Prenatal nutrition and birth outcomes

Impact of Wuhan lockdown on the indications of cesarean delivery and newborn weights during the epidemic period of COVID-19

Objective

To prevent the rapid spread of COVID-19, the Chinese government implemented a strict lockdown in Wuhan starting on 23 January, 2020, which inevitably led to the changes in indications for the mode of delivery. In this retrospective study, we present the changes in the indications for cesarean delivery (CD) and the birth weights of newborns after the lockdown in Wuhan.

Methods

A total of 3,432 pregnant women in the third trimester of their pregnancies who gave birth in our hospital from 23 January 2019 to 24 March 2020 were selected as the observation group, while 7,159 pregnant women who gave birth from 1 January 2019 to 22 January 2020 were selected as the control group; control group was matched using propensity score matching (PSM). A comparative analysis of the two groups was performed with the chi-square test, t test and rank sum test.

Results

The difference in the overall rate of CD between the two groups was not statistically significant (p<0.05). Among the indications for CD, CD on maternal request (CDMR) and fetal distress were also significantly more common in the observation group (p<0.05) than the control group. Furthermore, we found that the weight of newborns was significantly heavier in the observation group than in the control group when considering full-term or close-to-full-term births (p<0.05).

Conclusions

The results may provide useful information to management practices regarding pregnancy and childbirth after lockdown in other cities or countries, enabling better control of the rate of CD due to CDMR, reducing fetal distress, and controlling newborn weight. We recommend that pregnant women pay more attention to controlling the weight of newborns through diet and exercise.

Single Nucleotide Polymorphisms in Vitamin D Receptor Gene Affect Birth Weight and the Risk of Preterm Birth: Results From the "Mamma & Bambino" Cohort and A Meta-Analysis

The effect of vitamin D receptor gene (VDR) polymorphisms on adverse pregnancy outcomes—including preterm birth (PTB), low birth weight and small for gestational age—is currently under debate. We investigated 187 mother-child pairs from the Italian “Mamma & Bambino” cohort to evaluate the association of maternal VDR polymorphisms—BsmI, ApaI, FokI and TaqI—with neonatal anthropometric measures and the risk of PTB. To corroborate our results, we conducted a meta-analysis of observational studies. For the FokI polymorphism, we showed that gestational duration and birth weight decreased with increasing number of A allele (p = 0.040 and p = 0.010, respectively). Compared to the GG and GA genotypes, mothers who carried the AA genotype exhibited higher PTB risk (OR = 12.049; 95% CI = 2.606–55.709; p = 0.001) after adjusting for covariates. The meta-analysis confirmed this association under the recessive model (OR = 3.67, 95%CI 1.18–11.43), and also pointed out the protective effect of BsmI polymorphism against the risk of PTB under the allelic (A vs. G: OR = 0.74; 95%CI 0.59–0.93) and recessive (AA vs. GG + AG: OR = 0.62; 95%CI 0.43–0.89) models. Our results suggest the association between some maternal VDR polymorphisms with neonatal anthropometric measures and the risk of PTB.

Small for gestational age and obesity: epidemiology and general risks

Children born small for gestational age (SGA) have several life-long consequences. Previous epidemiological studies investigated from childhood to adulthood reported that a number of chronic diseases originate in the prenatal period. With the emerging era of obesity epidemic, more concerns are related to being obese than being short-statured in SGA children. The exact mechanisms are uncertain; however, growth hormone-insulin-like growth factor axis disturbance by fetal programming and accelerated postnatal weight gain contributed to central adiposity in SGA children. In this review, we summarized the definitions and prevalence of SGA, epidemiology, and general risks of obesity in SGA children. Early interventions, before and after birth, are needed for healthy catch-up growth to prevent later obesity and related complications.

