Maternal nutritional adequacy and gestational weight gain and their associations with birth outcomes among Vietnamese women

Nga Thuy Tran, Lam Thi Nguyen, Yatin Berde, Yen Ling Low, Siew Ling Tey, Dieu Thi Thu Huynh, Nga Thuy Tran, Lam Thi Nguyen, Yatin Berde, Yen Ling Low, Siew Ling Tey, Dieu Thi Thu Huynh

Abstract

Background: During pregnancy, a mother's nutritional needs increase to meet the added nutrient demands for fetal growth and development. An enhanced understanding of adequate nutrition and sufficient weight gain during pregnancy can guide development of policies and strategies for maternal nutrition care, actions that will ultimately promote better pregnancy outcomes. In a sample of pregnant women in Vietnam, this study characterized maternal nutrition status and gestational weight gain at a mid-pregnancy baseline, then examined the association of these variables with specific birth outcomes.

Methods: The study used baseline data from a randomized, controlled trial that compared pregnant Vietnamese women who received a nutritional intervention group with those who received only standard dietary counseling (control group). At baseline (26-29 weeks gestation), mothers' dietary reports were collected, and intake of 10 macro- and micronutrients was estimated; data for baseline gestational weight gain was collected for all pregnant women enrolled into the study (n = 228). This analysis also used weights, lengths, and head circumferences at birth for infants of mothers in the control group.

Results: At baseline, 95% of the pregnant women had concurrent inadequacies for more than five nutrients, and nearly half had concurrent inadequacies for more than ten nutrients. Almost two-thirds of the pregnant women did not meet recommendations for gestational weight gain. We found a significant, inverse association between the number of nutrient inadequacies and gestational weight gain (overall p ≤ 0.045). After adjusting for potential confounders, gestational weight gain was positively associated with birth weight, length at birth, birth weight-for-age z-score and length-for-age z-score (all p ≤ 0.006).

Conclusions: Our findings raise concern over the high proportion of pregnant women in Vietnam who have multiple concurrent nutrient inadequacies and who fall short of meeting recommended gestational weight gain standards. To ensure better birth outcomes in this population, policies and strategies to improve the status of maternal nutrition are greatly needed.

Trial registration: The trial was retrospectively registered at clinicaltrials.gov on December 20, 2013, registration identifier: NCT02016586.

Keywords: Birth outcomes; Gestational weight gain; Maternal nutritional status; Nutritional adequacy.

Conflict of interest statement

SLT, YLL and DTTH are employees of Abbott Nutrition. YB is an employee of Cognizant Technologies Solution Pvt. Ltd., a Contract Research Organization providing statistical services to Abbott Nutrition.

Figures

Fig. 1
Fig. 1
Percentage of pregnant women with inadequate intake (n = 226)

