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Lawson Y, Comerford KB, Mitchell EP. A review of dairy food intake for improving health for black women in the US during pregnancy, fetal development, and lactation. J Natl Med Assoc 2024; 116:219-227. [PMID: 38368233 DOI: 10.1016/j.jnma.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/19/2024]
Abstract
Pregnancy and lactation are special life stages that require regular nutritional and medical attention to help protect the health of the mother and promote the growth and development of the offspring. Despite an increased focus on maternal and fetal health over the last several decades, the rates of pregnancy-related morbidity and mortality are increasing in the United States (US). On average, Black women who are pregnant or lactating face greater health disparities and birth complications than other racial/ethnic groups in the US. The issues contributing to these disparities are multi-faceted and include sociocultural, economic, medical, and dietary factors. For example, Black women face greater rates of food insecurity, worse access to healthcare, and lower nutrient status when compared to White women. A growing body of research suggests that consuming a healthier dietary pattern is one of the most potent modifiable risk factors associated with improved fertility and reducing pregnancy-related complications. Recent publications have also shed light on the role of dairy foods in improving diet quality and nutrient status among Black women and for impacting maternal and fetal health outcomes, such as preeclampsia, spontaneous abortion, preterm birth, and fetal growth. To support healthy pregnancy and lactation, the current national dietary guidelines recommend the consumption of 3 servings of dairy foods per day. However, the vast majority of Black women in the US are falling short of these recommendations and are not meeting nutrient requirements for calcium and vitamin D. Therefore, strategies that target misconceptions surrounding lactose intolerance and focus on the health value of adequate dairy intake among Black women of child-bearing age may benefit both prenatal and postpartum health. This review presents the current evidence on health disparities faced by pregnant and lactating Black women in the US, and the role of dairy foods in supporting healthy pregnancy, fetal development, and lactation outcomes in this population.
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Affiliation(s)
- Yolanda Lawson
- FACOG, Associate Attending, Baylor University Medical Center, Dallas, TX, United States
| | - Kevin B Comerford
- OMNI Nutrition Science, California Dairy Research Foundation, Davis, CA, United States.
| | - Edith P Mitchell
- Sidney Kimmel Cancer at Jefferson, Philadelphia, PA, United States
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2
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Burton TCJ, Crooks N, Pezley L, Hemphill NO, Li Y, Sawatpanich A, Farrow V, Erbe K, Kessee N, Reed L, Tussing-Humphreys L, Koenig MD. Food Choice and Dietary Perspectives of Young, Urban, Black Pregnant Women: A Focus Group Study. Nutrients 2024; 16:781. [PMID: 38542692 PMCID: PMC10974382 DOI: 10.3390/nu16060781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/27/2024] [Accepted: 03/06/2024] [Indexed: 04/01/2024] Open
Abstract
Black pregnant women in Chicago are disproportionately affected by maternal morbidity and mortality and are more likely to reside in neighborhoods that experience greater economic hardships and food apartheid than any other race/ethnicity. Addressing social determinants of health such as structural inequities, economic environment, and food apartheid issues may provide insights into eliminating Black maternal morbidity and mortality disparities. This study explores food choice determinants and dietary perspectives of young, urban, Black pregnant women. Two audio-recorded focus groups were conducted in Chicago, IL between March 2019 and June 2019 to discuss pregnancy experiences and factors affecting maternal nutrition. Thematic analysis was used to identify the codes, themes, and subthemes of the data. Data analysis was guided by the Social Ecological Model (SEM) as a theoretical framework. Eleven, young, Black women were recruited. Three major themes were discussed across the SEM levels that influenced food choice including food access, stress and family influences on eating, and the need for nutritional education during pregnancy. These choices were primarily rooted in the detrimental effects of food apartheid experienced within the participants' neighborhoods. Therefore, acknowledging, understanding, and addressing food apartheid and its impact on Black maternal health disparities is needed in clinical practice, research, and policy change.
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Affiliation(s)
| | - Natasha Crooks
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave., Chicago, IL 60612, USA; (N.C.); (Y.L.); (A.S.); (V.F.); (M.D.K.)
| | - Lacey Pezley
- Department of Kinesiology and Nutrition, University of Illinois Chicago, 1919 W. Taylor St., Chicago, IL 60612, USA; (L.P.); (N.O.H.); (N.K.); (L.T.-H.)
| | - Nefertiti OjiNjideka Hemphill
- Department of Kinesiology and Nutrition, University of Illinois Chicago, 1919 W. Taylor St., Chicago, IL 60612, USA; (L.P.); (N.O.H.); (N.K.); (L.T.-H.)
| | - Yanqiao Li
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave., Chicago, IL 60612, USA; (N.C.); (Y.L.); (A.S.); (V.F.); (M.D.K.)
| | - Arissara Sawatpanich
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave., Chicago, IL 60612, USA; (N.C.); (Y.L.); (A.S.); (V.F.); (M.D.K.)
