Fetal Protection : The Roles of Social Learning and Innate Food Aversions in South India

Religion, Fetal Protection, and Fasting during Pregnancy in Three Subcultures

Fasting during pregnancy is an enigma: why would a woman restrict her food intake during a period of increased nutritional need? Relative to the costs to healthy individuals who are not pregnant, the physiological costs of fasting in pregnancy are amplified, with intrauterine death being one possible outcome. Given these physiological costs, the question arises as to the socioecological factors that give rise to fasting during pregnancy. There has been little formal research regarding the emic perceptions and socioecological factors associated with such fasting. This study therefore took an emic approach and investigated the types of fasts that are common in pregnancy, women's perceptions of the consequences of fasting, and the socioecological models of pregnancy fasting in three Indian communities. This cross-sectional study took place in Bhubaneshwar, Odisha state, and Mysore, Karnataka state, among two populations of Hindu women and one population of Muslim women (N = 85). In total, 64% of women fasted in prior pregnancies. Findings revealed variation in the number and types of fasts that are common in pregnancy across the three communities. Each community reported differences in positive and negative consequences of fasting, with varied emphasis on reproductive health, religiosity, and general health and well-being. Finally, quantitative analyses indicated that the best-fitting model for fasting during pregnancy was religiosity, and the poorest-fitting models were resource scarcity and general health. This study provides insight into motivations for such fasting and highlights the need to investigate the relationship between supernatural beliefs and maternal-fetal protection further, as well as social functions of pregnancy fasting within the family and community.

Modifications of academic competences and intelligence in a university grade

The aim of the study was to analyze differences in intelligence, academic competences, and academic achievement by gender and academic course in sports science university students. To reach the study aim we analyzed in 267 (226 males and 41 females) first and last year students' degree the variables of intelligence (Reasoning scale of the Primary Mental Abilities Test), academic achievement and self-perception of 40 academic competences (30 general competences and 10 specific competences). We found how last year degree students presented higher general and specific competences than first year students, not presenting differences in intelligence and academic achievement. Female students presented higher academic achievement and higher values in some general and specific competences but not in intelligence.

Food aversion during pregnancy and its association with nutritional status of pregnant women in Boricha Woreda, Sidama Regional State, Southern Ethiopia, 2019. A community based mixed crossectional study design

Background

Despite high prevalence, food aversions are closely linked to the dietary intake of pregnant women. Thus, understanding this behavior is important in addressing the issue of maternal nutrition. Therefore, the aim of this study is to provide information on the prevalence and associated factors of food aversion and its relationship with the nutritional status of pregnant women in Boricha Woreda, Sidama Regional state, Southern Ethiopia, 2019.

Methods

A community based mixed cross sectional study was conducted among 505 randomly selected pregnant mothers at Boricha Woreda, Southern Ethiopia from June 1–20, 2019. Pre-tested and structured face-to-face interview questionnaire and focus group discussion guide were used to collect quantitative and qualitative data respectively. The quantitative data were cleaned, coded and entered into Epi Info version 7.1.4.0 and then exported to SPSS IBM version 20 for further analysis. The qualitative data were analyzed manually using a content analysis.The bi-variable and multivariable logistic regression was used to identify the possible factors of food aversion. AOR with the respective 95% CIs was used to declare statistical significance.

Results

Nearly, seven-in-ten (69.2%) of the pregnant women were averted of at least one food. Cereal (45.9%) and enset (44.2%) were averted by majority of the participants. The mean (± SD) MUAC measurement was 22.7 (± 2.4) cm. Pregnant women of age group of 24–28 [AOR = 3.04, 95% CI (1.72–5.35)] and 29–33 years [AOR = 2.00, 95% CI (1.02–3.92)], nausea during [AOR = 1.77, 95% CI (1.16–2.70)] and having additional meal [AOR = 1.68, 95% CI (1.02–2.75)] were significantly associated with food aversion. Maternal nutritional status and food aversion was sstatistically significant (p-value < 0.001).

Conclusion

High prevalence of food aversions (69.2%) and under nutrition (34.6%) among pregnant women is found. Therefore, the Woreda Health Office needs to intensify the integration of maternal nutrition into ANC services and training of health providers as well as critical appraisal of health extension workers should also be considered.

