DIET HISTORY AND BIRTH WEIGHT RELATIONSHIP AMONG SAUDI PREGNANT WOMEN

Originl Article DIET HISTORY AND BIRTH WEIGHT RELATIONSHIP AMONG SAUDI PREGNANT WOMEN Ahmed A. Al-Shoshn 1 ABSTRACT Objective: The im of this study ws to see the reltionship between food intke pttern nd its effect on birth weight. Subjects nd Methods: 1771 Sudi pregnnt women who were dmitted for delivery t the government mternity hospitls in Riydh city of Sudi Arbi who gve birth to singleton live-born bbies were interviewed immeditely fter delivery. Results: During the pregnncy the verge energy nd protein intkes were 1815.7±624Cl. nd 86±30.9g, respectively. Intkes of vitmins A nd B12 supply 90% nd 92% of RDA for ech nutrient, respectively. The intke of 94%, 91% nd 90% of women were below 85% of RDA for folte, iron nd vitmin B1, respectively. Conclusions: Mothers of hevier infnts hve significntly higher verge intke of most nutrients. Intke level of individul nutrients correltes significntly with NAR index which prllel the findings for individul nutrient intkes nd ws the only vrible in the regression eqution clculted. KEY WORDS: Pregnncy, Mternl nutrition, Birth weight. INTRODUCTION Pregnncy is nturl phenomenon during which women encounter wide rnge of internl physicl nd emotionl chnges. Quntifiction of the impct of nutrition on humn reproductive performnce is importnt to plnners nd to justify investment in mternl nutrition progrms. This impct should reside in the current pregnncy for intervention to be effective. 1 Pregnncy nd the outcome growth re ffected by mternl nd vrious environmentl nd demogrphic fctors. 2 Growth in the intruterine phse is 1. Ahmed A. Al-Shoshn Associte professor Food Science nd Nutrition Deprtment College of Food nd Agriculturl Sciences King Sud University, Riydh - Sudi Arbi. Correspondence Ahmed A. Al-Shoshn E-mil: Drhmedn@hotmil.com * Received for Publiction: December 28, 2006 * Revision Received: Jnury 5, 2007 * Finl Revision Accepted: Mrch 11, 2007 Pk J Med Sci April 2007 Vol. 23 No. 2 176-181 dependent upon genetic fctors nd environmentl support. Plcentl fctors include vsculr bnormlities, plcentl hormones nd hypoxi. Chromosoml bnormlities or syndromes within the fetus itself influence fetl growt. 3 Becuse birth weight is often used s n indictor of the successful outcome of pregnncy, studies hve ttempted to explin vribility in birth weight ttributble to these fctors. 4-8 The positive reltionship between mternl nutrition nd birth weight hs been reported under cute strvtion 9-11 but less cler with moderte levels of mlnutrition. 12-14 In generl, some studies hve included dietry fctors 4,15 nd/or exmine overll dietry qulity s n independent vribl. 16 Assessment of dietry intke during pregnncy is importnt becuse it is well estblished tht both nutrient deficiencies nd excesses cn hve dverse effects on pregnncy outcome. 17 Among groups of pregnnt women in Sudi Arbi, deficiency of Vitmin D, nutrition knowledge nd food hbits hs been studied. 18-21 The effect on birth weight in 176 Pk J Med Sci 2007 Vol. 23 No. 2 www.pjms.com.pk