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok 10400, Thailand
| | - Vanessa Farrow
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave., Chicago, IL 60612, USA; (N.C.); (Y.L.); (A.S.); (V.F.); (M.D.K.)
| | - Katherine Erbe
- Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA;
| | - Nicollette Kessee
- Department of Kinesiology and Nutrition, University of Illinois Chicago, 1919 W. Taylor St., Chicago, IL 60612, USA; (L.P.); (N.O.H.); (N.K.); (L.T.-H.)
| | - Luecendia Reed
- New Moms, 5317 W. Chicago Ave., Chicago, IL 606051, USA;
| | - Lisa Tussing-Humphreys
- Department of Kinesiology and Nutrition, University of Illinois Chicago, 1919 W. Taylor St., Chicago, IL 60612, USA; (L.P.); (N.O.H.); (N.K.); (L.T.-H.)
| | - Mary Dawn Koenig
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave., Chicago, IL 60612, USA; (N.C.); (Y.L.); (A.S.); (V.F.); (M.D.K.)
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Versele V, Stas L, Aerenhouts D, Deliens T, Matthys C, Gucciardo L, Devlieger R, Clarys P, Bogaerts A. Dietary intake, physical activity and sedentary behavior and association with BMI during the transition to parenthood: a prospective dyadic study. Front Public Health 2023; 11:1092843. [PMID: 37333547 PMCID: PMC10272778 DOI: 10.3389/fpubh.2023.1092843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/05/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Little is known on how diet, physical activity (PA) and sedentary behavior (SB) changes during pregnancy and after childbirth in primiparous couples. Moreover, it is unclear how potential behavioral changes are associated with changes in BMI. This study examined changes in diet, PA and SB, and their association with changes in BMI in couples transitioning to parenthood. Methods Dietary intake (FFQ), PA, SB (both Actigraph GT3X accelerometers) and BMI of women and men were assessed at 12 weeks of gestation, 6 weeks and 6 months postpartum. Data were analyzed using dyadic longitudinal data analyses techniques. Results In women, a decrease in fruit intake, an increase in alcohol intake, an increase of light-intensity PA, and a decrease in SB were observed from the beginning of pregnancy up to 6 months postpartum. Decreases in fruit intake between 6 weeks and 6 months postpartum was associated with increases in BMI. Men did not show significant dietary changes, while an increase in light-intensity PA and a decrease in moderate-to-vigorous PA (MVPA) was observed at 6 months postpartum when compared to 12 weeks of gestation. Paternal increases in "avoidance food group" intake were associated with increases in BMI between baseline and 6 weeks postpartum. No associations of changes in BMI and changes in PA and SB were found. Discussion Not only mothers but also fathers experienced unfavorable changes in lifestyle during the transition to parenthood, with impact on BMI changes. This highlights the need to monitor unhealthy changes in lifestyle and body weight in both parents when expecting a child and after childbirth. Clinical trial registration Clinicaltrials.gov, NCT03454958.
