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Joshi G, Ichihashi M, Binaya C. Assessment of a Community-Based Nutrition Program for Women and Children in Nepal Using Demographic and Health Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:754. [PMID: 38928999 PMCID: PMC11203533 DOI: 10.3390/ijerph21060754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/26/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024]
Abstract
Undernutrition is a particularly acute problem in middle- and low-income countries. The "Suaahara" program is a 5-year community-focused program in Nepal, aimed at improving the health and nutrition of pregnant and lactating women and their children under the age of 2 years. This research contributes to evidence on the impact of the "Suaahara" program in 41 treated districts compared to 34 control districts. Using the difference-in-differences method, we found that the weight-for-height z-score and body mass index z-score of children under the age of 2 in the treated districts significantly increased by 0.223 standard deviations (SDs) and 0.236 SDs, respectively, compared with the control districts 5 years before and after the program. The number of antenatal care visits (at least four visits) and safe deliveries significantly increased for pregnant women by 10.4% and 9.1%, respectively, in the treated districts compared with the control districts. The prevalence of fever in children under 2 years of age was significantly reduced by 6.2% in the treated districts. The results show the significance of a policy evaluation with transparent indicators on public health, which is necessary for policymakers so that they can propose evidence-based policy.
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Affiliation(s)
- Gauri Joshi
- Graduate School of Humanities and Social Science, Hiroshima University, Higashihiroshima 739-8529, Japan; (G.J.)
- National Statistics Office, Kathmandu 44600, Nepal
| | - Masaru Ichihashi
- Graduate School of Humanities and Social Science, Hiroshima University, Higashihiroshima 739-8529, Japan; (G.J.)
- The IDEC Institute, Hiroshima University, Higashihiroshima 739-8529, Japan
- Graduate School of Innovation and Practice for Smart Society, Hiroshima University, Higashihiroshima 739-8529, Japan
- Network for Education and Research on Peace and Sustainability (NERPS), Hiroshima University, Higashihiroshima 739-8529, Japan
| | - Chalise Binaya
- Graduate School of Humanities and Social Science, Hiroshima University, Higashihiroshima 739-8529, Japan; (G.J.)
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Lamsal R, Yeh EA, Pullenayegum E, Ungar WJ. A Systematic Review of Methods and Practice for Integrating Maternal, Fetal, and Child Health Outcomes, and Family Spillover Effects into Cost-Utility Analyses. PHARMACOECONOMICS 2024:10.1007/s40273-024-01397-5. [PMID: 38819718 DOI: 10.1007/s40273-024-01397-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Maternal-perinatal interventions delivered during pregnancy or childbirth have unique characteristics that impact the health-related quality of life (HRQoL) of the mother, fetus, and newborn child. However, maternal-perinatal cost-utility analyses (CUAs) often only consider either maternal or child health outcomes. Challenges include, but are not limited to, measuring fetal, newborn, and infant health outcomes, and assessing their impact on maternal HRQoL. It is also important to recognize the impact of maternal-perinatal health on family members' HRQoL (i.e., family spillover effects) and to incorporate these effects in maternal-perinatal CUAs. OBJECTIVE The aim was to systematically review the methods used to include health outcomes of pregnant women, fetuses, and children and to incorporate family spillover effects in maternal-perinatal CUAs. METHODS A literature search was conducted in Medline, Embase, EconLit, Cochrane Collection, Cumulative Index to Nursing and Allied Health Literature (CINAHL), International Network of Agencies for Health Technology Assessment (INAHTA), and the Pediatric Economic Database Evaluation (PEDE) databases from inception to 2020 to identify maternal-perinatal CUAs that included health outcomes for pregnant women, fetuses, and/or children. The search was updated to December 2022 using PEDE. Data describing how the health outcomes of mothers, fetuses, and children were measured, incorporated, and reported along with the data on family spillover effects were extracted. RESULTS Out of 174 maternal-perinatal CUAs identified, 62 considered the health outcomes of pregnant women, and children. Among the 54 quality-adjusted life year (QALY)-based CUAs, 12 included fetal health outcomes, the impact of fetal loss on mothers' HRQoL, and the impact of neonatal demise on mothers' HRQoL. Four studies considered fetal health outcomes and the effects of fetal loss on mothers' HRQoL. One study included fetal health outcomes and the impact of neonatal demise on maternal HRQoL. Furthermore, six studies considered the impact of neonatal demise on maternal HRQoL, while four included fetal health outcomes. One study included the impact of fetal loss on maternal HRQoL. The remaining 26 only included the health outcomes of pregnant women and children. Among the eight disability-adjusted life year (DALY)-based CUAs, two measured fetal health outcomes. Out of 174 studies, only one study included family spillover effects. The most common measurement approach was to measure the health outcomes of pregnant women and children separately. Various approaches were used to assess fetal losses in terms of QALYs or DALYs and their impact on HRQoL of mothers. The most common integration approach was to sum the QALYs or DALYs for pregnant women and children. Most studies reported combined QALYs and incremental QALYs, or DALYs and incremental DALYs, at the family level for pregnant women and children. CONCLUSIONS Approximately one-third of maternal-perinatal CUAs included the health outcomes of pregnant women, fetuses, and/or children. Future CUAs of maternal-perinatal interventions, conducted from a societal perspective, should aim to incorporate health outcomes for mothers, fetuses, and children when appropriate. The various approaches used within these CUAs highlight the need for standardized measurement and integration methods, potentially leading to rigorous and standardized inclusion practices, providing higher-quality evidence to better inform decision-makers about the costs and benefits of maternal-perinatal interventions. Health Technology Assessment agencies may consider providing guidance for interventions affecting future lives in future updates.
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Affiliation(s)
- Ramesh Lamsal
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - E Ann Yeh
- Division of Neurology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, 11th Floor, Toronto, ON, M5G 0A4, Canada.
