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PhD student (University of Heidelberg), University of Health and Allied Sciences, Ho, Ghana


Does gestational intake of adequate diets affect haemoglobin levels at delivery and newborn health?

Introduction: Despite gestational iron-folic acid supplementation in Ghana, anaemia in pregnancy remains a public health problem and is associated with adverse materno-foetal pregnancy outcomes. Aim: To assess maternal intake of micronutrient-dense and dietary diversified foods during pregnancy and haemoglobin levels at delivery. Methods: Pregnant women (n=810) in their first and second trimesters of pregnancy were recruited from six antenatal clinics in the Volta region of Ghana onto the prospective cohort study. For this analysis, 342 women with complete delivery records are considered. A ten-food-group food frequency questionnaire was designed according to the FAO Minimum Dietary Diversity indicator for women. Dichotomous response was assigned each food item and the cumulative scores used to assess micronutrient adequacy of intakes. Daily intake of ≥5 food groups was rated adequate. Haemoglobin levels were measured and classified according to WHO guidelines. Data variability and correlation was tested using principal factor analysis while determinants of adequate dietary intake were tested through binary logistic regression in SPSS. Results: Mean dietary score was 5.07±2.21 (CI:4.83-5.31). Almost 53% consumed micronutrient-dense diets. Among the iron-rich foods, animal-source foods (86%) were most consumed whereas beans (36%), dark green leafy vegetables (29%) and eggs (23%) were less frequently consumed. Gestational age at delivery was 38.76±2.12 weeks with 11.9% pre-term deliveries. Mean haemoglobin level was 10.77±1.42g/dl (CI:10.59-10.96) while anaemia prevalence (Hb>11) was 52.6% (severe:0.3%, moderate:25.2% and mild:27.0%) making it a severe public health problem. Low birth weight was 9.4% whereas small-for-gestational-age and stillbirths were 5.5% and 2.0% respectively. Intake of iron-rich diet did not correlate with Hb levels (Pearson’s r=0.05, p=0.436). Among mothers whose intake was iron-rich, none was severely anaemic. However 13.6% and 31.8% were moderately and mildly anaemic respectively. Of the maternal-newborn factors tested, underweight in the first-trimester was a significant risk for anaemia (risk ratio:1.39; CI:1.08-1.95). Conclusion: Although consumption of iron-rich foods was not associated with Hb levels, it reduced the severity of anaemia. Low maternal first trimester BMI affected Hb levels at delivery. This reiterates the role of both nutritional and non-nutritional pre-conception interventions on anaemia prevention strategies.


Factors associated with compliance to recommended micronutrients uptake for prevention of anemia during pregnancy in urban, peri-urban, and rural communities in Southeast Nigeria.

Abstract: The study investigated the factors associated with compliance to the recommended ≥90-day uptake of micronutrients for prevention of iron-deficiency anemia during pregnancy in Nigeria.A cross-sectional study of 1500 women who had babies within 6 months prior to the survey, drawn from six urban, peri-urban, and rural local government areas in Enugu and Imo States of Nigeria, was conducted, using a structured questionnaire. A focus group discussion was held with grandmothers and fathers of the new baby. In-depth interviews were held with health workers.There were six demographic factors in the bivariate analysis: living in an urban center and close to health facility, and being wealthy, with post-secondary education as well as older and engaged in civil service showed significant association with compliance. The urban residents complied more than the peri-urban and rural residents (χ (2) = 12.749; p = 0.002). Those living close to the health facilities complied more than those living far away (χ (2) = 24.638; p < 0.001). Those in higher wealth quintile complied more (χ (2) = 13.216; p < 0.010). Utilization of antenatal clinics during pregnancy showed statistically significant association with compliance. Those who used the ANC services complied more than those that did not (χ (2) = 6.324; p = 0.010) and the more frequent the use of ANC services the more the compliance (χ (2) = 14.771; p < 0.001). These results were confirmed when the opinions expressed in the urban, peri-urban, and rural communities are compared. However, the multivariate binary logistic regression highlighted only urban residence, closeness to health facilities, and utilization of ANC services as positively associated with compliance.These findings could help in targeting health education program to increase compliance to the recommended uptake of micronutrients in prevention of anemia during pregnancy.

Pub.: 04 Nov '16, Pinned: 03 Jul '17

Maternal dietary intake during pregnancy and its association to birth size in rural Malawi: A cross-sectional study

