Strenuous work, nutrition and adverse pregnancy outcomes: a brief review

Prevalence and predictors of malnutrition during adolescent pregnancy in southern Ethiopia: a community-based study

Background

Adolescent pregnancy is a major public health problem with significant medical, nutritional, social and economic risk for mothers and their infants. The purpose of this study was to determine prevalence and predictors of malnutrition among pregnant adolescents in Kore district, southern Ethiopia.

Methods

Data were obtained from randomly selected consenting four hundred twenty five pregnant adolescents on March 2018 using interviewer-administered questionnaire and mid upper arm circumference (MUAC) measurement. A multivariable logistic regression analysis was used to identify the predictors of malnutrition in adolescent pregnancy.

Results

The study showed that 26.4% of study participants were malnourished (MUAC < 22 cm). Not owning livestock (AOR = 1.67, 95% CI = 1.26–2.19), unintended pregnancy (AOR = 1.36, 95% CI = 1.08–1.65), excess physical work in pregnancy (AOR = 1.29, 95% CI = 1.02–1.62) and being in the second (AOR = 1.70, 95% CI = 1.09–2.65) or third (AOR = 1.99, 95% CI = 1.29–3.07) pregnancy trimester were positively associated with malnutrition risk. Improved dietary intake in pregnancy (AOR = 0.46, 95% CI = 0.33–0.63) and support perceived by adolescents in pregnancy (AOR = 0.59, 95% CI = 0.43–0.82) were negatively associated with malnutrition risk.

Conclusion

More than one-quarter of the study population were malnourished. The information provides insight into the public health strategies to reduce malnutrition risk of the pregnant adolescents. Interventions aimed at improving socioeconomic status, dietary practice and physical work/activity through effective supports in pregnancy are recommended.

Effects of vitamin and mineral supplementation during pregnancy on maternal, birth, child health and development outcomes in low- and middle-income countries: A systematic review

Background

Almost two billion people who are deficient in vitamins and minerals are women and children in low- and middle-income countries (LMIC). These deficiencies are worsened during pregnancy due to increased energy and nutritional demands, causing adverse outcomes in mother and child. To reduce micronutrient deficiencies, several strategies have been implemented, including diet diversification, large-scale and targeted fortification, staple crop bio-fortification and micronutrient supplementation.

Objectives

To evaluate and summarize the available evidence on the effects of micronutrient supplementation during pregnancy in LMIC on maternal, fetal, child health and child development outcomes. This review will assess the impact of single micronutrient supplementation (calcium, vitamin A, iron, vitamin D, iodine, zinc, vitamin B12), iron-folic acid (IFA) supplementation, multiple micronutrient (MMN) supplementation, and lipid-based nutrient supplementation (LNS) during pregnancy.

Search Methods

We searched papers published from 1995 to 31 October 2019 (related programmes and good quality studies pre-1995 were limited) in CAB Abstracts, CINAHL, Cochrane Central Register of Controlled Trials, Embase, International Initiative for Impact Evaluations, LILACS, Medline, POPLINE, Web of Science, WHOLIS, ProQuest Dissertations & Theses Global, R4D, WHO International Clinical Trials Registry Platform. Non-indexed grey literature searches were conducted using Google, Google Scholar, and web pages of key international nutrition agencies.

Selection Criteria

We included randomized controlled trials (individual and cluster-randomized) and quasi-experimental studies that evaluated micronutrient supplementation in healthy, pregnant women of any age and parity living in a LMIC. LMIC were defined by the World Bank Group at the time of the search for this review. While the aim was to include healthy pregnant women, it is likely that these populations had one or more micronutrient deficiencies at baseline; women were not excluded on this basis.

Data Collection and Analysis

Two authors independently assessed studies for inclusion and risk of bias, and conducted data extraction. Data were matched to check for accuracy. Quality of evidence was assessed using the GRADE approach.