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Affiliation(s)
- Vickà Versele
- Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Lara Stas
- Support for Quantitative and Qualitative Research (SQUARE), Core Facility of the Vrije Universiteit Brussel, Brussels, Belgium
- Department of Biostatistics and Medical Informatics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Dirk Aerenhouts
- Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Tom Deliens
- Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Christophe Matthys
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Leonardo Gucciardo
- Department of Obstetrics and Prenatal Medicine, Faculty of Medicine, Vrije Universiteit Brussel, Brussels, Belgium
- Obstetrics and Prenatal Medicine, University Hospital Brussel, Brussels, Belgium
| | - Roland Devlieger
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Obstetrics and Gynaecology, University Hospital KU Leuven, Leuven, Belgium
- Department of Obstetrics, Gynaecology and Fertility, Wilrijk, Belgium
| | - Peter Clarys
- Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Annick Bogaerts
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
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Rollins L, Giddings T, Henes S, Culbreth W, Coleman AS, Smith S, White C, Nelson T. Design and Implementation of a Nutrition and Breastfeeding Education Program for Black Expecting Mothers and Fathers. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:794-803. [PMID: 35610157 DOI: 10.1016/j.jneb.2022.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To describe the intervention and research methods of Project Dads in Nutrition Education, an intervention that adds nutrition and breastfeeding education to the existing Healthy Start program in Georgia for Black expecting mothers and fathers to improve nutrition literacy, health outcomes, and breastfeeding rates. DESIGN This 2-year community-based participatory research study employs a cluster randomization factorial design. SETTING Six Healthy Start program sites (3 intervention and 3 control sites) in Georgia counties with high infant and maternal mortality rates. PARTICIPANTS Approximately 480 Black, expecting, Healthy Start program participants (20 couples [mother and father] and 40 single mothers from each site) will be enrolled over the study period. INTERVENTION(S) Project Dads in Nutrition Education will strengthen the capacity of the Georgia Healthy Start program to integrate an evidence-based nutrition education program, breastfeeding education, and father engagement into its routine services. MAIN OUTCOME MEASURE(S) Changes in prepost survey assessment of participants' nutrition literacy and eating behaviors; changes in prepost survey assessment of participants' breastfeeding knowledge, attitudes, intent, initiation, and duration; and health and food diary collected 3 times (ie, at baseline, 3 months, and 6 months after enrollment). ANALYSIS Process evaluation throughout the study to document implementation. Generalized linear mixed modeling will be used to determine the impact of the intervention.
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Affiliation(s)
- Latrice Rollins
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA.
| | - Tiara Giddings
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Sarah Henes
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, Athens, GA
| | - Wykinia Culbreth
- Maternal and Child Health Division, Georgia Department of Public Health, Atlanta, GA
| | | | - Shlonda Smith
- Special Supplementation Nutrition Program for Women, Infants, and Children, Georgia Department of Public Health, Atlanta, GA
| | | | - Twanna Nelson
- Maternal and Child Health Division, Georgia Department of Public Health, Atlanta, GA
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Braveman P, Dominguez TP, Burke W, Dolan SM, Stevenson DK, Jackson FM, Collins JW, Driscoll DA, Haley T, Acker J, Shaw GM, McCabe ERB, Hay WW, Thornburg K, Acevedo-Garcia D, Cordero JF, Wise PH, Legaz G, Rashied-Henry K, Frost J, Verbiest S, Waddell L. Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:684207. [PMID: 36303973 PMCID: PMC9580804 DOI: 10.3389/frph.2021.684207] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022] Open
Abstract
In 2017–2019, the March of Dimes convened a workgroup with biomedical, clinical, and epidemiologic expertise to review knowledge of the causes of the persistent Black-White disparity in preterm birth (PTB). Multiple databases were searched to identify hypothesized causes examined in peer-reviewed literature, 33 hypothesized causes were reviewed for whether they plausibly affect PTB and either occur more/less frequently and/or have a larger/smaller effect size among Black women vs. White women. While definitive proof is lacking for most potential causes, most are biologically plausible. No single downstream or midstream factor explains the disparity or its social patterning, however, many likely play limited roles, e.g., while genetic factors likely contribute to PTB, they explain at most a small fraction of the disparity. Research links most hypothesized midstream causes, including socioeconomic factors and stress, with the disparity through their influence on the hypothesized downstream factors. Socioeconomic factors alone cannot explain the disparity's social patterning. Chronic stress could affect PTB through neuroendocrine and immune mechanisms leading to inflammation and immune dysfunction, stress could alter a woman's microbiota, immune response to infection, chronic disease risks, and behaviors, and trigger epigenetic changes influencing PTB risk. As an upstream factor, racism in multiple forms has repeatedly been linked with the plausible midstream/downstream factors, including socioeconomic disadvantage, stress, and toxic exposures. Racism is the only factor identified that directly or indirectly could explain the racial disparities in the plausible midstream/downstream causes and the observed social patterning. Historical and contemporary systemic racism can explain the racial disparities in socioeconomic opportunities that differentially expose African Americans to lifelong financial stress and associated health-harming conditions. Segregation places Black women in stressful surroundings and exposes them to environmental hazards. Race-based discriminatory treatment is a pervasive stressor for Black women of all socioeconomic levels, considering both incidents and the constant vigilance needed to prepare oneself for potential incidents. Racism is a highly plausible, major upstream contributor to the Black-White disparity in PTB through multiple pathways and biological mechanisms. While much is unknown, existing knowledge and core values (equity, justice) support addressing racism in efforts to eliminate the racial disparity in PTB.
