An association of deficiencies in balanced dietary practices and inadequate iron and folic acid supplement's intake during pregnancy and increasing risk of pre-eclampsia or eclampsia among Indian women

Pre-eclampsia or eclampsia is a serious reproductive health problem which can cause maternal, fetal and neonatal morbidity and mortality worldwide. However till the notable reasons of it is not very clear at all. The main essence of the present study was to examine the association between dietary intake, iron and folic acid consumption during pregnancy and the chances of occurrences of pre-eclampsia or eclampsia among Indian women. A cross sectional observational study was performed by using NFHS-5 (2019-21) data. 190,797 ever married women aged between 15-49 years who had a live birth in the past five years preceding the survey were availed for this study. Multivariable logistic regression analysis was carried out to find out the association between dietary and supplementary intake and occurrences of eclampsia. About 3.6% of the sample women had pre-eclampsia or eclampsia. The results of the study indicated that the likelihood of the prevalence of pre-eclampsia or eclampsia was significantly higher among those women who did not take adequate diet and as well as not consumed iron and folic acid tablet or syrup for at least 90 days during pregnancy compared to those women who took adequate diet and iron and folic acid supplementation even after controlling some maternal, health and lifestyle, socio-economic and demographic characteristics. Integrated and quality ANC services can only ensure adequate nutritional intake in terms of healthy and balanced diet. So, quality ANC services and with this micronutrients intake could be an effective way to reduce the prevalence of pre-eclampsia or eclampsia.

MTHFR A1298C polymorphism: a predictor of reduced risk of preeclampsia in Punjab, Pakistan

OBJECTIVES

This study aimed to investigate the genetic association between MTHFR (A1298C) SNP and preeclampsia (PE) in Punjab, Pakistan.

METHODS

A sample of 80 pregnant women (40 healthy pregnant women and 40 with PE) was pooled for genotyping MTHFR A1298C polymorphism by using the tetra-primer amplification refractory mutation system (ARMS) PCR. The Genotypic and allelic assessments were performed using various statistical techniques.

RESULTS

The AC genotype and C allele of MTHFR A1298C were found to be associated with decreased risk of PE (odds ratio [OR]: 0.31, risk ratio [RR]: 0.58, p = 0.01), and (odds ratio [OR]: 0.49, risk ratio [RR]: 0.61, p = 0.04), respectively.

CONCLUSION

In conclusion, genetic polymorphism A1298C in MTHFR may pose a protective effect in the studied population.

Factors associated with preeclampsia among pregnant women in Gojjam zones, Amhara region, Ethiopia: a case-control study

PURPOSE

Little is known about the factors contributing to preeclampsia in Ethiopia. Therefore, this study was conducted to determine factors associated with preeclampsia among pregnant women in public hospitals.

METHODS AND MATERIALS

An institution based unmatched case-control study was conducted. Women with preeclampsia were cases, and those without preeclampsia were controls. The study participants were selected using the consecutive sampling method with a case-to-control ratio of 1:2. The data were collected through measurements and a face-to-face interview. Then the data were entered using Epi Info and exported to STATA 14 for analysis. The findings were presented in text, tables, and figures.

RESULTS

About 51 (46.4%) of cases and 81 (36.8%) of controls had no formal education. Multiple gestational pregnancies (AOR = 2.75; 95% CI: 1.20-6.28); history of abortion (AOR = 3.17, 95% CI: 1.31-7.70); change of paternity (AOR = 3.16, 95% CI: 1.47-6.83); previous use of implants (AOR = 0.41; 95% CI: 0.13-0.96); and fruit intake during pregnancy (AOR = 0.36, 95% CI: 0.18-0.72) were associated factors of preeclampsia.

CONCLUSION

History of abortion, change of paternity, and multiple gestational pregnancies were risk factors for preeclampsia. Fruit intake during pregnancy and previous use of implant contraceptives were negatively associated with preeclampsia. Further studies should be conducted regarding the effect of prior implant use on preeclampsia. Healthcare providers should give special attention to women with a history of abortion and multiple gestational pregnancies during the ANC follow-up period.

Determinants of pre-eclampsia among pregnant women attending antenatal care and delivery services at Bahir Dar public hospitals, northwest Ethiopia: A case-control study

Background and Aims

Pre-eclampsia (PE) is a pregnancy-related syndrome that occurs after 20 weeks of pregnancy. The current study was designed to evaluate the determinants of PE in pregnant women following antenatal and delivery services.