Mternity reserch reltion to other fctors ws lso investigted. 22 However, literture on the nutritionl sttus of Sudi pregnnt women is scrce, nd the reltionship between mternl nutrition nd the birth weight of infnts demnd further ttention. This study ws designed to mesure the dietry intke nd nutrition dequcy of Sudi women throughout pregnncy nd to relte the birth weight of infnt born to these nutritionl fctors. SUBJECTS AND METHODS A totl of 1771 Sudi pregnnt women were interviewed soon fter delivery for their food intke during the current pregnncy. The dt were collected 24 hours fter delivery from women delivered t the government mternity hospitls in Riydh city. A structured food frequency recll questionnire ws used in which most common food items were included. Additionl items of food were lso incorported ccording to the mother s consumption. The foods were grouped into exchnge lists, their nutrient content nlyzed nd food scores clculted with mximum score of 25 for ech of the food groups. All figures were compred to the Recommended Dietry Allownces (RDAs) for pregnnt women. 23 The dt ws then used to estimte intke levels of energy, twelve nutrients nd five food groups, nd to clculte nutrient dequcy rtio index (NAR). Nutrients estimted were protein, vitmin A, vitmin C, vitmin B1, vitmin B2, vitmin B6, vitmin B12, clcium, phosphorus, Iron nd folte. The food groups were milk, fruit, vegetble, cerel nd met group. The NAR index for ech pregnnt women ws obtined by converting intke to percentge of RDA for 12 nutrients, truncting mounts over 100% so tht excessive mounts of some nutrients would not ffect the index, nd then verging the percentges, procedure similr to tht used by Philipps nd Johnson. 15 Dt on neontl outcome ws obtined from the bbies medicl records for singleton live-born bbies. To relte infnt birth weight to food intke nd nutrition dequcy of expecting mother, pregnnt women under study were grouped ccording to their intke bove nd below the RDA level for ech nutrient. The resulting verge birth weight ws then clculted. Averge intke from ech nutrient nd food group ws lso determined for the mothers hving bbies with weight below nd bove 2500g. Dt coding ws crried out using commercil Dbse IV nd the subsequent nlyses were performed by the use of SPSS/PC+ sttisticl pckge. RESULTS The verge of dily intkes, intke s percentge of the RDA nd the percentge of women with intke below 85% of the RDA for energy nd selected nutrients re presented in Tble-I. Averge energy nd protein intke were 1815.7±624 Cl nd 86±30.9g which provided round 65.7% nd 96.0% of the recommended levels of ech respectively. Pregnnt women hd n intke levels tht supply 90.5% nd 92% of RDA for vitmins A nd B12 respectively. Folte, Iron nd vitmin B1 intkes were below 85% of RDA for 94%, 91% nd 89.6% of women respectively. The verge intke ws less thn the RDA for zinc followed by mgnesium, nd meet the recommended for nicin. The verge NAR index ws 69.17% of totl RDA for the 12 nutrients included. Averge score of intke of food groups nd the percentge of women with intke below 85% of the RDA exchnge for ech group re shown in Tble-II. The consumption of milk, met, nd vegetble groups fill below 85% of the RDA for 85.7%, 79.4%, nd 53.3% of the pregnnt women respectively, nd meet the recommended exchnges mong 81.8% nd 84.2% women for fruit nd cerel groups respectively. The NAR index prllel the findings for individul nutrient intkes. Tble-III presents the verge of infnt birth weight for women with intke below nd bove RDA levels for ech nutrient. Averge birth weight ws slightly higher mong mothers with intke bove 85% of the recommended, compred to those with less intke. The birth Pk J Med Sci 2007 Vol. 23 No. 2 www.pjms.com.pk 177

