of pregnancy. 1. To ensure the delivery of a full term healthy newborn baby of adequate size and appropriate body composition it is necessary that a woman ...
Rawal Medical Journal An official publication of Pakistan Medical Association Rawalpindi Islamabad branch Established 1975 Volume 36
Number 2
March- June
2011
Original Article
Effects of Maternal Macronutrient intake in 3rd trimester of normal pregnancy on the maternal weight gain and neonatal birth weight of full term neonates Tehzeeb Zulfiqar,* Farwa Rizvi,** Samina Jalali,*** S.A Shami,*** Nasira Tasnim,# Sarwat Jahan*** From Oxford Policy Management Limited (UK), Islamabad Office,* Department of Community Medicine, Islamabad Medical and Dental College (IMDC), Islamabad,** Department of Animal Sciences, Quaid-e-University, Islamabad, *** Department of Gynecology/Obstetrics, Pakistan Institute of Medical Science, Islamabad# ABSTRACT Objective To determine effects of maternal macronutrient intake in 3rd trimester of normal pregnancy on the maternal weight gain and neonatal birth weight of full term neonates. Patients and Methods The study was conducted from April, 2007 to November 2007 at Gynecology and Obstetrics Unit of Pakistan Institute of Medical Sciences, Islamabad. This hospital based Descriptive study was 1
carried out on pregnant women registered at 26 weeks of pregnancy by employing consecutive (non-probability) sampling technique. Dietary history was taken by a semi structured Food Frequency questionnaire and 24 hours dietary recall at the time of registration. Written informed consent was obtained. Results Mean energy and protein consumption of the pregnant women was 2168.89 Kcal/day and 65.71 g/day respectively in the last trimester of pregnancy. Fat and carbohydrate intake was 73.26 g/day and 306.14 g/day respectively. Maternal energy intake more than the National Recommended Dietary Allowance (RDA) for Pakistan showed a highly significant (P = 0.007) increase in the birth weight of the neonates but no increase was seen (P = 0.93) in the maternal weekly weight gain. Maternal fat consumption had a significant positive relation with both the neonatal birth weight (P = 0.005) as well as maternal weekly weight gain (P = 0.03) but carbohydrate consumption was only significantly related to maternal weight gain (P = 0.01). Conclusion This study suggests a strong role of maternal diet during pregnancy for optimal newborn weight. (Rawal Med J 2011;36:137-142). Key words Macronutrients, maternal weight gain, birth weight.
INTRODUCTION Maternal nutrition has its importance for the course and outcome of pregnancy.1 To ensure the delivery of a full term healthy newborn baby of adequate size and appropriate body composition it is necessary that a woman must enter pregnancy at a normal weight and with good nutritional status.2 The women who are undernourished or overweight at the time of conception need 2
special considerations.3,4 It has been evident from Dutch famine (winter of 1944-1945) that third-trimester exposure to famine was associated with lowest birth-weights.5 Mean birth-weight fell by about 300 g at the depths of the famine. There was no birth-weight decrease among infants conceived during and exposed to famine through the second trimester but whose mothers received adequate rations during the third trimester.5 The prevalence of maternal malnutrition is 25-50% in south Asia, and 7-21% elsewhere in the world.6 The maximum rate of fetal growth is during 32-38 weeks of pregnancy when the weight virtually doubles.7 The RDA of energy for non pregnant Pakistani women is 2160 kcal/day and of proteins, 55g/day.8 In pregnancy, an additional 350 kcal and 10 gram of proteins is recommended. The average energy intake of a Pakistani woman was found to be 2099 calories and 55 grams of proteins per day, which was below the national average.8 The current study explored the relationship between the nutritional status of pregnant Pakistani women with the birth weight of newborns. PATIENTS AND METHODS This hospital based descriptive study was conducted from April, 2007 to November, 2007 at Maternal and Child health centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad. A total of 3269 pregnant women attended the out-patient department (OPD) day during the study period. The data was collected on every alternate day. All the women with singleton pregnancy with a record of body weight at 12 weeks gestation, between 25 weeks to 27 weeks, planning to deliver in the hospital were enrolled for the study. The weeks of gestation were calculated by record of their last menstrual date and confirmed by ultra-sonographic finding. All study participants were tracked by their telephone numbers, recorded at the time of registration. In this study, the time 3
from conception until 12 weeks was considered as first trimester, from 13 weeks to end of 25 weeks was considered as 2nd trimester and after 26 weeks until birth was third trimester of pregnancy. The women who were considered as high risk for low birth weight (LBW) or preterm delivery (PTD)9 were not enrolled for the study. Such women included women with twin/multiple pregnancy, with congenitally abnormal fetuses, with hypertension, diabetes, smoking , chronic diseases, including tuberculosis (TB), hepatitis, kidney diseases, and women with anemia due to causes other than Iron
deficiency,
e.g.
