RELATIONSHIP BETWEEN DIETARY PATTERN, ANTHROPOMETRIC, BIOCHEMICAL INDICES, AND BIRTH OUTCOME AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINIC AT YUSUF DANTSOHO MEMORIAL HOSPITAL

ABSTRACT

Improper nutrition in pregnancy leads to unfavorable pregnancy outcome which can further influence maternal and newborn health status. This longitudinal study was undertaken to find out the relationship between maternal dietary pattern, anthropometric and some haematologicalindices, lipid profile with birth outcome among pregnant women in their 3^rd trimester attending antenatal clinic at Yusuf Dantsoho Memorial Hospital, Tudun Wada, Kaduna. A validated semi structured questionnaire was administered to pregnant women to elicit information on maternal dietary pattern and demographic. Sixty seven mothers – baby pair participated in the study. Weight, height, and MUAC ofmothers were measured with unclothed newborn length, weight, head and chest circumference also taken. Determination of maternal serum lipid profile and some serum minerals (copper, zinc and iron) were done using standard methods. Hemoglobin and packed cell volume determination was conducted using hemoglobinometer. Data obtained was analyzed using SPSS version 20.0 statistical software with One way ANOVA, student’s t-test to compare the means and Pearson correlation coefficients to know the relation between parameters. Results obtained shows mean maternal age, weight, height, and MUAC of31.20±8.40years, 70.37±12.73kg, 1.620±0.07m, 26.65±4.08cm, and 26.63±3.80kg/m² respectively. Majority of the pregnant women(77.60%) had good nutritional status while 16.40%, 6.00% are moderately and severely malnourished respectively. Maternal dietary pattern showed daily to weekly intake of all the food groups with less than 50% except for bread and cereals which is more than 50%. Maternal mean intake of total protein and total calories was close to the recommended daily intake of 60- 75 kg/day, and 2500 – 3000 kcal respectively. Maternal Heamatological level indicates 34.3% mildly anemic. Maternal reference range of serum total cholesterol (5.67 - 9.04 mmol/l), Low density cholesterol (2.62 - 5.80 mmol/l) and triglycerides (3.39 - 5.10mmol/l), zinc (7.7 – 11.8µmol/l), and iron (5 - 35µmol/l) were comparedwith recorded respondent serum micronutrient level and found to be within reference ranges except HDL-cholesterol and serum copper which were above recommended range. Newborn anthropometric measurements indicated that61.20%were mildly stunted, 70.10% mildly underweight, and 62.70% moderately wasted neonates.Head and chest circumference are within the normal range. Maternal anthropometry and dietary pattern showed a positive correlation with birth outcome and also maternal serum lipid profile except triglycerides that showed no relationship with birth outcome.

CHAPTER ONE

1.0 INTRODUCTION

1.1 Background of the Study

When a woman is expecting a baby, the quantity and quality of nourishment is of particular importance (Barker, et al, 2006). Nutrition during pregnancy plays a key role in well-being of the mother and newborn infant and further influences health during childhood and adulthood(Harding 2001). Horton (2008) reported that maternal undernutrition is a leading cause of maternal and child mortality and morbidity. Inadequate nutrition during pregnancy leads to adverse consequences like spontaneous abortion, intrauterine growth retardation, impaired learning ability and offspring behavioral problems and poor gestational weight gain (Higgins 2012). Assessment of dietary intake during pregnancy is very important because both nutrient deficiencies and excesses can have adverse effects on pregnancy outcome (Worthington-Robertet al., 2006).

According to Kazauraet al., (2011), many risk factors influence neonatal mortality which includematernal parity,age, race, marital status, birth weight, smoking, gestation age, labour complications, antenatal care, malaria and HIV infection and poor socio-economic conditions, maternal history of pregnancy complication like stillbirth, neonatal deaths, and maternal morbidity. Dietary pattern composed of dietary behavior of a population through food and nutrient-group analyses. Therefore it is moreinclined to public health nutrition recommendations than analyses that focus on single nutrients (Ramos-colon et al., 2015).

An anthropometric measurement isone of the most effective tools frequently usedfor assessing nutritional status of pregnant women. It is atool useful for prevention of prenatal mortality and morbidity, prediction of child health, and promotion of women's health (Oliveira etal., 2004).Assessing pregnant women nutritionalstatus by anthropometric measurements is a promising means of improving fetal growth (Okekeetal.,2011).Insufficient and excessive maternal gestation weight gain are strongly related to fetal complications like pregnancy inducedhypertention,gestational diabetes, microsomia, and low birth weight (Scotland et al., 2005; WHO 2006).