Energy and nutrients in self-reported diet before and at week 18–22 of pregnancy

Background

Objective

Design

Results

Conclusions

Investigation of Nutritional Behaviors in the First and Second Trimesters in Pregnant Women Referring to Clinics in Hamadan, Iran, in 2013

Background:

Pregnancy is a particular period in women’s life that is accompanied by an increase in nutritional needs. Having a normal pregnancy period and successful pregnancy outcomes depends on the intake of sufficient amount of food. The present study aimed to determine nutritional behaviors in pregnant women in the first and second trimesters referring to clinics in Hamadan, Iran.

Methods:

This cross-sectional study was conducted on 170 women referred to health and treatment centers of Hamadan in 2013. Among Hamadan’s health and treatment centers, 10 were selected as the research setting through cluster sampling. Then, the pregnant women at 8-24 weeks of gestation were randomly entered into the study. The data were collected using nutritional behaviors questionnaire in three months. Accordingly, mean scores below 50, between 50 and 75, and above 75 were considered as weak, moderate, and perfect nutritional behaviors, respectively. The data were analyzed using the SPSS statistical software, version 21 and P<0.05 was considered as statistically significant.

Results:

The results showed that more than three fourths of the study participants had moderate nutritional behaviors. Insufficient intake of fruit, vegetables, and cereals was detected in 80.6%, 54.1%, and 47.1% of the participants, respectively. Besides, 30% of the women had not used folic acid supplement during their pregnancy period or were not aware of its necessity. The results of multivariate analysis indicated that age was only significantly associated with pregnant women’s score of nutritional behaviors (P=0.010). Additionally, no significant relationship was found between the women’s nutritional behaviors and their strategies for elimination of common pregnancy complications, such as constipation, heartburn, urinary tract infection, and anemia.

Discussion and Conclusion:

Considering the participants’ moderate nutritional behaviors, health and treatment centers are recommended to provide the necessary training for improving pregnant women’s nutritional behaviors and supervise and follow their execution and evaluation.

Short-term nutrition education reduces low birthweight and improves pregnancy outcomes among urban poor women in Bangladesh

BACKGROUND

Maternal malnutrition and poor gestational weight gain are the most important causes of low birthweight and infant mortality in Bangladesh.

OBJECTIVE

To assess the effect of short-term nutrition education on weight gain in the third trimester of pregnancy, birth outcomes, and breastfeeding.

METHODS

Three hundred pregnant women participated in this randomized, controlled trial during a 3-month intervention period. The study was conducted in two antenatal clinics in urban Dhaka. One group of women was given monthly education sessions during the third trimester of pregnancy to promote consumption of khichuri, while the control group received only routine services from the health facilities. Birthweight was recorded within 24 hours after delivery. Breastfeeding practices were observed for 1 month after delivery.

RESULTS

In the intervention group, maternal weight gain in the third trimester was 60% higher (8.60 vs. 5.38 kg, p = .011), mean birthweight was 20% higher (2.98 vs. 2.49 kg, p < .001), the rate of low birthweight was 94% lower (2.7% vs. 44.7%; p < .001), and the rate of initiation of breastfeeding within 1 hour after birth was 52% higher (86.0% vs. 56.7%, p < .001), in comparison with the control group. Birthweight was associated with frequency of intake of khichuri (p < 0.001).

CONCLUSIONS

Nutrition education with a focus on promoting consumption of khichuri during the third trimester of pregnancy significantly reduced the rate of low birthweight and increased maternal weight gain.

