Traditional prenatal and postpartum food restrictions among women in northern Lao PDR

Abstract

Culturally determined food restrictions are common among pregnant and postpartum women in Asia. This study aimed to describe perinatal dietary restrictions, factors associated with food avoidances and attainment of minimum dietary diversity (MDD-W) among women in Lao PDR. Mother-child (aged 21 days to <18 months) dyads (n = 682) were enrolled into a cohort study in northern Lao PDR and interviewed at one time point postpartum. During pregnancy and postpartum, 1.6% and 97% of women reported following dietary restrictions, respectively. Cluster analysis identified four distinct postpartum dietary patterns: most restrictive (throughout first 2 months postpartum); least restrictive; 2 weeks highly restrictive and 1 month highly restrictive, followed by 19%, 15%, 5% and 62% of women, respectively. Greater maternal age, gravidity and higher household socioeconomic status were associated with allowing more diverse foods, while women from food insecure households followed more restrictive diets for longer. Women belonging to the Hmong ethnic group followed a highly restrictive diet of white rice and chicken for the first month postpartum. MDD-W was achieved by 10% of women restricting their diet at the time of the interview compared with 17% of women who were consuming their normal diet (p = 0.04). Postpartum dietary restrictions are widespread among women in northern Lao PDR. These highly restrictive diets, low dietary diversity and food insecurity likely contribute to micronutrient deficiencies in women that may have important consequences for their breastfed infants through reduced breastmilk micronutrient content, which requires further exploration. Culturally appropriate strategies to increase micronutrient intakes among women should be considered.

Trial registration: ClinicalTrials.gov NCT03626337.

Keywords: Lao PDR; diet; dietary diversity; food taboos; maternal nutrition; postpartum; pregnancy.

Conflict of interest statement

The spouse of SYH previously worked for the Bill & Melinda Gates Foundation. All other authors declare that they have no conflict of interest.

© 2021 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.

Figures

Figure 1

Proportion of women within each cluster who reported allowing food groups during the first 2 months postpartum

Figure 2

Bivariate (a) and multivariable (b) associations between maternal and household socio‐demographic characteristics and allowing food groups postpartum in weekly (for the first 4 weeks) and monthly intervals. HIFAS, household food insecurity access scale; SES index, socioeconomic status index. Positive associations indicate more likely to consume food groups and negative associations indicate less likely to consume food groups (p < 0.05). Predictors with p value <0.1 at bivariate level were included in the multivariable logistic regression model. Hmong ethnic group is compared with Lao ethnic group and district health centre; home or other delivery location is compared with delivery at a provincial hospital

Figure 3

Mean dietary diversity score and percentage of women who consumed food groups in the previous 24 h/day before going to hospital, for all women (n = 682) and by those who were following a restrictive diet at the time of interview (n = 212) and those who had resumed/were consuming their normal diet (n = 470)