Original articleMaternal dietary diversity and risk of small for gestational age newborn: Findings from a case–control study
Introduction
The gestational period is critical for mother and foetus. There are several physiologic changes to meet foetal requirements for growth and development. This means increased metabolic demands in order to keep mother and foetus health [1]. Thus, nutritional factors play an important role for pregnancy outcomes. In this way, an insufficient amount of micronutrients intake during pregnancy has been related to an increase of the risk of maternal and foetal complications [2]. For instance, vitamin B9 deficit is linked to congenital malformations [3], meanwhile an inadequate intake of iron or vitamin B12 is associated with anaemia and an increased risk of preterm delivery and low birth weight newborn [4].
Low birth weight (LBW) is a consequence of being born too small or too early. Since birth weight does not capture differences in gestational age and sex of the newborn, it is preferred to classify them according to their size-for-gestational age [5]. A newborn small for gestational age (SGA) is defined as a birth weight below the tenth percentile birth weight for an infant of a specific gestational age, stratified by sex [6]. SGA continues being a major public health problem worldwide, affecting not only the immediate health and survival of offspring [7], but also increasing other health-related conditions such as metabolic or cardiovascular diseases [8].
Despite traditional pregnant counselling has emphasized the consumption of prenatal complex vitamins in order to provide the necessary amount of some micronutrients to prevent SGA [9], the dietary guidelines underline that the better way to meet micronutrient requirements during pregnancy is through a varied and high nutrient density diet [10], [11], specifically for women living in high-income countries, with high access to animal products, fruit and vegetables – all of the foods rich in vitamins and minerals.
Although a varied diet is related to an adequate nutrient intake during pregnancy and has been widely studied among pregnant women in developing countries [12] being a significant determinant of adequate birth weight [13], the dietary diversity (DD) has not been widely studied in developed countries. Perhaps because in developed world we assume that abundance is related to nutrient adequacy, to our knowledge no one study has assessed the potential association between DD and nutrient adequacy on the risk of developing a SGA newborn in developed countries.
The hypothesis for this study was that women with SGA newborn would have lower DD than women of adequate for gestational age (AGA) newborn, meaning SGA mother have less varied diets which could exacerbated the risk of inadequate nutrient intake. The aim of this study was to assess the effect of DD on adequate nutrient intake in a sample of Spanish pregnant women, further to investigate their association on SGA delivery.
Section snippets
Materials and methods
This case–control study on dietary intake and risk of SGA newborn was conducted from May 15, 2012 through July 15, 2015 in women attended at five hospitals of Eastern Andalucía (Spain). These hospitals recruited participants from Primary Care Health to the National Health System: The University of Jaen Hospital (UJH), Ubeda Hospital (UB), the University of Granada Hospitals (two centres) (UGH), and Poniente Hospital (PH).
We estimated the appropriate sample size, based on the results of a
Results
Table 1 shows characteristics among SGA and AGA mothers. Women in SGA group were more likely to be smokers, have previous preterm or low-birthweight newborn, preeclampsia and intrauterine growth retardation (p < 0.001). In contrast, more women in the AGA group were married (p < 0.036), have a higher mean gestational weight gain and higher BMI prior to gestation (p < 0.001). No significant differences were observed according to education level, Kessner index or alcohol intake. With respect to
Discussion
In the present study, we evaluated the relationship between DDS and risk of having a SGA newborn in a sample of Spanish pregnant women. As far as we know, this is the first study to present data on DD and SGA in developed countries over a large sample of pregnant women. We observed that the prevalence of inadequate intake of all nutrients decreased across DDS quintiles in the whole sample with a significative p for trend, however the percentage of women with inadequate intake was higher in the
Conclusion
In conclusion, higher DDS is related with lower nutrient deficient intake and lower SGA's risk, probably due to best diet quality. Because to promote DD requires a simple and clear dietetic advice, it seems worthy to choose it as a dietetic intervention target to improve pregnancy nutrition and helping to reduce SGA newborn incidence.
