Household food security is associated with early childhood language development: results from a longitudinal study in rural Bangladesh

BACKGROUND

Although household food security (HHFS) has been linked to academic performance in school children, its association with early childhood development has received less attention, particularly in low-income countries. We investigated the association of HHFS with subsequent language development of children at 18 months of age in rural Bangladesh.

METHODS

We followed 1439 infants born in 2002-2003 to the mothers in Maternal and Infant Nutrition Intervention in Matlab study, a large intervention trial conducted in rural Bangladesh. A HHFS scale was created from data collected from mothers during pregnancy. At 18 months, children's language (expression and comprehension) development was assessed using a Bengali adaptation of MacArthur's Communicative Development Inventory which was based on mothers' report of their children's ability to comprehend and express words in different categories. General linear regression models were used to examine the association between HHFS and language development at 18 months of age adjusting for potential confounders.

RESULTS

Household food security was associated with language comprehension (B = 0.19, 95% CI = 0.09, 0.30, P < 0.001) and expression (B = 1.01, 95% CI = 1.00, 1.02, P < 0.01) at 18 months of age. Mean language comprehension and expression at 18 months of the children in higher quartiles of HHFS were higher (P < 0.05) than those of the children in lower quartiles.

CONCLUSIONS

Household food security is positively associated with subsequent language development of rural Bangladeshi children. Early language development has been reported to predict later child development. Therefore, strategies to ensure HHFS status in Bangladesh and similar settings should be considered for optimum child development.

Maternal supplementation differentially affects the mother and newborn

Although studying the effect of supplementation on maternal health or the outcome of pregnancy was not a primary goal of the Institute of Nutrition of Central America and Panama Oriente Longitudinal Study, many important findings in these areas were produced. As part of the study, a food supplementation program was implemented. Two villages received Atole, a gruel containing protein and energy, and 2 matched villages received a refreshing, low-energy drink containing no protein. Both drinks contained micronutrients. Some women did not choose to consume the supplements and those who did consumed widely varying amounts. More volume of Fresco was consumed than Atole. The energy in the supplements improved birthweight, with no apparent additional benefit from protein or micronutrients. Researchers identified several groups of women who benefited from supplementation more than others by having babies with higher birthweights, including those with poorer current nutritional status and those who consumed high amounts of the supplement continuously from one pregnancy to the next. Results from the study provided an early indication that supplementation might increase the duration of gestation and, thus, reduce preterm birth. On the other hand, maternal supplementation did not substantially alter the duration of postpartum amenorrhea once concurrent infant supplementation was taken into account. Finally, findings from this study provided evidence of a biological trade-off between maintenance of maternal nutritional status and increasing fetal size that was responsive to both current maternal nutritional status and supplement intake but not to the mother's nutritional status earlier in life.

Pregnancy outcomes related to gestational weight gain in women defined by their body mass index, parity, height, and smoking status

BACKGROUND

Recommendations for gestational weight gain (GWG) account for a woman's prepregnancy body mass index (BMI), but other factors may be important.

OBJECTIVES

The objectives were to investigate whether, within BMI categories, the GWG with the lowest risks to mother and infant varied with parity and to describe these risks in short (<160 cm), young (<20 y), and smoking women.

DESIGN

Of 27,030 primiparous and 31,407 multiparous women with term births within the Danish National Birth Cohort, self-reported GWG was divided into 6 categories (<5, 5-9, 10-15, 16-19, 20-24, and > or =25 kg). Population-based registers provided information about birth outcomes. GWG-specific absolute adjusted risks for emergency cesarean delivery, birth of a small-for-gestational-age (SGA) or large-for-gestational-age (LGA) infant, and postpartum (6 mo) weight retention (PPWR) were compared across different types of women.

RESULTS

The risk of SGA decreased with increasing GWG in both parity groups, but SGA risk <10% was reached at 2-3 GWG categories lower in multiparae than in primiparae. An excess risk of LGA was present only in obese primiparae and multiparae, but the PPWR risk increased with increasing GWG irrespective of BMI and parity. Young primiparae had better outcomes than other primiparae. Short women had a higher risk of emergency cesarean delivery that varied minimally with GWG. Smokers had a higher SGA risk and had a PPWR risk similar to that of nonsmokers.