Pregnancy is a complex and absolutely important period in women’s life. Thus, in order to sustain a successful pregnancy, a mother experiences a number of physiological and behavioral changes. Notably, food aversions are the number one changes experienced by pregnant women. Food aversions are characterized by the repulsion and avoidance of particular foods and the most common aversions are nonalcoholic caffeinated beverages, meat, fish, poultry and eggs. Therefore, the aim of this study was to determine the magnitude and its association with nutritional status of Pregnant Women in order to provide concrete scientific evidence for the concerned stakeholders.

A community based mixed cross-sectional study was conducted among 505 pregnant mothers selected from five randomly selected kebeles of Boricha Woreda. Pregnant women in the age range of 19 to 49 years and who were apparently healthy were interviewed. Four hundred ninety seven participants were interviewed voluntarily with a response rate of 98.4%. The mean (± SD) age of the women was 22.3 (± 5.5) years. Pregnant women who were averted at least one food were 344(69.2%); where cereal (45.9%) and enset (44.2%) were averted by the majority of the participants. Hence pregnant women who practice food aversion had higher likely to be a malnourished. Pregnant women who were less than thirty three years of age, who had nausea, and ate additional meal were more urged to avert a particular foods. Whereas, women with better nutritional status had less food aversion practice.

In conclusion; despite a pregnant woman requires a healthy diet embedded with adequate intake of energy, protein, vitamins and minerals to meet maternal and fetal needs, the magnitude of food aversion and maternal under nutrition in the study area was high.

The evolution of disgust for pathogen detection and avoidance

The behavioral immune system posits that disgust functions to protect animals from pathogen exposure. Therefore, cues of pathogen risk should be a primary driver influencing variation in disgust. Yet, to our knowledge, neither the relationship between current pathogen risk and disgust, nor the correlation between objective and perceived pathogen risk have been addressed using ecologically valid measures in a global sample. The current article reports two studies addressing these gaps. In Study 1, we include a global sample (n = 361) and tested the influence of both perceived pathogen exposure and an objective measure of pathogen risk-local communicable infectious disease mortality rates-on individual differences in pathogen and sexual disgust sensitivities. In Study 2, we first replicate Study 1's analyses in another large sample (n = 821), targeting four countries (US, Italy, Brazil, and India); we then replaced objective and perceived pathogen risk with variables specific to the SARS-CoV-2 pandemic. In Study 1, both local infection mortality rates and perceived infection exposure predicted unique variance in pathogen and sexual disgust. In Study 2, we found that perceived infection exposure positively predicted sexual disgust, as predicted. When substituting perceived and objective SARS-CoV-2 risk in our models, perceived risk of contracting SARS-CoV-2 positively predicted pathogen and sexual disgust, and state case rates negatively predicted pathogen disgust. Further, in both studies, objective measures of risk (i.e., local infection mortality and SARS-CoV-2 rates) positively correlated with subjective measures of risk (i.e., perceived infection exposure and perceived SARS-CoV-2 risk). Ultimately, these results provide two pieces of foundational evidence for the behavioral immune system: 1) perceptions of pathogen risk accurately assay local, objective mortality risk across countries, and 2) both perceived and objective pathogen risk explain variance in disgust levels.

Pregnancy Fasting in Ramadan: Toward a Biocultural Framework

Pregnancy fasting poses a paradox: why would a woman restrict her diet during a period of increased nutritional need? This qualitative, cross-sectional study applied biological and cultural evolutionary theories of pregnancy diet to emic models of fasting with the aim of establishing a testable biocultural framework of pregnancy fasting. The research took place with Muslim women residing in Mysore, India. In-depth interviews were conducted with pregnant women who have experience and knowledge of fasting during during the holy month of Ramadan. Our findings indicate that pregnancy fasting is socially acquired via multiple modes of transmission and that women do not fast according to mainstream evolutionary theories of pregnancy diet, but perhaps to gain moral capital.

Dietary diversity and its correlates among pregnant adolescent girls in Ghana

BACKGROUND

Dietary diversity, a qualitative measure of dietary intake, which reflects the variety of foods consumed has been recommended to assuage nutritional problems related to insufficient micronutrients, and food insecurity. To better understand the underlying factors for poor birth outcomes in Ghana, we assessed factors associated with dietary diversity among rural and urban pregnant adolescents in the Ashanti Region of Ghana.

METHODS

As part of a larger longitudinal cohort of 416 pregnant adolescents, the FAO minimum dietary diversity for women index was used to determine the dietary diversity score (DDS) of the participants from a previous days' 24-hour dietary recall data. The household hunger scale (HHS) and lived poverty index (LPI) were used to determine hunger and socioeconomic status. Eating behavior and socio-demographic data were gathered using interviewer-administered questionnaires.