Abstract: In low-resource settings, such as rural Malawi, pregnant women are prone to energy and micronutrient deficiencies with the consequence of delivering low-birth weight infants with higher risks of morbidity and mortality. This study aimed to examine the association between maternal dietary intakes during pregnancy and infant birth size. Dietary intakes of 203 pregnant women were assessed between 28 and 35 weeks of gestation and their infants' (n = 132) birth size measured. Intakes of energy, macronutrients, and 11 micronutrients were estimated using a 3-day interactive 24-hr diet recall. Semiquantitative data on food intakes for four additional days were also collected to assess food patterns. Using multilevel linear regression modeling, maternal intakes of carbohydrate were negatively associated with neonate length (β: −0.1; 95% CI: −0.2, 0.0 cm/E%) and abdominal circumference (β: −0.1, 95% CI: −0.2, 0.0 cm/E%), whereas intakes of fat were positively associated with neonate length (β: 0.1; 95% CI: 0.0, 0.2 cm/E%) and abdominal circumference (β: 0.1; 95% CI: 0.0, 0.2 cm/E%). Vitamin C intakes were positively associated with birth weight (β: 1.4; 95% CI: 0.5, 2.3 g/mg). The frequency of milk intake was positively associated with birth weight (β: 75.3; 95% CI: 13.6, 137.0 g/day). These findings offer practical suggestions for food-based interventions in the study area to promote inclusion of fat, vitamin C-rich foods, and milk in pregnancy.

Pub.: 19 Feb '17, Pinned: 03 Jul '17

[Prevalence and factors associated with anemia in pregnant women attending the General Hospital in Douala].

Abstract: Anemia is a public health problem, prevalent among children and women of childbearing age. Our study aims to determine the prevalence and factors associated with anemia in pregnant women at Douala General Hospital.We conducted a cross sectional study from July 2012 to July 2013. All consenting pregnant women attending antenatal consultation and having undergone complete blood count (CBC) were included in the study. Sociodemographic characteristics, individual's obstetrical history and the results of the CBC were recorded on a pre tested data collection sheet. Anemia was defined according to the WHO criteria. After some descriptive statistics, we performed a bivariate analysis using the Chi-square test and Fisher exact probability test in order to determine the factors associated with anemia. P value <0.05 was considered significant.A total of 415 pregnant women were enrolled in the study. Anemia prevalence was 39,8%. The average age was 29,89±4,835 years. The mean hemoglobin level was 10.93 ± 1.23. Normochromic normocytic anemia (53,3%) was prevalent. Anaemia was severe in 2,4% of cases. Anemia in pregnancy was significantly associated with a personal history of chronic diseases (P = 0.02) and of anemia in a previous pregnancy (P = 0.003). Anemia was more frequently observed during the 3rd trimester (P = 0.04) and breastfeeding played a protective role (P = 0.02).The prevalence of anemia during pregnancy remains high. A better management of chronic diseases in pregnant women and of postpartum follow-up is necessary to treat anemia before a subsequent pregnancy.

Pub.: 16 Mar '17, Pinned: 03 Jul '17

Anemia in pregnancy in Western Jamaica.

Abstract: Anemia is one of the most prevalent problems in pregnancy. In 2011, 29.9% of all pregnant women in Jamaica were diagnosed with anemia.The objective of this study was to determine the prevalence and predictors of anemia in pregnancy in Western Jamaica.A cross-sectional study was conducted among 293 mothers attending post-natal clinics in Western Jamaica. A questionnaire was administered to the mothers, and an abstraction form was used to collect clinical data from the mothers' records.The prevalence of anemia among the women was 37.6%. Younger mothers (aged 18-24 years) were more likely to be anemic compared to those ≥35 years (odds ratio [OR]: 3.44, 95% CI: 1.07-11.06). Mothers who reported not always washing their hands after using the toilet were almost 10 times more likely to be anemic (OR: 9.7, 95% CI: 1.72-54.78) compared to those who reported always washing their hands. Mothers who attended a public facility for antenatal care were 2.3 times more likely to be anemic (OR: 2.31, 95% CI: 1.03-5.18) compared to those who obtained care at a private facility, and mothers who reported being told that they were anemic by a health care provider (HCP) were almost six times more likely to be anemic compared with those who were not told (OR: 5.58, 95% CI: 1.73-17.93).The results of the study indicate that early identification and treatment of anemia, especially among younger pregnant women, should be a priority. HCP should ensure that women understand the need to be cured of their anemia and to adhere to preventive hygienic practices.

Pub.: 28 Jun '17, Pinned: 03 Jul '17

Impact of Second Trimester Maternal Dietary Intake on Gestational Weight Gain and Neonatal Birth Weight.

Abstract: Poor maternal nutrition is a major contributor to the high incidence of low birth weight deliveries in developing countries. This study aimed to assess the impact of second trimester maternal dietary intake on gestational weight gain and neonatal birth weight. A longitudinal study was conducted in a tertiary care hospital in Sri Lanka. Participants were 141 pregnant women at 18-24 weeks gestation who were followed up until delivery. Maternal dietary intake was assessed using a validated Food Frequency Questionnaire at 21.1 ± 1.8 gestational weeks. Gestational weight gain was examined at the end of 28 weeks gestation and at the end of pregnancy. Energy and nutrient intakes were calculated using NutriSurvey 2007 (EBISpro, Willstaett, Germany) nutrient analysis software, modified for Sri Lankan foods. The mean total gestational weight gain of women with low carbohydrate intake (229-429 g/day) was 2.2 kg less than that of women with moderate carbohydrate intake (430-629 g/day) (95% confidence interval (CI) 0.428-4.083 kg; p = 0.016). Similarly, babies of women with low carbohydrate intake were 312 g lighter compared with those of women with a moderate carbohydrate intake (95% CI 91-534 g; p = 0.006). Our results suggest that second trimester maternal carbohydrate intake has significant impacts on total gestational weight gain and neonatal birth weight.