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Affiliation(s)
- Paula Braveman
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
- *Correspondence: Paula Braveman
| | - Tyan Parker Dominguez
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Wylie Burke
- University of Washington School of Medicine, Seattle, WA, United States
| | - Siobhan M. Dolan
- Albert Einstein College of Medicine, New York, NY, United States
| | | | | | - James W. Collins
- Northwestern University School of Medicine, Chicago, IL, United States
| | - Deborah A. Driscoll
- University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Terinney Haley
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Julia Acker
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Gary M. Shaw
- Stanford University School of Medicine, Stanford, CA, United States
| | - Edward R. B. McCabe
- David Geffen School of Medicine at University of California, Los Angeles, CA, United States
| | | | - Kent Thornburg
- School of Medicine, Oregon State University, Portland, OR, United States
| | | | - José F. Cordero
- University of Georgia College of Public Health, Athens, GA, United States
| | - Paul H. Wise
- Stanford University School of Medicine, Stanford, CA, United States
| | - Gina Legaz
- March of Dimes, White Plains, NY, United States
| | | | | | - Sarah Verbiest
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Greathouse KL, Padgett RN, Petrosino J, Hastings-Tolsma M, Faucher MA. Exploration of Diet Quality by Obesity Severity in Association with Gestational Weight Gain and Distal Gut Microbiota in Pregnant African American Women: Opportunities for Intervention. Matern Child Health J 2021; 26:882-894. [PMID: 34462812 DOI: 10.1007/s10995-021-03198-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To conduct an exploratory examination of dietary patterns and quality during pregnancy in African-American women who were class I, II, or III obese, and those women with normal pre-pregnancy body mass index (pBMI), as well to identify dietary factors associated with GWG, and changes in the distal gut microbiome. African American women represent the largest group affected by pre-pregnancy obesity, a risk factor for several adverse birth outcomes. METHODS This prospective study investigated the association between diet, distal gut microbiome, and GWG among African-American women (n = 21) with obesity (n = 15) compared to women with a normal pre-pregnancy body mass index (pBMI) (n = 6) at two time points, 27-29 and 37-39 weeks gestation. Dietary patterns associated with obesity severity and GWG gain were assessed using Welch's T-test and Mann-Whitney U. The association between the gut microbiome and dietary patterns was assessed using a regression-based kernel association test and the adaptive microbiome-based sum of powered score test. RESULTS In early pregnancy, dietary intake of Total Fruits and Greens and Beans was significantly different between pBMI and GWG groups; significance was 0.022 and 0.028 respectively. Women with Class II/III obesity and those with GWG above guidelines had Healthy Eating Index (HEI) scores below 50, meeting less than 75% of dietary guidelines, and did not meet recommendations for fruit and vegetable or fiber intake. We found no significant associations between the microbiome composition and diet (HEI Scores). CONCLUSIONS FOR PRACTICE Overall, the results indicate that women with pBMI obesity are not meeting minimum dietary guidelines for nutrient intakes during pregnancy, specifically fruits, vegetables, and fiber, regardless of GWG. Interventions for African-American women with pre-pregnancy obesity, with a focus on increasing consumption of fruits and vegetables, would be beneficial to control GWG and improve birth outcomes.
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Affiliation(s)
- K Leigh Greathouse
- Nutrition Science, Baylor University, One Bear Place 97346, Waco, TX, 76798-7346, USA. .,Department of Biology, Baylor University, One Bear Place 97346, Waco, TX, 76798-7346, USA.