CONCLUSIONS

The tradeoff in risk between mother and infant is reached at lower GWG in multiparae than in primiparae; therefore, a lower GWG may be needed among multiparae. Differential guidelines seem unnecessary for short or young women or smokers.

Maternal, infant, and household factors are associated with breast-feeding trajectories during infants' first 6 months of life in Matlab, Bangladesh

Women's breast-feeding patterns are complex, and existing definitions of breast-feeding behavior do not capture this complexity adequately. We used results from a prior qualitative study to define trajectories for feeding during the first half of infancy, and then examined household-, maternal-, and infant-level determinants of these trajectories using logistic regression analysis. The 1472 women in the study cohort lived in rural Bangladesh and were participants in the Maternal and Infant Nutrition Intervention in Matlab trial. The 3 infant feeding trajectories included women who fed only breast milk and water [full breast-feeding trajectory (FBT)]; offered mixed feeding continuously when their babies were 0-4 mo old [continuous mixed feeding trajectory (CMFT)]; and practiced any other type of breast-feeding [intermittent feeding trajectory (IFT)], which was the normative feeding behavior in this community. In adjusted regression models, women who lived in rural areas [odds ratio (OR), 2.1; 95% CI, 1.2, 3.4], came from the poorest households (OR, 3.4; 95% CI, 1.5, 7.7), and offered prelacteal (OR, 1.7; 95% CI, 1.0-2.7) were more likely to be in the FBT. Women from the richest households (OR, 1.6; 95% CI, 1.1, 2.6), employed mothers (OR, 1.7; 95% CI, 1.1, 2.6), and older mothers (OR, 1.02; 95% CI, 1.0, 1.1) were more likely to be in the CMFT, and women with higher birth-weight infants (OR, 0.6; 95% CI, 0.4-0.8) were less likely to be in the CMFT. Thus, these trajectories were associated with distinct groups of women and these results provide information useful for developing interventions to improve breast-feeding practices.

Micronutrient supplementation affects maternal-infant feeding interactions and maternal distress in Bangladesh

BACKGROUND

Good maternal-infant interaction is essential for optimal infant growth, health, and development. Although micronutrient malnutrition has been associated with poorer interaction, the effects of maternal micronutrient supplementation on interaction are unknown.

OBJECTIVES

We examined differences in maternal-infant feeding interaction between 3 maternal pre- and postpartum micronutrient supplementation groups that differed in iron dose and inclusion of multiple micronutrients and determined whether any differences observed were mediated by maternal distress.

DESIGN

A cohort of 180 pregnant women was selected from 3300 women in the randomized controlled trial Maternal Infant Nutritional Interventions Matlab, which was conducted in Matlab, Bangladesh. At 8 wk of gestation, women were randomly assigned to 1 of 3 groups to receive a daily supplement of micronutrients (14 wk gestation to 12 wk postpartum): 60 or 30 mg Fe each with 400 microg folic acid or multiple micronutrients (MuMS; 30 mg Fe, 400 microg folic acid, and other micronutrients). A maternal-infant feeding interaction was observed in the home when infants were 3.4-4.0 mo of age, and maternal distress was assessed.

RESULTS

Compared with 30 mg Fe, 60 mg Fe decreased the quality of maternal-infant feeding interaction by approximately 10%. Compared with 30 mg Fe, MuMS did not improve interaction but reduced maternal early postpartum distress. Distress did not mediate the effects of micronutrient supplementation on interaction.

CONCLUSION

For pregnant and postpartum women, micronutrient supplementation should be based on both nutritional variables (eg, iron status) and functional outcomes (eg, maternal-infant interaction and maternal distress).