References

    1. Gresham E, Byles JE, Bisquera A, Hure AJ. Effects of dietary interventions on neonatal and infant outcomes: a systematic review and meta-analysis. Am J Clin Nutr. 2014;100(5):1298–1321. doi: 10.3945/ajcn.113.080655.
    1. Gresham E, Bisquera A, Byles JE, Hure AJ. Effects of dietary interventions on pregnancy outcomes: a systematic review and meta-analysis. Matern Child Nutr. 2016;12(1):5–23. doi: 10.1111/mcn.12142.
    1. Nnam NM. Improving maternal nutrition for better pregnancy outcomes. Proc Nutr Soc. 2015;74(4):454–459. doi: 10.1017/S0029665115002396.
    1. Papathakis PC, Singh LN, Manary MJ. How maternal malnutrition affects linear growth and development in the offspring. Mol Cell Endocrinol. 2016;435:40–47. doi: 10.1016/j.mce.2016.01.024.
    1. Procter SB, Campbell CG. Position of the academy of nutrition and dietetics: nutrition and lifestyle for a healthy pregnancy outcome. J Acad Nutr Diet. 2014;114(7):1099–1103. doi: 10.1016/j.jand.2014.05.005.
    1. Bukhary NBI, Isa ZM, Shamsuddin K, Lin KG, Mahdy ZA, Hassan H, Yeop NSH. Risk factors for antenatal hypovitaminosis d in an urban district in Malaysia. BMC Pregnancy Childbirth. 2016;16(1):156. doi: 10.1186/s12884-016-0939-3.
    1. Ministry of Health and Sports (MoHS) and ICF . Myanmar demographic and health survey 2015–16. Pyi Taw and Rockville: Ministry of Health and Sports and ICF; 2017.
    1. Moench-Pfanner R, Silo S, Laillou A, Wieringa F, Hong R, Hong R, Poirot E, Bagriansky J. The economic burden of malnutrition in pregnant women and children under 5 years of age in Cambodia. Nutrients. 2016;8(5):292. doi: 10.3390/nu8050292.
    1. Sukchan P, Liabsuetrakul T, Chongsuvivatwong V, Songwathana P, Sornsrivichai V, Kuning M. Inadequacy of nutrients intake among pregnant women in the deep south of Thailand. BMC Public Health. 2010;10(1):572. doi: 10.1186/1471-2458-10-572.
    1. The Food and Nutrition Research Institute of the Department of Science and Technology (FNRIDOST). 8th national nutrition survey 2013. Philippines: Food and Nutrition Research Institute; 2017.
    1. Winichagoon P. Thailand nutrition in transition: situation and challenges of maternal and child nutrition. Asia Pac J Clin Nutr. 2013;22(1):6–15.
    1. Grieger J, Clifton V. A review of the impact of dietary intakes in human pregnancy on infant birthweight. Nutrients. 2015;7(1):153–178. doi: 10.3390/nu7010153.
    1. Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2017;(4):Art. No.: CD004905. 10.1002/14651858.CD004905.pub5.
    1. Martin JC, Zhou SJ, Flynn AC, Malek L, Greco R, Moran L. The assessment of diet quality and its effects on health outcomes pre-pregnancy and during pregnancy. Semin Reprod Med. 2016;34(02):83–92. doi: 10.1055/s-0036-1571353.
    1. Vaivada T, Gaffey MF, Das JK, Bhutta ZA. Evidence-based interventions for improvement of maternal and child nutrition in low-income settings: What's new? Curr Opin Clin Nutr Metab Care. 2017;20(3):204–210. doi: 10.1097/MCO.0000000000000365.
    1. Victora CG, de Onis M, Hallal PC, Blössner M, Shrimpton R. Worldwide timing of growth faltering: revisiting implications for interventions. Pediatrics. 2010;125(3):e473–e480. doi: 10.1542/peds.2009-1519.
    1. Canani RB, Di Costanzo M, Leone L, Bedogni G, Brambilla P, Cianfarani S, Nobili V, Pietrobelli A, Agostoni C. Epigenetic mechanisms elicited by nutrition in early life. Nutr Res Rev. 2011;24(2):198–205. doi: 10.1017/S0954422411000102.
    1. Danielewicz H, Myszczyszyn G, Dębińska A, Myszkal A, Boznański A, Hirnle L. Diet in pregnancy—more than food. Eur J Pediatr. 2017;176(12):1573–1579. doi: 10.1007/s00431-017-3026-5.
    1. Hanley B, Dijane J, Fewtrell M, Grynberg A, Hummel S, Junien C, Koletzko B, Lewis S, Renz H, Symonds M, et al. Metabolic imprinting, programming and epigenetics – a review of present priorities and future opportunities. Br J Nutr. 2010;104(S1):S1–S25. doi: 10.1017/S0007114510003338.
    1. Lowensohn RI, Stadler DD, Naze C. Current concepts of maternal nutrition. Obstet Gynecol Surv. 2016;71(7):413–426. doi: 10.1097/OGX.0000000000000329.
    1. Enomoto K, Aoki S, Toma R, Fujiwara K, Sakamaki K, Hirahara F. Pregnancy outcomes based on pre-pregnancy body mass index in japanese women. PLoS One. 2016;11(6):e0157081. doi: 10.1371/journal.pone.0157081.
    1. Pongcharoen T, Gowachirapant S, Wecharak P, Sangket N, Winichagoon P. Pre-pregnancy body mass index and gestational weight gain in thai pregnant women as risks for low birth weight and macrosomia. Asia Pac J Clin Nutr. 2016;25(4):810–817.
