Gestational nutrition improves outcomes of vaginal deliveries in Jordan: an epidemiologic screening
Introduction
Adverse outcomes of pregnancy are prevalent throughout the world and are impacted by poor maternal nutrition. Poor pregnancy outcomes can be life-threatening for both the mother and the offspring [1], [2], [3]. Adequate and balanced nutrition during gestation has been acknowledged as a prerequisite for a healthy pregnancy, yet the impact of specific nutrients on gestational age, birth weight, and labor spontaneity is less known. Infants born prematurely or with low birth weight have a greater risk of poor physical and neurocognitive development and greater risk of illness later in life [4], [5], [6]; hence, investigating the association of nutrients' consumption during gestation with pregnancy outcomes becomes crucial.
Nutritional deficiencies are common in women of reproductive age in developing countries and can impact maternal and fetal health [[7], [8]]. It is widely accepted that deficiencies of specific nutrients during pregnancy may lead to suboptimal embryonic and fetal nutrition, congenital malformations, serious pregnancy complications, and preterm deliveries [9], [10]. Micronutrients thought to play essential roles in supporting pregnancy include zinc [11], [12], calcium [7], [13], vitamin B6 [14], vitamin C [15], vitamin A [16], and folic acid [17]. Marginal depletion of zinc is associated with delivery complications, impaired immune function [18], [19], reduced birth weight for gestational age, preterm delivery, and prolonged labor [19], [20]. Calcium deficiency may result in decreased serum ionized calcium level that is crucial for the production of endothelial nitric oxide. The later is known to be responsible for maintaining vasodilatation, that is, characteristic of a normal pregnancy [21]. The link between serum ionized calcium, nitric oxide, and the vasodilatation explains the preventive effect of calcium to pregnancy-induced hypertension [22].
Vitamin A seems to be a necessary nutrient for placental development. High amounts of retinol binding proteins are found in the placenta and even in higher amounts than that observed in the retina [16]. Faisel and Pittrof [16] reported that the placenta β-carotene level is twice as high as that found in the liver. Vitamin B6 is known to be vital to DNA synthesis and to the formation of cerebrosides needed in myelination of the central nervous system for the infant [23]. Casanueva et al [24] suggested an association between low plasma level of vitamin C and premature rupture of amniotic membranes. This association was made based on the role of vitamin C in collagen metabolism. Finally, folic acid is also a critical micronutrient required in pregnancy. It acts as a cofactor for many essential cellular reactions including the transfer of single-carbon units and is required for cell division because of its role in DNA synthesis [25], [26]. It has been reported that a lower concentration of serum folate at week 28 is associated with a greater risk of preterm delivery and delivery of a low-birth-weight baby [26].
Prepregnancy weight and the magnitude and pattern of weight gain during pregnancy have been suggested to impact pregnancy outcomes. Low prepregnancy body mass index (BMI) is considered to be a strong predictor of preterm birth and fetal growth restriction [27]. On the other hand, obese pregnant women may develop peripheral and hepatic insulin resistance during pregnancy, which may lead to gestational diabetes [28]. Moreover, obese pregnant women have increased risk for fetal malformations and injury to the mother and/or child during parturition. In addition, children born to obese women are at greater risk for becoming overweight later in life [29].
Studies have investigated the relationship between single-nutrient consumption on birth weight or gestational age. However, studies using a comprehensive approach comparing a package of dietary factors with several pregnancy outcomes are limited. Moreover, very little is known about the impact of nutrition during pregnancy on labor spontaneity. This research is essential and timely because it comprehensively examined the impact of several gestational nutrition-related factors on birth weight, gestational age, and labor spontaneity. This survey aimed to test the hypothesis that maternal nutrition (macronutrients intake, micronutrients intake, and weight gain) during gestation will impact gestational outcomes (gestational age, birth weight, and labor spontaneity). The objectives of this study were to test the impact of macronutrients and micronutrients consumed during gestation, pregestational weight and weight gain during gestation on gestational age, birth weight, and labor spontaneity among Jordanian women.
Section snippets
Methods and materials
This study met the criteria set by the institutional review board committee at Jordan University of Science and Technology and was given approval to be funded from the deanship of research at the Jordan University of Science and Technology (project no. 45/2007).
Sample description
Seven hundred women completed the study. The mean (SEM) age was 28.7 (15.7) years, with the most subjects being between 18 and 35 years of age. Half of the participants had monthly income of approximately 400 JD or less (Table 1). Most women were nonsmokers and had sedentary lifestyles. Mean (SEM) pregestational BMI was 24.2 (0.19). Of the 700 women, 44 were underweight, 363 were normal weight, 182 were overweight, and 85 were obese. Approximately three quarters of the sample (76%) were
Discussion
Our study described typical dietary intake and specific nutrients and nutrition-related factors that impacted pregnancy outcomes in a large group of Middle Eastern women. We were able to reject the null hypothesis; there is no impact of factors related to gestational nutrition on pregnancy outcomes. Although average energy intake of our participants was in the recommended range, most of the micronutrients intakes consumed were less than the DRIs. Most women reported lower than recommended
Acknowledgment
The authors would like to thank the Deanship of Research at Jordan University of Science and Technology for providing financial support for this project (project no. 45/2007). The collaboration of the volunteers is also greatly appreciated. The authors also appreciate the efforts by Engr Amal Al-Dwairy in data entry.
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