Pub.: 21 Jun '17, Pinned: 25 Jun '17

Influence of the Mediterranean diet during pregnancy in the development of wheezing and eczema in infants in Pamplona, Spain.

Abstract: This study examined the relationship between different food groups and the adherence to a Mediterranean diet during pregnancy and the risk of wheezing and eczema in children aged 12-15 months.The study involves 1087 Spanish infants from the International Study of Wheezing in Infants (Estudio Internacional de Sibilancias en Lactantes, EISL). The study of the association of the different food consumption and Mediterranean diet with wheezing, recurrent wheezing and eczema was performed using different models of unconditional logistic regression to obtain adjusted prevalence odds ratios (OR) and 95% confidence intervals (95% CI).No association was found between a good adherence to the Mediterranean diet during pregnancy and the development of wheezing (p=0.372), recurrent wheezing (p=0.118) and eczema (p=0.315). The consumption once or twice a week of white fish (OR: 1.95[1.01-3.75]), cooked potatoes (OR: 1.75[1.22-2.51]) and industrial pastry (OR: 1.59[1.13-2.24]), and the consumption more than three times a week of industrial pastry (OR: 1.47 [1.01-2.13]) during pregnancy increases the risk of "wheezing" at 12 months. Instead, high fruit consumption during the pregnancy has a protective effect against "wheezing" in 12-month-old infants (OR: 0.44 [0.20-0.99]). No statistically significant differences were observed between food intake during pregnancy and "recurrent wheezing". No statistically significant differences were observed between the consumption of any food during pregnancy and the presence of eczema at 12 months.The present study showed that the consumption of Mediterranean diet during pregnancy did not have a protective effect for wheezing, recurrent wheezing or eczema.

Pub.: 21 Jun '17, Pinned: 25 Jun '17

Should women be advised to use calcium supplements during pregnancy? A decision analysis

Abstract: Adequate calcium intake during pregnancy is important in the prevention of pre-eclampsia. A substantial proportion of pregnant women do not meet the recommended daily calcium intake, even in developed countries. Nonetheless, calcium supplementation is not routinely advised to pregnant women in most countries. We aimed to predict the impact of advising pregnant women to use calcium supplements (1,000 mg/day) on the number of cases of pre-eclampsia prevented and related health care costs. By use of a decision-analytic model, we assessed the expected impact of advising calcium supplementation to either (1) all pregnant women, (2) women at high risk of developing pre-eclampsia, or (3) women with a low dietary calcium intake compared with current care. Calculations were performed for a hypothetical cohort of 100,000 pregnant women living in a high-income country, although input parameters of the model can be adjusted so as to fit other settings. The incidence of pre-eclampsia could be reduced by 25%, 8%, or 13% when advising calcium supplementation to all pregnant women, women at high risk of pre-eclampsia, or women with a low dietary calcium intake, respectively. Expected net financial benefits of the three scenarios were of €4,621,465, €2,059,165, or €2,822,115 per 100,000 pregnant women, respectively. Advising pregnant women to use calcium supplements can be expected to cause substantial reductions in the incidence of pre-eclampsia as well as related health care costs. It appears most efficient to advise calcium supplementation to all pregnant women, not subgroups only.

Pub.: 18 Jun '17, Pinned: 25 Jun '17

Is improvement in the Healthy Food Intake Index (HFII) related to a lower risk for gestational diabetes?

Abstract: The aim was to analyse whether changes in the Healthy Food Intake Index (HFII) during pregnancy are related to gestational diabetes (GDM) risk. The 251 pregnant women participating had a pre-pregnancy BMI≥30 kg/m2 and/or a history of GDM. A 75 g oral glucose tolerance test (OGTT) was performed during the first and second trimesters of pregnancy for assessment of GDM. A normal OGTT result at first trimester was an inclusion criterion for the study. FFQ collected at first and second trimesters served for calculating the HFII. A higher HFII score reflects higher adherence to the Nordic Nutrition Recommendations (NNR) (score range 0-17). Statistical methods included Student's t test, Mann-Whitney U test, Fisher's exact test and linear and logistic regression analyses. The mean HFII at first trimester was 10·1 (95 % CI 9·7, 10·4) points, and the mean change from the first to the second trimester was 0·35 (95 % CI 0·09, 0·62) points. The range of the HFII changes varied from -7 to 7. The odds for GDM decreased with higher HFII change (adjusted OR 0·83 per one unit increase in HFII; 95 % CI 0·69, 0·99; P=0·043). In the analysis of the association between HFII-sub-indices and GDM, odds for GDM decreased with higher HFII-Fat change (fat percentage of milk and cheese, type of spread and cooking fats) but it was not significant in a fully adjusted model (P=0·058). Dietary changes towards the NNR during pregnancy seem to be related to a lower risk for GDM.

Pub.: 26 May '17, Pinned: 25 Jun '17