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Miani C, Ludwig A, Doyle IM, Breckenkamp J, Hoeller-Holtrichter C, Spallek J, Razum O. The role of education and migration background in explaining differences in folic acid supplementation intake in pregnancy: results from a German birth cohort study. Public Health Nutr 2021; 24:6094-6102. [PMID: 34420537 PMCID: PMC11148613 DOI: 10.1017/s1368980021003621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Official German recommendations advise women to start taking folic acid supplementation (FAS) before conception and continue during the first pregnancy trimester to lower the risk of birth defects. Women from lower socio-economic background and ethnic minorities tend to be less likely to take FAS in other European countries. As little is known about the determinants of FAS in Germany, we aimed to investigate the association between FAS and formal education and migration background, adjusting for demographic factors. DESIGN We used data (2013-2016) on nutrition and socio-economic and migration background from the baseline questionnaire of the BaBi cohort study. We performed multivariate regressions and mediation analyses. SETTING Bielefeld, Germany. PARTICIPANTS Nine-hundred forty-seven women (pregnant or who had given birth in the past 2 months). RESULTS 16.7% of the participants (158/947) did not use FAS. Migration-related variables (e.g. language, length of stay) were not associated with FAS in the adjusted models. FAS was lower in women with lower level of formal education and in unplanned pregnancies. Reasons given by women for not taking FAS were unplanned pregnancy and lack of knowledge of FAS. CONCLUSIONS Health practitioners may be inclined to see migrant women as an inherently at-risk group for failed intake of FAS. However, it is primarily women who did not plan their pregnancy, and women of lower formal education level, who are at risk. Different public health strategies to counter low supplementation rates should be supported, those addressing the social determinants of health (i.e. education) and those more focused on family planning.
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Affiliation(s)
- Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Angelique Ludwig
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- Center for Innovation in Health Economics (ZIG OWL),Bielefeld, Germany
| | - Ina-Merle Doyle
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Jürgen Breckenkamp
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Chantal Hoeller-Holtrichter
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Jacob Spallek
- Department of Public Health, Institute for Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
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Huang L, Shang L, Yang W, Li D, Qi C, Xin J, Wang S, Yang L, Zeng L, Chung MC. High starchy food intake may increase the risk of adverse pregnancy outcomes: a nested case-control study in the Shaanxi province of Northwestern China. BMC Pregnancy Childbirth 2019; 19:362. [PMID: 31638947 PMCID: PMC6802140 DOI: 10.1186/s12884-019-2524-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 09/20/2019] [Indexed: 02/08/2023] Open
Abstract
Background There was a wider disparity in the diet characterization among most studies on diet and pregnancy outcomes in different countries, and the research in northern China is limited. Therefore, the purpose of the present study that was conducted in northwest China was to understand the dietary characteristics of periconceptional women and to explore the relationship between and specific dietary patterns with adverse pregnancy outcomes. Methods A nested case-control study was conducted from October 2017 to November 2018 in Shaanxi, China. Based on a prospective cohort of 368 women who were pregnant or prepared for pregnancy, 63 participants who developed the outcomes of gestational hypertension, gestational diabetes, preterm birth, low birth weight, and birth defects were included in the case group. A total of 237 healthy pregnant women were included during the same period in the control group. Dietary intake was assessed using a validated food frequency questionnaire for the three months before pregnancy and the first trimester. Information on delivery details and antenatal pregnancy complications was obtained from the hospital maternity records. Dietary patterns were derived using factor analysis. Stratified analysis was performed on the overall, single and multiple adverse pregnancy outcomes categories. Adjustment was made for sociodemographic characteristics and nutritional supplement status. Results Six major dietary patterns were identified. The ‘starchy’ dietary pattern, composed of high intake in noodle and flour products and/or rice and its products, was associated with the odds of developing of adverse pregnancy outcomes (OR: 2.324, 95% CI: 1.293–4.178). This risk remained significant following adjustment for potential confounders of maternal demographic characteristics and nutritional status (aOR: 2.337, 95% CI:1.253–4.331). Strong association were found during the first trimester of pregnancy, but showed no association during the three months before pregnancy (aOR:1.473, 95% CI: 0.682–3.234). Conclusions High starchy food intake was associated with adverse pregnancy outcomes, particularly during the first trimester of pregnancy. Health education focusing on periconceptional dietary patterns could be a practical strategy for preventing adverse pregnancy outcomes.