Main Results

A total of 314 papers across 72 studies (451,723 women) were eligible for inclusion, of which 64 studies (439,649 women) contributed to meta-analyses. Seven studies assessed iron-folic acid (IFA) supplementation versus folic acid; 34 studies assessed MMN vs. IFA; 4 studies assessed LNS vs. MMN; 13 evaluated iron; 13 assessed zinc; 9 evaluated vitamin A; 11 assessed vitamin D; and 6 assessed calcium. Several studies were eligible for inclusion in multiple types of supplementation. IFA compared to folic acid showed a large and significant (48%) reduction in the risk of maternal anaemia (average risk ratio (RR) 0.52, 95% CI 0.41 to 0.66; studies = 5; participants = 15,540; moderate-quality evidence). As well, IFA supplementation demonstrated a smaller but significant, 12% reduction in risk of low birthweight (LBW) babies (average RR 0.88, 95% CI 0.78 to 0.99; studies = 4; participants = 17,257; high-quality evidence). MMN supplementation was defined as any supplement that contained at least 3 micronutrients. Post-hoc analyses were conducted, where possible, comparing the differences in effect of MMN with 4+ components and MMN with 3 or 4 components. When compared to iron with or without FA, MMN supplementation reduced the risk of LBW by 15% (average RR 0.85, 95% CI 0.77 to 0.93; studies = 28; participants = 79,972); this effect was greater in MMN with >4 micronutrients (average RR 0.79, 95% CI 0.71 to 0.88; studies = 19; participants = 68,138 versus average RR 1.01, 95% CI 0.92 to 1.11; studies = 9; participants = 11,834). There was a small and significant reduction in the risk of stillbirths (average RR 0.91; 95% CI 0.86 to 0.98; studies = 22; participants = 96,772) and a small and significant effect on the risk of small-for-gestational age (SGA) (average RR 0.93; 95% CI 0.88 to 0.98; studies = 19; participants = 52,965). For stillbirths and SGA, the effects were greater among those provided MMN with 4+ micronutrients. Children whose mothers had been supplemented with MMN, compared to IFA, demonstrated a 16% reduced risk of diarrhea (average RR 0.84; 95% CI 0.76 to 0.92; studies = 4; participants = 3,142). LNS supplementation, compared to MMN, made no difference to any outcome; however, the evidence is limited. Iron supplementation, when compared to no iron or placebo, showed a large and significant effect on maternal anaemia, a reduction of 47% (average RR 0.53, 95% CI 0.43 to 0.65; studies = 6; participants = 15,737; moderate-quality evidence) and a small and significant effect on LBW (average RR 0.88, 95% CI 0.78 to 0.99; studies = 4; participants = 17,257; high-quality evidence). Zinc and vitamin A supplementation, each both compared to placebo, had no impact on any outcome examined with the exception of potentially improving serum/plasma zinc (mean difference (MD) 0.43 umol/L; 95% CI -0.04 to 0.89; studies = 5; participants = 1,202) and serum/plasma retinol (MD 0.13 umol/L; 95% CI -0.03 to 0.30; studies = 6; participants = 1,654), respectively. When compared to placebo, vitamin D supplementation may have reduced the risk of preterm births (average RR 0.64; 95% CI 0.40 to 1.04; studies = 7; participants = 1,262), though the upper CI just crosses the line of no effect. Similarly, calcium supplementation versus placebo may have improved rates of pre-eclampsia/eclampsia (average RR 0.45; 95% CI 0.19 to 1.06; studies = 4; participants = 9,616), though the upper CI just crosses 1.

Authors' Conclusions

The findings suggest that MMN and vitamin supplementation improve maternal and child health outcomes, including maternal anaemia, LBW, preterm birth, SGA, stillbirths, micronutrient deficiencies, and morbidities, including pre-eclampsia/eclampsia and diarrhea among children. MMN supplementation demonstrated a beneficial impact on the most number of outcomes. In addition, MMN with >4 micronutrients appeared to be more impactful than MMN with only 3 or 4 micronutrients included in the tablet. Very few studies conducted longitudinal analysis on longer-term health outcomes for the child, such as anthropometric measures and developmental outcomes; this may be an important area for future research. This review may provide some basis to guide continual discourse around replacing IFA supplementation with MMN along with the use of single micronutrient supplementation programs for specific outcomes.

[Should physical activity be contraindicated during pregnancy in relation to its potentially related risks?]

OBJECTIVE

This paper aimed at providing a critical analysis of data on the risks associated with physical activity of women during their pregnancy.

METHODS

Cochrane Library, Google Scholar, PubMed (Medline) and Web of Sciences were searched using a combination of MeSH terms associated to "Physical activity", "Pregnancy" and "Adverse events" or "Risks". Only review papers published from inception of these databases to November 2016 were used in the present analysis.

RESULTS

The electronic search yield a total of 104 citations. After a critical analysis of abstracts and/or full-texts, only a systematic review and cohort study on injuries related to physical activity during pregnancy appeared relevant for the current study. Data reveals a very small proportion (<1 %) of adverse events in direct link with the physical activity behavior of pregnant women. Furthermore, there would be less than one serious adverse event per 5000hours of physical activity. The only serious adverse event attributable to physical activity during pregnancy was uterine contractions. The threat of preterm labor and miscarriage risk cannot be primarily attributed to the participation of pregnant women in a physical activity, even vigorous. Moreover, no adverse effects of maternal physical activity on neonatal outcomes were found.

CONCLUSION

Physical activity-related risks during pregnancy appear to be infrequent and of minor severity. Though further studies are required to better understand the risk/benefit balance of physical activity during pregnancy, current data do not support the contraindication of this behavior in pregnant women.

Placental DHA and mRNA levels of PPARγ and LXRα and their relationship to birth weight

BACKGROUND

A very large number of fatty acids play wide range of physiological roles in cellular growth and function in placental as well as fetal growth. However, docosahexaenoic acid (DHA), in addition to its critical role in cellular membranes, is known to act as a ligand for several nuclear receptors and regulates the activity of transcription factor families like peroxisome proliferator-activated receptor, liver X receptor (LXR), retinoid X receptor (RXR), and sterol regulatory element binding protein (SREBP). These transcription factors and DHA are known to regulate the placental and fetal growth and development.

