Nutritional status in the periconception period and lifestyle factors associated with preterm birth among mothers giving birth in Kawempe and Naguru hospital, Kampala, Uganda: A case control study

Abstract

Background: Nutritional status in the periconception period and lifestyle factors constitute series of modifiable and non-modifiable exposures that influence adverse pregnancy outcomes such as preterm delivery. Unfortunately, due to limited research, knowledge regarding such factors are lacking in many Low- and Middle-Income Countries and thus failing programmes that are geared towards improving maternal and newborn health. Objective: The purpose of this study therefore, was to determine the nutritional status in the periconception period and lifestyle factors associated with Preterm Birth among mothers giving birth in Kawempe and Naguru hospitals in Kampala, Uganda. Additional inquiry sought to explore perceptions of mothers towards nutritional and lifestyle factors associated with PTB. Method: Un-matched hospital-based case control study was conducted in Kawempe and Naguru hospitals. Data on nutritional status and lifestyle exposure factors for PTB including mothers’ perceptions towards nutritional and lifestyle factors for PTB was collected using face to face interview of 310 cases and controls. Results: Majority of the respondents (65.2%) were between 20 to 29 years old, 42.6% had given birth to at least one child, 76.8% lived in urban, only 5.2% had attained university education while significant percentage (41.3) had secondary school qualification. Their main occupations were trade and domestic work (equal percentage of 27.1) and 56.4% had married. After adjusting for age, marital status and other potential confounders, the odds of having had anemia were 2.37 times higher among mothers of PTB than mothers without PTB (AOR; 2.37, 95%CI:1.25-4.49, P=0.008). Among lifestyle factors, the odds of exposure to tobacco product through passive smoking at home among mothers who had PTB were 4.44 times greater than that among mothers who never had preterm babies (AOR; 4.44; 95%CI:2.24-8.78, P=0.000). The odds of caffeine consumption over 200mg per day were 0.27 times higher among cases than controls (AOR; 0.27, 95%CI: 0.10-0.69, P=0.006). The odds of exercise among those who had PTB are 0.22 times lower among mothers with PTB than mothers with full term babies (AOR; 0.22, 95%CI: 0.11-0.42, P=0.000). For sleep quality, the odds of exposure among cases were 1.64 higher than that among controls (OR:1.64; 95%CI:1.02-2.63; P=0.040). Qualitatively, 8 out of 10 mothers indicated varied views towards BMI, general nutrition, alcohol, caffeine and tobacco consumption. Majority expressed divergent sentiments towards their babies. After giving birth, many felt the baby belonged to them. However, few weeks later, these feelings disappeared and many began to feel so worried, anxious, broken down and empty. Conclusion: Results from our study lay open the independent and joint roles of periconception anemia, lack of fruit consumption, passive smoking and poor sleep quality as key determinants of PTB among the nutritional and lifestyle factors assessed. On the other hand, living in rural, BMI, vegetable consumption, exercise and caffeine intake were protective against PTB. Generally, maternal perceptions towards nutritional and lifestyle factors during periconception in relation to PTB were poor and irrational.

Recommendations: Governments, donors and private sectors to strengthen programmes that address lifestyle modification in the periconception period to reduce risk of preterm birth among women of child bearing age.