Use of the new World Health Organization child growth standards to describe longitudinal growth of breastfed rural Bangladeshi infants and young children

BACKGROUND

Although the National Center for Health Statistics (NCHS) reference has been widely used, in 2006 the World Health Organization (WHO) released new standards for assessing growth of infants and children worldwide.

OBJECTIVE

To assess and compare the growth of breastfed rural Bangladeshi infants and young children based on the new WHO child growth standards and the NCHS reference.

METHODS

We followed 1343 children in the Maternal and Infant Nutrition Intervention in Matlab (MINIMat) study from birth to 24 months of age. Weights and lengths of the children were measured monthly during infancy and quarterly in the second year of life. Anthropometric indices were calculated using both WHO standards and the NCHS reference. The growth pattern and estimates of undernutrition based on the WHO standards and the NCHS reference were compared.

RESULTS

The mean birthweight was 2697 +/- 401 g, with 30% weighing <2500 g. The growth pattern of the MINIMat children more closely tracked the WHO standards than it did the NCHS reference. The rates of stunting based on the WHO standards were higher than the rates based on the NCHS reference throughout the first 24 months. The rates of underweight and wasting based on the WHO standards were significantly different from those based on the NCHS reference.

CONCLUSIONS

This comparison confirms that use of the NCHS reference misidentifies undernutrition and the timing of growth faltering in infants and young children, which was a key rationale for constructing the new WHO standards. The new WHO child growth standards provide a benchmark for assessing the growth of breastfed infants and children.

Breastfeeding reduces postpartum weight retention

BACKGROUND

Weight gained during pregnancy and not lost postpartum may contribute to obesity in women of childbearing age.

OBJECTIVE

We aimed to determine whether breastfeeding reduces postpartum weight retention (PPWR) in a population among which full breastfeeding is common and breastfeeding duration is long.

DESIGN

We selected women from the Danish National Birth Cohort who ever breastfed (>98%), and we conducted the interviews at 6 (n = 36 030) and 18 (n = 26 846) mo postpartum. We used regression analyses to investigate whether breastfeeding (scored to account for duration and intensity) reduced PPWR at 6 and 18 mo after adjustment for maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG).

RESULTS

GWG was positively (P < 0.0001) associated with PPWR at both 6 and 18 mo postpartum. Breastfeeding was negatively associated with PPWR in all women but those in the heaviest category of prepregnancy BMI at 6 (P < 0.0001) and 18 (P < 0.05) mo postpartum. When modeled together with adjustment for possible confounding, these associations were marginally attenuated. We calculated that, if women exclusively breastfed for 6 mo as recommended, PPWR could be eliminated by that time in women with GWG values of approximately 12 kg, and that the possibility of major weight gain (>or=5 kg) could be reduced in all but the heaviest women.

CONCLUSION

Breastfeeding was associated with lower PPWR in all categories of prepregnancy BMI. These results suggest that, when combined with GWG values of approximately 12 kg, breastfeeding as recommended could eliminate weight retention by 6 mo postpartum in many women.

Household food security is associated with infant feeding practices in rural Bangladesh

Although household food security (HHFS) has been shown to affect diet, nutrition, and health of adults and also learning in children, no study has examined associations with infant feeding practices (IFP). We studied 1343 infants born between May 2002 and December 2003 in the Maternal and Infant Nutrition Intervention in Matlab study to investigate the effect of HHFS on IFP in rural Bangladesh. We measured HHFS using a previously developed 11-item scale. Cumulative and current infant feeding scales were created from monthly infant feeding data for the age groups of 1-3, 1-6, 1-9, and 1-12 mo based on comparison to infant feeding recommendations. We used lagged, dynamic, and difference longitudinal regression models adjusting for various infant and maternal variables to examine the association between HHFS and changes in IFP, and Cox proportional hazards models to examine the influence of HHFS on the duration of breast-feeding and the time of introduction of complementary foods. Better HHFS status was associated with poor IFP during 3-6 mo but was associated with better IFP during 6-9 and 9-12 mo of age. Although better HHFS was not associated with the time of introduction of complementary foods, it was associated with the type of complementary foods given to the infants. Intervention programs to support proper IFP should target mothers in food-secure households when their babies are 3-6 mo old and also mothers in food-insecure households during the 2nd half of infancy. Our results provide strong evidence that HHFS influences IFP in rural Bangladesh.

Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy

BACKGROUND

Although both maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG) may affect birth weight, their separate and joint associations with complications of pregnancy and delivery and with postpartum weight retention are unclear.

OBJECTIVES

We aimed to investigate the combined associations of prepregnancy BMI and GWG with pregnancy outcomes and to evaluate the trade-offs between mother and infant for different weight gains.

DESIGN

Data for 60892 term pregnancies in the Danish National Birth Cohort were linked to birth and hospital discharge registers. Self-reported total GWG was categorized as low (<10 kg), medium (10-15 kg), high (16-19 kg), or very high (>or=20 kg). Adjusted associations of prepregnancy BMI and GWG with outcomes of interest were estimated by logistic regression analyses.

RESULTS

High and very high GWG added to the associations of high prepregnancy BMI with cesarean delivery and were strongly associated with high postpartum weight retention. Moreover, greater weight gains and high maternal BMI decreased the risk of growth restriction and increased the risk of the infant's being born large-for-gestational-age or with a low Apgar score. Generally, low GWG was advantageous for the mother, but it increased the risk of having a small baby, particularly for underweight women.

CONCLUSIONS

Heavier women may benefit from avoiding high and very high GWG, which brings only a slight increase in the risk of growth restriction for the infant. High weight gain in underweight women does not appear to have deleterious consequences for them or their infants, but they may want to avoid low GWG to prevent having a small baby.

Appropriate infant feeding practices result in better growth of infants and young children in rural Bangladesh

BACKGROUND

The World Health Organization and the United Nations International Children's Emergency Fund recommend a global strategy for feeding infants and young children for proper nutrition and health.

OBJECTIVE

We evaluated the effects of following current infant feeding recommendations on the growth of infants and young children in rural Bangladesh.

DESIGN

The prospective cohort study involved 1343 infants with monthly measurements on infant feeding practices (IFPs) and anthropometry at 17 occasions from birth to 24 mo of age to assess the main outcomes of weight, length, anthropometric indexes, and undernutrition. We created infant feeding scales relative to the infant feeding recommendations and modeled growth trajectories with the use of multilevel models for change.

RESULTS

Mean (+/-SD) birth weight was 2697 +/- 401 g; 30% weighed < 2500 g. Mean body weight at 12 and 24 mo was 7.9 +/- 1.1 kg and 9.7 +/- 1.3 kg, respectively. More appropriate IFPs were associated (P < 0.001) with greater gain in weight and length during infancy. Prior IFPs were also positively associated (P < 0.005) with subsequent growth in weight during infancy. Children who were in the 75th percentile of the infant feeding scales had greater (P < 0.05) attained weight and weight-for-age z scores and lower proportions of underweight compared with children who were in the 25th percentile of these scales.

CONCLUSIONS

Our results provide strong evidence for the positive effects of following the current infant feeding recommendations on growth of infants and young children. Intervention programs should strive to improve conditions for enhancing current infant feeding recommendations, particularly in low-income countries.

High prepregnant body mass index is associated with early termination of full and any breastfeeding in Danish women

BACKGROUND

An association between high prepregnant body mass index (BMI) and early termination of breastfeeding has been observed, but this finding may have depended on the sociocultural context.

OBJECTIVE

The objective was to determine whether this association was stronger with increasing maternal obesity, was modified by gestational weight gain, and still existed when there was greater social support for breastfeeding.

DESIGN

Study participants (37 459 women) were drawn from the Danish National Birth Cohort. The association of prepregnant BMI and gestational weight gain with the termination of full or any breastfeeding by 1, 16, or 20 wk postpartum was assessed with logistic regression analyses, and the risk of early termination of full and any breastfeeding during the first 18 mo postpartum was assessed with Poisson regression analyses.