Ahmed A. Al-Shoshn Tble-I: Averge dily intkes; the verge intke s percentge of the RDA nd the percentge of women with intke below 85% of the RDA for energy nd selected nutrients. Nutrient Men ± SD RDA intkeof RDA % below 85% RDA b Clorie (Cl) 1815.74 ± 624.06 2700 65.70 ± 19.58 54.5% Protein (g) 85.99 ± 30.90 60 96.03 ± 11.04 9.8% Vitmin A (Mg RE) 1034.96 ± 480.02 800 90.45 ± 18.19 29.3% Vitmin C (mg) 75.87 ± 43.07 70 82.40 ± 22.92 40.5% Folte (Mg) 77.75 ± 26.74 400 19.43 ± 6.69 94.0% Vitmin B1 (mg) 71.00 ± 0.27 1.5 46.84 ± 17.48 89.6% Vitmin B2 (mg) 1.77 ± 0.80 1.6 86.79 ± 19.33 29.5% Vitmin B6 (mg) 1.27 ± 0.51 2.2 56.85 ± 21.41 72.4% Vitmin B12 (Mg) 3.12 ± 1.58 2.2 91.97 ± 16.83 19.3% Clcium (mg) 897.17 ± 450.68 1200 68.46 ± 25.10 72.2% Phosphorus (mg) 1253.32 ± 467.96 1200 87.63 ± 17.73 37.9% Iron (mg) 11.22 ± 4.19 30 37.37 ± 13.97 91.1% Mgnesium (mg) 246.33 ± 97.74 320 Zinc (mg) 6.49 ± 2.79 15 Nicin (mg NE) 17.81 ± 7.85 17 Crbohydrte (g) 250.92 ± 101.04 Totl Ft (g) 43.49 ± 18.37 Cholesterol (mg) 286.01 ± 151.92 NAR index 69.17 ± 13.70 The verge of intke mong pregnents s percentge of RDA for ech nutrient. b The percentge with intkes below 85% of the RDA. weight difference ws significnt with higher intke of vitmin A, vitmin C, phosphorus (P<0.001), vitmin B2 (P<0.05), nd ws insignificnt in respect to energy nd other nutrients including protein intke. Mens of intke for mothers with birth weight below nd bove 2500g for nutrient nd food groups re presented in Tble-IV nd Tble-V respectively. Mothers with infnt weight over 2500g show significnt higher intke of energy nd nutrients, except Nicin. Their RNA index ws 69.50±13.47% which is significntly higher thn tht for those with smller infnt weight, 65.34±15.72. DISCUSSION In simple correltion test, intke level of individul nutrients correltes significntly with overll dequcy mesured by RNA index (P<0.001). Both show no correltion with the resulting birth weight of infnts. In multiple regression stepwise method, to predict birth weight, the totl R 2 ws 0.069, with RNA index being the only vrible in the eqution. An pproprite eting pttern is essentil throughout the childbering yers nd during pregnncy to ensure helthy pregnncy nd bby. 24 In country such s Sudi Arbi where food is esily vilble, nutritionl sttus of women during the course of pregnncy is expected to be comptible to those in other societies with similr stndrds of living. In this study the verges of intke of Sudi pregnnt women for energy nd selected nutrients were compred to the recommended dily llownce. Pregnnt women in this study found to consume on verge 65.7±20% of the recommended clories which left more thn 54.5% of them below two third of RDA level. Almost ll pregnnt women included hd level of intke fr below the recommended from Tble-II: Scores of intke of food groups nd the percentge of women with intke < 85 % of the RDA exchnges. Food Men+SD RDA % women groups Exchnge below 85 % of RDA Milk 15.92 ± 6.95 4-5 85.7 Fruit 23.26 ± 4.23 2-3 18.2 Vegetble 21.11 ± 2.51 2-3 53.3 Cerel 23.62 ± 3.67 4-6 15.8 Met 19.24 ± 6.15 7-8 79.4 Mximum score is 25. 178 Pk J Med Sci 2007 Vol. 23 No. 2 www.pjms.com.pk