RESULTS

The mean age of the participants was 17.5 (±1.4) years with an MDD-W of 4.4 and 56% recording inadequate MDD score. More rural (63.6%) than urban dwellers (50.6%) had inadequate DDS (p = 0.008). Among all the multiple variables tests of associations on dietary diversity, only hunger status (p = 0.028) and both food aversion and poverty status (p = 0.003) had a significant effect on the adolescents' dietary diversity. Rural dwelling adolescents (AOR = 1.7, p = 0.035, 95% CI = 1.0-2.6) recorded higher odds for inadequate DD compared with the urban respondents. Pregnant adolescents with severe hunger had higher odds (Unadjusted OR = 1.9, p = 0.053, 95% CI 1.1-3.8) for inadequate dietary diversity compared with those with no hunger.

CONCLUSIONS

Inadequate DD is common among pregnant adolescents in this study and is associated with rural living, food insecurity, poverty, and food craving. Livelihood support for pregnant teenagers and nutrition education are recommended interventions to improve dietary quality and limit the consequences of poor dietary diversity.

Exploring biocultural models of chewing tobacco and paan among reproductive-aged women: Self-medication, protection, or gender inequality?

OBJECTIVES

Tobacco and areca nut are two of the most widely used psychoactive plant substances worldwide, yet the biocultural factors that account for variation in use patterns are not well understood. Here we attempt to understand the high prevalence of, and variation in, tobacco and areca nut use among reproductive-aged women.

METHODS

Research was carried out in Mysore, Karnataka, India. First, we conducted a qualitative investigation where participants engaged in semistructured interviews and focus group discussions to uncover cultural norms of women's tobacco use. Findings informed the second stage of research which quantitatively tested three models of tobacco and areca nut use (N = 74).

RESULTS

The qualitative study found that women were more likely to chew "natural" forms of tobacco and areca nut products (kaddipudi and paan). Quantitative tests of our hypotheses revealed that kaddipudi and combined tobacco use were best explained by the self-medication model, with somatic and environmental stress as strong indicators of use. The presence of cotinine, our biological indicator of tobacco use, was best modeled by gender inequality. We also found that men and women reported approximately equal tobacco use, even though their preferred types of tobacco and areca nut products differed.

CONCLUSIONS

Findings did not support the protection hypothesis as it relates to plant toxins. Instead, this study suggests that women might exploit neurotoxins such as nicotine and arecoline to offset the cognitive and energetic costs associated with iron deficiency in stressful environments.

Reframing HIV Stigma and Fear : Considerations from Social-ecological and Evolutionary Theories of Reproduction

HIV stigma and fears surrounding the disease pose a challenge for public health interventions, particularly those that target pregnant women. In order to reduce stigma and improve the lives of vulnerable populations, researchers have recognized a need to integrate different types of support at various levels. To better inform HIV interventions, the current study draws on social-ecological and evolutionary theories of reproduction to predict stigma and fear of contracting HIV among pregnant women in South India. The aims of this study were twofold: compare the social-ecological model to a modified maternal-fetal protection model and test a combined model that included strong predictors from each model. The study took place in 2008-2011 in Mysore District, Karnataka, India. Using data from a cross-sectional survey and biological indicators of health, we statistically modeled social-ecological variables representing individual, interpersonal, and community/institutional levels. Participants were 645 pregnant women. The social-ecological and combined models were the best-fitting models for HIV-related stigma, and the combined model was the best fit for HIV-related fear. Our findings suggest that combining reproductive life history factors along with individual, interpersonal, and community/institutional factors are significant indicators of HIV-related stigma and fear. Results of this study support a multifaceted approach to intervention development for HIV-related stigma and fear. The combined model in this study can be used as a predictive model for future research focused on HIV stigma and fear, with the intent that dual consideration of social-ecological and evolutionary theories will improve public health communication efforts.

Medicinal foods and beverages among Maasai agro-pastoralists in northern Tanzania

ETHNOPHARMACOLOGICAL RELEVANCE

Pastoralist Maasai populations of east Africa use several different wild plants as dietary and medicinal additives in beverages (soups and teas), yet little is known about how the plants used and the rationales for use compare and contrast across different Maasai beverages, including how gender specific dietary and health concerns structure patterns of intake.

AIM OF THE STUDY

We investigated three Maasai beverages: almajani (tea or herbal infusion); motorí (traditional soup); and okiti (psychoactive herbal tea). In order to build knowledge about the cultural functions of these Maasai food-medicines and their incidence of use we also investigated use rationales and self-reported frequencies of use. We conclude by examining gender differences and the possible pharmacological antimicrobial activity of the most frequently used plants.

