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Kabahenda MK, Stoecker BJ. Associations between maternal dietary intake and nutritional status with fetal growth at 14 to 26 weeks gestation: a cross- sectional study. BMC Nutr 2024; 10:77. [PMID: 38783359 PMCID: PMC11112879 DOI: 10.1186/s40795-024-00885-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Maternal undernutrition during pregnancy is currently estimated at 23.5% in Africa, which is worrying given the negative impacts of malnutrition on maternal and fetal birth outcomes. The current study aimed at characterizing the associations of maternal dietary intake and nutritional status with fetal growth at 14-26 weeks gestation. It was hypothesized that maternal dietary intake was positively associated with maternal nutritional status and fetal growth both in early and late pregnancy. METHODS This was a cross-sectional survey of 870 pregnant women in mid-western Uganda conducted in August 2013. Data were collected on women's dietary intake (indicated by women's dietary diversity and the diet quality score) and nutritional status (indicated by hemoglobin level and mid-upper arm circumference) at 14-26 weeks gestation. Fetal growth was determined by symphysis-fundal height Z-scores processed using the INTERGROWTH-21st calculator. Associations between maternal dietary intake and nutritional status with fetal growth were determined using correlations and chi-square tests. RESULTS Overall, only 25% had adequate dietary diversity and the most utilized food groups were White tubers, roots and starchy vegetables; Pulses, nuts and seeds; Cereals and grains, Dark green leafy vegetables, and Fats and oils. A larger proportion of younger women (15-29 y) were classified as anemic (20.4% versus 4.4%) and underweight (23.7% versus 5.0%) compared to older women (30-43 y). Additionally, women aged 15 to 24 years had significantly lower mean SFH-for-gestation age Z-scores than women 36-43 years (F4, 783 = 3.129; p = 0.014). Consumption of legumes nuts and seeds was associated with reduced risk of anemia while consumption of dairy products (mostly milk) was positively associated with better fetal growth. Surprisingly, low Hb level was positively associated with normal fetal growth (rP = -0.133; p = 0.016) after 20 weeks gestation, possibly indicating normal fetal growth paralleled with physiologically necessary hemodilution. CONCLUSIONS Sub-optimal dietary patterns, characterized by limited dietary diversity and low protein intake, are likely to compromise maternal nutrition and fetal growth in limited resource settings. Improving pregnant women's access to cheaper but nutrient-dense protein sources such as pulses, nuts and dairy products (mostly milk) has potential to improve women's nutritional status and enhance fetal growth.
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Affiliation(s)
- Margaret Kiiza Kabahenda
- Department of Food Technology and Nutrition, College of Agricultural and Environmental Sciences, Makerere University, Kampala, Uganda.
| | - Barbara J Stoecker
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA
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Tesfaye A, Tamiru D, Belachew T. Effect of nutrition counseling on nutritional status and gestational weight gain of pregnant adolescents in West Arsi, Central Ethiopia: a cluster randomized controlled trial. Sci Rep 2024; 14:5070. [PMID: 38429426 PMCID: PMC10907709 DOI: 10.1038/s41598-024-55709-y] [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: 09/26/2023] [Accepted: 02/27/2024] [Indexed: 03/03/2024] Open
Abstract
When pregnancy occurs in adolescence, the growth and development of the mother and fetus may be impaired due to strong competition for nutrients between the still-growing adolescent and the fetus. Pregnant adolescents constitute an underserved population; they lack adequate nutritional knowledge. Therefore, this study investigated the effect of nutritional behavior change communication (NBCC) through alliance for development (AFD) on the nutritional status and gestational weight gain (GWG) of pregnant adolescents. A two-arm parallel cluster randomized controlled community trial was conducted in the West Arsi Zone, central Ethiopia, from August 2022 to July 2023. The nutritional status of the pregnant adolescent was assessed using mid-upper arm circumference. Weight was measured at baseline and at the end of the intervention. A total of 207 and 219 pregnant adolescents participated in the intervention and control clusters, respectively. The intervention started before 16 weeks of gestation, and the intervention group attended four NBCC sessions. The NBCC was based on the health belief model (HBM) and was given at the participants' homes with their husbands. The NBCC intervention was delivered by AFDs and community-level health actors. Pregnant adolescents in the control group received routine nutrition education from the health care system. A linear mixed-effects model and difference in difference (DID) were used to measure the intervention effect after adjusting for potential confounders. After the implementation of the trial, the mean mid-upper arm circumference (MUAC) in the intervention arm significantly increased from baseline (p ≤ 0.001), 23.19 ± 2.1 to 25.06 ± 2.9 among intervention group and 23.49 ± 2.1 to 23.56 ± 2.0 among control group and the mean difference in the MUAC (DID) was 1.89 ± 2 cm (p ≤ 0.001); the mean GWG in the intervention arm significantly increased from baseline; 51.54 ± 4.7 to 60.98 ± 4.6 among intervention group and 52.86 ± 5.27 to 58 ± 5.3 among control group; the mean GWG in the intervention group was 9.4 kg, and that in the control group was 5.14 kg, and the difference in difference was 4.23 kg and this was statically significant p ≤ 0.001). This study demonstrated that the use of the HBM for NBCC delivered through the AFD was effective at improving the nutritional status and GWG of pregnant adolescents. These results imply the need for the design of model-based nutritional counseling guidelines.Clinical trial registration: PACTR202203696996305, Pan African Clinical Trials Registry, date of first registration: 16/03/2022.
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Affiliation(s)
- Adane Tesfaye
- Department of Nutrition and Dietetics, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia.
- Department of Nutrition, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia.
| | - Dessalegn Tamiru
- Department of Nutrition and Dietetics, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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3
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Wakwoya EB, Belachew T, Girma T. Effects of intensive nutrition education and counseling on nutritional status of pregnant women in East Shoa Zone, Ethiopia. Front Nutr 2023; 10:1144709. [PMID: 37469548 PMCID: PMC10352577 DOI: 10.3389/fnut.2023.1144709] [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: 03/06/2023] [Accepted: 06/20/2023] [Indexed: 07/21/2023] Open
Abstract
Background Nutritional status is defined as an individual's health condition as it is influenced by the intake and utilization of nutrients. Maternal malnutrition is widespread throughout the world, with Sub-Saharan Africa and Asia bearing the brunt of the burden. The objective of this study was to evaluate the effect of intensive nutrition education and counseling on nutritional status during pregnancy. Methods and materials The study was a one-year, two-arm parallel design cluster randomized controlled trial conducted in the East Shoa zone, Ethiopia, from January 1, 2021, to February 30, 2022. A total of 374 participants were enrolled in the intervention (n = 185) and control (n = 189) groups. End-line data were collected from 163 women, from each group. The intervention package provided three counseling sessions by trained midwives, three-page take-home brochures prepared in local languages, and the delivery of 18 weekly serial short text messages. The women in the control group received routine nutrition education from the health facilities. After adjusting for potential confounders, a linear mixed-effects model was employed to assess the intervention effect. Results After the intervention, the mean mid-upper arm circumference in the intervention group increased by 1.8% (23.08 vs. 23.44, p < 0.01). Similarly, the proportion of undernutrition in the intervention group was 11% (25 vs. 36%, p = 0.02) lower compared to the control arm. At the end of the trial, women in the intervention arm had significantly better nutritional status than women in the control group (β = 0.47, p < 0.01). Conclusion The findings showed that intensive nutrition education and counseling using the health belief model was effective in improving nutritional status and reducing undernutrition among pregnant women. As a result, nutrition education and counseling using HBM constructs, as well as regular reminder messages, should be provided to pregnant women as part of the routine antenatal care service.