An exploratory investigation amongst Australian mothers regarding pharmacies and opportunities for nutrition promotion

The early years life-stage (1 year either side of childbirth) is an important period for preventive action focusing on optimizing nutritional health for mothers and babies. Community pharmacy is a much utilized, easily accessed setting for health promotion and exposure to the primary health care system. The literature suggests that there has been limited exploration of pharmacy utilization by mothers, particularly in the context of nutrition focused health promotion. This study aimed to explore mothers' expectations and experiences of pharmacy based health care and to explore mothers' attitudes and opinions regarding opportunities and scope for nutrition-related health promotion in pharmacy. Qualitative semi-structured telephone interviews were conducted amongst a purposive sample of 28 mothers from across Queensland, Australia. Interviews were transcribed and analysed thematically using an iterative approach. Participants as relatively frequent users of pharmacy services accessed pharmacy for medicines or product related concerns but expected information and health advice to be available. Opportunities for nutrition promotion in pharmacy, identified by participants, related primarily to addressing their personal needs for information, advice and support during this life-stage. Improving and reorienting pharmacy staff practices may contribute to more supportive guidance being provided to mothers in this setting.

Use of micronutrient supplements among pregnant women in Alberta: results from the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort

Maternal nutrient intake in the prenatal period is an important determinant of fetal growth and development and supports maternal health. Many women, however, fail to meet their prenatal nutrient requirements through diet alone and are therefore advised to consume nutrient supplements. The purpose of this study was to describe the use of natural health products (NHP) by pregnant women in each trimester of pregnancy. Women (n = 599) participating in the first cohort of the Alberta Pregnancy Outcomes and Nutrition (APrON) study completed an interviewer-administered supplement intake questionnaire during each trimester of pregnancy. NHP use was high, with >90% taking multivitamin/mineral supplements, and nearly half taking at least one additional single-nutrient supplement. Compliance with supplementation guidelines was high for folic acid (>90%), vitamin D (∼70%) and calcium (∼80%), but low for iron (<30%) and for all four nutrients together (≤11%). On average, women met or exceeded the recommended dietary allowance for folic acid, vitamin D and iron from NHPs alone, with median daily intakes of 1000 μg, 400 IU and 27 mg, respectively. The median calcium intake was 250 mg d(-1) . Up to 26% of women exceeded the tolerable upper intake level for folic acid and up to 19% did so for iron at some point of their pregnancy. Findings highlight the need to consider both dietary and supplemental sources of micronutrients when assessing the nutrient intakes of pregnant women.

Effects of third trimester counseling on pregnancy weight gain, birthweight, and breastfeeding among urban poor women in Bangladesh

BACKGROUND

Maternal malnutrition and poor gestational weight gain are the most important causes of low birth weight and high rates of newborn mortality.

OBJECTIVE

To assess the effects of nutrition counseling in the third trimester of pregnancy on maternal weight gain, birth weight of newborn, and breastfeeding practices.

METHODS

This was a longitudinal experimental study with nutrition intervention for a period of 3 months. One hundred fifteen women (57 in the intervention group and 58 in the comparison group) who were visiting the Maternal and Child Health Training Institute at 6 months of pregnancy were randomly selected. The intervention group was given nutrition education twice in the first month and once a month for the next 2 months before delivery; the comparison group received routine hospital advice on food intake, immunization, personal hygiene, and breastfeeding. The women were weighed monthly up to delivery, the newborn infants' birth weights were measured within 24 hours after delivery, and breastfeeding practices were observed 1 month after delivery.

RESULTS

Women in the intervention group gained 1.73 kg more weight during the third trimester than women in the comparison group (5.61 vs. 3.88 kg, p < 0.001). The mean birthweight of babies of women in the intervention group was 0.44 kg greater than that of babies of women in the comparison group (2.86 vs. 2.42 kg, p < 0.001). In the intervention group, 10.5% of babies were born with low birthweight, compared with 48.3% of the babies of women in the comparison group (p < 0.001). In the intervention group, 75.4% of mothers initiated breastfeeding within 1 hour after birth, compared with 34.5% of mothers in the comparison group (p < 0.001).

CONCLUSIONS

Nutrition education only during the third trimester improved weight gain during pregnancy, reduced 78% of low birth weight, and improved breastfeeding practices.