RESULTS

The risk of early termination of any (with similar results for full) breastfeeding rose progressively with increasing prepregnant BMI values (in kg/m(2)), from 1.12 (95% CI: 1.09, 1.16) for overweight (BMI = 25.0-29.9) women to 1.39 (95% CI: 1.19, 1.63) for obese class III women (BMI >or= 40) compared with normal-BMI women. Gestational weight gain did not add to or modify the association between prepregnant BMI and breastfeeding.

CONCLUSIONS

These findings extend the observation to a broader range of BMIs that the greater the prepregnant BMI, the earlier the termination of breastfeeding. Together with the fact that this association was evident in a more supportive social context for breastfeeding, these findings suggest a biological basis for the association.

Obesity, gestational weight gain and preterm birth: a study within the Danish National Birth Cohort

The aim of the present study was to assess the impact of obesity and gestational weight gain on the risk of subtypes of preterm birth, because little is known about these associations. The study included 62 167 women within the Danish National Birth Cohort for whom self-reported information about prepregnancy body mass index (BMI) and gestational weight gain was available. Information about spontaneous preterm birth with or without preterm premature rupture of membranes (PPROM) and about induced preterm deliveries was obtained from national registers. Cox regression analyses were used to examine associations of prepregnancy BMI and gestational weight gain with subtypes of preterm birth. The crude risks of PPROM and of induced preterm deliveries were higher in obese women (BMI > or = 30) than in normal-weight women (18.5 < or = BMI < 25), especially before 34 completed weeks of gestation, when obese women faced twice the risk. In the adjusted analysis, the hazard ratios and 95% confidence intervals for PPROM and for induced preterm delivery in obese women were 1.5 [1.2, 1.9] and 1.2 [1.0, 1.6] respectively. When obesity-related diseases were accounted for, no excess risk of induced preterm deliveries was seen in obese women, but the increased risk of PPROM was unchanged. Low weight gain was associated with an increased risk of all subtypes of preterm birth compared with normal weight gain, especially in early spontaneous preterm births, where the risk was doubled. We concluded that prepregnancy obesity was associated with a higher risk of PPROM and early induced preterm deliveries.

Maternal energy depletion is buffered among malnourished women in Punjab, Pakistan

Women's nutritional status is believed to deteriorate with increasing reproductive stress (so-called maternal depletion). To evaluate this phenomenon, a new theoretical framework has been suggested that incorporates the concepts of a full reproductive cycle, relative lengths of potential depletion and repletion phases, and initial plane of nutrition. We developed the corresponding statistical model and tested predictions provided by the framework about the effect of reproductive pattern on maternal overall weight change (deltaW) during one reproductive cycle. Seventy-six Pakistani women were classified as well-nourished, marginally nourished or malnourished. The relationship between deltaW and length of all phases of the reproductive cycle, each of which is characterized by varying degrees of reproductive stress, was evaluated with multiple regression analysis. Across the reproductive cycle, well-nourished women had a slight weight increase. Surprisingly, malnourished women gained weight in contrast to marginally nourished women. Also surprisingly, for the latter two groups, periods of moderate reproductive stress were associated with weight loss but periods of high reproductive stress were associated with weight gain. Mechanisms such as efficiency and nutrient partitioning are discussed.

A description of lactation counseling practices that are used with obese mothers

Maternal overweight and obesity are associated with failure to initiate breastfeeding successfully and to sustain breastfeeding adequately. The purpose of this study was to describe how health care providers counsel obese mothers about breastfeeding. The authors surveyed (by telephone or in-person interview) health care providers who counsel mothers about breastfeeding in rural upstate New York (n = 89). They also surveyed lactation consultants (n = 31) from New York, New Jersey, Florida, Nebraska, California, and Texas by e-mail. The authors found that the majority of health care providers surveyed neither believed that there was a difference in the success rate between obese mothers and normal-weight mothers nor advised obese mothers differently about breastfeeding. Given the excess risk for premature lactation failure among obese women, these findings suggest that those who care for such women need to be made aware of this risk so that they can develop and provide appropriate services.