1.2 Statement of the Problem

Malnutrition is a problem among women which poses a great challenge thatmake maternal ill-health a global burden which needs to be addressed (NDHS, 2013).Malnutrition is one of the major cause of maternal mortality and determinant of a successful pregnancy and birth outcome. The relationship between maternal nutrition and birth outcome is conflicting and intermingled by many factors like biological, socioeconomic, and demographic factors(Villaret al., 2003; Blumenshineet al., 2010).Consequential effect of maternal malnutrition does not just affect the pregnant woman but also has a devastating effect on the fetus (WHO 2012) Unfortunatelyin developing countries, pregnant women are nutritionally the most insecure group and many expectant mothers do not receive optimum level of essential nutrients during their gestational period (Tianan 2005).

Nearly 4 million newborns die within 28 days of birth (Population Reference Bureau 2006; WHO 2012; Addai 2010) with more millions suffering from, disease, infection,injuryand disability. Almost equal percent (98%) of the world neonatal deaths and stillbirths are from developing countries, while the highest proportion are from sub-Saharan Africa (Kazauraet al., 2011). According to UNICEF(2011)more than half a million women die from causes related to pregnancy and childbirth yearly. Maternal mortality rate for a woman in the developing countries is 300 times greater than for women living in the developed countries (UNICEF2011).Ninety five percent(95%) of the world’s maternal mortality are from Africa and Asia (WHO 2012) with precisely 50% of the global total coming from Sub-Saharan Africa and 35% from South Asia. In 2008, maternal death ratio in Kaduna city was 800/100,000 live births which is, about 1 death for every 125 pregnant women.In 2003, the North West zone has the highest proportion (27 percent) of children reported weighing less than 2.5 kg at birth, more than a third (36 percent) of children whose birth weights are known in Kaduna weighed less than 2.5 kg at births (NDHS 2013). Infant mortality rate in Kaduna city was 115 per 1,000 live births(Nigerian Urban Reproductive Health Initiative, 2014).Although, research findings on the importance of maternal nutrition to fetal development and birth outcomes has obviously been demonstrated in experimental animal studies (Northstoneet al., 2011), the findings of studies in humans are much less dependable, due, to secondary factors that differ from study to study like baseline maternal nutritional status, socioeconomic status of the study population, timing and methods of assessing maternal nutritional variables(Northstoneet al., 2011).

In addition, there is presently no data on dietary pattern, nutritional status and birth outcome among pregnant women in Kaduna, Nigeria. This study tends to investigate the relationship between dietary pattern, nutritional status and birth outcome among pregnant mothers attending antenatal clinic at Yusuf Dantsoho Memorial Hospital Kaduna.

1.3 Justification

Poor maternal nutritional status is a risk factor of public health importance that can be changed and integrated into efforts to prevent adverse birth outcomes, especially among economically developing orlow-income populations (Fallet al., 2011). A nutritionally adequate dietary pattern is important throughout the trimesters to ensure a healthy pregnancy and baby (Pickelet al., 2005). Pregnant women in developing country have been reported to consume diets deficient in both macro and micronutrients (Raoet al., 2010). There is limited data on dietary pattern and micronutrient status of pregnant women in Kaduna, the capital city of Kaduna State, north western Nigeria.

The outcome of this study may contribute to understanding the relationship between maternal dietary pattern, anthropometric indices and birth outcomes which may provide a basis for developing nutritional interventions in order to address the problem. Therefore, the present study wascarried out among pregnant women residing in Kaduna metropolis attending Yusuf Dantsoho Memorial Hospital, Kaduna.

1.4 AIM AND OBJECTIVES 

1.4.1 Aim

The aim of this study is to investigate the relationship between maternal dietary pattern, anthropometric, heamatological, and biochemical indices and birth outcome among pregnant women attending Yusuf Dantsoho Memorial Hospital, Kaduna.

1.4.2 Specific Objectives 

1. To assess dietary pattern and anthropometric indices of pregnant women in third trimester of pregnancy.

2. To determine the level of some heamotological parameters(packed cell volume,heamoglobin),lipid profile (cholesterol, triglycerides) and some serum minerals (Iron, Copper, Zinc) among pregnant women in their third trimester of pregnancy.

3. To assess the nutritional status of neonate using anthropometry.

1.5       Research Null Hypothesis

Ho: There is no relationship between dietary patterns, anthropometric indices of pregnantwomen and birth outcome.

HI:There is relationship between dietary patterns, anthropometric indices of pregnant women and birth outcome.

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