Inflammatory profiles in the non-pregnant state predict offspring birth weight at Cebu: evidence for inter-generational effects of low grade inflammation

BACKGROUND

Although maternal infection and inflammation during pregnancy can adversely affect offspring birth weight (BW), whether low grade inflammation in the non-pregnant state predicts BW is unknown.

AIM

To evaluate relationships between offspring BW and pro- and anti-inflammatory factors measured in parous but non-pregnant women.

SUBJECTS AND METHODS

Data come from 234 parous Filipino females (21.5 ± 0.3 years) in the Cebu Longitudinal Health and Nutrition Survey, a population-based birth cohort in Metropolitan Cebu, Philippines. Pro-inflammatory [Interleukin-6 (IL-6), Interleukin-1 beta (IL-1β), tumour necrosis factor alpha (TNFα), C-reactive protein (CRP)] and anti-inflammatory [Interleukin-10 (IL-10)] factors were measured in fasting plasma when the women were not pregnant, and related to recalled offspring BW.

RESULTS

BW in female offspring was lower only among women with high IL-1β. Although pro-inflammatory cytokines did not predict BW in male offspring, women with higher anti-inflammatory IL-10 gave birth to larger males. Women with a combination of low inflammatory (IL-6) and high anti-inflammatory (IL-10) factors (interaction p < 0.104) gave birth to the largest males.

CONCLUSION

Immune factors measured outside of pregnancy predict offspring BW in these young women. Stable variation in inflammatory phenotype could impact the gestational environment of offspring, thus pointing to potential inter-generational effects of chronic low-grade inflammation.

Validity and reproducibility of a semi-quantitative food frequency questionnaire for use among Portuguese pregnant women

This study aimed to evaluate the validity and reproducibility of a semi-quantitative food frequency questionnaire (FFQ) to estimate nutrient intake among Portuguese pregnant women. A sample of 101 pregnant women completed a 3-day food diary (FD) in each pregnancy trimester (reference method) and an interviewer-administered FFQ in the immediate post-partum period. Ranking women according to their usual intake showed that, on average, 65% were classified into the same +/-1 quintile and 2.4% into opposite quintiles by the two methods. Energy-adjusted and de-attenuated correlation coefficients ranged from 0.20 (protein) to 0.58 (riboflavin). Similar results were obtained when the FFQ was compared to each trimester-specific FD. To assess the FFQ reproducibility, 70 women in their third pregnancy trimester were interviewed twice within a 2-week interval. The level of agreement was high, with > or = 75% of the participants being classified into the same +/-1 quintile by the two administrations for 13 of the 15 nutrients examined. A review of the published literature revealed that this is the first FFQ to take the whole pregnancy as its reference time window. Our findings showed that a single administration of this FFQ in the immediate post-partum period is a valid tool to rank Portuguese pregnant women according to their intakes.

The relationship between water intake and foetal growth and preterm delivery in a prospective cohort study

BACKGROUND

Interpretation of previous associations between water intake and adverse birth outcomes is challenging given that amount and type of water consumed can be non-specific markers of exposure or underlying behavioural characteristics. We examined the relationship between water intake measures and adverse birth outcomes in participants from three study sites in the United States.

METHODS

Using a prospective cohort study, we examined daily intake of bottled, cold tap, total tap, and total water in relation to birth weight and risk of small-for-gestational-age (SGA) among term births and risk of preterm delivery.

RESULTS

Based on water consumption data collected between 20-24 weeks of gestation, the adjusted mean birth weight was 27 (95% confidence interval [CI]: -34, 87), 39 (95% CI: -22, 99), and 50 (95% CI: -11, 110) grams higher for the upper three total water intake quartiles (> 51-78, > 78-114, and > 114 ounces/day) compared to the lowest quartile (≤ 51 ounces/day). Adjusted birth weight results were similar for bottled water, cold tap water, and total tap water intake. An exposure-response gradient was not detected for either preterm delivery or SGA with increasing total water intake and total tap water intake, but adjusted relative risks for all three upper quartiles were below 1.0 (range: 0.6-0.9) for SGA.