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Tugume P, Mustafa AS, Walusansa A, Ojelel S, Nyachwo EB, Muhumuza E, Nampeera M, Kabbale F, Ssenku JE. Unravelling taboos and cultural beliefs associated with hidden hunger among pregnant and breast-feeding women in Buyende district Eastern Uganda. JOURNAL OF ETHNOBIOLOGY AND ETHNOMEDICINE 2024; 20:46. [PMID: 38693532 PMCID: PMC11064283 DOI: 10.1186/s13002-024-00682-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/29/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Food taboos and cultural beliefs among pregnant and breast-feeding women influence their food consumption patterns and hence the health of women and unborn children. Cognizant of their neglect in programs aimed to ameliorate hidden hunger among pregnant and breast-feeding women in Buyende and other resource-poor communities in sub-Saharan Africa, we opted for a study to unravel them to inform program design. METHODS We documented food taboos and beliefs amongst pregnant and breast-feeding women from six sub-counties of Buyende district in Eastern Uganda. A mixed-methods approach was used, which was comprised of questionnaire interviews with 462 women, eight focus group discussions with 6-10 participants in each and a total of 15 key informant interviews. RESULTS The present study revealed that 129 (27.9%) of the respondents practice food taboos and adhere to cultural beliefs related to their dietary habits during pregnancy and breast-feeding that are fuelling the prevalence of hidden hunger. The most tabooed foods during pregnancy were sugarcane (17.8%), fishes which included lung fish, catfish and the Lake Victoria sardine (Rastrineobola argentea) (15.2%), oranges (6.6%), pineapples (5.9%), eggs (3.3%), chicken (3.3%) and cassava, mangoes and Cleome gynandra (each at 3%). Most foods were avoided for reasons associated with pregnancy and labour complications and undesirable effects on the baby. Most women learnt of the taboos and beliefs from the elders, their own mother, grandparents or mother-in-law, but there was also knowledge transmission in social groups within the community. CONCLUSIONS The taboos and cultural beliefs in the study area render pregnant and breast-feeding women prone to micronutrient deficiency since they are denied consumption of a diversity of nutritious foods. There is a need to educate such women about consumption of nutrient-rich foods like fish, eggs, fruits and vegetables in order to improve their health, that of the unborn and children being breast fed. Additionally, culturally appropriate nutrition education may be a good strategy to eliminate inappropriate food taboos and beliefs with negative impact on the health of pregnant and breast-feeding women.
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Affiliation(s)
- Patience Tugume
- Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Abubakar Sadik Mustafa
- Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Abdul Walusansa
- Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
- Department of Medical Microbiology, Habib Medical School, Faculty of Health Sciences, Islamic University in Uganda, P. O. Box 7689, Kampala, Uganda
| | - Samuel Ojelel
- Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Evelyne B Nyachwo
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Emmanuel Muhumuza
- Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - Maria Nampeera
- Department of Health Nutrition, Buyende District Local Government, P. O. Box 87, Kamuli, Uganda
| | - Fredrick Kabbale
- Directorate of Research and Quality Assurance, Busoga University, P. O. Box 154, Iganga, Uganda
- Department of Production, Buyende District Local Government, P. O. Box 87, Kamuli, Uganda
| | - Jamilu E Ssenku
- Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda.
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Feng Q, Ireland G, Gilbert R, Harron K. Data Resource Profile: A national linked mother-baby cohort of health, education and social care data in England (ECHILD-MB). Int J Epidemiol 2024; 53:dyae065. [PMID: 38703040 PMCID: PMC11069107 DOI: 10.1093/ije/dyae065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/13/2024] [Indexed: 05/06/2024] Open
Affiliation(s)
- Qi Feng
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Georgina Ireland
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Ruth Gilbert
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Katie Harron
- Great Ormond Street Institute of Child Health, University College London, London, UK
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Agarwal S, Fulgoni VL. Contribution of Beef to Key Nutrient Intakes and Nutrient Adequacy in Pregnant and Lactating Women: NHANES 2011-2018 Analysis. Nutrients 2024; 16:981. [PMID: 38613015 PMCID: PMC11013741 DOI: 10.3390/nu16070981] [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: 03/08/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Beef is an important source of high-quality protein and several micronutrients, including iron, zinc, and B-vitamins. The objective was to assess the association of beef intake with nutrient intake and adequacy among pregnant and lactating women using 24-h dietary recall data. Usual intakes from foods were determined with the National Cancer Institute (NCI) method and % population below Estimated Average Requirement (EAR) or above Adequate Intake (AI) were estimated. A high proportion of pregnant and lactating women had inadequate intakes for vitamin D (94%), vitamin E (82%), vitamin C (52%), and vitamin A (50%), magnesium (35%), folate (31%), zinc (25%), and vitamin B6 (22%); only 4% and 35% met AI for choline and potassium, respectively. About 67% of pregnant and lactating women were beef consumers, consuming 49 g beef/day. Beef consumers had higher intakes (p < 0.05) of energy, protein, calcium, iron, phosphorus, selenium, sodium, zinc, thiamin, riboflavin, and niacin, and a higher proportion (p < 0.05) met nutrient recommendations for protein, calcium, iron, zinc, thiamin, riboflavin, niacin, vitamin B6, and vitamin B12 compared to non-consumers. In conclusion, pregnant and lactating women generally have inadequate nutrient intakes from their diets. Beef consumers have higher intakes and adequacy for certain nutrients, many of which are inherently available in beef or in foods eaten with beef.
