Nutrition before birth, programming and the perpetuation of social inequalities in health

Maternal and neonatal anthropometric analyses: Determining birth outcomes in low-risk pregnancies at Alex Ekwueme Federal University Teaching Hospital, Abakaliki

OBJECTIVE

To assess the input of maternal and neonatal body physique anthropometries to birth outcomes.

METHODS

A prospective study of 177 full-term births at Alex Ekwueme Federal Teaching Hospital Abakaliki from July to December, 2019. Maternal and neonatal anthropometric parameters and birth outcomes: mode of delivery and Apgar score were considered in this study. The measurements followed the guidelines outlined by the Institute of Medicine.

RESULTS

The prevalence of low birth weight (6.21%), cesarean delivery (14.12%), and abnormal Apgar score (9.04%) was relatively low in the study. Birth weight was dependent on maternal age, weight, body mass index, percentage body fat, and waist and hip circumference (P < 0.05). Normal Apgar score at 1 min after birth of male neonates was dependent on maternal BMI and neonatal head circumference whereas abnormal Apgar score in male and female neonates was dependent on maternal age and waist:hip ratio, respectively (P < 0.05).

CONCLUSION

Maternal and neonatal body physique anthropometries can be used to identify mothers and neonates at risk of having birth complications. This provided a practical alternative means to know the possible risk of undesirable birth outcomes with spontaneous vaginal delivery in low-risk pregnancies.

'You must not confuse poverty with laziness': a case study on the power of discourse to reproduce diabetes inequalities

The disproportionate impact of type 2 diabetes (T2DM) on low-income groups and the social and biological processes linking poverty and T2DM inequalities are well-documented. Moreover, millions of dollars are invested annually in programs aimed at reducing T2DM inequalities, yet these remain stubbornly high. Our article explores how public discourses influence T2DM and related health inequalities in a low-income neighborhood in Northern California, through a thematic analysis of interviews and focus groups of staff and clients at a non-governmental organization. We probe participants' beliefs vis-a-vis the causes of, and solutions to, T2DM inequalities and explore whether and how the discourses normalizing them are challenged. We find that staff identify the ultimate source of T2DM inequalities within health sufferers (i.e., their lifestyle choices, psychological makeup, or cultural preferences), even as they acknowledge the widespread poverty, unemployment, and other social determinants that present serious barriers to their health. Notably, we find this normalizing discourse .among clients themselves. While our study is empirical, its goal is primarily conceptual: to add to the evolving understanding of discourse as a social practice that may contribute both to status quo reproduction and to social change and resistance.

The Elephant in the Room: The Invisibility of Poverty in Research on Type 2 Diabetes

Over two hundred years of anecdotal, epidemiological, and experimental evidence indicate that poverty breeds disease. This holds true for type 2 diabetes, which both in the United States and other developed nations disproportionately occurs, cripples, and kills among the poor. In this article we examine rhetorical strategies used in 30 journal articles indexed under type 2 diabetes and poverty. As we show, poverty is rarely highlighted in this literature as a causal factor. Instead, explanations for diabetes among poor people overwhelmingly emphasize features of patients—their biology, behaviors, psychology, culture, or other “risk factors”—while ignoring, reframing or neglecting the links between poverty and disease. By so doing, these discursive strategies naturalize higher rates of diabetes among poor persons, legitimize relations of domination in the larger society, and encourage only research projects, treatment practices and health and social policies that do not challenge existing social relations. We discuss the implications of these discursive practices for medical research and care, and for social and public health policies.

Obesity and diabetes in vulnerable populations: reflection on proximal and distal causes

Around the world obesity and diabetes are climbing to epidemic proportion, even in countries previously characterized by scarcity. Likewise, people from low-income and minority communities, as well as immigrants from the developing world, increasingly visit physicians in North America with obesity, metabolic syndrome, or diabetes. Explanations limited to lifestyle factors such as diet and exercise are inadequate to explain the universality of what can be called a syndemic, a complex and widespread phenomenon in population health produced by multiple reinforcing conditions. Underlying the problem are complex factors-genetic, physiological, psychological, familial, social, economic, and political-coalescing to overdetermine these conditions. These interacting factors include events occurring during fetal life, maternal physiology and life context, the thrifty genotype, the nutritional transition, health impact of urbanization and immigration, social attributions and cultural perceptions of increased weight, and changes in food costs and availability resulting from globalization. Better appreciation of the complexity of causation underlying the worldwide epidemic of obesity and diabetes can refocus the work of clinicians and researchers to work at multiple levels to address prevention and treatment for these conditions among vulnerable populations.

Maternal stress and fetal responses: evolutionary perspectives on preterm delivery

New epidemiological and neurohormonal evidence provides insights into the persistent public health issue of preterm delivery and its long-term health consequences for the newborn. Mechanisms linked to preterm delivery may originate early in gestation as a result of maternal cues signaling a stressful intrauterine environment. When these signals are present, the fetus responds with a series of facultative responses, including accelerated organ maturation. If these responses are unsuccessful and the environment remains insufficient, a series of feed-forward mechanisms initiate the hormonal cascade that leads to parturition, and thus, early expulsion from a stressful environment. The internal environmental cues are delivered via glucocorticoids (stress hormones) in the circulatory system, but fetal responses and the initiation of the final terminal pathway to parturition are regulated by placentally derived corticotropin-releasing hormone (CRH). The potential costs of early expulsion from a stressful intrauterine environment are high and include an increased likelihood of perinatal and infant mortality. Permanent alterations in organ and metabolic functioning may occur, suggesting considerable fitness trade-offs. There is some evidence that preterm parturition is a maternal adaptation to limit the energetic costs of individual pregnancies in the face of poor condition at the time of conception. Moreover, nutritional stress is not the only indicator that signals a stressful environment: maternal psychosocial stress, and thus her response to an assessment of the social environment, also signal an insufficient internal environment to the fetus. The epidemiological and neurohormonal evidence for these relationships and mechanisms responsible for regulating such delicate negotiations are explored. In turn, the implications of such findings are examined from life history and public health perspectives.

Socioeconomic factors and low birth weight in Mexico

Background

Low birth weight (LBW) is a public health problem linked to lack of equity in populations. Despite efforts to decrease the proportion of newborns with LBW, success has been quite limited. In recent years, studies focused on explaining how social factors influence this problem have shown that populations with greater inequities have a greater proportion of newborns with LBW.

Methods

The objective was to describe socioeconomic factors related to LBW adjusted by demographic, reproductive and health services variables in Mexico City. A case-control study was carried out in three hospitals with gynaecological and obstetrics services in Mexico City during the first half of 1996. During the recruiting period all children with LBW (cases), defined as newborns weighing <2500 grams, were matched with children born on the same day to control for time of birth. Upon arrival at the hospital for delivery, women were interviewed to determine if they met our inclusion criteria. Women with a history of chronic conditions and those with twin or multiple pregnancies were excluded. Variables with clinical and statistical significance were included in a multivariate model (logistic regression).

Results

We found that low socioeconomic level was the most important risk factor for LBW and was independent of other factors, including those related to reproduction and nutrition, smoking, morbidity during pregnancy, accessibility to health services and prenatal care (OR 2.68; 95% CI 1.19, 6.03).

Conclusion

We found that socioeconomic factors are relevant to LBW. However further research should be done in different population groups as well as developing precise ways of measuring socioeconomic factors and their role in reproductive health.