MATERIALS AND METHODS

Research was conducted in 2015, with a population of semi-nomadic agropastoralist Maasai residing in northern Tanzania. Data were collected using key informant interviews, plant collections, n = 32 structured surveys, and n = 40 freelist interviews followed by a literature review to determine the known antimicrobial activity of the most used plants.

RESULTS

We identified 20 plants that Maasai add to soup, 11 in tea, and 11 in the psychoactive tea, for a total of 24 herbal additives. Seven plant species were used in all three Maasai beverages, and these clustered with 10 common ailments. Based on self-reports, women use the beverages less frequently and in smaller amounts than men. There were also several gender differences in the plants that Maasai add to motorí and their associated use rationales.

CONCLUSIONS

There are several intersections concerning the plant species used and their associated rationales for use in almajani, motori, and okiti. Moving outward, Maasai beverages and their additives increasingly involve gender specific concerns. Female use of food-medicines, relative to men, is structured by concerns over pregnancy, birth, and lactation. The frequent consumption of herbal additives, many of which contain antimicrobial compounds, potentially helps modulate infections, but could have other unintentional effects as well.

Financial decision making power is associated with moderate to severe anemia: A prospective cohort study among pregnant women in rural South India

OBJECTIVE

According to the World Health Organization, about half of all pregnant women in India suffer from some form of anemia. While poor nutrition is the most common cause, social factors, such as gender and religion, also impact anemia status. This study investigates the relationship between anemia and socioeconomic and health-related factors among pregnant women in Mysore, India.

DESIGN

Prospective cohort study conducted between January 2009 and 2012 SETTING: 144 rural villages ten or more kilometers outside of Mysore City received integrated antenatal care and HIV testing services provided by mobile medical clinic in their communities.

PARTICIPANTS

1675 pregnant women from the villages were screened. All women and their infants were then followed up for up to a year after childbirth.

METHODS

women who provided informed consent underwent an interviewer-administered questionnaire, physical examination by a doctor, and antenatal laboratory investigations including blood test for anemia. Women were followed through pregnancy and 12 months after childbirth to assess mother-infant health outcomes. Anemia was categorised as normal, mild, moderate, and severe, with moderate/severe anemia defined as a hemoglobin concentration of less than 100 g/l.

MEASUREMENTS AND FINDINGS

two out of three pregnant women were anemic at baseline (1107/1654; 66.9%). Of those women, 32.7% (362) had mild anemia, 64.0% (708) had moderate anemia, and 3.3% (37) had severe anemia. Anemia was associated with lower education among spouses (p = 0.021) and lower household income (p = 0.022). Women living in a household where others had control over household decision-making had lower odds of moderate/severe anemia (Adjusted Odds Ratio: 0.602; 95% Confidence Interval: 0.37-0.97) as compared to women who shared decision-making power with others in the household.

CONCLUSION

Interventions to reduce anemia should focus on education among men and other household decision makers on the importance of nutrition during pregnancy in India.

IMPLICATIONS FOR PRACTICE

To our knowledge, this research is one of the first to examine how control of household resources is related to risk for anemia among pregnant women in India. Our data suggests that interventions aimed at reducing anemia may need to address economic factors beyond nutrition and iron status to reduce the burden of anemia among women in developing countries.

A test of four evolutionary hypotheses of pregnancy food cravings: evidence for the social bargaining model

The onset of cravings for items not typically desired is often considered a hallmark of pregnancy. Given the ubiquity of cravings, this phenomenon remains surprisingly understudied. The current study tested four hypotheses of pregnancy food cravings: behavioural immune system, nutrient seeking, resource scarcity and social bargaining. The research took place in Tamil Nadu, South India, with pregnant women residing in rural villages (N = 94). Methods included structured interviews and anthropometric measures. Findings revealed that unripe mango and unripe tamarind were the two most frequently mentioned food cravings among this population, but were not sufficiently supported by the a priori models. Results confirmed that the social bargaining model was the best explanation for the etic category of toxic/pathogenic food items, suggesting that pregnant women crave dangerous foods when experiencing heightened social pressures. Finally, toxicity/pathogenicity was a confounding factor for the nutrient seeking and resource scarcity models, calling into question the validity of these models in adverse environments. Overall, these findings present important implications for research on pregnancy food cravings, such that in resource-scarce and pathogen-dense environments, cravings might target teratogenic items that signal a need for increased social support.