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Affiliation(s)
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Jimma University, Jimma, Ethiopia
| | - Tsinuel Girma
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
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Prevalence, predictors of low birth weight and its association with maternal iron status using serum ferritin concentration in rural Eastern Ethiopia: a prospective cohort study. BMC Nutr 2022; 8:70. [PMID: 35883202 PMCID: PMC9327330 DOI: 10.1186/s40795-022-00561-4] [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: 01/14/2022] [Accepted: 07/12/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Low birth weight (LBW) is one of the major predictors of perinatal survival, infant morbidity, and mortality, as well as the risk of developmental disabilities and illnesses in future lives. The effect of the nutritional status of pregnant women on birth outcomes is becoming a common research agenda, but evidence on the level of low birth weight (LBW) and its association with prenatal iron status in Ethiopia, particularly among rural residents, is limited. Thus, this study aimed to assess the prevalence, predictors of LBW, and its association with maternal iron status using serum ferritin concentration in Haramaya district, eastern Ethiopia, 2021. Methods A community-based prospective cohort study design was conducted. Of a total of 427 eligible pregnant women followed until birth, 412 (96.48%) were included in the final analysis. Iron status was determined using serum ferritin (SF) concentration from venous blood collected aseptically from the ante-cubital veins analyzed on a fully automated Cobas e411 (German, Japan Cobas 4000 analyzer series) immunoassay analyzer. Iron deficiency(ID) and iron deficiency anemia (IDA) were classified as having SF less than 15 μg/L and SF less than 15 μg/L and Hb level of < 11.0 g/dl during the first or third trimester or < 10.5 g/dl during the second trimester as well, respectively. Birthweight was measured within 72 h of birth and < 2500 g was considered LBW. Birthweight was measured within 72 h of birth and < 2500 g was considered as LBW. A Poisson regression model with robust variance estimation was used to investigate the factors associated with LBW and the association between maternal iron status and LBW. An adjusted prevalence ratio with a 95% confidence interval was reported to show an association using a p-value < 0.05. Results About 20.2% (95% CI: 16%-24%) of neonates were born with LBW. The prevalence of LBW was 5.04 (95% CI = 2.78–9.14) times higher among women who were iron deficient during pregnancy compared to those who were normal. The neonates of women who were iron deficient during pregnancy had lower birth weight (aPR=5.04; 95% CI = 2.78–9.14) than the neonates of women who were normal. Prevalence of LBW was higher among mothers who were undernourished (MUAC < 23cm) (aPR = 1.92; 95% CI= 1.33–2.27), stunted (height <145cm) (aPR=1.54; 95% CI=1.04–2.27) and among female neonates (aPR=3.70; 95% CI= 2.28–6.00). However, women who were supplemented with iron and folic acid (IFAS) during pregnancy had a 45% decreased chance of delivering low birth weight (aPR= 0.55; 95% CI=0.36–0.84). Conclusion We found that LBW is of public health significance in this predominantly rural setting. ID during pregnancy is found to have a negative effect on birth weight. IFA supplementation, the maternal under-nutrition, height, and sex of neonates were identified as predictors of low weight at birth. To improve maternal nutritional status, health interventions must address targeted strategies promoting desirable food behavior and nutritional practices. These include; promoting the consumption of diversified and rich iron food to improve the maternal nutritional status. A continued effort is needed in enhancing universal access and compliance with IFA supplementation to improve maternal health. Intervention strategies that are complementary and comprehensive across the vulnerable periods for women during pregnancy and their neonates that are based on a life-cycle approach are suggested.
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Simulation of 3D Body Shapes for Pregnant and Postpartum Women. SENSORS 2022; 22:s22052036. [PMID: 35271183 PMCID: PMC8914684 DOI: 10.3390/s22052036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/18/2022] [Accepted: 03/01/2022] [Indexed: 12/04/2022]
Abstract
Several studies have reported that pre-pregnant women’s body mass index (BMI) affects women’s weight gain with complications during pregnancy and the postpartum weight retention. It is important to control the BMI before, during and after pregnancy. Our objectives are to develop a technique that can compute and visualize 3D body shapes of women during pregnancy and postpartum in various gestational ages, BMI, and postpartum durations. Body changes data from 98 pregnant and 83 postpartum women were collected, tracked for six months, and analyzed to create 3D model shapes. This study allows users to simulate their 3D body shapes in real-time and online, based on weight, height, and gestational age, using multiple linear regression and morphing techniques. To evaluate the results, precision tests were performed on simulated 3D pregnant and postpartum women’s shapes. Additionally, a satisfaction test on the application was conducted on new 149 mothers. The accuracy of the simulation was tested on 75 pregnant and 74 postpartum volunteers in terms of relationships between statistical calculation, simulated 3D models and actual tape measurement of chest, waist, hip, and inseam. Our results can predict accurately the body proportions of pregnant and postpartum women.
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6
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Budhram S, Vannevel V, Botha T, Chauke L, Bhoora S, Balie GM, Odell N, Lombaard H, Wise A, Georgiou C, Ngxola N, Wynne E, Mbewu U, Mabenge M, Phinzi S, Gubu-Ntaba N, Goldman G, Tunkyi K, Prithipal S, Naidoo K, Venkatachalam S, Moodley T, Mould S, Hlabisa M, Govender L, Maistry C, Habineza JP, Israel P, Foolchand S, Tsibiyane NV, Panday M, Soma-Pillay P, Adam S, Molokoane F, Mojela MS, van Rensburg EJ, Mashamba T, Matjila M, Fawcus S, Osman A, Venter M, Petro G, Fakier A, Langenegger E, Cluver CA, Bekker A, de Waard L, Stewart C, Ngene NC, Lunda O, N Cebekhulu S, Moodley S, Koranteng-Peprah MA, Ati EMC, Maswime S, Yates LM. Maternal characteristics and pregnancy outcomes of hospitalized pregnant women with SARS-CoV-2 infection in South Africa: An International Network of Obstetric Survey Systems-based cohort study. Int J Gynaecol Obstet 2021; 155:455-465. [PMID: 34499750 PMCID: PMC9087659 DOI: 10.1002/ijgo.13917] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/06/2021] [Indexed: 11/25/2022]
Abstract
Objective To describe risk factors and outcomes of pregnant women infected with SARS‐CoV‐2 admitted to South African healthcare facilities. Methods A population‐based cohort study was conducted utilizing an amended International Obstetric Surveillance System protocol. Data on pregnant women with SARS‐CoV‐2 infection, hospitalized between April 14, 2020, and November 24, 2020, were analyzed. Results A total of 36 hospitals submitted data on 673 infected hospitalized pregnant women; 217 (32.2%) were admitted for COVID‐19 illness and 456 for other indications. There were 39 deaths with a case fatality rate of 6.3%: 32 (14.7%) deaths occurred in women admitted for COVID‐19 illness compared to 7 (1.8%) in women admitted for other indications. Of the women, 106 (15.9%) required critical care. Maternal tuberculosis, but not HIV co‐infection or other co‐morbidities, was associated with admission for COVID‐19 illness. Rates of cesarean delivery did not differ significantly between women admitted for COVID‐19 and those admitted for other indications. There were 179 (35.4%) preterm births, 25 (4.7%) stillbirths, 12 (2.3%) neonatal deaths, and 162 (30.8%) neonatal admissions. Neonatal outcomes did not differ significantly from those of infected women admitted for other indications. Conclusion The maternal mortality rate was high among women admitted with SARS‐CoV‐2 infection and higher in women admitted primarily for COVID‐19 illness with tuberculosis being the only co‐morbidity associated with admission. A multicenter, observational study describing the risk factors and pregnancy outcomes of women admitted with SARS‐CoV‐2 infection in South Africa, a low‐ and middle‐income country.
