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European Journal of Applied Sciences – Vol. 10, No. 2

Publication Date: April 25, 2022

DOI:10.14738/aivp.102.11735. Raje, S., & Rao, S. (2022). Maternal Diet Influences Association of Gestational Weight Gain and Birth Weight Among Undernourished

Mothers. European Journal of Applied Sciences, 10(2). 15-26.

Services for Science and Education – United Kingdom

Maternal Diet Influences Association of Gestational Weight Gain

and Birth Weight Among Undernourished Mothers

Swati Raje

Department of Community Medicine

MIMER Medical College, Talegaon Dabhade, Maharashtra, India

Shobha Rao

Society for Initiatives in Nutrition and Development, Pune 411 007, India

ABSTRACT

Objective: Maternal nutrition intervention improves birth outcomes in

undernourished but not in well-nourished populations. Therefore, objective was to

examine its role in association of weight gain and pregnancy outcome in

undernourished mothers. Design: Prospective study Setting: Obstetrics and

Gynaecology out patients department of Rural Hospital Talegaon, Participants:

Mothers (n=370) registering within 20 weeks of gestation were studied for

socioeconomic variables, diet, anthropometric measurements and were followed

up till delivery. Results: Mothers were undernourished with mean weight 45.9±7.3

kg, height150.8±6.1 cm and BMI 20.2±3.1kg/m2. In fact proportion of mothers

below LBW risk cur off for weight (38Kg), height (<145 cm) and BMI(18.5 kg/m2 )

was respectively 9.8 %, 8.6 % and 32.8%. Mothers in lower tertile of weight (<42.5

Kg), BMI (<18.5Kg/m2) body fat (<21.8%) had babies with significantly lower birth

weights with highest prevalence of LBW. Maternal BMI associated inversely with

weight gain but positively with birth weight indicating that foetal growth was not

benefitted fully by gained weight in undernourished mothers. Consumption of

milk/milk products, fruits, non-vegetarian foods, dal and roti was associated with

birth weight but not with weight gain. Comparison of mothers of LBW and normal

weight babies within low (18.5 kg/m2) and high (≥21.1kg/m2) BMI groups showed

that consumption of milk was discriminatory, indicating importance of proteins

and micronutrients in facilitating foetal growth. Conclusion: Consumption of milk

facilitated sparing of gained weight for foetal growth among undernourished

mothers and promoting it could be a simple public health approach for prevention

of LBW in rural India.

Key words: Maternal diet, weight gain, birth weight, undernourished mothers

INTRODUCTION

Almost 20 million low birth weight infants are born each year, a large majority of those births

occurring in low and middle income countries (LMIC). Poor foetal growth in developing world

is largely attributed to widespread maternal undernutrition. High prevalence of LBW in

developing countries is therefore reflection of a more severe and massive problem related to

maternal undernutrition. In fact, poor nutritional status at conception, low gestational weight

gain due to inadequate dietary intake and short maternal stature due to mothers own

childhood under nutrition and / or infection are believed to be the major determinants for LBW

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European Journal of Applied Sciences (EJAS) Vol. 10, Issue 2, April-2022

Services for Science and Education – United Kingdom

in developing countries (1). It is worthwhile to note that the countries where high proportions

of LBW are seen are also the countries where women have low body mass index indicating

maternal undernutrition.

Although poor maternal nutritional status is a major determinant of LBW, the factors

responsible range from socio demographic to genetic, illustrating a wide spectrum of

underlying causes. For example, poor socio economic environment is known to affect food

availability (2 ), the work load of the mother (3) and important decisions like seeking antenatal

care during pregnancy (4) that influence birth outcome. Equally important are the

demographic factors like early age at marriage and conception (5), delayed age of menarche

coupled with early conception (6), short spacing (<2 yr) between successive deliveries (7, 8, 9,

10) and the history of repeated abortions make women from low socio-economic class more

vulnerable for poor pregnancy outcome (11).

Mother’s nutritional status prior to conception and her nutrition through pregnancy influence

birth weight considerably. It is believed that the impact of poor nutritional status of mother is

more pervasive than the impact of other factors on birth weight. In particular, maternal pre

pregnancy weight, an indicator of current nutritional status, is known to have independent

influence on birth weight. (12,13,14). Similarly, statistically significant associations between

short maternal stature, an indicator of past undernutrition, and adverse birth outcome are

reported (15) using extensive meta-analysis of large data sets from LMIC.