Funding
This work was supported by a grant from the National Institute of Health Carlos III belonging to the Ministry of Economy and Competitiveness (grant numbers PI11/02199). Finally, N.C-I. would like to acknowledge support from the Ministry of Education of Spain (grant numbers FPU14/03630).
Conflicts of interest
The authors declare no conflict of interest.
CRediT authorship contribution statement
Naomi Cano-Ibáñez: Conceptualization, Methodology, Writing - original draft, Writing - review & editing. Juan Miguel Martínez-Galiano: Conceptualization, Methodology, Data curation, Writing - original draft, Writing - review & editing, Funding acquisition, Project administration, Supervision. Carmen Amezcua-Prieto: Conceptualization, Methodology, Writing - review & editing. Rocío Olmedo-Requena: Conceptualization, Methodology, Writing - review & editing. Aurora Bueno-Cavanillas:
Acknowledgement
The authors are grateful to the pregnant women and midwiferies for participating in the study.
References (42)
- et al.
Anaemia in pregnancy
Best Pract Res Clin Obstet Gynaecol
(2012) - et al.
Intrauterine growth restriction increases morbidity and mortality among premature neonates
Am J Obstet Gynecol
(2004) - et al.
Association of preterm birth and small for gestational age with metabolic outcomes in children and adolescents: a population-based cohort study from Taiwan
Pediatr Neonatol
(2018) - et al.
Dietary diversity predicts the adequacy of micronutrient intake in pregnant adolescent girls and women in Bangladesh, but use of the 5-group cutoff poorly identifies individuals with inadequate intake
J Nutr
(2018) - et al.
Alcohol consumption during pregnancy and risk of small-for-gestational-age newborn
Women Birth
(2019 Jun) - et al.
Dietary diversity and subsequent mortality in the first national health and nutrition examination survey epidemiologic follow-up study
Am J Clin Nutr
(1993) - et al.
Integrating nutrition interventions into an existing maternal, neonatal, and child health program increased maternal dietary diversity, micronutrient intake, and exclusive breastfeeding practices in Bangladesh: results of a cluster-randomized program evaluation
J Nutr
(2017) - et al.
Women's dietary patterns change little from before to during pregnancy
J Nutr
(2009) Consumption of energy-dense, nutrient-poor foods by adult Americans: nutritional and health implications. The third National Health and Nutrition Examination Survey, 1988–1994
Am J Clin Nutr
(2000)- et al.
Pregnancy: metabolic adaptations and nutritional requirements
(2015)
Inequalities in health
Folic acid in pregnancy and fetal outcomes
J Obstet Gynaecol
US birth weight/gestational age-specific neonatal mortality: 1995–1997 rates for whites, hispanics, and blacks
Pediatrics
Anthropometric reference data for international use: recommendations from a WHO expert committee
Food Nutr Bull
Effect of multiple micronutrient supplementation during pregnancy on maternal and birth outcomes
BMC Public Health
Nutrition in pregnancy
Nutr Bull
Food, pregnancy and lactation: dietary guidelines for pregnant women
Public Health Nutr
A health facility based case-control study on determinants of low birth weight in Dassie town, Northeast Ethiopia: the role of nutritional factors
Nutr J
Diet in pregnancy and risk of small for gestational age birth: results from a retrospective case-control study in Italy
Matern Child Nutr
[The fetal development curves of newborn infants in the Hospital de Cruces (Vizcaya). II. Length, head circumference and ponderal index]
An Esp Pediatr
La medicina de la Clase Social en Ciencias de la Salud, Informe de un Grupo de Trabajo de la Sociedad Española de Epidemiología
Cited by (13)
Maternal Dietary Diversity and Birth Weight in Offspring: Evidence from a Chinese Population-Based Study
2023, International Journal of Environmental Research and Public Health