Mternity reserch Tble-III: mens of birth weight for women with itke < nd >RDA levels for ech nutrient. Nutrient Birth Weight Men ± SD Group 1 Group 2 b P Vlue Clorie 3194.83 ± 595.21 3227.14 ± 521.22 0.22 Protein 3181.42 ± 615.30 3212.56 ± 557.00 0.48 Vitmin A 3151.23 ± 609.62 3233.71 ± 540.67 0.001 Vitmin C 3163.82 ± 599.59 3240.67 ± 534.42 0.001 Folte 3209.53 ± 562.84 Vitmin B1 3207.63 ± 566.61 3250.63 ± 474.98 0.50 Vitmin B2 3164.90 ± 599.98 3228.24 ± 545.68 0.02 Vitmin B6 3204.00 ± 574.57 3224.04 ± 531.11 0.50 Vitmin B12 3177.60 ± 581.79 3217.16 ± 558.15 0.24 Clcium 3209.38 ± 580.06 3209.91 ± 516.04 Phosphorus 3162.86 ± 598.21 3238.01 ± 538.41 0.003 Iron 3209.19 ± 564.54 3246.87 ± 330.38 0.78 Birth weight for group of mothers with intke < 85% of the RDA. B Birth weight for group of mothers with intke 85% of the RDA. folte, iron nd vitmin B1. Met, milk nd vegetble groups were below the consumption level expected. In interpreting the insufficient intke observed, certin fctors re worth mentioning. First, this study ws crried out t government hospitls in which lrger percentge of deliveries re tht for women of low nd middle socioeconomic levels. Second, the RNA index vlue obtined prllel the findings for individul nutrient intkes which my support its use s better overll mesure to test the dequcy of mother s diet. In this regrd, the qulity of the mother s diet expressed s NAR index determined by this study is somewht comprble to tht of Americn women, 74.7±12.8. 17 Birth weight ws slightly ffected by level of intke of most nutrients nd food groups (Tbles III-V). Higher intke nd higher RNA index, on verge, resulted on hevier bbies nd smller bbies were born to mothers who hd less intke of nutrients nd food groups during pregnncy. However, Hutcheon, et l 25 relted higher birth weights to incresed mternl ge, pre-pregncy body mss index, weight gin during pregnncy nd crbohydrte intke. Such reltive dequcy of nutrients nd food choice of food groups s found in this study did not, on verge, determine (insignificnt figures) the positive effect on birth weight. The bsence of meningfull positive correltion between either individul nutrients Tble IV: Mens of intke for mothers with birth weight < nd >2500g for selected nutrients. Nutrient Intke (Men ± SD) Group 1 Group 2 b P Vlue Clorie (Cl) 1692.28 ± 593.34 1826.51 ± 625.69 0.01 Protein (g) 79.69 ± 28.94 86.54 ± 31.01 0.01 Vitmin A (Mg RE) 895.93 ± 441.17 1047.09 ± 481.48 0.004 Vitmin C (mg) 69.36 ± 40.17 76.43 ± 43.27 0.05 Folte (Mg) 72.97 ± 27.66 78.16 ± 26.62 0.02 Vitmin B1 (mg) 0.64 ± 00.24 0.71 ± 0.27 0.00 Vitmin B2 (mg) 1.57 ± 00.69 1.79 ± 0.80 0.001 Vitmin B6 (mg) 1.17 ± 00.50 1.27 ± 0.51 0.02 Vitmin B12 (Mg) 2.80 ± 01.27 3.15 ± 1.60 0.01 Clcium (mg) 809.70 ± 413.75 905.89 ± 453.05 0.01 Phosphorus (mg) 1150.28 ± 443.13 1262.31 ± 469.11 0.003 Iron (mg) 10.27 ± 3.99 11.29 ± 4.20 0.001 Mgnesium (mg) 225.12 ± 94.06 248.17 ± 97.86 0.001 Zinc (mg) 5.94 ± 02.45 6.53 ± 2.80 0.01 Nicin (mg NE) 16.95 ± 07.29 17.88 ± 7.89 0.17 Crbohydrte (g) 234.37 ± 93.10 252.36 ± 101.60 0.04 Totl Ft (g) 39.68 ± 17.04 43.81 ± 18.45 0.003 Cholesterol (mg) 259.84 ± 143.54 288.29 ± 152.46 0.03 NAR index 65.34 ± 15.72 69.50 ± 13.47 0.002 Mothers with newnte birth weight < 2500g. b Mothers with newnte birth weight 2500g. Pk J Med Sci 2007 Vol. 23 No. 2 www.pjms.com.pk 179