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Affiliation(s)
- Samantha Budhram
- Maternal Foetal Medicine Unit, Department of Obstetrics and Gynaecology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.,Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Valerie Vannevel
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, Cape Town, South Africa.,Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SA MRC), Cape Town, South Africa.,Department of Obstetrics & Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Tanita Botha
- Department of Statistics, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa
| | - Lawrence Chauke
- Department of Obstetrics and Gynecology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Shastra Bhoora
- Department of Obstetrics and Gynecology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.,Maternal Critical Care, Baylor College, Houston, Texas, USA
| | - Gaynor M Balie
- Department of Obstetrics and Gynecology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Natalie Odell
- Department of Obstetrics and Gynecology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Hennie Lombaard
- Department Obstetrics and Gynaecology, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Amy Wise
- Department Obstetrics and Gynaecology, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Chrysanthi Georgiou
- Department Obstetrics and Gynaecology, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Nondumiso Ngxola
- Department of Obstetrics and Gynaecology, Frere Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Emma Wynne
- Department of Obstetrics and Gynaecology, Frere Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Unati Mbewu
- Department of Obstetrics and Gynaecology, Frere Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Mfundo Mabenge
- Department of Obstetrics and Gynecology, Dora Nginza Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Sibusiso Phinzi
- Department of Obstetrics and Gynaecology, Nelson Mandela Academic Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Nontsikelelo Gubu-Ntaba
- Department of Obstetrics and Gynaecology, Nelson Mandela Academic Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Gareth Goldman
- Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Kay Tunkyi
- Department of Obstetrics and Gynaecology, Addington Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Sudhir Prithipal
- Department of Obstetrics and Gynaecology, Addington Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Keshree Naidoo
- Department of Obstetrics and Gynecology, Mahatma Gandhi Memorial Regional Hospital, University of KwaZulu Natal, Durban, South Africa
| | - Santhi Venkatachalam
- Department of Obstetrics and Gynecology, Mahatma Gandhi Memorial Regional Hospital, University of KwaZulu Natal, Durban, South Africa
| | - Terence Moodley
- Department of Obstetrics and Gynecology, Prince Mshiyeni Memorial Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Sean Mould
- Department of Obstetrics and Gynecology, R.K. Khan Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Mzuvele Hlabisa
- Department of Obstetrics and Gynecology, R.K. Khan Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Logie Govender
- Department of Obstetrics & Gynecology, Queen Nandi Regional Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Charlene Maistry
- Department of Obstetrics and Gynecology, Port Shepstone Regional Hospital, Port Shepstone, South Africa
| | - John P Habineza
- Department of Obstetrics and Gynecology, Port Shepstone Regional Hospital, Port Shepstone, South Africa
| | - Priya Israel
- Department of Obstetrics and Gynecology, Edendale Hospital, Pietermaritzburg, South Africa.,University of Kwazulu Natal, Durban, South Africa
| | - Serantha Foolchand
- Maternal Fetal Unit: Department of Obstetrics and Gynecology, Greys Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Nomandla V Tsibiyane
- Maternal Fetal Unit: Department of Obstetrics and Gynecology, Greys Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Mala Panday
- Department of Obstetrics and Gynaecology, King Dinizulu Hospital Complex, University of Kwazulu Natal, Durban, South Africa
| | - Priya Soma-Pillay
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, Cape Town, South Africa.,Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SA MRC), Cape Town, South Africa.,Department of Obstetrics and Gynaecology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Sumaiya Adam
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, Cape Town, South Africa.,Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SA MRC), Cape Town, South Africa.,Department of Obstetrics and Gynaecology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Felicia Molokoane
- Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, Cape Town, South Africa.,Maternal and Infant Health Care Strategies Unit, South African Medical Research Council (SA MRC), Cape Town, South Africa.,Department of Obstetrics & Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Matthew S Mojela
- Department of Obstetrics & Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Elizabeth J van Rensburg
- Department of Obstetrics & Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Tshililo Mashamba
- Department of Obstetrics and Gynecology, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Mushi Matjila
- Department of Obstetrics and Gynecology, Groote Schuur Hospital, Cape Town, South Africa.,MRC/UCT Receptor Biology Unit, Division of Medical Biochemistry, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Sue Fawcus
- Department of Obstetrics and Gynecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Ayesha Osman
- Department of Obstetrics and Gynecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Mareli Venter
- Department of Obstetrics and Gynecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Gregory Petro
- Department of Obstetrics and Gynecology, New Somerset Hospital, University of Cape Town, Cape Town, South Africa
| | - Ahminah Fakier
- Department of Obstetrics and Gynecology, New Somerset Hospital, University of Cape Town, Cape Town, South Africa
| | - Eduard Langenegger
- Department of Obstetrics and Gynecology, University of Stellenbosch, Cape Town, South Africa
| | - Catherine A Cluver
- Department of Obstetrics and Gynecology, University of Stellenbosch, Cape Town, South Africa.,Translational Obstetrics Group, Mercy Perinatal, Department of Obstetrics and Gynaecology, Melbourne University, Melbourne, Victoria, Australia
| | - Adrie Bekker
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Liesl de Waard
- Department of Obstetrics and Gynecology, University of Stellenbosch, Cape Town, South Africa
| | - Chantal Stewart
- Department of Obstetrics and Gynecology, Mowbray Maternity Hospital, University of Cape Town, Cape Town, South Africa
| | - Nnabuike C Ngene
- Department of Obstetrics and Gynecology, Klerksdorp/Tshepong Hospital Complex, Klerksdorp, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | - Ongombe Lunda
- Department of Obstetrics and Gynecology, Klerksdorp/Tshepong Hospital Complex, Klerksdorp, South Africa.,University of the Witwatersrand, Johannesburg, South Africa
| | - Sylvia N Cebekhulu
- Department of Obstetrics and Gynecology, Bongani Regional Hospital, University of Free State, Bloemfontein, South Africa
| | - Siva Moodley
- Department of Obstetrics and Gynaecology, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Mama-Asu Koranteng-Peprah
- Department of Obstetrics and Gynaecology, Midlands/Eden Gardens private Hospital, Pietermaritzburg, South Africa
| | - Emmanuel M C Ati
- Department of Obstetrics and Gynecology, R.K. Khan Hospital, University of Kwazulu Natal, Durban, South Africa
| | - Salome Maswime
- Global Surgery Division, Department of Surgery, University of Cape Town, South Africa
| | - Laura M Yates
- Clinical Genetics Unit, Department of Paediatrics, Inkosi Albert Luthuli Central Hospital, University of Kwazulu-Natal, Durban, South Africa.,KwaZulu-Natal Research and Innovation Sequencing Platform, University of Kwazulu-Natal, Durban, South Africa
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Mishra KG, Bhatia V, Nayak R. Maternal Nutrition and Inadequate Gestational Weight Gain in Relation to Birth Weight: Results from a Prospective Cohort Study in India. Clin Nutr Res 2020; 9:213-222. [PMID: 32789151 PMCID: PMC7402978 DOI: 10.7762/cnr.2020.9.3.213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/14/2020] [Accepted: 07/17/2020] [Indexed: 11/24/2022] Open
Abstract
Inadequate/excessive gestational weight gain (GWG) can cause adverse pregnancy outcomes and only few studies have described patterns of weight gain in Indian women. Also, studies pertaining to dietary intake throughout gestation are insufficient. This prospective cohort study was conducted to evaluate GWG and nutrient intake in all trimesters of pregnancy and investigate the relationship between themselves along with that of birth weight (BW). Our study was carried out in a population-based prospective birth cohort in Odisha, India. The 418 pregnant women were followed till delivery with measurements of maternal weight, weight gain throughout gestation, and BW. Macronutrients were assessed based on a 24-hour dietary recall method in each trimester. Women characterized by under-weight pre-pregnancy body mass index (BMI) were 16.20%, and a total of 6.45% did not comply with current weight gain recommendations. Particularly, overweight and obese women gained more weight than recommended. In a multivariate analysis GWG correlated significantly with BMI (p = 0.03), total calorie intake (p < 0.001) and fat intake (p < 0.001), while BW of newborns correlated significantly with adequacy of weight gain and fat intake (p < 0.001). Though measures are taken by health workers to record the weight but nutritional counseling is not being provided regularly. A high priority should be given to increase awareness among general population regarding the importance of diet in pregnancy and how to adhere to the balanced diet for optimal growth of child.