Methods

An institution-based case-control study was performed in governmental hospitals of Bahir Dar city. The data were collected using an interview-administered questionnaire and analyzed by SPSS version 20 software. Bivariate and multivariable logistic regression models were utilized for the analysis of variables. A p < 0.05 was used to declare the level of significance.

Results

In this study, the mean ages (in years) of cases and controls were 28.20 ± 5.66 and 27.52 ± 4.70, respectively. Factors such as: being primiparous (adjusted odds ratio [AOR]: 3.19 at 95% confidence interval [CI]: 1.71, 5.97), family history of hypertension (HTN) (AOR: 4.14 at 95% CI: 1.71, 10.05), previous history of PE (AOR: 7.97 at 95% CI: 2.42, 26.63), number of antenatal care (ANC) visits (AOR: 5.43 at 95% CI: 2.86, 10.33), not taking iron and folic acid supplement (AOR: 4.46 at 95% CI: 1.59, 12.48), body mass index ≥25 kg/m² (AOR: 3.47 at 95% CI: 1.78, 6.77), not consuming vegetables (AOR: 1.99 at 95% CI: 1.07, 3.69) and not consuming egg, milk and milk products (AOR: 3.00 at 95% CI: 1.47, 6.11) were the determinants of PE.

Conclusion

In this study, different determinants of PE were identified. Hence, special attention should be given for primiparous women, women having previous history of PE and family history of HTN. Moreover, nutritional counseling should be given for pregnant women during ANC visits. Besides, higher officials should design an appropriate strategy to increase the number of mothers to complete their ANC visits and to take iron and folic acid supplements. Furthermore, to verify the determinants of PE, community-based cohort studies are warranted.

Association between iron-folic acid supplementation and pregnancy-induced hypertension among pregnant women in public hospitals, Wolaita Sodo, Ethiopia 2021: a case- control study

BACKGROUND

Pregnancy-induced hypertension is the new onset of high blood pressure after 20 weeks of gestation in women with previously normal blood pressure. To the best of our knowledge, no study has been conducted in our country to investigate the association between this pregnancy problem and iron-folic acid supplementation. The aim of this study was to determine the association between iron-folic acid supplementation and pregnancy-induced hypertension (PIH) in pregnant women at public hospitals in the Wolaita Sodo zone.

METHODS

An institution-based case-control study was conducted among pregnant women who visited public hospitals in the Wolaita Sodo zone from March 3, 2022, to August 30, 2022. A consecutive sampling method was used to select the study participants. The total sample size was 492, of which 164 were cases and 328 were controls. The data were collected by conducting face-to-face interviews and measurements. The data were entered into EpiData version 4.6 and exported to STATA 14 for analysis. Those variables with a p-value less than 0.05 were considered statistically significant. Descriptive statistics and odds ratios were presented using texts, tables, and figures.

RESULTS

A total of 471 women participated in this study, yielding a response rate of 96%. The cases had a mean age of 25 ± 4.43, while the controls had a mean age of 25 ± 3.99. The mean age at first pregnancy among cases was 20 ± 2.82 and among controls was 20 ± 2.97. The average number of deliveries for cases and controls was 1.97 ± 1.41 and 1.95 ± 1.38, respectively. There is no significant association between iron-folic acid supplementation and PIH. Pregnant women with high hemoglobin levels had higher odds of PIH as compared to those without it (AOR = 3.65; 95% CI: 1.0-12.9). Eating kocho (AOR = 14.4; 95% CI: 1.2-16.7) was positively associated with PIH.

CONCLUSIONS

There is no association between iron-folic acid supplementation during pregnancy and pregnancy-induced hypertension. Pregnant women with high hemoglobin levels had higher odds of PIH as compared to those without it. There is an association between kocho consumption and PIH. More research should be done using stronger designs.

Determinants of Preeclampsia Among Pregnant Women in Public Hospitals of Wolaita and Dawuro Zones, Southern Ethiopia: A Case-Control Study

INTRODUCTION

Preeclampsia is a leading cause of maternal and fetal morbidity and mortality in Ethiopia. It is defined by the onset of new hypertension (HTN) and proteinuria in the second trimester of pregnancy. There is a research gap in the study area and there is an inconsistency of findings in previous studies. Therefore, this study aimed to determine the factors of preeclampsia among pregnant women in public hospitals.