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Ambreen S, Yazdani N, Alvi AS, Qazi MF, Hoodbhoy Z. Association of maternal nutritional status and small for gestational age neonates in peri-urban communities of Karachi, Pakistan: findings from the PRISMA study. BMC Pregnancy Childbirth 2024; 24:214. [PMID: 38519904 PMCID: PMC10958913 DOI: 10.1186/s12884-024-06420-3] [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: 01/10/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Early pregnancy nutritional status can be associated with adverse birth outcomes such as small-for-gestational age (SGA) and low birth weight (LBW). BMI (Body Mass Index) and MUAC (Mid-upper arm circumference) are easy to use assessments and are indicative of the pre-pregnancy nutritional status if obtained in the first trimester. This study primarily assesses the association of maternal nutritional status using BMI and MUAC with SGA in a community-based cohort of Pakistani women. It also aims to determine the predictive ability of MUAC and BMI in predicting SGA. Secondarily, we assessed the association between maternal nutrition and large for gestational age (LGA) and LBW. METHODS This study is a secondary analysis of an ongoing pregnancy cohort "Pregnancy Risk Infant Surveillance and Measurement Alliance (PRISMA)"in Ibrahim Hyderi and Rehri Goth, Karachi. PRISMA participants who were enrolled between January 2021 to August 2022 were included given they had a gestational age < 14 weeks confirmed via ultrasound, MUAC and BMI measurements were available and birth weight was captured within 72 hours. Multivariable logistic regression was used to determine an association between maternal nutritional status and SGA. The PRISMA study was approved by the Aga Khan University Ethics Review Committee (2021-5920-15,518). RESULTS Of 926 women included in the analysis, 26.6% (n = 247) had a low MUAC (< 23 cm) while 18.4% (n = 171) were underweight (BMI < 18.5 kg/m2). Nearly one third of low MUAC and underweight women delivered SGA infants (34.4 and 35.1% respectively). Underweight women and women with low MUAC had a statistically significant association with SGA (Underweight: OR 1.49, 95% CI 1.1,2.4; Low MUAC-OR 1.64, 95% CI 1.2,2.3) as well as LBW (Underweight: OR-1.63, 95% CI 1.1,2.4; Low MUAC-OR-1.63, 95% CI 1.2,2.3). ROC curves showed that MUAC and BMI had modest predictability for SGA (AUC < 0.7). CONCLUSION Maternal nutritional status as indicated by BMI and MUAC are strongly associated with adverse pregnancy outcomes including SGA, LGA and LBW. Although MUAC and BMI are widely used to determine maternal nutritional status, they have poor predictive ability for newborn size. Further research is needed to identify other tools or a combination of tools to better predict adverse birth outcomes in resource-limited settings and plan interventions.
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Affiliation(s)
| | - Nida Yazdani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Zahra Hoodbhoy
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
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Hossain MI, Habib MJ, Zinia FA, Rahman A, Methun MIH, Haq I. Rural-urban disparities in nutritional status among ever-married women in Bangladesh: A Blinder-Oaxaca decomposition approach. PLoS One 2023; 18:e0289880. [PMID: 38096318 PMCID: PMC10721169 DOI: 10.1371/journal.pone.0289880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 07/28/2023] [Indexed: 12/18/2023] Open
Abstract
This study aims to investigate socioeconomic disparities in nutritional status among ever-married women in Bangladesh and to break down urban-rural differences in the underlying causes of undernutrition. We utilized data from the Bangladesh Demographic and Health Survey 2017-18, a sample size of 18328 ever-married women, including 5170 from urban residences, and 13159 from rural residences. To explore socioeconomic inequality, we employed a concentration indexing measure, while a multiple binary logistic regression model was carried out to identify the determinants associated with the outcome variable. A Blinder-Oaxaca decomposition analysis was performed to decompose the urban-rural gap in women's nutritional status using associated factors. The prevalence of undernutrition among ever-married women in Bangladesh was 12 percent. Notably, this percentage varied by region, with urban residents accounting for 8.6% and rural residents accounting for 13.3%. Our findings confirmed that undernutrition was more prevalent among women with lower wealth indexes in Bangladesh, as indicated by the concentration index (CIX = -0.26). The multivariable analysis investigating the determinants of undernutrition status among ever-married women, with a focus on residence revealed significant associations with respondent age, education, marital status, mass media access, wealth status, and division. According to the Blinder-Oaxaca decomposition and its extension, the prevalence was significantly higher in rural residences of Bangladesh than in urban residences, and the endowment effect explained 86 percent of the total urban-rural difference in undernutrition prevalence. The results of this study indicate that the factors that influence women's nutritional status in rural areas play a significant role in the gap, and the majority of the gap is caused by education and economic position. In order to effectively promote maternal health policies in Bangladesh, intervention techniques should be created that are aimed at the population, that is, the poorest and least educated.
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Affiliation(s)
- Md. Ismail Hossain
- Department of Computer Science and Engineering, Daffodil International University, Dhaka, Bangladesh
| | | | | | - Azizur Rahman
- Department of Statistics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | | | - Iqramul Haq
- Department of Agricultural Statistics, Sher-e-Bangla Agricultural University, Dhaka, Bangladesh
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Madden C, Ferber M, Cantwell S, Xaverius P, Christopher KM. Maternal Malnutrition During Pregnancy Among Women with Metabolic and Bariatric Surgery. Obes Surg 2023; 33:2276-2281. [PMID: 37329409 DOI: 10.1007/s11695-023-06678-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 05/30/2023] [Accepted: 06/08/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION As the utilization of metabolic and bariatric surgery (MBS) continues to rise, it is important to address the nutritional needs of women who had MBS who become pregnant. Not meeting those nutritional needs could lead to complications associated with malnutrition. To better understand the relationship between MBS, pregnancy, and malnutrition, this study sought to determine whether differences exist in the presence of malnutrition during pregnancy in women with a history of MBS compared to women without a history of MBS. METHODS This cross-sectional study used the National Inpatient Sample (NIS) from 2012 to 2017, which samples 20% of hospital discharges in the USA. Multivariate logistic regression models were fitted, and odds rations and 95% confidence intervals were calculated with obesity and MBS as the independent variables and malnutrition during pregnancy as the dependent variable. Covariates included in the multivariate model were age, primary payer, hypertension, hyperlipidemia, and depression. RESULTS Compared to women who did not have MBS, women who had MBS had higher odds of malnutrition during pregnancy (aOR = 8.33, 95% CI 7.30-9.50), this result was moderated by racial category (aORBlack = 6.35, 95% CI 4.97-8.13; aORwhite = 8.25, 95% CI 7.00-9.73; aORLatina = 10.93, 95% CI 8.38-14.25). Women with obesity also had higher odds of malnutrition during pregnancy. CONCLUSIONS The increased odds of malnutrition among women with MBS suggests that it is important to consider tailoring nutrition recommendations to address the different nutritional needs of pregnant women who had MBS and may be at risk for malnutrition.