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Affiliation(s)
- Kumar Guru Mishra
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences (AIIMS) Bhubaneswar, Bhubaneswar, Odisha 751019, India
| | - Vikas Bhatia
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences (AIIMS) Bhubaneswar, Bhubaneswar, Odisha 751019, India
| | - Ranjeeta Nayak
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences (AIIMS) Bhubaneswar, Bhubaneswar, Odisha 751019, India
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8
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Muche AA, Olayemi OO, Gete YK. Effects of gestational diabetes mellitus on risk of adverse maternal outcomes: a prospective cohort study in Northwest Ethiopia. BMC Pregnancy Childbirth 2020; 20:73. [PMID: 32013909 PMCID: PMC6998275 DOI: 10.1186/s12884-020-2759-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023] Open
Abstract
Background Gestational diabetes mellitus is a leading medical condition woman encounter during pregnancy with serious short- and long-term consequences for maternal morbidity. However, limited evidence was available on potential impacts of gestational diabetes mellitus using updated international diagnostic criteria on adverse maternal outcomes. Therefore, this study aimed to assess the effects of gestational diabetes mellitus on the risk of adverse maternal outcomes in Northwest Ethiopia. Methods A prospective cohort study was conducted among pregnant women followed from pregnancy to delivery. Gestational diabetes mellitus status was determined by using a two-hour 75 g oral glucose tolerance test and based on updated international diagnostic criteria. Multivariable log-binomial model was used to examine the effects of gestational diabetes mellitus on the risk of adverse maternal outcomes. Results A total of 694 women completed the follow-up and included in the analysis. Women with gestational diabetes mellitus had a higher risk of composite adverse maternal outcome (ARR=1.58, 95% CI: 1.22, 2.04), caesarean delivery (ARR=1.67; 95%: 1.15, 2.44), pregnancy induced hypertension (ARR= 3.32; 95%: 1.55, 7.11), premature rupture of membranes (ARR= 1.83; 95%: 1.02, 3.27), antepartum hemorrhage (ARR= 2.10; 95%: 1.11, 3.98) and postpartum hemorrhage (ARR= 4.85; 95%:2.28, 10.30) compared to women without gestational diabetes mellitus. Conclusions Gestational diabetes mellitus increased the risk of adverse maternal outcomes. This implies that maternal care and intervention strategies relating to women with gestational diabetes mellitus should be strengthened.
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Affiliation(s)
- Achenef Asmamaw Muche
- Department of Obstetrics and Gynecology, Pan African University Life and Earth Sciences Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria. .,Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - Oladapo O Olayemi
- Department of Obstetrics and Gynecology, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Yigzaw Kebede Gete
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Woday A, Muluneh A, St Denis C. Birth asphyxia and its associated factors among newborns in public hospital, northeast Amhara, Ethiopia. PLoS One 2019; 14:e0226891. [PMID: 31860643 PMCID: PMC6924666 DOI: 10.1371/journal.pone.0226891] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/08/2019] [Indexed: 12/18/2022] Open
Abstract
Background Birth asphyxia is a leading cause of infant morbidity and mortality in developing nations, such as Ethiopia. Though Ethiopia has made considerable achievement in the reduction of under-five mortality rate, the neonatal mortality burden has not experienced the same reduction, which may be attributed to birth asphyxia. Thus, this study attempts to assess the prevalence and associated factors of birth asphyxia among newborns in public hospitals in the northeastern Amhara region, Ethiopia. Methods An institution-based cross-sectional study was conducted on 357 births from 1st April to 2nd May 2018. The sample size was proportionally allocated to randomly selected three public hospitals namely, Dessie referral hospital, Debre Berhan referral hospital, and Woldia general hospital. The allocation was made by taking the average number of deliveries given in each hospital six months before the data collection period. Using the delivery registration of hospitals a systematic random sampling technique was used to get all study participants. The diagnosis of birth asphyxia was confirmed based on the physician’s diagnosis of an APGAR score < 7 in the 1st and 5th minutes of birth. A pretested and structured questionnaire was used to collect data. Variables with p-values < 0.25 in the bivariable analysis were entered into a multivariable logistic regression analysis. A statistical significant level was declared at a p-value of <0.05. Results The prevalence of birth asphyxia was found to occur 22.6% of the time [95% CI 19.2% - 26.4%] in the first minute of birth. In the multivariable logistic regression being primipara [AOR = 3.77: 95% CI 1.86, 7.65], presented with complicated labor [AOR = 3.45: 95% CI 1.58, 7.49], premature rupture of membrane [AOR = 3.85: 95% CI 1.76, 8.44) and having blood-stained amniotic fluid at birth [AOR = 5.02: 95% CI 1.69, 14.87] were the independent predictors of birth asphyxia. Conclusion The study revealed that birth asphyxia is a common newborn complication in the Amhara region. Integrated mitigation measure to reduce neonatal mortality in the Amahar region should give due attention to primipara women and for these high-risk pregnancies in order for the region to achieve national and global commitment to have sustainable change in women and neonatal health.
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Affiliation(s)
- Abay Woday
- Samara University, College of Medical and Health Sciences, Department of Public Health, Afar Region, Samara, Ethiopia
- * E-mail:
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Vasundhara D, Hemalatha R, Sharma S, Ramalaxmi BA, Bhaskar V, Babu J, Kankipati Vijaya RK, Mamidi R. Maternal MUAC and fetal outcome in an Indian tertiary care hospital: A prospective observational study. MATERNAL AND CHILD NUTRITION 2019; 16:e12902. [PMID: 31833195 PMCID: PMC7083480 DOI: 10.1111/mcn.12902] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 11/28/2022]
Abstract
Studies to date demonstrated the relatedness of mid‐upper arm circumference (MUAC) measurement of pregnant women to their anthropometry/weight. Hence, the objective was to determine whether maternal MUAC at different gestational age predicted birthweight, and if so, to identify which cut‐offs provided the best prediction of low birthweight (LBW) in pregnant women cohort. A total of 928 pregnant women, free of any obstetrical and medical complications known to affect fetal growth, were followed from 20 to 24 weeks' gestation till delivery. Weight, height, and MUAC were determined for the pregnant women, and gestational age along with newborns anthropometry was collected. The mean birthweight was 2.6 ± 0.460 kg. Maternal age, height, weight, MUAC (three time points), gestational age at delivery, and post‐natal weight showed positive correlation with birthweight, crown heel length, and head circumference of the neonates. The cut‐off limit with the best sensitivity–specificity (54.0 and 59.8, respectively) for MUAC was 23 cm, whereas maternal weight of 55 kg had sensitivity and specificity of 62.5 and 59.9 for predicting LBW. Maternal weight of 55 kg and MUAC value of 23 cm had almost similar sensitivity and specificity for predicting LBW. MUAC (≤23 cm) can be considered as a potential indicator of LBW where weighing of pregnant women is not feasible or when presentation for antenatal care is late, especially where pre‐pregnancy weights are not available.