METHODS AND MATERIALS

An institution-based unmatched case-control study was conducted in public hospitals in Wolaita and Dawuro Zones from February 1 to June 26, 2021. Women who were diagnosed with preeclampsia were cases, while those who did not have it were controls. They were selected using a consecutive sampling method. Descriptive statistics and logistic regression were done by STATA.

RESULTS

A total of 349 cases and 698 controls participated in this study. The average age of the cases and controls was 26.1 ± 4.6 standard deviation (SD) and 24.6 ± 4.8 SD years, respectively. The determinants of preeclampsia in this study were a family history of HTN (adjusted odds ratio [AOR = 11.5; 95% confidence interval, CI: 6.46-20.41], family history of diabetes mellitus [AOR = 2.1; 95% CI: 1.10-3.90], having two or multiple pregnancies [AOR = 6.33; 95% CI: 2.28-17.51], primigravida [AOR = 1.49; 95% CI: 1.01-2.21], and being gravida 5-9 [AOR = 2.47; 95% CI: 1.34-4.58]).

CONCLUSION

In this study, family history of HTN, family history of diabetes mellitus, history of preeclampsia, primigravida, and multiple gestation pregnancies were the determinants of preeclampsia. As a result, health care providers should pay special attention to pregnant women with a family history of HTN, primigravida, and two or multiple gestation pregnancies during antenatal care follow-up.

Determinants of Preeclampsia Among Pregnant Women in Chiro Referral Hospital, Oromia Regional State, Ethiopia: Unmatched Case-Control Study

BACKGROUND

Preeclampsia causes striking maternal, fetal, and neonatal mortality and morbidity both in developed and developing countries. However, evidence of risk factors of preeclampsia is limited in the study area.

OBJECTIVE

To identify determinants of preeclampsia among pregnant women attending antenatal care services in Ciro Referral Hospital, Ethiopia, 2020.

METHODS

A facility-based unmatched case-control study was conducted from July 1 to July 30, 2020, in Chiro Referral Hospital on a sample size of 306 (ie, 76 cases and 230 controls; with a 1:3 ratio). Data were coded and entered into Epi Info version 7 and then exported to SPSS version 21 for analysis. The odds ratio was calculated with 95% confidence intervals to show the strength of association and p-value<0.05 was used to declare statistical significance.

RESULTS

A total of 302 (75 cases and 227 controls) pregnant mothers were interviewed with a response rate of 98.7%. Being in the age group ≥35 years (AOR=4.00; 95% CI=1.25-12.80), rural residence (AOR=3.30; 95% CI=1.50-7.26), having a family history of hypertension (AOR=3.25; 95% CI=1.36-7.73), and being primigravida (AOR=3.71; 95% CI=1.49-9.22) were identified as risk factors for preeclampsia. However, consuming fruits more than 2-4 times per a week in their diet (AOR=0.38; 95% CI=0.15-0.98) was a protective predictor of preeclampsia.

CONCLUSION

Maternal age, residence, family history of hypertension, gravida, and frequency of fruit consumption were identified determinants of preeclampsia. Thus, healthcare providers should give emphasis for pregnant mothers in the older age category, primigravida, those who have a history of a family with hypertension, and those from a rural residence to diagnose the diseases as early as possible. Additionally, advising pregnant mothers attending antenatal care to consume fruits as early as possible in their daily diet reduces the risk of preeclampsia.

Major dietary patterns in relation to preeclampsia among Iranian pregnant women: a case-control study

Background: Preeclampsia is a pregnancy disorder that increases the risk of prenatal and maternal complications. Therefore, prevention of preeclampsia requires identifying its preventable risk factors such as dietary patterns.Objective: This study aimed to investigate the relationship between the major dietary patterns and preeclampsia.Study design: In this case-control study, the dietary patterns of a total of 510 pregnant women were investigated. Data on their dietary intake, sociodemographics, and daily physical activity levels were collected using a 198 item semi-quantitative food frequency questionnaire, a sociodemographic questionnaire, and a physical activity questionnaire, respectively. To identify the major dietary patterns and to model the relationship between dietary patterns and preeclampsia, factor analysis and unconditional logistic regression were employed, respectively. The three major dietary patterns identified were as follows: healthy dietary pattern (i.e. high in fruits, low-fat dairy, dried fruits, nuts, vegetables, fruit juice, liquid oil, and tomatoes), western dietary pattern (i.e. high in red meat, processed meat, fried potatoes, and pickles), and Iranian traditional dietary pattern (i.e. high in eggs, potatoes, and legumes).Results: After adjustment for confounding factors, we found that with an increase in the healthy dietary pattern score, the odds of preeclampsia were reduced to 87.5% (OR = 0.125, 95%CI: 0.070-0.221, p < .001); with an increase in the western dietary pattern score, the odds of preeclampsia were increased 5.99 times (OR = 5.99, 95%CI: 3.414-10.53, p < .001); and with an increase in the Iranian traditional dietary pattern score, the odds of preeclampsia were reduced to 81.7% (OR = 0.183, 95%CI: 0.109-0.308, p < .001).Conclusion: The findings showed that the western dietary pattern had a direct relationship and the healthy and Iranian traditional patterns had a reverse relationship with preeclampsia.