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Affiliation(s)
- Colleen Madden
- Marion County Public Health Department, 3838 N Rural St, Indianapolis, IN, 46205, USA
| | - Megan Ferber
- College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO, 63104, USA
| | - Sophia Cantwell
- Medical Family Therapy Program, Department of Family and Community Medicine, Saint Louis University, 3700 Lindell Blvd, Morrissey Hall Suite 1127, Saint Louis, MO, 63108, USA
| | - Pamela Xaverius
- University of Health Sciences and Pharmacy in St. Louis, 1 Pharmacy Place, Saint Louis, MO, 63110, USA
| | - Kara M Christopher
- Souers Stroke Institute, Department of Neurology, Saint Louis University, 1008 S. Spring Ave, 3rd Floor, Saint Louis, MO, 63110, USA.
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Young MF, Nguyen PH, Tran LM, Khuong LQ, Hendrix S, Martorell R, Ramakrishnan U. Maternal preconception BMI and gestational weight gain are associated with weight retention and maternal and child body fat at 6-7 years postpartum in the PRECONCEPT cohort. Front Nutr 2023; 10:1114815. [PMID: 37305082 PMCID: PMC10254082 DOI: 10.3389/fnut.2023.1114815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/03/2023] [Indexed: 06/13/2023] Open
Abstract
Background There is limited evidence from prospective cohorts in low-resource settings on the long-term impact of pre-pregnancy body mass index (PPBMI) and gestational weight gain (GWG) on postpartum weight retention (PPWR) and maternal and child body composition. Objectives We examined the associations between PPBMI and timing of GWG on PPWR at 1, 2, and 6-7 years and maternal and child percent body fat at 6-7 years. Methods We used data from the PRECONCEPT study (NCT01665378) that included prospectively collected data on 864 mother-child pairs from preconception through 6-7 years postpartum. The key outcomes were PPWR at 1, 2, and 6-7 years, and maternal and child percent body fat at 6-7 years that was measured using bioelectric impedance. Maternal conditional GWG (CGWG) was defined as window-specific weight gains (< 20wk, 21-29wk, and ≥ 30wk), uncorrelated with PPBMI and all prior body weights. PPBMI and CGWG were calculated as standardized z-scores to allow for relative comparisons of a 1 standard deviation (SD) increase in weight gain for each window. We used multivariable linear regressions to examine the associations, adjusting for baseline demographic characteristics, intervention, breastfeeding practices, diet and physical activity. Results Mean (SD) PPBMI and GWG were 19.7 (2.1) kg/m2 and 10.2 (4.0) kg, respectively. Average PPWR at 1, 2, and 6-7 years was 1.1, 1.5 and 4.3 kg, respectively. A one SD increase in PPBMI was associated with a decrease in PPWR at 1 year (β [95% CI]: -0.21 [-0.37, -0.04]) and 2 years (-0.20 [-0.39, -0.01]); while a one SD in total CGWG was associated with an increase in PPWR at 1 year (1.01 [0.85,1.18]), 2 years (0.95 [0.76, 1.15]) and 6-7 years (1.05 [0.76, 1.34]). Early CGWG (< 20 weeks) had the greatest association with PPWR at each time point as well as with maternal (0.67 [0.07, 0.87]) and child (0.42 [0.15, 0.69]) percent body fat at 6-7 years. Conclusion Maternal nutrition before and during pregnancy may have long-term implications for PPWR and body composition. Interventions should consider targeting women preconception and early in pregnancy to optimize maternal and child health outcomes.
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Affiliation(s)
- Melissa F. Young
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Phuong Hong Nguyen
- Poverty, Health and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, DC, United States
- Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | - Lan Mai Tran
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | | | - Sara Hendrix
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States
| | - Reynaldo Martorell
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Usha Ramakrishnan
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
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Grammatikopoulou MG, Nigdelis MP, Haidich AB, Kyrezi M, Ntine H, Papaioannou M, Mintziori G, Bogdanos DP, Mavromatidis G, Goulis DG. Diet Quality and Nutritional Risk Based on the FIGO Nutrition Checklist among Greek Pregnant Women: A Cross-Sectional Routine Antenatal Care Study. Nutrients 2023; 15:2019. [PMID: 37432147 DOI: 10.3390/nu15092019] [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: 03/15/2023] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 07/12/2023] Open
Abstract
The International Federation of Gynecology and Obstetrics (FIGO) nutrition checklist is a tool for everyday antenatal clinical practice, easy to use by most healthcare professionals, aiming to initiate a conversation regarding gestational weight gain (GWG) and nutrition and identify women who might require further assessment. The present cross-sectional study aimed to apply the FIGO nutrition checklist to pregnant women attending routine antenatal care and identify nutritional risk factors. Pregnant women (n = 200) were recruited from the outpatient pregnancy clinics of two hospitals in Thessaloniki and completed the checklist. The FIGO-diet quality score and the FIGO-nutritional risk score (NRS) were calculated. The results revealed that 99% of the women exhibited at least one nutritional risk factor based on the checklist. The median FIGO diet quality score of the sample was 4.0 (3.0-5.0), with 95% of the participants responding negatively to at least one question, indicating the need for improving diet quality. Improved diet quality was noted in cases of hyperemesis gravidarum and among those receiving vitamin D supplements. A large percentage of the participants (36%) exhibited five or more nutritional risk factors, as indicated by a total FIGO-NRS below 5. Women with low middle-upper arm circumference, indicative of protein-energy malnutrition (20.6% of the sample), exhibited more nutritional risk factors compared with the rest. On the other hand, being in the third trimester of pregnancy was associated with lower nutritional risk and, subsequently, better diet quality.