Ahmed A. Al-Shoshn Tble-V: mens of intke for mothers with birth weight < nd 2500 g for food groups. Food Men±SD Intke score P Vlue groups Men±SD Group 1 Group 2 b Milk 15.92 ± 6.95 14.80 ± 7.27 16.02 ± 6.92 0.04 Fruit & Veg 23.26 ± 4.23 22.56 ± 4.85 23.32 ± 4.17 0.04 Cerel 23.62 ± 3.67 23.26 ± 3.94 23.65 ± 3.65 0.21 Met 19.24 ± 6.15 18.14 ± 6.48 19.33 ± 6.11 0.02 Mothers with newnte birth weight <2500g. b Mothers with newnte birth weight >2500g. or food group intkes nd birth weight indicte tht birth weight ws not determinl fctor mong mothers, regrdless of their level of intke. The NAR index being the only vrible in the regression eqution clculted, support its use s better determinnt of birth weight. Studies investigting the ssocition between women diet nd the outcome of pregnncy, reported inconsistent results. 26 In their study, Seiler nd Fox 27 found no significnt correltion between dietry score nd birth weight. This bsence of cler reltionship between birth weight nd food intke during pregnncy on those studies could be due in prt to the fct tht most of the women of the studied popultions were reltively well noriushed. In this study, the verge intke ws insufficient indictor of birth weight for both groups. Furthermore, the number of women included in this study, hving n outcome with birth weight <2500g ws 140 compred to 1631 women who gve birth weight >2500g. Although there is evidence for the importnce of mternl nutrition s determinnt of the course nd outcome of pregnncy, inconsistent results being reported from ttempts to find direct correltion between diet nd birth weight of infnts. 1,17 There ppers to be miniml level of nutrients which must be vilble in order to obtin dequte birth weight. However, bove this minimum level, pregnnt women cn dpt themselves to wide vriety of food intke, both in quntity nd qulity, without ffecting birth weight. 28 In conclusion, the observed low intke of energy my divert the use of sufficient ingested protein s source of energy nd in turn my mke such diet indequte even for protein. The mounts of iron nd folte provided in the pregnnt women s diet, could not meet the gretly incresed requirements during this stte of life. And even though those nutrients re widely supplemented for pregnnt women round the country, the observed mgnitude of their deficiency should rise helth concern nd worth deeper investigtion. In this respect, Turner, et l 29 concluded tht the prticipnts in their study did not consume dequte mounts of iron from food to meet the needs of pregnncy, nd therefore iron supplementtion is wrrnted in tht popultion. The verge diet (s reveled in this study) is deficient in importnt nutrients nd the importnce of micronutrients, specilly of plnt source, is to be ddressed long with vitmin D nd clcium which hs been proven by others s deficient. 23,18 The uprise for nutrition wreness progrms mong pregnnt women is recommended. Food preferences should be encourged to ccommodte suitble sources in term of dequte energy nd micronutrient intkes. The fct tht the verge of low birth weight rte is within n cceptble figure should not led to overlooking of other less observed signs nd effects of nutrient deficiencies. However, there could be other fctors responsible for low birth weight in spite of mternl nutrition. ACKNOWLEDGEMENT The uthor would like to cknowledge the unfiling support nd ssistnce provided by ll concerned personl nd employees of the Helth Ministry nd The Nutrition Deprtment in Riydh. REFERENCES 1. Bergner L, Susser MW. Low birth weight nd prentl nutrition: n interprettive review. Peditrics 1970;46:946-56. 2. Musiger AO. Fctors ssocited with birthweight in Bhrin. J Trop Medicine Hygience 1985;88:31-6. 3. Gokhle R, Kirschner BS. Assessment of growth nd Nutrition. Best prctice nd Reserch Clinicl Gstroenterology 2003;17(2):153-62. 180 Pk J Med Sci 2007 Vol. 23 No. 2 www.pjms.com.pk

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