Dietary patterns and the risk of pregnancy-associated hypertension in the Danish National Birth Cohort: a prospective longitudinal study

OBJECTIVE

To examine the association between mid-pregnancy dietary patterns and pregnancy-associated hypertension (PAH).

DESIGN

A prospective longitudinal cohort study.

SETTING

Denmark.

POPULATION

About 55 139 Danish women with single enrolments and recorded food frequency questionnaire dates with complete information on dietary intake.

METHODS

Women were eligible if they could speak Danish and were planning to carry to term. Diet was assessed using a validated semi-quantitative 360-item food frequency questionnaire and dietary patterns were derived using factor analysis.

MAIN OUTCOME MEASURES

Gestational hypertension (GH) and pre-eclampsia (PE).

RESULTS

Disease prevalence was 14% for GH (5491/39 362); 2% for PE (1168/54 778), and 0.4% for severe PE (234/55 086). Seven dietary patterns were characterised in the population, of which two were associated with PAH. The Seafood diet characterised by high consumption of fish and vegetables was inversely associated with the odds of developing GH [odds ratio (OR) 0.86; 95% CI 0.77-0.95)] and PE (OR 0.79; 95% CI 0.65-0.97). The Western diet characterised by high consumption of potatoes (including French fries), mixed meat, margarine and white bread increased the odds of developing GH (OR 1.18; 95% CI 1.05-1.33) and PE (OR 1.40; 95% CI 1.11-1.76). No association was seen with severe PE.

CONCLUSIONS

We found protective associations of Seafood diet and harmful associations of Western diet with PAH. Dietary interventions encouraging the reduction of Western diet may contribute to a decrease of PAH.

TWEETABLE ABSTRACT

Western diet increases (Seafood diet decreases) the likelihood of developing pre-eclampsia among Danish pregnant women.

A High Adherence to Six Food Targets of the Mediterranean Diet in the Late First Trimester is Associated with a Reduction in the Risk of Materno-Foetal Outcomes: The St. Carlos Gestational Diabetes Mellitus Prevention Study

A prenatal diet affects materno-foetal outcomes. This is a post hoc analysis of the St. Carlos gestational diabetes mellitus (GDM) Prevention Study. It aims to evaluate the effect of a late first-trimester (>12 gestational weeks) degree of adherence to a MedDiet pattern-based on six food targets-on a composite of materno-foetal outcomes (CMFCs). The CMFCs were defined as having emergency C-section, perineal trauma, pregnancy-induced hypertension and preeclampsia, prematurity, large-for-gestational-age, and/or small-for-gestational-age. A total of 874 women were stratified into three groups according to late first-trimester compliance with six food targets: >12 servings/week of vegetables, >12 servings/week of fruits, <2 servings/week of juice, >3 servings/week of nuts, >6 days/week consumption of extra virgin olive oil (EVOO), and ≥40 mL/day of EVOO. High adherence was defined as complying with 5⁻6 targets; moderate adherence 2⁻4 targets; low adherence 0⁻1 targets. There was a linear association between high, moderate, and low adherence, and a lower risk of GDM, CMFCs, urinary tract infections (UTI), prematurity, and small-for-gestational-age (SGA) newborns (all p < 0.05). The odds ratios (95% CI) for GDM and CMFCs in women with a high adherence were 0.35((0.18⁻0.67), p = 0.002) and 0.23((0.11⁻0.48), p < 0.001), respectively. Late first-trimester high adherence to the predefined six food targets is associated with a reduction in the risk of GDM, CMFCs, UTI, prematurity, and SGA new-borns.