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Affiliation(s)
- Maria G Grammatikopoulou
- Unit of Immunonutrition and Clinical Nutrition, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Meletios P Nigdelis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, GR-56403 Thessaloniki, Greece
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Gebäude 9, Kirrberger Straße, DE-66421 Homburg, Germany
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, GR-54124 Thessaloniki, Greece
| | - Maria Kyrezi
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, GR-56403 Thessaloniki, Greece
| | - Helga Ntine
- 2nd Academic Department of Obstetrics and Gynaecology, Hippokration General Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, GR-54642 Thessaloniki, Greece
| | - Maria Papaioannou
- 2nd Academic Department of Obstetrics and Gynaecology, Hippokration General Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, GR-54642 Thessaloniki, Greece
| | - Gesthimani Mintziori
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, GR-56403 Thessaloniki, Greece
| | - Dimitrios P Bogdanos
- Unit of Immunonutrition and Clinical Nutrition, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - George Mavromatidis
- 2nd Academic Department of Obstetrics and Gynaecology, Hippokration General Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, GR-54642 Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, GR-56403 Thessaloniki, Greece
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Graham ME, Jelin A, Hoon AH, Wilms Floet AM, Levey E, Graham EM. Assisted reproductive technology: Short- and long-term outcomes. Dev Med Child Neurol 2023; 65:38-49. [PMID: 35851656 PMCID: PMC9809323 DOI: 10.1111/dmcn.15332] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 01/05/2023]
Abstract
Assisted reproductive technology (ART) includes fertility treatment in which either eggs or embryos are handled outside a female's body to promote successful pregnancies and healthy offspring. Current ART procedures encompass in vitro fertilization with or without intracytoplasmic sperm injection. The most common complication of ART is related to the consequences of multiple pregnancy, which can be prevented or minimized by reducing the number of embryos transferred to the uterus, commonly single embryo transfer. ART has been shown to be variably associated with adverse short- and long-term perinatal outcomes, including cerebral palsy, autism, neurodevelopmental imprinting disorders, and cancer. However, there is uncertainty as to whether reported problems are related to the ART procedure itself, to factors related to infertility, to other medical and environmental factors, or a combination thereof. From a pathophysiological perspective, whether ART alters epigenetic mechanisms of gene expression, leading to later developmental, medical, and behavioral disorders, is an area of active investigation. With the meticulously conducted short- and long-term outcome studies completed so far, overall, and after controlling for multiple gestations and preterm delivery, the results suggest that ART is a safe procedure, offering hope to many parent(s) wishing for a healthy child. This paper highlights ART methods and the risk factors and confounders in the interpretation of short- and long-term outcome data, providing the reader with a means to evaluate findings and conclusions of outcome studies. WHAT THIS PAPER ADDS: Assisted reproductive technology (ART) is a relatively safe procedure. Single embryo implantation optimizes outcome. Informed consent, including the risks and benefits of ART, should be required. Ongoing longitudinal studies are necessary to fully understand ART outcomes.
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Affiliation(s)
- Mary Elaine Graham
- College of Arts and Sciences, Washington and Lee University, Lexington, VA, USA
| | - Angie Jelin
- Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander H. Hoon
- Department of Pediatrics, Division of Developmental Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA,Phelps Center for Cerebral Palsy and Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Anna Maria Wilms Floet
- Department of Pediatrics, Division of Developmental Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA,Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA,Center for Development and Learning, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Eric Levey
- Health Services for Children with Special Needs, Washington, DC, USA
| | - Ernest M. Graham
- Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA,Neuroscience Intensive Care Nursery Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Wakwoya EB, Belachew T, Girma T. Determinants of nutritional status among pregnant women in East Shoa zone, Central Ethiopia. Front Nutr 2022; 9:958591. [PMID: 36590215 PMCID: PMC9797973 DOI: 10.3389/fnut.2022.958591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Background Undernutrition is an insufficient intake of energy and nutrients to meet an individual's needs to maintain good health. Undernutrition during pregnancy severely affects the health of mothers and her baby. Globally it contributes directly or indirectly to 3.5 million maternal deaths annually. This study aimed to determine the level of undernutrition and identify factors associated with undernutrition among pregnant women attending public health facilities in the East Shoa Zone, Central Ethiopia. Methods Institution-based cross-sectional study was conducted among 472 randomly selected pregnant women from June to August 2021. Sociodemographic, obstetrics, and knowledge related data were collected using a structured interviewer-administered questionnaire, and maternal nutritional status was measured using the Mid Upper Arm Circumference (MUAC). The collected data were entered to EPI-info version 3.5.4 and then exported to SPSS for windows version 26.0 software for analysis. Multivariable regression analysis was fitted to identify determinants of undernutrition. An adjusted odds ratio with 95% confidence intervals and a p-value < 0.05 was considered a statistically significant. Results The prevalence of undernutrition among pregnant women was 13.9% [95% CI: 11.0-17.4]. On multivariable logistic regression model after adjusting background variables, wealth (AOR: 4.9, 95% CI 1.34-18.20), women's decision making power (AOR: 3.31, 95% CI 1.18-7.79), and nutritional counseling (AOR: 3.53, 95% CI 1.29-9.60) were independently associated with nutritional status of pregnant women. Conclusion Findings indicated that significant number of pregnant women in the study were undernourished. Higher wealth index, nutritional counseling, and women's decision-making power were inversely associated with undernutrition. The findings imply the need for economic empowerment of women, enhancing decision-making ability of women and routine and consistent nutritional counseling to decrease undernutrition among pregnant women.