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Affiliation(s)
| | | | - Saurabh Sharma
- National Institute of Medical statistics (ICMR), New Delhi, India
| | | | - Varanasi Bhaskar
- National Institute of Nutrition (ICMR), Jamai Osmania, Hyderabad, India
| | - JagJeevan Babu
- National Institute of Nutrition (ICMR), Jamai Osmania, Hyderabad, India
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Muche AA, Olayemi OO, Gete YK. Prevalence of gestational diabetes mellitus and associated factors among women attending antenatal care at Gondar town public health facilities, Northwest Ethiopia. BMC Pregnancy Childbirth 2019; 19:334. [PMID: 31519151 PMCID: PMC6743162 DOI: 10.1186/s12884-019-2492-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 09/05/2019] [Indexed: 12/11/2022] Open
Abstract
Background Globally, Gestational Diabetes Mellitus (GDM) is rising, but it is a neglected health threat to mothers and their children in low resource countries. Although, GDM is known in Ethiopia, information regarding it remains scarce by recent diagnostic criteria. Therefore, this study aimed to determine the prevalence of GDM and associated factors among women attending antenatal care at Gondar town public health facilities, Northwest Ethiopia. Methods A cross-sectional study was conducted among 1027 pregnant women selected by the systematic random sampling technique. The universal one-step screening and diagnostic strategy was done using a two-hour 75 g oral glucose tolerance test. GDM was diagnosed using updated diagnostic criteria (2017 American Diabetes Association (ADA) or 2013 World Health Organization (WHO) or modified International Association of the Diabetes and Pregnancy Study Groups diagnostic criteria (IADPSG)). Binary logistic regression model was used to identify factors associated with GDM. Results Of the total 1027 pregnant women, 12.8% (95% CI: 10.8–14.8) were diagnosed with GDM. Overweight and/or obesity (MUAC ≥28 cm) (AOR = 2.25, 95% CI: 1.18–4.26), previous history of GDM (AOR = 5.82, 95% CI: 2.57–13.18), family history of diabetes (AOR = 4.03, 95% CI: 1.57–10.35), low physical activity (AOR = 3.36, 95% CI: 1.60–7.04), inadequate dietary diversity (AOR = 1.9, 95% CI: 1.02–3.53), and antenatal depression (AOR = 4.12, 95% CI: 1.85–9.20) were significantly associated with GDM. Conclusions The prevalence of GDM among women attending antenatal care at Gondar town public health facilities was high. Previous history of GDM, antenatal depression, family history of diabetes, low physical activity, overweight and/or obesity and inadequate dietary diversity were significantly associated with GDM. Routine screening of pregnant women and healthy lifestyle are strongly recommended.
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Affiliation(s)
- Achenef Asmamaw Muche
- Pan African University Life and Earth Sciences Institute (including health and agriculture), Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria. .,Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - Oladapo O Olayemi
- Department of Obstetrics and Gynaecology, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Yigzaw Kebede Gete
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Ng CM, Badon SE, Dhivyalosini M, Hamid JJM, Rohana AJ, Teoh AN, Satvinder K. Associations of pre-pregnancy body mass index, middle-upper arm circumference, and gestational weight gain. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 20:60-65. [PMID: 31084820 DOI: 10.1016/j.srhc.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/01/2019] [Accepted: 03/18/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES An optimal gestational weight gain is essential for maternal health and to reduce adverse birth outcomes. Current guidelines to monitor gestational weight gain are based on pre-pregnancy body mass index (BMI). However, middle-upper arm circumference (MUAC) is increasingly used as an alternative nutritional status measure for pregnant women. Hence, this study aimed to determine associations of MUAC and pre-pregnancy BMI with gestational weight gain rate among Malaysian pregnant women. STUDY DESIGN A cross-sectional study was conducted among 444 pregnant women (≥20 weeks gestation). MAIN OUTCOMES MEASURES Women completed questionnaires on sociodemographic data, maternal characteristics and pre-pregnancy weight. Height, current weight and MUAC were measured at study visit (from 1st February 2016 to 31st January 2017). RESULTS About a third (34.24%) of pregnant women were overweight or obese prior to pregnancy. MUAC was inversely associated with an inadequate rate of gestational weight gain (OR = 0.77; 95% CI: 0.68, 0.87) as compared to normal gestational weight gain. In contrast, a higher MUAC was associated with a higher odds ratio (OR = 1.28; 95% CI: 1.11, 1.49) of having excessive rate of gestational weight. No associations were found for pre-pregnancy BMI categories for gestational weight gain rate. CONCLUSION Our findings revealed that women with low MUAC were more likely to have an inadequate gestational weight gain rate during pregnancy whereas higher MUAC was associated with an excessive gestational weight gain rate. MUAC may be a useful indicator of nutritional status associated with GWG. Routine measurement of MUAC in pregnant women may help health professionals, particularly in middle-income countries, to counsel women about gestational weight gain.
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Affiliation(s)
- C M Ng
- Faculty of Applied Sciences, UCSI University, 1, Jalan Puncak Menara Gading, Taman Connaught, 56000 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - S E Badon
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, United States.
| | - M Dhivyalosini
- Faculty of Applied Sciences, UCSI University, 1, Jalan Puncak Menara Gading, Taman Connaught, 56000 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - J J M Hamid
- School of Health Sciences, Universiti Sains Malaysia, USM Health Campus, Kubang Kerian, 15200 Kubang Kerian, Kelantan, Malaysia.
| | - A J Rohana
- School of Medical Sciences, Universiti Sains Malaysia, USM Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.
| | - A N Teoh
- Faculty of Applied Sciences, UCSI University, 1, Jalan Puncak Menara Gading, Taman Connaught, 56000 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - K Satvinder
- Faculty of Applied Sciences, UCSI University, 1, Jalan Puncak Menara Gading, Taman Connaught, 56000 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.
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Nombo AP, Mwanri AW, Brouwer-Brolsma EM, Ramaiya KL, Feskens EJM. Gestational diabetes mellitus risk score: A practical tool to predict gestational diabetes mellitus risk in Tanzania. Diabetes Res Clin Pract 2018; 145:130-137. [PMID: 29852237 DOI: 10.1016/j.diabres.2018.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/04/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Universal screening for hyperglycemia during pregnancy may be in-practical in resource constrained countries. Therefore, the aim of this study was to develop a simple, non-invasive practical tool to predict undiagnosed Gestational diabetes mellitus (GDM) in Tanzania. METHODS We used cross-sectional data of 609 pregnant women, without known diabetes, collected in six health facilities from Dar es Salaam city (urban). Women underwent screening for GDM during ante-natal clinics visit. Smoking habit, alcohol consumption, pre-existing hypertension, birth weight of the previous child, high parity, gravida, previous caesarean section, age, MUAC ≥ 28 cm, previous stillbirth, haemoglobin level, gestational age (weeks), family history of type 2 diabetes, intake of sweetened drinks (soda), physical activity, vegetables and fruits consumption were considered as important predictors for GDM. Multivariate logistic regression modelling was used to create the prediction model, using a cut-off value of 2.5 to minimise the number of undiagnosed GDM (false negatives). RESULTS Mid-upper arm circumference (MUAC) ≥ 28 cm, previous stillbirth, and family history of type 2 diabetes were identified as significant risk factors of GDM with a sensitivity, specificity, positive predictive value, and negative predictive value of 69%, 53%, 12% and 95%, respectively. Moreover, the inclusion of these three predictors resulted in an area under the curve (AUC) of 0.64 (0.56-0.72), indicating that the current tool correctly classifies 64% of high risk individuals. CONCLUSION The findings of this study indicate that MUAC, previous stillbirth, and family history of type 2 diabetes significantly predict GDM development in this Tanzanian population. However, the developed non-invasive practical tool to predict undiagnosed GDM only identified 6 out of 10 individuals at risk of developing GDM. Thus, further development of the tool is warranted, for instance by testing the impact of other known risk factors such as maternal age, pre-pregnancy BMI, hypertension during or before pregnancy and pregnancy weight gain.