CONCLUSION

These data suggest that high water intake may be associated with higher mean birth weight following adjustment for confounding.

Serum reference levels of selenium, zinc and copper in healthy pregnant women at a prenatal screening program in southeastern Mediterranean region of Turkey

PROJECT

The aim of the study was to investigate the serum reference range for Selenium (Se), Zinc (Zn) and Copper (Cu) levels in women of 10-14 (group I) and 16-20 (group II) weeks of gestation and compare them with those in non-pregnant healthy women and healthy men.

PROCEDURE

This cross-sectional study was performed in 351 pregnant women [group I (n: 177) and group II (n: 174)], 30 non-pregnant women and 30 men as controls. The levels of Se, Zn and Cu levels were determined on flame and furnace atomic absorption spectrophotometer using Zeeman background correction.

RESULTS

In the 10-14 weeks of gestation Se, Zn and Cu serum levels were 44.85+/-9.23, 81.30+/-31.94 and 132.33+/-38.24 microg/dl, in 16-20 weeks of gestation were 47.18+/-10.92, 74.25+/-22.47 and 164.86+/-39.69 microg/dl, in non-pregnant women were 55.38+/-8.81, 121.41+/-29.22 and 104.75+/-39.14 microg/dl also in men 72.24+/-9.28, 134.85+/-15.95 and 78.29+/-20.90 microg/dl, respectively.

CONCLUSION

A significant low level of serum Se, Zn and a high level of Cu in the pregnant women in the 10-14 and 16-20 weeks of gestation were detected when compared with that of non-pregnant women and men.

Dietary intake and nutritional adequacy prior to conception and during pregnancy: a follow-up study in the north of Portugal

Objective

To assess maternal diet and nutritional adequacy prior to conception and during pregnancy.

Design

Follow-up of a cohort of pregnant women with collection of questionnaire data throughout pregnancy and after delivery.

Setting

Antenatal clinics at two public hospitals in Porto, Portugal.

Subjects

Two hundred and forty-nine pregnant women who reported a gestational age below 13 weeks at the time they attended their first antenatal visit.

Results

Intakes of energy and macronutrients were within recommended levels for most women. Pregnancy was accompanied by increases in the dietary intake of vitamins A and E, riboflavin, folate, Ca and Mg, but declines in the intake of alcohol and caffeine. The micronutrients with higher inadequacy prevalences prior to pregnancy were vitamin E (83 %), folate (58 %) and Mg (19 %). These three micronutrients, together with Fe, were also those with the highest inadequacy prevalences during pregnancy (91 %, 88 %, 73 % and 21 %, respectively, for folate, Fe, vitamin E and Mg). Ninety-seven per cent of the women reported taking supplements of folic acid during the first trimester, but the median gestational age at initiation was 6·5 (interquartile range 5, 9) weeks. Self-reported prevalences of Fe and Mg supplementation were high, and increased throughout pregnancy.

Conclusion

The study identified low dietary intakes of vitamin E, folate and Mg both in the preconceptional period and during pregnancy, and low intake of Fe during pregnancy only. The low dietary intake of folate and the late initiation of supplementation indicate that current national guidelines are unlikely to be effective in preventing neural tube defects.

Successful pregnancy following partial pancreatectomy after complications from a laparoscopic adjustable gastric banding

Each year, increasing numbers of bariatric surgeries are being performed to reduce health risks related to obesity. The improvement in health for these patients has promoted an increase in the possibility of pregnancy for some woman. Because there are lifelong adjustments and the possibility of unique complications from bariatric surgery, pregnancy presents special nursing concerns. Very few cases have been identified in nursing literature discussing pregnancy after complications following a bariatric surgery. This article presents a successful pregnancy after a partial pancreatectomy was performed secondary to acute pancreatitis and ischemic enterocolitis as a complication of laparoscopic gastric banding.