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Affiliation(s)
- Ermias Bekele Wakwoya
- Department of Nutrition and Dietetics, Jimma University, Jimma, Ethiopia,*Correspondence: Ermias Bekele Wakwoya
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Jimma University, Jimma, Ethiopia,Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Tsinuel Girma
- Department of Nutrition and Dietetics, Jimma University, Jimma, Ethiopia
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Anandh U, Meena P, Karam S, Luyckx V. Social, political and legal determinants of kidney health: Perspectives from lower- and middle-income countries with a focus on India. FRONTIERS IN NEPHROLOGY 2022; 2:1024667. [PMID: 37745281 PMCID: PMC10513032 DOI: 10.3389/fneph.2022.1024667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/21/2022] [Indexed: 09/26/2023]
Abstract
The social determinants of health (SDoH) are the non-medical factors that influence kidney health outcomes directly or indirectly in a substantial manner and include conditions in which people are born, grow, work, live, and age. Many such challenges in lower- and middle- income countries have an unfavourable impact on kidney health. These conditions potentially influence economic policies and systems, development agendas, social norms, social policies, and political systems. In addition, many political and legal factors also determine and modify the ultimate outcome in patients with kidney disease. Legal factors that ensure universal health care, promote gender and racial equality, prevent malpractices and regulate strict laws in the field of kidney transplantation are the paramount determinants for the provision of necessary kidney care. Converging lines of evidence have supported the impact of social variables such as socioeconomic resources, social inclusion, housing conditions, educational attainment, and financial status on kidney health, particularly affect vulnerable and disadvantaged groups and result in challenges in kidney care delivery. Furthermore, the climate is an important SDoH that plays a crucial role in the occurrence, prevalence, and progression of kidney diseases as highlighted by the presence of higher prevalence of chronic kidney disease in hot tropical countries. The rising incidence of water and vector-borne diseases causing acute kidney injury is another consequence of disruptive environmental and climate change which is detrimental to kidney health. Political risk factors such as conflict also have a devastating influence on kidney health. The relationship between SDoH and kidney health outcomes requires more clarity. Gaps in the current knowledge need to be identified to inform the development of appropriate interventions to address upstream socio-economic risk factors for kidney disease.
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Affiliation(s)
- Urmila Anandh
- Department of Nephrology, Amrita Hospitals, Faridabad, Delhi NCR, India
| | - Priti Meena
- Department of Nephrology, All India Institute of Medical Sciences, Bhubaneshwar, India
| | - Sabine Karam
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
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Nyadanu SD, Dunne J, Tessema GA, Mullins B, Kumi-Boateng B, Lee Bell M, Duko B, Pereira G. Prenatal exposure to ambient air pollution and adverse birth outcomes: An umbrella review of 36 systematic reviews and meta-analyses. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 306:119465. [PMID: 35569625 DOI: 10.1016/j.envpol.2022.119465] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/12/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
Multiple systematic reviews and meta-analyses linked prenatal exposure to ambient air pollutants to adverse birth outcomes with mixed findings, including results indicating positive, negative, and null associations across the pregnancy periods. The objective of this study was to systematically summarise systematic reviews and meta-analyses on air pollutants and birth outcomes to assess the overall epidemiological evidence. Systematic reviews with/without meta-analyses on the association between air pollutants (NO2, CO, O3, SO2, PM2.5, and PM10) and birth outcomes (preterm birth; stillbirth; spontaneous abortion; birth weight; low birth weight, LBW; small-for-gestational-age) up to March 30, 2022 were included. We searched PubMed, CINAHL, Scopus, Medline, Embase, and the Web of Science Core Collection, systematic reviews repositories, grey literature databases, internet search engines, and references of included studies. The consistency in the directions of the effect estimates was classified as more consistent positive or negative, less consistent positive or negative, unclear, and consistently null. Next, the confidence in the direction was rated as either convincing, probable, limited-suggestive, or limited non-conclusive evidence. Final synthesis included 36 systematic reviews (21 with and 15 without meta-analyses) that contained 295 distinct primary studies. PM2.5 showed more consistent positive associations than other pollutants. The positive exposure-outcome associations based on the entire pregnancy period were more consistent than trimester-specific exposure averages. For whole pregnancy exposure, a more consistent positive association was found for PM2.5 and birth weight reductions, particulate matter and spontaneous abortion, and SO2 and LBW. Other exposure-outcome associations mostly showed less consistent positive associations and few unclear directions of associations. Almost all associations showed probable evidence. The available evidence indicates plausible causal effects of criteria air pollutants on birth outcomes. To strengthen the evidence, more high-quality studies are required, particularly from understudied settings, such as low-and-middle-income countries. However, the current evidence may warrant the adoption of the precautionary principle.
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Affiliation(s)
- Sylvester Dodzi Nyadanu
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia; Education, Culture, and Health Opportunities (ECHO) Ghana, ECHO Research Group International, P. O. Box 424, Aflao, Ghana.