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Affiliation(s)
- Anna Patrick Nombo
- Sokoine University of Agriculture, Department of Food Technology, Nutrition and Consumer Sciences, P.O. Box 3006, Morogoro, Tanzania
| | - Akwilina Wendelin Mwanri
- Sokoine University of Agriculture, Department of Food Technology, Nutrition and Consumer Sciences, P.O. Box 3006, Morogoro, Tanzania.
| | - Elske M Brouwer-Brolsma
- Wageningen University and Research Centre, Division of Human Nutrition, Wageningen, The Netherlands
| | | | - Edith J M Feskens
- Wageningen University and Research Centre, Division of Human Nutrition, P.O. Box 17, 6700AA Wageningen, The Netherlands
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Schlossman N, Brown C, Batra P, de Sa AB, Balan I, Balan A, Gamache MG, Wood L, Pruzensky W, Saltzman E, Roberts SB, Balé C. A Randomized Controlled Trial of Two Ready-to-Use Supplementary Foods Demonstrates Benefit of the Higher Dairy Supplement for Reduced Wasting in Mothers, and Differential Impact in Infants and Children Associated With Maternal Supplement Response. Food Nutr Bull 2017; 38:275-290. [PMID: 28374648 DOI: 10.1177/0379572117700754] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is no consensus over best approaches to reliably prevent malnutrition in rural communities in low-income countries. OBJECTIVE We compared the effectiveness of 2 lipid-based ready-to-use supplementary foods (RUSFs) differing in dairy protein content to improve the nutritional status of mothers and at-risk infants and young children in rural Guinea-Bissau. METHODS A 3-month cluster-randomized controlled pilot trial of 2 RUSFs was conducted with 692 mothers and 580 mildly or moderately malnourished infants (6-23 months) and children (24-59 months) from 13 villages. The RUSFs contained either 478 (mothers, children) or 239 kcal/d (infants) with 15% or 33% of protein from dairy and were distributed at community health centers 5 d/wk. Controls were wait-listed to receive RUSF. Primary outcomes were mid-upper arm circumference (MUAC) in mothers, and weight-for-age and height-for-age z-scores (WAZ and HAZ) in infants and children. RESULTS There was a significant effect of the RUSF-33% on MUAC in mothers ( P = .03). The WAZ and HAZ increased substantially, by ≈1 z-score, in infants and children ( P < .01) independent of group randomization. In children, but not infants, baseline WAZ and change in maternal MUAC were associated with change in WAZ (β = .07, P = .02). CONCLUSION Ready-to-use supplementary foods with higher dairy protein content had a significant benefit in village mothers, supporting a comparable recent finding in preschool children. In addition, supplementation of children <2 years resulted in improved growth independent of family nutritional status, whereas success in older children was associated with change in maternal nutrition, suggesting the need for community-level education about preventing malnutrition in older, as well as younger, children.
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Affiliation(s)
- Nina Schlossman
- 1 Global Food & Nutrition Inc, Washington, DC, USA.,2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA
| | - Carrie Brown
- 2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA
| | - Payal Batra
- 2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA
| | - Augusto Braima de Sa
- 3 International Partnership for Human Development, Leesburg, VA, USA, and Bissau, Guinea-Bissau
| | - Ionela Balan
- 3 International Partnership for Human Development, Leesburg, VA, USA, and Bissau, Guinea-Bissau
| | - Adrian Balan
- 3 International Partnership for Human Development, Leesburg, VA, USA, and Bissau, Guinea-Bissau
| | - Madeleine G Gamache
- 2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA
| | - Lauren Wood
- 1 Global Food & Nutrition Inc, Washington, DC, USA
| | - William Pruzensky
- 3 International Partnership for Human Development, Leesburg, VA, USA, and Bissau, Guinea-Bissau
| | - Edward Saltzman
- 2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA
| | - Susan B Roberts
- 2 Friedman School of Nutrition Science and Policy, USDA Human Nutrition Research Center, Tufts University, Boston, MA, USA
| | - Carlito Balé
- 3 International Partnership for Human Development, Leesburg, VA, USA, and Bissau, Guinea-Bissau
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Jeminusi OA, Sholeye OO, Abosede OA. Maternal anthropometry in rural and urban areas of Ogun-East senatorial district, Nigeria: A comparative study. ACTA ACUST UNITED AC 2015. [DOI: 10.5897/ijnam2014.0174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Horan MK, McGowan CA, Gibney ER, Donnelly JM, McAuliffe FM. Maternal low glycaemic index diet, fat intake and postprandial glucose influences neonatal adiposity--secondary analysis from the ROLO study. Nutr J 2014; 13:78. [PMID: 25084967 PMCID: PMC4124499 DOI: 10.1186/1475-2891-13-78] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 07/08/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The in utero environment is known to affect fetal development however many of the mechanisms by which this occurs remain unknown. The aim of this study was to examine the association between maternal dietary macronutrient intake and lifestyle throughout pregnancy and neonatal weight and adiposity. METHODS This was an analysis of 542 mother and infant pairs from the ROLO study (Randomised cOntrol trial of LOw glycaemic index diet versus no dietary intervention to prevent recurrence of fetal macrosomia). Food diaries as well as food frequency and lifestyle and physical activity questionnaires were completed during pregnancy. Maternal anthropometry was measured throughout pregnancy and neonatal anthropometry was measured at birth. RESULTS Multiple linear regression analysis revealed the main maternal factor associated with increased birth weight was greater gestational weight gain R2adj 23.3% (F = 11.547, p < 0.001). The main maternal factor associated with increased birth length was non-smoking status R2adj 27.8% (F = 6.193, p < 0.001). Neonatal central adiposity (determined using waist:length ratio) was negatively associated with maternal age, and positively associated with the following parameters: smoking status, maternal pre-pregnancy arm circumference, percentage energy from saturated fat in late pregnancy, postprandial glucose at 28 weeks gestation and membership of the control group with a positive trend towards association with trimester 2 glycaemic load R2adj 38.1% (F = 8.000, p < 0.001). CONCLUSIONS Several maternal diet and lifestyle factors were associated with neonatal anthropometry . Low glycaemic index dietary intervention in pregnancy was found to have a beneficial effect on neonatal central adiposity. Additionally, central adiposity was positively associated with maternal dietary fat intake and postprandial glucose highlighting the important role of healthy diet in pregnancy in promoting normal neonatal adiposity. TRIAL REGISTRATION Current Controlled Trials ISRCTN54392969.
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Affiliation(s)
- Mary K Horan
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Ciara A McGowan
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Eileen R Gibney
- Science Centre – South, University College Dublin School Of Agriculture & Food Science, Belfield, Dublin 4, Ireland
| | - Jean M Donnelly
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - Fionnuala M McAuliffe
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
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Li N, Matchi E, Spiegelman D, Chalamilla G, Hertzmank E, Sando D, Sando MM, Liu E, Muya A, Fawzi W. Maternal mortality among HIV-infected pregnant women in Tanzania. Acta Obstet Gynecol Scand 2014; 93:463-8. [PMID: 24617748 DOI: 10.1111/aogs.12374] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 02/27/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate risk factors for maternal mortality among HIV-infected women in Tanzania. DESIGN Prospective cohort study. SETTING HIV care and treatment clinics in Dar es Salaam, Tanzania. POPULATION HIV-infected pregnant women. METHODS Data were collected for all patients enrolled in an HIV/AIDS care and treatment program. Between November 2004 and September 2011, there were 18 917 women pregnant at least once during the follow-up. Thirteen percent of these women had more than one pregnancy, with 21 645 pregnancies occurring. Logistic regression was used to explore the predictors of maternal death among these women. MAIN OUTCOME MEASURES Maternal mortality. RESULTS During the study period, 363 maternal deaths occurred, giving a maternal mortality ratio of 1729 [95% confidence interval (CI) 1553-1905] per 100 000 live births. Being wasted [odds ratio (OR) 3.38, 95% CI 2.58-4.45] or anemic (OR 2.26, 95% CI 1.70-3.00) was associated with a higher risk of maternal mortality. Women who were initiated on antiretroviral therapy before their pregnancy had a 55% decreased risk of maternal mortality (95% CI 0.29-0.70) compared with women who were not. The risk of maternal mortality decreased with the length of time on antiretroviral therapy during pregnancy, by 8% for each additional month (OR 0.92, 95% CI 0.88-0.96). CONCLUSIONS Maternal mortality was high among HIV-infected women. Initiating women on antiretroviral therapy as early as possible and providing nutritional interventions during pregnancy should be considered as means to reduce the maternal mortality among these women.
