The influence of maternal nutritional status, dietary intake, heamoglobin level and workloads on birth size in Kaberamaido District, Uganda
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Fetal growth retardation is one of the major public health problems particularly because children are at increased risk of being stunted and malnourished in childhood and when reaching reproductive age. Furthermore they are at risk of maternal morbidity and mortality and of delivering low birth weight (LBW) babies. This results in a burden of malnutrition throughout the life cycle. In addition, studies reveal that infants who are born small for their gestational ages are at increased susceptibility to obesity, cardiovascular diseases and type 2 diabetes mellitus. These diseases are on the increase in developing countries and reducing the incidence of LBW is regarded as a major research priority in improving the health and wellbeing of mothers and their families. Furthermore, infants who are born short (stunted) and those with excessively smaller and larger head circumference for their gestational age usually suffer from impaired growth potential and malfunction of the central nervous system respectively. To evaluate the influence of the nutritional status, dietary intake, heamoglobin level and workloads on birth size, a longitudinal survey study design based at health facilities was used. Pregnant mothers (n=219) who were antenatal care (ANC) attendees at Kalaki Health Centre IV and Lwala Hospital, Kaberamaido district in third trimester (24-36 weeks pregnancy) of pregnancy were weighed twice at an interval of one month to ascertain the recommended maternal weight gain of at least 1kg per month. The mothers were assessed for their dietary intakes (using the 24 hour recall and food frequency questionnaire), maternal height measurements and heamoglobin levels were also determined. A 24- hour physical activity level of the mothers was assessed, and in addition, the birth weight, length and head circumferences of their infants were determined within 72 hours after delivery. The nutritional status of the mothers was poor as evidenced by 62.0% of the mothers failing to gain the recommended 1kg of body weight per month and 21.0% being anaemic. The prevalence of IUGR was 13.7% (comparable to the national average of 12.0% (UNICEF (2007) and 10.0%, UBOS (2011)), infant stunting 17.8% and small head circumference 13.2%. Maternal work load had no significant influence on birth weight (r= 0.073, p=0.285), length (r= 0.037, p=0.636) and infant head circumference(r= 0.020, p=0.774) and the mean maternal work load was 88.5±9.1 METS/hr/day. Maternal dietary intake of most nutrients was below the recommended dietary allowance (RDA), namely: energy, fat, protein, vitamin B12 and zinc while intakes of iron, folate and vitamin B6 were above RDA. It was concluded that predictors of birth size were maternal intakes of vitamins B6, maternal height, frequency of consumption of milk and meat, maternal weight gain per month, maternal intakes of iron and zinc. Therefore the recommendation made was to encourage pregnant mothers to effectively diversify their diets. The diets should include meat, milk and dairy products amongst others. In addition, micronutrient intake should be encouraged through maternal consumption of vegetables and fruits. Consequently an adequate supply of nutrients is probably the most important environmental factor affecting pregnancy outcome.