| | - Jennifer Dunne
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia
| | - Gizachew Assefa Tessema
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia; School of Public Health, University of Adelaide, Adelaide, South Australia, 5000, Australia
| | - Ben Mullins
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia
| | - Bernard Kumi-Boateng
- Department of Geomatic Engineering, University of Mines and Technology, P. O. Box 237, Tarkwa, Ghana
| | - Michelle Lee Bell
- School of the Environment, Yale University, New Haven, CT, 06511, USA
| | - Bereket Duko
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia; Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, 0473, Oslo, Norway; enAble Institute, Curtin University, Perth, Kent Street, Bentley, Western Australia, 6102, Australia
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15
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Bora K, Barman B, Pala S, Das A, Doke G, Tripura A. Coverage of antenatal iron-folic acid and calcium distribution during pregnancy and their contextual determinants in the northeastern region of India. Front Nutr 2022; 9:894245. [PMID: 35923196 PMCID: PMC9339897 DOI: 10.3389/fnut.2022.894245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022] Open
Abstract
Iron-folic acid (IFA) and calcium supplementation are nutritional interventions recommended prophylactically (against maternal anemia and preeclampsia, respectively) to all antenatal mothers in India under basic antenatal care (ANC) services. Using Health Management Information System data (reporting period: 2018–19 to 2020–21), we mapped the coverage of antenatal IFA and calcium distribution across the remote northeastern region of India relative to the number of pregnant women (PW) who registered for ANC, disaggregated by states and districts. Variations in coverage were also investigated by subgroups based on contextual attributes, viz., physiography (hilly/ plateau/ plain), socioeconomic development (“aspirational”/ “non-aspirational”) and proportion of early ANC visits (low/ medium/ high). Full course of antenatal IFA and calcium supplements were received by 79.36 (95% CI: 79.31–79.40) and 61.26 (95% CI: 61.21–61.32) PW per 100 ANC registered women, respectively. There was widespread heterogeneity in outreach, with calcium coverage generally trailing behind IFA coverage. Among states, coverage of the two interventions (per 100 ANC registered women) was highest in Assam (97.06 and 78.11 PW, respectively) and lowest in Nagaland (24.87 and 16.77 PW, respectively). At the district-level, the two interventions failed to reach even 50 PW per 100 ANC registered women in 32 (out of 115) districts. The coverage tended to be inferior in districts that were hilly, “non-aspirational” and had low proportion of early ANC visits. The granular information provided by our findings will facilitate monitoring, root cause analyses, microplanning, informed resource allocation and tailoring of locally appropriate solutions to achieve targeted coverage improvements.
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Affiliation(s)
- Kaustubh Bora
- Hematology Division, ICMR-Regional Medical Research Centre North East Region, Dibrugarh, India
- *Correspondence: Kaustubh Bora
| | - Bhupen Barman
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | - Star Pala
- Department of Community Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | - Ananya Das
- Department of Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | - Goter Doke
- Department of Obstetrics and Gynecology, Tomo Riba Institute of Health and Medical Sciences, Naharlagun, India
| | - Amar Tripura
- Department of Community Medicine, Agartala Government Medical College, Agartala, India
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Gokhale D, Rao S. Socio-economic and socio-demographic determinants of diet diversity among rural pregnant women from Pune, India. BMC Nutr 2022; 8:54. [PMID: 35787284 PMCID: PMC9254638 DOI: 10.1186/s40795-022-00547-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Diet diversity signifies the nutrient adequacy of an individual and thus has gained widespread significance in recent times. In developing countries achieving maximum diet diversity, especially among pregnant women from rural areas is challenging although of great importance. However, to do so understanding the primary factors associated with diet diversity is important. This paper, therefore, assessed the socio-demographic and socio-economic determinants of diet diversity among rural pregnant women in India. Methods The study consisted of a community-based prospective cohort of n = 204 pregnant women attending primary healthcare centers (PHC) across 14 villages in Mulshi Taluka, Pune, Maharashtra, India. The data was collected using a structured questionnaire through a one-to-one interview method. Results The prevalence of low, medium and high diet diversity was 56.4%, 33.3%, and 10.3% respectively. Minimum diversity in the diet was achieved among 73.5% of pregnant women. The mean diet diversity score (DDS) was 3.6 ± 1.3 with starchy staples being (100%) of commonly consumed foods. Young (< 20 years) women (OR = 5.2; CI:1.9- 13.8), housewives (OR = 3; CI:1.4–6.7), husbands working as skilled laborers (OR = 2.5; CI:1.2–5.5) were at significant risk of having low diet diversity scores. Whereas, those living in a joint family (OR = 0.3; CI:0.1–0.6), not owning a house (OR = 0.5; CI:0.2–0.9), and having a poor income (OR = 1.9; CI: 0.9- 3.7) were less likely to have low diet diversity. Conclusion Socio-economic and demographic factors (maternal age, mother's occupation, and husband's occupation) influenced the diet diversity among pregnant women. Monotonous diets are commonly seen in developing countries, especially in rural areas which can be a risk factor for poor nutrient adequacy and health of pregnant women. Policies and programs about these determinants of diet diversity should be enacted to replace the poor quality diets to ensure improved diet diversity and nutrient adequacy.
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Affiliation(s)
- Devaki Gokhale
- Symbiosis Institute of Health Sciences, Symbiosis International (Deemed University), Maharashtra, 412115, India.
| | - Shobha Rao
- Society for Initiatives in Nutrition and Diseases, Pune Maharashtra, 411007, India
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Liu X, An H, Li N, Li Z, Zhang Y, Zhang L, Li H, Liu J, Ye R. Preconception Hemoglobin Concentration and Risk of Low Birth Weight and Small-for-Gestational-Age: A Large Prospective Cohort Study in China. Nutrients 2022; 14:nu14020271. [PMID: 35057452 PMCID: PMC8780179 DOI: 10.3390/nu14020271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 12/18/2022] Open
Abstract
Less is known about the impact of maternal preconception anemia on birth outcomes. We aimed to examine associations between preconception hemoglobin (Hb) concentrations with risk of low birth weight (LBW) and small-for-gestational-age (SGA). This study was from a large population-based prospective cohort in China and included 124,725 women with singleton live births delivered at gestational ages of 28–45 weeks who were registered before pregnancy. Maternal Hb concentrations were measured during registration, and other health-related information was recorded prospectively. Logistic regression was used to evaluate the associations between preconception Hb concentrations with risk of LBW and SGA, adjusting for potential confounders. The results showed women with preconception anemia accounted for 22.28%. The incidences of LBW/SGA were 2.37%/6.30% among anemic women, and 2.01%/5.48% among non-anemic women, respectively. Preconception mild anemia increased by 17% (95% confidence interval (CI): 1.06, 1.28) and 14% (95% CI: 1.07, 1.21) the risk for LBW and SGA, while moderate-to-severe anemia had no significant association with LBW and SGA. Compared with the 120–129 g/L group, a U-shaped association was observed between preconception Hb concentrations with LBW and SGA. In conclusion, not only maternal anemia but also elevated Hb concentrations before pregnancy contribute to an increased risk of LBW and SGA.