Gestational weight gain is yet another important factor associated with pregnancy outcome but

most of the evidence is from developed countries (16). Therefore, these associations may differ

by countries, ethnic diversity and especially among undernourished populations (17). For, in

less developed Asian countries women achieve less gestational weight gain than IOM

recommendations. Secondly, less is known about weight gain by time in pregnancy and its

influence on birth size. Finally, inadequacy of key nutrients required for foetal growth may

affect weight gain and its association with pregnancy outcome.

Although importance of maternal nutrition to foetal development and birth outcomes has been

clearly demonstrated in experimental animal studies, the findings of studies in humans are

much less consistent (18 ). Unfortunately, maternal diets in most developing countries are often

inadequate both in macronutrients and micronutrients. But, studies of energy protein

supplementation during pregnancy have produced varying and sometimes conflicting results

(19). Similarly, available data on relationship of maternal micronutrient status with actual

pregnancy outcome is extremely scanty and the more logical approach of multiple

micronutrient supplements has been inadequately tested (20). Further, nutritional insults

during different periods of gestation have differing effects on birth. For example, acute severe

maternal malnutrition may adversely affect the birth weight of the foetus especially when the

exposure is during the third trimester of pregnancy (21) while early work (22) has shown that

undernutrition in early intra uterine life tends to produce small but normally proportional

animals whereas undernutrition later in development leads to selective organ damage and

disproportionate growth. Maternal nutrition is thus of paramount importance and needs

critical understanding for planning effective strategies to improve birth outcome.

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Raje, S., & Rao, S. (2022). Maternal Diet Influences Association of Gestational Weight Gain and Birth Weight Among Undernourished Mothers.

European Journal of Applied Sciences, 10(2). 15-26.

URL: http://dx.doi.org/10.14738/aivp.102.11735

In a recent study (23) improved maternal intakes of milk in early gestation and of GLV and fruit

in late gestation were reported to result in improved fetal growth and authors suggest that

these foods probably provide a more effective combination of nutrients than do conventional

supplements that contain only one or two micronutrients or macronutrients. Milk intake in

pregnancy was also observed (24) to be associated with higher birth weight for gestational age,

lower risk of SGA, and higher risk of LGA while a study in Ghana (25) reports that increase in

dietary diversity is effective in reduction of prevalence of LBW. The implication is that, specific

foods providing specific nutrients may be of importance rather than absolute intake of calories

or proteins. The present study thus attempts to investigate the associations between maternal

nutritional status at registration, nutrition and weight gain during gestation with birth weight.

MATERIALS AND METHODS

Present study was a hospital based prospective study, carried out at Dr. Bhausaheb Sardesai

Rural Hospital Talegaon, attached to MIMER medical college.

Subjects - The study population comprised of Antenatal Care cases who registered at the

Obstetrics and Gynaecology out patients department of the hospital within 20 weeks of

gestation. Considering 35% prevalence of LBW with 5% tolerance estimated sample size was

425 cases allowing for 15% loss to follow up. Clinically apparently normal ANC cases within 18

to 40 years of age, were enrolled in the study after obtaining their oral informed consent. Out

of 459 initially enrolled, there were exclusions due to abortions (21), still births (3 ), intra

uterine growth retarded (IUGR) (2). Of the remaining 433 cases, exclusions due to multiple

pregnancies (4), major illness (thyroid -1 and pregnancy induced hypertension-1), changing

the place of delivery (6) and premature deliveries (51), data on 370 full term mothers is

analysed. Ethical clearance was sought from Ethical Committee of MIMER medical college.

Qualitative information: Maternal socio economic and demographic information was

collected on each enrolled woman at the time of registration using a structured and validated

questionnaire. It comprised of size of the family, monthly income, education and occupation of

the mother as well as her husband. The demographic information about her age at menarche,

marriage and at registration was also recorded. Similarly, obstetric information on variables

like parity, spacing and previous abortions, if any, was recorded for each mother. Maternal

activity was also recorded as time spent in domestic work, leisure activities and work done

outside, using pretested activity questionnaire.

Anthropometric measurements - Maternal height was measured (up to 0.1 cm) using

stadiometer(Standard Steel Co. Model SECA213, India), weight was measured using (up to 100

g) digital weighing balance (Smart Care Co. Model SCS110A, India) , Body fat (%) was recorded

using body fat analyser (HBF300, OMRON Corporation, Japan) at each ANC visit. Babies were

measured at birth using digital weighing scale (Homedics Group Ltd. Model Salter 914, India)

was used for measuring length.

Maternal dietary intake – Dietary intake was assessed using pre tested food frequency

questionnaire (FFQ) to record consumption of various foods and their frequency in last one

month. It covered total of 54 food items divided into 13 groups such as milk, milk products,

cereals, lentils, legumes, vegetables, green leafy vegetables, fruits, non-vegetarian foods, snacks,