| | - R Noah Padgett
- Educational Psychology, Baylor University, One Bear Place 97346, Waco, TX, 76798-7346, USA
| | - Joseph Petrosino
- The Alkek Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, TX, USA
| | - M Hastings-Tolsma
- Louise Herrington School of Nursing, Dallas, TX; Midwifery Specialty, Baylor University, 333 N. Washington Ave., Dallas, TX, USA
| | - M A Faucher
- Advanced Practice Nursing Women's Centers, Parkland Health and Hospital System, 5200 Harry Hines Boulevard, Dallas, TX, 75235, USA
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Najpaverova S, Kovarik M, Kacerovsky M, Zadak Z, Hronek M. The Relationship of Nutritional Energy and Macronutrient Intake with Pregnancy Outcomes in Czech Pregnant Women. Nutrients 2020; 12:nu12041152. [PMID: 32325979 PMCID: PMC7230203 DOI: 10.3390/nu12041152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 11/16/2022] Open
Abstract
Maternal nutrition and metabolism play important roles for the well-being of both mother and fetus during pregnancy. This longitudinal study brings an original evaluation of the relationship between the nutritional energy and macronutrients intake (NEMI) and pregnancy outcomes and an assessment of the changes in such intake over the previous ten years. Sixty-five healthy Czech pregnant women were examined in three pregnancy periods (1st: 17th-27th; 2nd: 28th-35th; 3rd: 36th-38th gestational weeks). Results of 7-day dietary records were analyzed using NutriDan software. Energy intake decreased from 30.0 kcal/kg to 25.0 kcal/kg during pregnancy. The data also showed a decrease in macronutrients intake (p < 0.0001) with the advancing stage of pregnancy. Positive correlations were demonstrated between NEMI and birth weight (r = 0.410, p < 0.001). In the second pregnancy period, NEMI (excluding carbohydrates) positively associated with neonatal birth length (p < 0.01) and negatively with duration of birth (p < 0.05). An increased NEMI in the last period of pregnancy shortened the length of pregnancy.
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Affiliation(s)
- Simona Najpaverova
- Department of Biological and Medical Sciences, Faculty of Pharmacy in Hradec Kralove, Charles University, 500 03 Hradec Kralove, Czech Republic; (S.N.); (M.K.)
- Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic;
| | - Miroslav Kovarik
- Department of Biological and Medical Sciences, Faculty of Pharmacy in Hradec Kralove, Charles University, 500 03 Hradec Kralove, Czech Republic; (S.N.); (M.K.)
- Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic;
| | - Marian Kacerovsky
- Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic;
| | - Zdenek Zadak
- Department of Research and Development, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic;
| | - Miloslav Hronek
- Department of Biological and Medical Sciences, Faculty of Pharmacy in Hradec Kralove, Charles University, 500 03 Hradec Kralove, Czech Republic; (S.N.); (M.K.)
- Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic;
- Correspondence: ; Tel.: +420-495-067-254
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Desyibelew HD, Dadi AF. Burden and determinants of malnutrition among pregnant women in Africa: A systematic review and meta-analysis. PLoS One 2019; 14:e0221712. [PMID: 31490956 PMCID: PMC6730925 DOI: 10.1371/journal.pone.0221712] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/13/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Malnutrition in pregnancy remains unacceptably high across all regions of Africa though promising progresses have been made globally. Primary studies might not be sufficient to portrait a comprehensive picture of malnutrition during pregnancy and its main risk factors. Therefore, we intended to review the burden of malnutrition, for this specific review implies to protein energy malnutrition, during pregnancy in Africa to present its magnitude and determinant factors. METHODS We did a systematic review of observational studies published from January 1/2008 to January 31/2018. The CINAHL(EBSCO), MEDLINE (via Ovid), Emcare, PubMed databases and Google scholar were searched. Articles quality was assessed using the Newcastle-Ottawa Scale and studies with fair to good quality were included. We pooled malnutrition prevalence and an odds ratio estimates for risk factors after checking for heterogeneity and publication bias. This review has been registered in Prospero with a protocol number CRD42018114949. RESULT 23 studies involving 20,672 pregnant women were included. Using a random effect model, the overall pooled prevalence of malnutrition among pregnant women in Africa was 23.5% (95%CI: 17.72-29.32; I2 = 98.5%). Based on the current review pooled odds ratio finding; rural residency (POR = 2.6%; 95%CI: 1.48-4.65; I2 = 0%), low educational status of partners (POR = 1.7%; 95%CI: 1.19-2.53; I2 = 54.8%), multiple pregnancy (POR = 2.15%; 95%CI: 1.27-3.64; I2 = 0%) and poor nutritional indicators (POR = 2.03%; 95%CI: 1.72-2.4, I2 = 0%) were positively determine maternal malnutrition. On contrary, better household economic status (POR = 0.47%; 95%CI: 0.36-0.62; I2 = 24.2%) negatively determine maternal malnutrition. CONCLUSION A significant number of the pregnant population in Africa are suffering of malnutrition, above 10% of the standard acceptable malnutrition rate. Thus, efforts should be renewed to ensure a proper and widespread implementation of programs that would address issues identified in the current review to reduce the burden of malnutrition.