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Affiliation(s)
- Liyan Huang
- Department of Obstetrics and Gynecology, Maternal & Child Health Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Li Shang
- Department of Obstetrics and Gynecology, Maternal & Child Health Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Wenfang Yang
- Department of Obstetrics and Gynecology, Maternal & Child Health Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China. .,Department of Public Health and Community Medicine, Tufts University School of Medicine, MA, Boston, USA.
| | - Danyang Li
- Department of Obstetrics and Gynecology, Maternal & Child Health Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China.,Department of Women's and Children's Health, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Cuifang Qi
- Department of Obstetrics and Gynecology, Maternal & Child Health Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Juan Xin
- Department of Obstetrics and Gynecology, Maternal & Child Health Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Shanshan Wang
- Department of Obstetrics and Gynecology, Maternal & Child Health Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Liren Yang
- Department of Obstetrics and Gynecology, Maternal & Child Health Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China
| | - Mei Chun Chung
- Department of Obstetrics and Gynecology, Maternal & Child Health Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, Shaanxi Province, 710061, People's Republic of China.,Department of Public Health and Community Medicine, Tufts University School of Medicine, MA, Boston, USA
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de Andrade Silva Cavalcanti R, Diniz ADS, de Arruda IKG. Concentrations of Intra-erythrocyte Folate, Serum Vitamin B12, and Hemoglobin in Women of Childbearing Age and Associated Factors. J Am Coll Nutr 2019; 38:739-745. [PMID: 30990764 DOI: 10.1080/07315724.2019.1592725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective: The aim was to verify the relations among intra-erythrocyte folate, serum vitamin B12, and hemoglobin concentrations in women of childbearing age and their association with several socioeconomic and demographic variables, nutritional status, and food consumption in the city of Recife, Northeastern Brazil.Methods: This was a cross-sectional study with a random sample of 1,210 women of childbearing age from the city of Recife. Concentrations of serum vitamin B12 and intra-erythrocyte folate were analyzed by immunoassay and hemoglobin concentrations by automated determination. A questionnaire was used to collect socioeconomic and demographic data of nutritional status and a food frequency questionnaire was used to evaluate food consumption.Results: Reductions in hemoglobin concentrations were found in 141 women (12.0%; 95% confidence interval (CI), 10.3-13.9), serum vitamin B12 in 81 women (7.0%; 95% CI, 5.7-8.6), and only 1 woman had a reduction in intra-erythrocyte folate concentrations. No women had a concomitant reduction of intra-erythrocyte folate, serum vitamin B12, and hemoglobin concentrations. However, 13 women (1.1%; 95% CI, 0.6-1.9) had a concomitant deficiency of hemoglobin and vitamin B12. Intra-erythrocyte folate concentrations were higher in women of a higher age and income. Hemoglobin concentrations were lower in smokers, and serum vitamin B12 concentrations did not show a significant variation in relation to socioeconomic, demographic, and anthropometric parameters. There was no strong correlation between food consumption and biochemical concentrations evaluated.Conclusion: Despite the strategies to eradicate anemia, this nutritional deficiency was dominant. Serum vitamin B12 deficiency outpacing intra-erythrocyte folate is worrying due to the lack of programs to fight against vitamin B12 insufficiency. Age and income were directly related to intra-erythrocyte folate concentrations. Food consumption suggests that there is a homeostatic control to maintain equilibrium at biochemical concentrations.
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Affiliation(s)
| | - Alcides da S Diniz
- Centro de Ciências da Saúde/Departamento de Nutrição, Universidade Federal de Pernambuco, Recife-PE, Brazil
| | - Ilma K G de Arruda
- Centro de Ciências da Saúde/Departamento de Nutrição, Universidade Federal de Pernambuco, Recife-PE, Brazil
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