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Affiliation(s)
- Nan Li
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA
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Mwanri AW, Kinabo J, Ramaiya K, Feskens EJM. Prevalence of gestational diabetes mellitus in urban and rural Tanzania. Diabetes Res Clin Pract 2014; 103:71-8. [PMID: 24367971 DOI: 10.1016/j.diabres.2013.11.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 11/28/2013] [Indexed: 12/14/2022]
Abstract
AIM To estimate prevalence of gestational diabetes mellitus (GDM) and associated determinants in urban and rural Tanzania. METHODS A cross-sectional study was conducted from 2011 through 2012 in selected urban and rural communities. Pregnant women (609 urban, 301 rural), who were not previously known to have diabetes, participated during usual ante-natal clinic visits. Capillary blood samples were collected at fasting and 2h after 75 g glucose load and were measured using HemoCue. Diagnosis of GDM was made using 1999 World Health Organization (WHO) criteria. RESULTS Women in rural areas were younger (26.6 years) than in urban areas (27.5 years). Mean gestational age, height, and mid-upper arm circumference (MUAC) were similar for the two areas. Overall prevalence of GDM averaged 5.9%, with 8.4% in urban area and 1.0% in rural area. Prevalence of GDM was higher for women who had a previous stillbirth (OR 2.8, 95% CI 1.5-5.4), family history of type 2 diabetes (OR 2.1, 95% CI 1.1-4.2), and MUAC above 28 cm (OR 1.9, 95% CI 1.1-3.3), and lower for women with normal hemoglobin compared with anemia (OR 0.45, 95% CI 0.22-0.93). CONCLUSIONS Prevalence of GDM is higher than expected in urban areas in Tanzania, indicating an increasing population who are at risk for delivery complications and type 2 diabetes in Sub-Saharan Africa.
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Affiliation(s)
- Akwilina W Mwanri
- Wageningen University, Division of Human Nutrition, P.O. Box 8129, 6700 EV Wageningen, The Netherlands; Sokoine University of Agriculture, Department of Food Science and Nutrition, P.O. Box 3006, Chuo Kikuu, Morogoro, Tanzania.
| | - Joyce Kinabo
- Wageningen University, Division of Human Nutrition, P.O. Box 8129, 6700 EV Wageningen, The Netherlands
| | - Kaushik Ramaiya
- Hindu Mandal Hospital, P.O. Box 11571, Dar es Salaam, Tanzania
| | - Edith J M Feskens
- Sokoine University of Agriculture, Department of Food Science and Nutrition, P.O. Box 3006, Chuo Kikuu, Morogoro, Tanzania
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Okereke CE, Anyaehie UB, Dim CC, Iyare EE, Nwagha UI. Evaluation of some anthropometric indices for the diagnosis of obesity in pregnancy in Nigeria: a cross-sectional study. Afr Health Sci 2013; 13:1034-40. [PMID: 24940329 DOI: 10.4314/ahs.v13i4.25] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Obesity in pregnancy is a global health problem which is associated with poor pregnancy outcomes. The use of weight and height, measured at about ten weeks of gestation, to produce pre-gestational body mass index is recommended for the diagnoses of the condition but limitations abound in under resourced settings. OBJECTIVES To measure anthropometric indices such as mid upper arm circumference, calf circumference, waist circumference and waist to hip ratio, for identification of obesity in pregnancy. METHODS Anthropometric measurements were carried out on cohorts of pregnant women from 4 hospitals in Enugu, South-eastern Nigeria. RESULTS There were no significant difference in the mean mid upper arm circumference (MUAC) and calf circumference (CC) across the trimester groups. The mean values of waist circumferences, hip circumference and waist to hip ratios changed significantly across the trimesters. The 75(th) percentile of MUAC (33 cm) and CC (39 cm) in all trimesters, had sensitivity and specificity of more than 70% for identifying obesity in pregnancy. CONCLUSION MUAC and CC values of 33cm and 39cm respectively might be reliable cut off points for diagnoses of obesity throughout pregnancy in Enugu, Nigeria.
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Affiliation(s)
- C E Okereke
- Department of Physiology, College of Medicine University of Nigeria Enugu campus (UNEC), Enugu Nigeria
| | - U B Anyaehie
- Department of Physiology, College of Medicine University of Nigeria Enugu campus (UNEC), Enugu Nigeria
| | - C C Dim
- Departments of Obstetrics & Gynaecology/Physiology, College of Medicine UNEC, Enugu Nigeria
| | - E E Iyare
- Department of Physiology, College of Medicine University of Nigeria Enugu campus (UNEC), Enugu Nigeria
| | - U I Nwagha
- Departments of Obstetrics & Gynaecology/Physiology, College of Medicine UNEC, Enugu Nigeria
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Which anthropometric indicators identify a pregnant woman as acutely malnourished and predict adverse birth outcomes in the humanitarian context? PLOS CURRENTS 2013; 5. [PMID: 23787989 PMCID: PMC3682760 DOI: 10.1371/currents.dis.54a8b618c1bc031ea140e3f2934599c8] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Currently there is no consensus on how to identify pregnant women as acutely malnourished and when to enroll them in nutritional programmes. Médecins Sans Frontières Switzerland undertook a literature review with the purpose of determining values of anthropometric indicators for acute malnutrition that are associated with adverse birth outcomes (such as low birth weight (LBW)), pre-term birth and intra-uterine growth retardation (IUGR). A literature search in PUBMED was done covering 1 January 1995 to 12 September 2012 with the key terms maternal anthropometry and pregnancy. The review focused on the humanitarian context. Mid-upper-arm circumference (MUAC) was identified as the preferential indicator of choice because of its relatively strong association with LBW, narrow range of cut-off values, simplicity of measurement (important in humanitarian settings) and it does not require prior knowledge of gestational age. The MUAC values below which most adverse effects were identified were <22 and <23 cm. A conservative cut-off of <23 cm is recommended to include most pregnant women at risk of LBW for their infants in the African and Asian contexts.
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Gebremedhin S, Enquselassie F, Umeta M. Independent and joint effects of prenatal Zinc and Vitamin A Deficiencies on birthweight in rural Sidama, Southern Ethiopia: prospective cohort study. PLoS One 2012; 7:e50213. [PMID: 23272058 PMCID: PMC3521768 DOI: 10.1371/journal.pone.0050213] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 10/22/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The effects of prenatal Zinc Deficiency (ZD) and Vitamin A Deficiency (VAD) on birthweight are controversial and their interaction has not been investigated. OBJECTIVE To assess the independent and interaction effects of prenatal zinc and vitamin A deficiencies on birthweight in rural Sidama, Southern Ethiopia. METHODOLOGY A community-based prospective cohort study design was employed. Six hundred fifty pregnant women in their second or third trimester were randomly selected and their serum zinc and retinol concentrations were determined. About 575 subjects were successfully followed until delivery and birthweight was measured within 72 hours after delivery. The association between the exposures and birthweight was examined using log-binomial and liner regression analyses. Potential interaction between ZD and VAD was examined using Synergy Index (SI). RESULTS The mean birthweight (± standard deviation) was 2896 g (±423). About 16.5% (95% CI: 13.5-19.6%) of the babies had Low Birthweight (LBW). Prenatal ZD and VAD were not significantly associated to LBW with Adjusted Relative Risk (ARR) of 1.25 (95 CI: 0.86-1.82) and 1.27 (95% CI: 0.86-1.87), respectively. Stratified analysis on the basis of gestational trimester showed that the occurrence of the deficiencies neither in the second nor third trimester were associated to LBW. The deficiencies did not show synergetic interaction in causing LBW [SI = 1.04 (95% CI: 0.17-6.28)]. Important risk factors of LBW were maternal illiteracy [RR = 1.80 (95% CI: 1.11-2.93)], female sex of the newborn [RR = 1.79 (95% CI: 1.19-2.67)], primiparity [RR = 1.16 (95% CI: 1.02-1.35)], short maternal stature [RR = 1.63 (95% CI: 1.06-2.51)] and maternal thinness [RR = 1.52 (95% CI: 1.03-2.25)]. In the linear regression model, elevated CRP was also negatively associated to birthweight. CONCLUSION LBW is of public health significance in the locality. The study did not witness any independent or interaction effect of prenatal ZD and VAD on birthweight.