Risk factors for hypertensive disorders of pregnancy among mothers in Tigray region, Ethiopia: matched case-control study

BACKGROUND

Hypertensive disorders of pregnancy are a global public health concern both in developed and developing countries. However, evidences regarding the risk factors of hypertensive disorders of pregnancy are limited particularly in Ethiopia. The aim of the study was to assess risk factors associated with hypertensive disorders of pregnancy among mothers in public hospitals of Tigray.

METHODS

The study was conducted in seven public hospitals of Tigray region, Ethiopia from June 2017 to November 2017. A facility based matched case-control study was employed to select 110 cases and 220 controls who were pregnant women. Cases and controls were matched by parity status. A case was a mother diagnosed to have hypertensive disorders of pregnancy by an obstetrician in the antenatal period while a control was a mother who did not have a diagnosis of hypertensive disorders of pregnancy. Data were collected by face to face interview technique using a pretested questionnaire and a checklist. Conditional logistic regression analysis was used to identify the independent predictor variables. Adjusted matched odds ratio with its corresponding 95% confidence interval was used and significance was claimed at P-value less than 0.05. Overall findings were presented in texts and tables.

RESULTS

Rural residents were at greater odds of suffering from hypertensive disorders (OR = 3.7, 95% CI; 1.9, 7.1). Similarly, mothers who consume less amount of fruits in their diet had 5 times higher odds of developing hypertensive disorders than those who consume fruits regularly (OR = 5.1, 95% CI; 2.4, 11.15). Overweight (BMI > 25 Kg/m2) mothers were also at risk of developing hypertensive disorders of pregnancy as compared with the normal and underweight mothers (AOR = 5.5 95% CI; 1.12, 27.6). The risk of developing hypertensive disorders of pregnancy was 5.4 times higher among diabetic mothers.

CONCLUSION

Rural residence, less fruit consumption, multiple pregnancy, presence of gestational diabetes mellitus and pre-pregnancy overweight were identified as independent risk factors in this study. It is recommended that health care givers may use these factors as a screening tool for the prediction, early diagnoses as well as timely interventions of hypertensive disorders of pregnancy.

Dietary factors associated with preeclampsia or eclampsia among women in delivery care services in Addis Ababa, Ethiopia: a case control study

OBJECTIVE

Preeclampsia or eclampsia, which is one of the direct obstetric complication, results in maternal and child morbidity and mortality. The factors associated with it remains unclear. So, the aim of the study was to assess the dietary factors associated with preeclampsia or eclampsia among women in delivery care services in Addis Ababa, Ethiopia.

RESULTS

Factors which were investigated as protective for preeclampsia or eclampsia were: Fruit intake during pregnancy (AOR: 0.94, 95% CI 0.20, 4.32), vegetable intake during pregnancy (AOR: 0.95, 95% CI 0.01, 0.71) and receiving nutritional counseling during antenatal care (AOR: 0.17, 95% CI 0.05, 0.6). In the other side being nulliparous women was a risk factor for preeclampsia or eclampsia (AOR: 2.02, 95% CI 1.15, 3.55).

Nutrition of Black Women During Pregnancy

OBJECTIVE

To examine the consistency and adequacy of nutritional intake in a population of Black women in the second and third trimesters of pregnancy.

DESIGN

This was a longitudinal descriptive study. Data were collected from women with low-risk pregnancies at 22- to 24-week prenatal visits and two subsequent visits.

SETTING

Participants were recruited from urban prenatal clinics in one city in the Northeastern United States.

PARTICIPANTS

Pregnant women who self-identified as Black (N = 195).

METHODS

A 24-hour diet recall was obtained at each of the three study time points. Food models and measuring cups were used to improve the accuracy of portion size reporting. Data from diet recalls were manually entered in Food Processor software to compute nutritional content.

RESULTS

A linear mixed-effects model was used to examine dietary intake. Dietary patterns were stable from the second to the third trimesters, and caloric intake was inadequate. Women met minimal daily requirements for carbohydrate and protein intake, but the overall percentages of fat, protein, and carbohydrates indicated that additional calories needed to come from protein. Although more than 80% of women regularly took prenatal vitamins, micronutrient and fiber intake were consistently inadequate.

CONCLUSION

Prenatal care to help women identify foods that are rich in fiber, protein, and micronutrients is important for the health of women and newborns. Knowing that nutritional intake is consistently inadequate, nurses can counsel pregnant women whenever they have contact with them to attempt to improve nutritional intake and make women aware of inexpensive nutrient sources.