thalassemia
and
Glucose-6-Phospho-
dehydrogenase deficiency. A total of 157 women fulfilled the selection criteria. Consecutive sampling was employed and sample size was calculated using WHO sample size calculator.6 The enrolled women did not receive any intervention during their pregnancy and received the standard prenatal care based on the rules of Gynecology and Obstetrics Unit A of PIMS. The informed written consent was obtained. Information regarding socioeconomic, educational, gynecological, obstetric, and medical history was collected. Maternal weight and hemoglobin were recorded at registration and twice at subsequent visits. At the time of delivery neonatal weight and type of delivery was recorded. In a face to face interview, the women was asked to recall and describe all foods and beverages consumed over the past 24 hours, in a chronological order from first food or beverage consumed in the morning till the last food or beverage consumed at night at registration (26 weeks) and at all subsequent visits. However, only the record taken at registration (25-26 weeks), 32 weeks and the visit nearest to the delivery was used for data analysis. This was about 36-40 weeks for the full term deliveries. The nutrient content of a standard portion of each food was 4
multiplied by its reported frequency of use to calculate average daily nutrient intake. A computerized program was developed using food consumption tables for Pakistani Population (2001). Energy from food, quantity of individual macronutrients (Proteins, carbohydrates and fats), iron and calcium in the food, was calculated using this program. The energy was recorded as Kilo-calories (kcal)/day and amount of the macronutrients in diet were recorded as grams/day. Energy from the macronutrients was calculated by using the guidelines of UNHCR/UNICEF/WFP/WHO (2001). Statistical analysis involved calculation of differences between group by Student’s t test. Regression analysis was used to examine the trends between neonatal birth weight and the maternal dietary intake including energy, protein, carbohydrates and lipids. Data analysis was done on Graph-pad version 5. RESULTS More than half of the pregnant women were nulliparous and more than 2/3rd of the population had monthly income lower than 400 dollars (Table 1). Table 1. Characteristics of the subjects.
5
Characteristic Maternal Age at the time of registration Maternal body weight at registration (26 wks of pregnancy) (kg) Maternal Body height (cm) Weeks of pregnancy at registration according to LMP Weeks of pregnancy according to Ultrasound Maternal parity (n=157) Nullipara Para 1 Multipara (two or more) Maternal Education (n=157) No schooling School education College education University level Total House hold Income (Rs/month) (n=157) < 8000 (134 US$) 8001-16000 (134-267 US$) 16,001 – 24000 (267-400 US$) 24001-32,000 (400-533 US$) >32001 (above 533 US$) Maternal employment (n=157) No employment Employed
Mean ± SD 25.10 ± 0.32
% age
n 157
62.85 ± 0.89
157
156.56 ± 0.40 26.30 ± 0.01
157 157
26.52 ± 0.03
157
52.229 22.929 24.840
82 36 39
8.917 43.312 36.942 10.828
14 68 58 17
45.859 36.942 6.363
72 58 10
6.363 4.458
10 7
87.261 12.738
137 20
n= number of patients, One US $= Rs 84
The analysis of only those women was included who had a term delivery after completion of 37 weeks of gestation.
Table 2. Mean Maternal total energy and nutrient intake and birth weight of full term neonates.
6
Daily Energy intake (Kcal)/day
N
Maternal energy intake (26 weeks till delivery)(K cal/day)
2601 Regression analysis of Variance
41 44 20 13
1833.48 2158.71 2462.47 2776.50
Maternal weight gain (26 weeks till delivery) (g/week)
Neonatal Birth weight (g)
318.37 364.64 394.7 362.05 (b=0.0517 (F1.2) =1.59; P= 0.33) Categories of daily protein intake g (Kcal)