    1. Xiao L, Ding G, Vinturache A, Xu J, Ding Y, Guo J, Huang L, Yin X, Qiao J, Thureraja I, et al. Associations of maternal pre-pregnancy body mass index and gestational weight gain with birth outcomes in shanghai, China. Sci Rep. 2017;7:41073. doi: 10.1038/srep41073.
    1. Young MF, Hong Nguyen P, Addo OY, Pham H, Nguyen S, Martorell R, Ramakrishnan U. Timing of gestational weight gain on fetal growth and infant size at birth in Vietnam. PLoS One. 2017;12(1):e0170192. doi: 10.1371/journal.pone.0170192.
    1. Hanieh S, Ha TT, Simpson JA, Thuy TT, Khuong NC, Thoang DD, Tran TD, Tuan T, Fisher J, Biggs B-A. Postnatal growth outcomes and influence of maternal gestational weight gain: a prospective cohort study in rural Vietnam. BMC Pregnancy Childbirth. 2014;14(1):339. doi: 10.1186/1471-2393-14-339.
    1. Goldstein RF, Abell SK, Ranasinha S, et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA. 2017;317(21):2207–2225. doi: 10.1001/jama.2017.3635.
    1. Murai U, Nomura K, Kido M, Takeuchi T, Sugimoto M, Rahman M. Pre-pregnancy body mass index as a predictor of low birth weight infants in Japan. Asia Pac J Clin Nutr. 2017;26(3):434–437.
    1. Nomura K, Kido M, Tanabe A, Nagashima K, Takenoshita S, Ando K. Investigation of optimal weight gain during pregnancy for japanese women. Sci Rep. 2017;7(1):2569. doi: 10.1038/s41598-017-02863-1.
    1. Ota E, Haruna M, Suzuki M, Anh DD, Tho LH, Tam NTT, Thiem VD, Anh NTH, Isozaki M, Shibuya K, et al. Maternal body mass index and gestational weight gain and their association with perinatal outcomes in Viet Nam. Bull World Health Organ. 2011;89(2):127–136. doi: 10.2471/BLT.10.077982.
    1. Wrottesley SV, Lamper C, Pisa PT. Review of the importance of nutrition during the first 1000 days: maternal nutritional status and its associations with fetal growth and birth, neonatal and infant outcomes among african women. J Dev Orig Health Dis. 2016;7(2):144–162. doi: 10.1017/S2040174415001439.
    1. Berti C, Cetin I, Agostoni C, Desoye G, Devlieger R, Emmett PM, Ensenauer R, Hauner H, Herrera E, Hoesli I, et al. Pregnancy and infants’ outcome: nutritional and metabolic implications. Crit Rev Food Sci Nutr. 2016;56(1):82–91. doi: 10.1080/10408398.2012.745477.
    1. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, Ezzati M, Grantham-McGregor S, Katz J, Martorell R, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382(9890):427–451. doi: 10.1016/S0140-6736(13)60937-X.
    1. Kominiarek MA, Peaceman AM. Gestational weight gain. Am J Obstet Gynecol. 2017;217(6):642–651. doi: 10.1016/j.ajog.2017.05.040.
    1. Ahmed T, Hossain M, Sanin KI. Global burden of maternal and child undernutrition and micronutrient deficiencies. Ann Nutr Metab. 2012;61(Suppl. 1):8–17. doi: 10.1159/000345165.
    1. Christian P, Mullany LC, Hurley KM, Katz J, Black RE. Nutrition and maternal, neonatal, and child health. Semin Perinatol. 2015;39(5):361–372. doi: 10.1053/j.semperi.2015.06.009.
    1. Stevens B, Buettner P, Watt K, Clough A, Brimblecombe J, Judd J. The effect of balanced protein energy supplementation in undernourished pregnant women and child physical growth in low- and middle-income countries: a systematic review and meta-analysis. Matern Child Nutr. 2015;11(4):415–432. doi: 10.1111/mcn.12183.
    1. Yan J. Maternal pre-pregnancy bmi, gestational weight gain, and infant birth weight: a within-family analysis in the United States. Econ Hum Biol. 2015;18:1–12. doi: 10.1016/j.ehb.2015.03.002.
    1. Huynh Dieu T. T., Tran Nga T., Nguyen Lam T., Berde Yatin, Low Yen Ling. Impact of maternal nutritional supplementation in conjunction with a breastfeeding support program on breastfeeding performance, birth, and growth outcomes in a Vietnamese population. The Journal of Maternal-Fetal & Neonatal Medicine. 2017;31(12):1586–1594. doi: 10.1080/14767058.2017.1320984.
    1. Filmer D, Pritchett LH. Estimating wealth effects without expenditure data—or tears: an application to educational enrollments in states of India. Demography. 2001;38(1):115–132.
    1. Institute of Medicine (IOM) and National Research Council (NRC) Weight gain during pregnancy: Reexamining the guidelines. Washington, DC: The National Academies Press; 2009.