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Assefa N, Berhane Y, Worku A. Wealth status, mid upper arm circumference (MUAC) and antenatal care (ANC) are determinants for low birth weight in Kersa, Ethiopia. PLoS One 2012; 7:e39957. [PMID: 22792140 PMCID: PMC3386987 DOI: 10.1371/journal.pone.0039957] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 05/29/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Low Birth Weight (LBW) is one of the major risk factor for death in early life. However, little is known about predictors of LBW in sub-Saharan Africa. Therefore, the aim of this study was to measure the incidence and determinants of LBW in a rural population of Ethiopia. METHODS An observational cohort study on pregnant women was conducted from December 2009 to November 2010. During the study period 1295 live birth were registered and the weights of 956 children were measured within 24 hours after birth. Socio-demographic, economic, maternal and organizational factors were considered as a predicators of LBW, defined as birth weight below 2500g. Logistic regression was used to analyze the data, odds ratio (OR) and confidence intervals (CI) are reported. RESULT The incidence of LBW was 28.3%. It is significantly associated with poverty [OR 2.1; 95% CI: 1.42, 3.05], maternal Mid Upper Arm Circumference (MUAC) less than 23 cm [OR 1.6; 95% CI: 1.19, 2.19], not attending ANC [OR 1.6; 95% CI: 1.12, 2.28], mother's experience of physical violence during pregnancy [OR 1.7; 95% CI: 1.12, 2.48], and longer time to walk to health facility [OR 1.6; 95% CI: 1.11, 2.40]. CONCLUSION AND RECOMMENDATION The incidence of LBW was high in Kersa. Babies born to women who were poor, undernourished, experienced physical violence during pregnancy and who had poor access to health services were more likely to be LBW in this part of the country. In this largely poor community where ANC coverage is low, to reduce the incidence of LBW, it is essential to improve access for maternal health care. The involvement of husbands and the community at large to seek collective action on LBW is essential.
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Affiliation(s)
- Nega Assefa
- College of Health Science, Haramaya University, Harar, Ethiopia.
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Ochiai F, Ohzeki T. Rate of trabecular bone area in 3-6-year-old children and relation to intrauterine growth. Pediatr Int 2012; 54:375-8. [PMID: 22192491 DOI: 10.1111/j.1442-200x.2011.03548.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of the present study was to investigate bone mass using rate of trabecular bone area (RTBA) in Japanese children to determine its relationship with indices of growth such as height and weight from before birth through childhood. METHODS A cross-sectional study was conducted. The sample consisted of Japanese boys (n= 716) and girls (n= 586) aged 3-6 years. RTBA was measured using quantitative ultrasound (ultrasonic bone densitometer, Benus III; Ishikawa Seisakusho, Kanazawa, Japan). The relation between RTBA and height and weight during childhood and also at birth was assessed. RESULTS The average RTBA in boys was 27.7 ± 1.59% (mean ± SD) and that in girls was 27.9 ± 1.59%. RTBA significantly correlated with weight both in boys (P= 0.013) and girls (P= 0.016). Significant correlation was demonstrated between RTBA and height, especially in girls (P= 0.045). Statistical significance was shown between RTBA and birth length in boys (P= 0.015) and girls (P= 0.007), and weight at birth in boys (P= 0.014). On multiple regression analysis RTBA correlated significantly with birthweight for boys (standardized coefficient β= 0.093, P= 0.028) and birth length for girls (β= 0.122, P= 0.007). CONCLUSION Augmentation of bone mass is related not only to weight and height during childhood but also to prenatal factors such as growth, and possibly with nutrition in utero.
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Affiliation(s)
- Fumie Ochiai
- Department of Midwifery, Kanazawa Medical University School of Nursing, Ishikawa, Japan.
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López LB, Calvo EB, Poy MS, del Valle Balmaceda Y, Cámera K. Changes in skinfolds and mid-upper arm circumference during pregnancy in Argentine women. MATERNAL AND CHILD NUTRITION 2010; 7:253-62. [PMID: 21689268 DOI: 10.1111/j.1740-8709.2009.00237.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This investigation describes the pattern of changes in mid-upper arm circumference (MUAC), triceps, biceps and subscapular skinfold thicknesses during the course of pregnancy, and its relationship with maternal and newborn outcomes. A prospective cohort of 1066 pregnant women were selected in seven different urban regions in Argentina. Measurements of MUAC were carried out at 16, 28 and 36 gestational weeks. In a subsample of 488 women, triceps, biceps and subscapular skinfold thicknesses were measured. Mean total increase in subscapular, tricipital and bicipital skinfolds from 16 to 36 weeks of gestation were 4.5, 3.6 and 2.6 mm, respectively. MUAC showed a mean increase of 1.7 cm in the same period. Overweight or obese women at the start of pregnancy had lower increases in all measurements compared with women with normal or low body mass index. Maternal anthropometry was related to birthweight; women who gave birth to infants of less than 3000 g had lower average values in all measurements than those who had normal birthweight infants. LMS curves for MUAC and skinfolds by gestational age are presented, which can be used as a reference to assess maternal nutrition status during pregnancy. MUAC, tricipital and subscapular skinfold for gestational age curves are proposed for monitoring maternal nutritional status during pregnancy. MUAC cut-off points of 24.5, 25.5 and 26.5 cm for 16, 28 and 36 weeks of gestation, respectively, are also proposed as a proxy to detect low birthweight.
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Affiliation(s)
- Laura Beatriz López
- School of Nutrition, Faculty of Medicine, University of Buenos Aires, Marcelo T de Alvear 2202, Ciudad de Buenos Aires, Argentina.
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Abstract
OBJECTIVE To identify determinants of low birth weight (LBW) in Karachi, Pakistan, including environmental exposures and nutritional status of the mother during pregnancy. DESIGN Cross-sectional study.ParticipantsFive hundred and forty mother-infant pairs. We interviewed mothers about obstetric history, diet and exposure to Pb. We measured birth weight and blood lead level (BLL). We performed multiple log binomial regression analysis to identify factors related to LBW. RESULTS Of 540 infants, 100 (18.5 %) weighed <or=2.5 kg. Umbilical cord BLL was not significantly associated with LBW. Maternal poor self-rated health (adjusted prevalence ratio (adjPR) = 1.83; 95 % CI 1.09, 3.07) and none or one prenatal visit (adjPR = 2.18; 95 % CI 1.39, 3.43) were associated with LBW. A statistically significant interaction between mothers' mid upper-arm circumference (MUAC) and dietary vitamin C intake was noted. Compared with mothers with MUAC above the median and dietary vitamin C intake above the 3rd quartile (>208.7 mg/d), infants of mothers with MUAC less than or equal to the median and dietary vitamin C intake >208.7 mg/d (adjPR = 10.80; 95 % CI 1.46, 79.76), mothers with MUAC above the median and vitamin C intake <or=208.7 mg/d (adjPR = 10.67; 95 % CI 1.50, 76.02) and mothers with MUAC less than or equal to the median and vitamin C intake <or=208.7 mg/d (adjPR = 13.19; 95 % CI 1.85, 93.79) more likely to give birth to an LBW infant. CONCLUSIONS In Pakistan, poor nutritional status and inadequate prenatal care were major determinants of LBW in this setting. Environmental factors including umbilical cord BLL were not significantly associated with LBW.
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