hydrolysed urea was resynthesized to urea, and a further 10 per cent may have been lost in the stool, it is estimated that 58 mg nitrogen/kg/d was available for synthetic metabolic activity. Urea kinetics in sickle cell disease subjects are markedly different from normals, and this may be a reflection of the metabolic demands for increased red cell synthesis.

Thiamin status in normal and malnourished children in Jamaica.

Thiamin status has been measured using the erythrocyte transketolase (EC 2.2.1.1) assay in twenty-eight normal children and in twenty-five severely-malnourished children throughout the course of recovery. Subclinical thiamin deficiency was found in 7% of the normal children and 36% of the malnourished children on admission. There was no significant association between thiamin status and oedema, stunting or wasting, history of breast-feeding, pattern of weaning, age or sex. Five malnourished children, who died, all had a normal thiamin status on admission; however, two developed biochemical evidence of thiamin deficiency preterminally.

Breast-feeding in decline in Kingston, Jamaica, 1973.

PIP: A 12-month longitudinal study was undertaken in Jamaica to examine the following: 1) the effect of current infant feeding practices on infant growth and the frequency of infections; and 2) the extent to which differences in feeding patterns could be attributed to the education the mothers had received at the University Hospital of the West Indies. 81 mothers who were admitted to the Department of Obstetrics and Gynecology at the University Hospital of the West Indies gave birth to 82 infants between December 26, 1972 and January 15, 1973. The age range of the mothers was 15-44 years. Obstetric histories and information regarding the infants were obtained from the hospital notes. The mothers were interviewed in the hospital, usually within 24 hours of delivery. At 3 weeks postpartum, all but 1 of the mothers was visited at home. The mothers were asked to attend 10 clinics. At all visits or clinics the infants' method of feeding, infections, the family income and expenditure on food were recorded. Most mothers breast fed fully (65%) in the hospital, but by 3 weeks only 25% were still breast feeding fully. Partial breast feeding was not prolonged. At 5 months only 38% of the infants were still breast fed. More women aged 27 years or older tended to breast feed for 4 months or longer (69%) although they appeared less successful at complete breast feeding in hospital (41%) than younger women (77%). This decline in breast feeding occurred in a context of poverty in which the majority of the mothers' weekly income (88%) was spent on food. As the program to promote breast feeding could not be exactly defined, the relationship between the program and the infant feeding practices was unclear.^ieng