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Affiliation(s)
- Xiaojing Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (H.A.); (Y.Z.); (L.Z.); (H.L.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
| | - Hang An
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (H.A.); (Y.Z.); (L.Z.); (H.L.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
| | - Nan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (H.A.); (Y.Z.); (L.Z.); (H.L.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
- Correspondence: (N.L.); (Z.L.)
| | - Zhiwen Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (H.A.); (Y.Z.); (L.Z.); (H.L.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
- Correspondence: (N.L.); (Z.L.)
| | - Yali Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (H.A.); (Y.Z.); (L.Z.); (H.L.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
| | - Le Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (H.A.); (Y.Z.); (L.Z.); (H.L.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
| | - Hongtian Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (H.A.); (Y.Z.); (L.Z.); (H.L.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
| | - Jianmeng Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (H.A.); (Y.Z.); (L.Z.); (H.L.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
| | - Rongwei Ye
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China; (X.L.); (H.A.); (Y.Z.); (L.Z.); (H.L.); (J.L.); (R.Y.)
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing 100191, China
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Effect of dehydration during pregnancy on birth weight and length in West Jakarta. J Nutr Sci 2021; 10:e70. [PMID: 34527228 PMCID: PMC8411261 DOI: 10.1017/jns.2021.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 11/25/2022] Open
Abstract
Nutrition and maternal behavior are critical factors in fetal development. Maternal water intake is necessary to regulate metabolism and may influence fetal growth. This study aims to determine the effect of dehydration during pregnancy on birth weight and length. This cohort-prospective study took place in the area of Kebon Jeruk District Health Centre. A total of 38 subjects of pregnant women in their second trimester were examined. Subject characteristics were collected through direct measurements and interviews. Urine and blood samples were collected at the sixth trimester (32–34 and 35–37 weeks) to determine hydration status. Nutritional status was collected through food recall, while birth weight and length were obtained from the anthropometric measurements 30 min after birth. From a total of 38 subjects, 20 were dehydrated, and 18 were well hydrated. There was a significant relationship between hydration status and water intake, birth weight and length, head circumference, and chest circumference. After being corrected to the level of water intake, the difference in birth weight and length between the two groups were 500⋅6 g and 0⋅4 cm, and 0⋅8 cm and 1⋅4 cm for the head circumference and chest circumference (P < 0⋅05). It is recommended for mothers to monitor their weight and ensure fluid intake of 3⋅0 l per day. Further research requires more subjects to observe the effects of chronic maternal dehydration on pregnancy output and a cohort study that monitors infant development in the first six months of life.
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Nilsson PM, Sundquist J, Sundquist K, Li X. Sibling rank and sibling number in relation to cardiovascular disease and mortality risk: a nationwide cohort study. BMJ Open 2021; 11:e042881. [PMID: 34035122 PMCID: PMC8162087 DOI: 10.1136/bmjopen-2020-042881] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The number and rank order of siblings could be of importance for risk of cardiovascular disease and mortality. Previous studies have used only fatal events for risk prediction. We, therefore, aimed to use also non-fatal coronary and cardiovascular events in fully adjusted models. METHODS From the Multiple-Generation Register in Sweden, data were used from 1.36 million men and 1.32 million women (born 1932-1960), aged 30-58 years at baseline and with follow-up from 1990 to 2015. Mean age at follow-up was 67 years (range 55-83 years). Fatal and non-fatal events were retrieved from national registers. RESULTS Compared with men with no siblings, those with 1-2 siblings had a lower, and those with four or more siblings had a higher adjusted risk of cardiovascular events. Again, compared with men with no siblings, those with more than one sibling had a lower total mortality risk, and those with three or more siblings had an increased risk of coronary events.Correspondingly, compared with women with no siblings those women with three siblings or more had an increased risk of cardiovascular events, and those with two siblings or more had an increased risk of coronary events. Women with one sibling or more were at lower total mortality risk, following full adjustment. CONCLUSION Being first born is associated with a favourable effect on non-fatal cardiovascular and coronary events for both men and women. The underlying biological mechanisms for this should be studied in a sociocultural context.
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Affiliation(s)
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | | | - Xinjun Li
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
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Leocádio PCL, Lopes SC, Dias RP, Alvarez-Leite JI, Guerrant RL, Malva JO, Oriá RB. The Transition From Undernutrition to Overnutrition Under Adverse Environments and Poverty: The Risk for Chronic Diseases. Front Nutr 2021; 8:676044. [PMID: 33968973 PMCID: PMC8102690 DOI: 10.3389/fnut.2021.676044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/26/2021] [Indexed: 12/29/2022] Open
Affiliation(s)
- Paola Caroline L Leocádio
- Laboratory of Atherosclerosis and Nutritional Biochemistry, Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Department of Nutrition, Nursing School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Synara C Lopes
- Laboratory of Tissue Healing, Ontogeny, and Nutrition, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Ronaldo P Dias
- Laboratory of Tissue Healing, Ontogeny, and Nutrition, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Jacqueline I Alvarez-Leite
- Laboratory of Atherosclerosis and Nutritional Biochemistry, Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Richard L Guerrant
- Center for Global Health, University of Virginia, Charlottesville, VA, United States
| | - João O Malva
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
| | - Reinaldo B Oriá
- Laboratory of Tissue Healing, Ontogeny, and Nutrition, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
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Haschke F. How to Feed the Fetus. ANNALS OF NUTRITION AND METABOLISM 2021; 76 Suppl 3:1-2. [PMID: 33508846 DOI: 10.1159/000511240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/31/2020] [Indexed: 11/19/2022]
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