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Affiliation(s)
- Hanna Demelash Desyibelew
- Department of Public Health Nutrition, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abel Fekadu Dadi
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- College of Medicine and Public Health, School of Public Health, Flinders University, Bedford Park, Australia
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9
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Flynn AC, Begum S, White SL, Dalrymple K, Gill C, Alwan NA, Kiely M, Latunde-Dada G, Bell R, Briley AL, Nelson SM, Oteng-Ntim E, Sandall J, Sanders TA, Whitworth M, Murray DM, Kenny LC, Poston L. Relationships between Maternal Obesity and Maternal and Neonatal Iron Status. Nutrients 2018; 10:nu10081000. [PMID: 30061547 PMCID: PMC6115715 DOI: 10.3390/nu10081000] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/20/2018] [Accepted: 07/24/2018] [Indexed: 12/29/2022] Open
Abstract
Obesity in pregnancy may negatively influence maternal and infant iron status. The aim of this study was to examine the association of obesity with inflammatory and iron status in both mother and infant in two prospective studies in pregnancy: UPBEAT and SCOPE. Maternal blood samples from obese (n = 245, BMI ≥ 30 kg/m2) and normal weight (n = 245, BMI < 25 kg/m2) age matched pregnant women collected at approximately 15 weeks’ gestation, and umbilical cord blood samples collected at delivery, were analysed for a range of inflammatory and iron status biomarkers. Concentrations of C- reactive protein and Interleukin-6 in obese women compared to normal weight women were indicative of an inflammatory response. Soluble transferrin receptor (sTfR) concentration [18.37 nmol/L (SD 5.65) vs. 13.15 nmol/L (SD 2.33)] and the ratio of sTfR and serum ferritin [1.03 (SD 0.56) vs. 0.69 (SD 0.23)] were significantly higher in obese women compared to normal weight women (P < 0.001). Women from ethnic minority groups (n = 64) had higher sTfR concentration compared with white women. There was no difference in maternal hepcidin between obese and normal weight women. Iron status determined by cord ferritin was not statistically different in neonates born to obese women compared with neonates born to normal weight women when adjusted for potential confounding variables. Obesity is negatively associated with markers of maternal iron status, with ethnic minority women having poorer iron statuses than white women.
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Affiliation(s)
- Angela C Flynn
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, 10th Floor North Wing St Thomas' Hospital, London SE1 7EH, UK.
| | - Shahina Begum
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, 10th Floor North Wing St Thomas' Hospital, London SE1 7EH, UK.
| | - Sara L White
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, 10th Floor North Wing St Thomas' Hospital, London SE1 7EH, UK.
| | - Kathryn Dalrymple
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, 10th Floor North Wing St Thomas' Hospital, London SE1 7EH, UK.
| | - Carolyn Gill
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, 10th Floor North Wing St Thomas' Hospital, London SE1 7EH, UK.
| | - Nisreen A Alwan
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
| | - Mairead Kiely
- School of Food and Nutritional Sciences, Food Science Building, University College Cork, T12 Y337 Cork, Ireland.
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Department of Obstetrics and Gynaecology, University College Cork, T12 Y337 Cork, Ireland.
| | - Gladys Latunde-Dada
- Department of Nutritional Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London SE1 7EH, UK.
| | - Ruth Bell
- Institute of Health & Society, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.
| | - Annette L Briley
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, 10th Floor North Wing St Thomas' Hospital, London SE1 7EH, UK.
| | - Scott M Nelson
- School of Medicine, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow G31 2ER, UK.
| | - Eugene Oteng-Ntim
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, 10th Floor North Wing St Thomas' Hospital, London SE1 7EH, UK.
| | - Jane Sandall
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, 10th Floor North Wing St Thomas' Hospital, London SE1 7EH, UK.
| | - Thomas A Sanders
- Department of Nutritional Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London SE1 7EH, UK.
| | - Melissa Whitworth
- Manchester University NHS Foundation Trust, St Mary's Hospital, Manchester M13 9WL, UK.
| | - Deirdre M Murray
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Department of Obstetrics and Gynaecology, University College Cork, T12 Y337 Cork, Ireland.
- Department of Paediatrics & Child Health, University College Cork, T12 Y337 Cork, Ireland.
| | - Louise C Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Department of Obstetrics and Gynaecology, University College Cork, T12 Y337 Cork, Ireland.
- Department of Obstetrics and Gynaecology, University College Cork, T12 Y337 Cork, Ireland.
| | - Lucilla Poston
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, King's College London, 10th Floor North Wing St Thomas' Hospital, London SE1 7EH, UK.
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