Innate food aversions and culturally transmitted food taboos in pregnant women in rural southwest India: separate systems to protect the fetus?

Pregnancy increases women's nutritional requirements, yet causes aversions to nutritious foods. Most societies further restrict pregnant women's diet with food taboos. Pregnancy food aversions are theorized to protect mothers and fetuses from teratogens and pathogens or increase dietary diversity in response to resource scarcity. Tests of these hypotheses have had mixed results, perhaps because many studies are in Westernized populations with reliable access to food and low exposure to pathogens. If pregnancy food aversions are adaptations, however, then they likely evolved in environments with uncertain access to food and high exposure to pathogens. Pregnancy food taboos, on the other hand, have been theorized to limit resource consumption, mark social identity, or also protect mothers and fetuses from dangerous foods. There have been few tests of evolutionary theories of culturally transmitted food taboos. We investigated these and other theories of psychophysiological food aversions and culturally transmitted food taboos among two non-Western populations of pregnant women in Mysore, India, that vary in food insecurity and exposure to infectious disease. The first was a mixed caste rural farming population (N = 72), and the second was the Jenu Kurubas, a resettled population of former hunter-gatherers (N = 30). Women rated their aversions to photos of 31 foods and completed structured interviews that assessed aversions and socially learned avoidances of foods, pathogen exposure, food insecurity, sources of culturally acquired dietary advice, and basic sociodemographic information. Aversions to spicy foods were associated with early trimester and nausea and vomiting, supporting a protective role against plant teratogens. Variation in exposure to pathogens did not explain variation in meat aversions or avoidances, however, raising some doubts about the importance of pathogen avoidance. Aversions to staple foods were common, but were not associated with resource stress, providing mixed support for the role of dietary diversification. Avoided foods outnumbered aversive foods, were believed to be abortifacients or otherwise harmful to the fetus, influenced diet throughout pregnancy, and were largely distinct from aversive foods. These results suggest that aversions target foods with cues of toxicity early in pregnancy, and taboos target suspected abortifacients throughout pregnancy.

Food Aversions and Cravings during Pregnancy on Yasawa Island, Fiji

Women often experience novel food aversions and cravings during pregnancy. These appetite changes have been hypothesized to work alongside cultural strategies as adaptive responses to the challenges posed by pregnancy (e.g., maternal immune suppression). Here, we report a study that assessed whether data from an indigenous population in Fiji are consistent with the predictions of this hypothesis. We found that aversions focus predominantly on foods expected to exacerbate the challenges of pregnancy. Cravings focus on foods that provide calories and micronutrients while posing few threats to mothers and fetuses. We also found that women who experience aversions to specific foods are more likely to crave foods that meet nutritional needs similar to those provided by the aversive foods. These findings are in line with the predictions of the hypothesis. This adds further weight to the argument that appetite changes may function in parallel with cultural mechanisms to solve pregnancy challenges.

The low prevalence of female smoking in the developing world: gender inequality or maternal adaptations for fetal protection?

BACKGROUND

Female smoking prevalence is dramatically lower in developing countries (3.1%) than developed countries (17.2%), whereas male smoking is similar (32% vs 30.1%). Low female smoking has been linked to high gender inequality. Alternatively, to protect their offspring from teratogenic substances, pregnant and lactating women appear to have evolved aversions to toxic plant substances like nicotine, which are reinforced by cultural proscriptions. Higher total fertility rates (TFRs) in developing countries could therefore explain their lower prevalence of female smoking.

OBJECTIVE

To compare the associations of TFR and gender inequality with national prevalence rates of female and male smoking.

METHODS

Data from a previous study of smoking prevalence vs gender inequality in 74 countries were reanalysed with a regression model that also included TFR. We replicated this analysis with three additional measures of gender equality and 2012 smoking data from 173 countries.

RESULTS

A 1 SD increase in TFR predicted a decrease in female smoking prevalence by factors of 0.58-0.77, adjusting for covariates. TFR had a smaller and unexpected negative association with male smoking prevalence. Increased gender equality was associated with increased female smoking prevalence, and, unexpectedly, with decreased male smoking prevalence. TFR was also associated with an increase in smoking prevalence among postmenopausal women.

CONCLUSIONS

High TFR and gender inequality both predict reduced prevalence of female smoking across nations. In countries with high TFR, adaptations and cultural norms that protect fetuses from plant toxins might suppress smoking among frequently pregnant and lactating women.