OBJECTIVE

The objective of the present study was to examine the fatty acids and transcription factors in the placenta of women delivering low birth weight (LBW) babies.

METHODS

The present study examines the fatty acid and mRNA levels of various transcription factors in the placentae of women delivering normal birth weight (NBW) (n = 38) and women delivering LBW (n = 36). Placental fatty acids were analyzed using gas chromatography. Placental mRNA levels of PPARα, PPARγ, SREBP-1c, LXRα, RXRα, and RXRγ were examined using quantitative real time PCR.

RESULT

Placental DHA levels and mRNA levels of placental PPARγ and LXRα were lower (P < .05 for all) in women delivering LBW babies. There was a positive association of placental PPARγ mRNA levels and placental DHA levels with baby weight (P < .05 for both).

CONCLUSION

Our data suggest that lower placental DHA and transcription factors may have a vital role in the etiology of LBW babies.

Nutritional management of the low birth weight/preterm infant in community settings: a perspective from the developing world

Globally, about 20 million infants are born with low birth weight (LBW; <2500 g). Of all LBW infants, approximately 95% are born in developing countries. The greatest incidence of LBW occurs in South-Central Asia; the second greatest is in Africa. The two main reasons for LBW are preterm birth (<37 weeks) and intrauterine growth restriction (IUGR), which are risk factors for increased morbidity and mortality in newborn infants. Maternal nutrition status is one of the most important risk factors for LBW/IUGR. Providing balanced protein energy and multiple micronutrient supplements to pregnant women will reduce incidence of IUGR. Calcium supplementation during pregnancy will reduce the incidence of pre-eclampsia and preterm birth in developing countries. Exclusive breastfeeding is protective for a mother and her infant and has been shown to reduce morbidity and mortality in infancy. Kangaroo mother care for preterm infants will reduce severe morbidity and mortality as well. Community-based intervention packages are among the most effective methods of reducing morbidity and mortality in mothers and children. Future research should focus on improving triage of preterm and IUGR infants. Exclusive breastfeeding should be promoted, and appropriate alternative food supplements should be provided when breastfeeding is not possible.

Patterns of daily activity and time spent in bed of adult women and adolescent and preadolescent girls from a rural community in Senegal, West Africa

BACKGROUND

In rural Africa, women and adolescent girls sustain a high burden of domestic and agricultural tasks. This could result in energy imbalance and impair their nutritional status.

OBJECTIVE

The aim of the study was to investigate activity during the day and time spent in bed during the night for adult women and adolescent and preadolescent girls living in the same household. The hypothesis was that more prolonged physical inactivity and time spent in bed could be an efficient means for lowering energy expenditure and hence maintaining an adequate nutritional state.

METHODS

Physical activity during the day was qualitatively recorded using 'spot observation' (Super 1989), and quantitatively using accelerometers. A total of 110 females--55 adult women, 45 adolescents and 10 preadolescents--were included in the study. Anthropometric measurements (weight, height and four subcutaneous skinfolds) served as indicators of nutritional status.

RESULTS

Day-to-day reliability of accelerometry counts was acceptable (average intraclass correlation coefficient = 0.73). Differences in daytime activity varied according to age group. Adolescent and preadolescent girls had higher overall activities than adults (p < 0.01). Preadolescent girls went to bed earlier and for longer periods than adult women (p < 0.001). There existed significant relationships between time spent in bed and activity during the day in adult women but not in adolescent or preadolescent girls. A significant relationship between nutritional status and physical activity indices was observed in preadolescent and adolescent girls, but not in women.

CONCLUSIONS

The findings partially support the hypothesis of some compensation of daytime activity by time spent in bed in adult women, but not in adolescent or preadolescent girls.

Previous physical activity decreases the risk of low back pain and pelvic pain during pregnancy

AIMS

The aim of the study was to investigate physical activity prior to pregnancy, occupation, and treatment in women with low back pain and pelvic pain (LBPP) during pregnancy.

METHODS

All women who gave birth at two hospitals in northern Sweden from 1 January 2002 to 30 April 2002 were invited to complete a questionnaire on their obstetric and gynaecological history, actual pregnancy, and delivery. The sample was analysed with calculation of odds ratios (OR) and their 95% confidence intervals (CI). Cox regression analyses were performed. Women with LBPP reporting a pain maximum of 7 or more on a visual analogue scale (0-10 cm) were considered to have "high pain score LBPP" (hps-LBPP).

RESULTS

The response rate was 83% (n = 891). A higher number of years of regular leisure physical activity (RLPA) decreased the risk of LBPP during pregnancy. The risk of hps-LBPP was increased for women who characterized their occupation as "mainly active" (OR = 2.0, 95% CI: 1.1-3.5) and "physically demanding" (OR = 1.9, 95% CI: 1.1-3.2). Visiting a physician as a result of LBPP was reported by 46.2%, and the mean number of visits was 2.0. One-third of women with LBPP had received treatment, as had half of women with hps-LBPP.

CONCLUSIONS

A higher number of years of previous RLPA decreases the risk of LBPP during pregnancy. Occupations described as "mainly active" and "physically demanding" are associated with increased risk of hps-LBPP during pregnancy.