Managing Excessive Weight Gain During Pregnancy and the Postpartum Period

Childbearing is a period in the life cycle during which some women may gain weight, become overweight, or become obese. Despite guidelines issued in 1990 for gestational weight gain, many women exceed them. Women who are overweight before pregnancy are most vulnerable to excessive gestational weight gain. Prenatal interventions to prevent excessive gain have had mixed results. During the postpartum period, 14% to 20% of women may retain weight from pregnancy, which elevates risk of later health problems. Although postpartum weight loss interventions have been shown to have efficacy, these have been tested primarily with White women. Continued efforts are needed in practice and research to develop effective approaches for managing weight during pregnancy and postpartum, especially for low-income and ethnic minority women.

Assessing diet quality in a population of low-income pregnant women: a comparison between Native Americans and whites

OBJECTIVE

To assess diet quality of pregnant women in the WIC program in North Dakota and to compare Native Americans with whites, we used a DQI-P (diet quality index for pregnancy) among low-income pregnant women enrolled in WIC, a special supplemental program for women, infants, and children.

METHODS

Dietary information was collected for all participants using the Harvard Service Food Frequency Questionnaire (HSFFQ). DQI-P scores were based on 10 components previously used in other diet quality indices: percent recommended intake of grains, vegetables, fruits, folate, calcium, and iron; total fat, saturated fat, and cholesterol; and dietary diversity. Each component contributed 10 points to the total possible DQI-P score of 100.

RESULTS

The mean DQI-P score was 53.9. Native Americans (51.8) had significantly lower DQI-P scores (51.8 vs. 54.2; p<0.0001); significantly higher scores for iron and folate; and significantly lower scores for cholesterol, total fat intake, and saturated fat components than did whites. As DQI-P scores increased, diet improved and scores for individual components increased.

CONCLUSION

While there were significant differences between the diet quality of Native American and white pregnant women, the differences were minimal. The DQI-P scores for all women in this population indicate that their diets are not meeting dietary recommendations. Interventions should focus on decreasing fat intake and increasing iron and folate intake to meet national dietary recommendations. More emphasis should be placed on eating whole fruit and vegetables.

Maternal antioxidant intake in pregnancy and wheezing illnesses in children at 2 y of age

BACKGROUND

Low intakes of dietary antioxidants may contribute to increases in asthma and allergy.

OBJECTIVE

We investigated the association of maternal total intakes (foods + supplements) of 10 antioxidant nutrients during pregnancy with wheezing and eczema in 2-y-old children.

DESIGN

Subjects were 1290 mother-child pairs in an ongoing cohort study. Maternal dietary and supplement intakes were assessed by using a validated food-frequency questionnaire administered in the first and second trimesters. Antioxidant nutrient intakes were calculated, and the mean for each nutrient was considered to be the exposure during pregnancy. The outcomes of interest were any wheezing by the child during either the first or second year of life, recurrent wheezing in both years, and eczema in either the first or second year.

RESULTS

No association was observed between maternal total intake of any antioxidant nutrient and eczema. In multivariate logistic regression models, the highest quartile compared with the lowest quartile of maternal total intakes of vitamin E [odds ratio (OR): 0.70; 95% CI: 0.48, 1.03] and zinc (OR: 0.59; 95% CI: 0.41, 0.88) was inversely associated with any wheezing at 2 y of age (P for trend = 0.06 and 0.01 over quartiles of intake for vitamin E and zinc, respectively). Similar results were obtained for recurrent wheezing at 2 y of age with vitamin E (OR: 0.49; 95% CI: 0.27, 0.90) and zinc (OR: 0.49; 95% CI: 0.27, 0.87) (P for trend = 0.05 and 0.06 over quartiles of intake for vitamin E and zinc, respectively).

CONCLUSION

Our results suggest that higher maternal total intakes of antioxidants during pregnancy may decrease the risks for wheezing illnesses in early childhood.