    1. Rahman MM, Abe SK, Kanda M, Narita S, Rahman MS, Bilano V, Ota E, Gilmour S, Shibuya K. Maternal body mass index and risk of birth and maternal health outcomes in low- and middle-income countries: a systematic review and meta-analysis. Obes Rev. 2015;16(9):758–770. doi: 10.1111/obr.12293.
    1. Ververs M-T, Antierens A, Sackl A, Staderini N, Captier V. Which anthropometric indicators identify a pregnant woman as acutely malnourished and predict adverse birth outcomes in the humanitarian context? PLoS Curr. 2013;5 ecurrents.dis.54a58b618c611bc031ea140e613f2934599c2934598.
    1. Vietnam National Institute of Nutrition . Vietnam recommended dietary allowances 2016. Hanoi: Medical Publishing House; 2016.
    1. Gibson RS. Evaluation of nutrient intakes and diets. In: Gibson RS, editor. Principles of nutritional assessment. New York: Oxford University Press; 2005. pp. 197–228.
    1. Who Multicentre Growth Reference Study Group Who child growth standards based on length/height, weight and age. Acta Paediatr. 2006;95:76–85. doi: 10.1111/j.1651-2227.2006.tb02378.x.
    1. Lee PA, Chernausek SD, Hokken-Koelega ACS, Czernichow P. International small for gestational age advisory board consensus development conference statement: management of short children born small for gestational age, april 24–october 1, 2001. Pediatrics. 2003;111(6):1253–1261. doi: 10.1542/peds.111.6.1253.
    1. Laillou A, Pham TV, Tran NT, Le HT, Wieringa F, Rohner F, Fortin S, Le MB, Tran DT, Moench-Pfanner R, et al. Micronutrient deficits are still public health issues among women and young children in Vietnam. PLoS One. 2012;7(4):e34906. doi: 10.1371/journal.pone.0034906.
    1. Tu N, King JC, Dirren H, Thu HN, Ngoc QP, Diep ANT. Effect of animal-source food supplement prior to and during pregnancy on birthweight and prematurity in rural Vietnam: a brief study description. Food Nutr Bull. 2014;35(4 Suppl):S205–S208. doi: 10.1177/15648265140354S307.
    1. Vietnam Ministry of Health . In: General nutrition survey 2009-2010. National Institute of Nutrition, editor. Ha Noi: Ministry of Health; 2012.
    1. Young MF, Nguyen PH, Addo OY, Hao W, Nguyen H, Pham H, Martorell R, Ramakrishnan U. The relative influence of maternal nutritional status before and during pregnancy on birth outcomes in Vietnam. Eur J Obstet Gynecol Reprod Biol. 2015;194:223–227. doi: 10.1016/j.ejogrb.2015.09.018.
    1. Liu P, Xu L, Wang Y, Zhang Y, Du Y, Sun Y, Wang Z. Association between perinatal outcomes and maternal pre-pregnancy body mass index. Obes Rev. 2016;17(11):1091–1102. doi: 10.1111/obr.12455.
    1. Pan Yi, Zhang Shikun, Wang Qiaomei, Shen Haiping, Zhang Yiping, Li Yuanyuan, Yan Donghai, Sun Lizhou. Investigating the association between prepregnancy body mass index and adverse pregnancy outcomes: a large cohort study of 536 098 Chinese pregnant women in rural China. BMJ Open. 2016;6(7):e011227. doi: 10.1136/bmjopen-2016-011227.
    1. Ramakrishnan U, Grant F, Goldenberg T, Zongrone A, Martorell R. Effect of women's nutrition before and during early pregnancy on maternal and infant outcomes: a systematic review. Paediatr Perinat Epidemiol. 2012;26:285–301. doi: 10.1111/j.1365-3016.2012.01281.x.
    1. Khan NC, Hoan PV. Vietnam recommended dietary allowances 2007. Asia Pac J Clin Nutr. 2008;17(Suppl 2):409–415.
    1. Nguyen PH, Nguyen H, Gonzalez-Casanova I, Copeland E, Strizich G, Lowe A, Pham H, Truong TV, Nguyen S, Martorell R, et al. Micronutrient intakes among women of reproductive age in Vietnam. PLoS One. 2014;9(2):e89504. doi: 10.1371/journal.pone.0089504.
    1. Dewey KG. Reducing stunting by improving maternal, infant and young child nutrition in regions such as south asia: evidence, challenges and opportunities. Matern Child Nutr. 2016;12(Suppl. 1):27–38. doi: 10.1111/mcn.12282.
    1. Imdad A, Bhutta ZA. Maternal nutrition and birth outcomes: effect of balanced protein-energy supplementation. Paediatr Perinat Epidemiol. 2012;26:178–190. doi: 10.1111/j.1365-3016.2012.01308.x.
    1. Shenkin SD, Starr JM, Deary IJ. Birth weight and cognitive ability in childhood: a systematic review. Psychol Bull. 2004;130(6):989–1013. doi: 10.1037/0033-2909.130.6.989.
    1. Veena SR, Gale CR, Krishnaveni GV, Kehoe SH, Srinivasan K, Fall CHD. Association between maternal nutritional status in pregnancy and offspring cognitive function during childhood and adolescence; a systematic review. BMC Pregnancy Childbirth. 2016;16(1):220. doi: 10.1186/s12884-016-1011-z.

Source: PubMed

3
S'abonner