http://doi.org/10.33698/NRF0274-Himani, OJ Mariam, Anita Tahlan, Rimpy Tandon
ABSTRACT
Background: Adequate nutrition is essential especially during pregnancy for the growth and development of the foetus. Inadequate diet during pregnancy can have serious impact on birth weight and health of the neonate. Various socio- demographic variables may inuence the diet and nutrient intake during pregnancy thus inuencing the pregnancy outcomes. Objectives: To assess the nutrient intake among the primigravida antenatal women. Methodology: Quantitative research approach was used to conduct a descriptive study in the antenatal OPD of Govt. Medical College & Hospital of sector- 32 Chandigarh among 481 Primi- gravid antenatal mothers selected by using consecutive sampling technique. Written informed consent was obtained from the participants and they were interviewed as per semi- structured interview schedule for the complete dietary assessment. Reliability coefcient of tool was 0.74 (Cronbach alpha coefcient). Results: The ndings revealed that the nutrient intake among the primigravid antenatal women was lacking in respect to energy, proteins, iron, vitamin C (enhancer for iron absorption), folic acid (vital for prevention of neural tube defect) and vitamin B12 as compared to the recommended value. On the other hand, the intake of carbohydrates and fats (phytates- inhibitor for iron absorption) was in excess as compared to the guidelines. Energy and protein intake were signicantly associated with socio- economic status; and vitamin B 12 intake was associated with occupational status of the study subjects. Conclusion: The dietary intake of most of pregnant women was inadequate. Thus it was recommended to impart nutritional education and counselling as per socio- demographic factors of participants to improve pregnancy outcomes.
Keywords: Nutrient intake, primigravid antenatal women
Corresponding Author:
Himani,
Lecturer, College of Nursing, Govt. Medical College & Hospital, Sector-32, Chandigarh.
Email: h.bhola14@gmail.com
Introduction:
Diet during pregnancy is recognized as one of the environmental factors that can have an impact on maternal health, inuencing foetus and children’ s development and health across the whole life course. Recent epidemiological studies have underlined the importance of assessing the impact of the overall diet quality on health, stressing the concept of d i e t a r y p a t t e r n s . W h i l e s e v e r a l observational studies have suggested that an adequate intake of micro nutrients prevent several adverse pregnancy o u t c o m e s . S u c h a s f o l i c a c i d supplementation prevents neural tube al5 reveals that the dietary structure of defects.1
The dietary pattern is interlinked with many other lifestyle factors, including smoking, BMI, education, age and urban versus rural residency.2 Dietary patterns are specic to populations. They may vary with age, socioeconomic status, ethnicity, cultural traditions, and food availability. Identication of factors that inuence dietary choices is crucial for the assessment of population needs and development of effective public health messages and interventions. A recently published systematic review, based on the results from pregnant women is less irrational. The energy and protein intake are below the daily recommended intake. In the late pregnancy, iron and zinc intake are high. The selenium, vitamin B2 and C intake are inadequate, a serious lack of calcium, iodine and folic acid in whole pregnancy.
Pregnancy is a determining period of future health for women and children. Nutritional status during pregnancy will affect the outcomes for the mother and the baby, but the evidence for a benecial effect of specic multinational supplements for w o m e n o f r e p r o d u c t i v e a g e i s 12 studies, indicated that diet in pregnancy inconclusive.6 Hence in order to plan is patterned along with social gradient and aligned with other health behaviours (with older, better educated, afuent, non- smoking and physically active women) being more likely to follow healthier dietary patterns.3
A cross- sectional study conducted by Pathak P et al4 shows that nearly 73.4% and 26.3% percent pregnant women were decient in iron and folic acid respectively. Over 19 % pregnant women were consuming l ess t han 50 % of t he recommended calories. Similarly, most of the pregnant women were consuming less than 50% of the recommended folic a c i d ( 9 9 % ) a n d i r o n ( 7 5 . 4 % ) . T h e consumption of food groups rich in micronutrients was infrequent. Univariate and Multivariate logistic regression analysis revealed that low dietary intake of n u t r i e n t s a n d l o w f r e q u e n c y o f consumption of food groups rich in micronutrients were important factors leading to micronutrient deciencies. Findings of a study by Kozlowska A et nutrition supplement for pregnant women it is important to assess their dietary pattern.
Objective:
To assess the nutrient intake of the primigravid antenatal women visiting Antenatal OPD, GMCH-32, Chandigarh.
Methods:
A descriptive study was conducted using quantitative research approach to assess the nutrient intake of the primigravid antenatal women visiting antenatal OPD of Govt. Medical College & Hospital, Sector – 32, Chandigarh. The study was approved by the research and ethics committee of the institute. Four hundred and eighty-one subjects were selected using the consecutive sampling technique. The subjects were explained about the study and informed written consent was obtained. Condentiality was maintained throughout the study.
The tools were designed after extensive review of literature on relevant topics, discussion with the research guide and co- guides and experts and by applying the knowledge and experience of the researcher. The tools used was an interview schedule comprised of- 1 . Socio- demographic prole of the subjects, socio- economic s tatus was assessed by calculating socio-economic class score using Modied Kuppuswamy socio- economic scale updated for January 20186 which is based on education, occupation of head of the family and total monthly income of the family. 2. Complete dietary assessment consisting of nutrient intake. Energy, carbohydrates, proteins, fats, vitamin C, folic acid and vitamin B12 intake were estimated by using 24- hour recall method. Content validity of the tool was done by a panel of ten experts from the eld of Nursing, Medicine, Obstetrics & Gynaecology, Pathology and Dietetics. The reliability of the tool was 0.74 Cronbach’s
Results:
The analysis of demographic variables and association with nutrient intake of 481 primigravid antenatal women reveals that – Half of the subjects i.e. 238 (49.5%) were in the age group of 21-25 years. Two- third of the subjects i.e. 312 (64.9%) resided in rural area, 63.6% subjects were Hindu. 309 (64.2%) subjects had normal BMI (between 18-24.9 kg/m2) and 69% of the subjects were vegetarian. More than half of the subjects i.e. 257(53.4%) were educated up to graduation & above.
Majority of the subjects were house- wives i.e. 424 (88.1%); 397 (82.5%) subjects were from joint family and 210 (43.7%) subjects were from lower middle socio- economic class (score between 11- 15) as per modied Kuppuswamy Socio- economic scale. Two-third of the subjects i.e. 329 (68.4%) registered pregnancy at alpha coefcient. 12+1 weeks of gestation. Most of the Primi- gravid antenatal mothers attending Antenatal OPD of Government Medical College & Hospital of sector-32, Chandigarh were selected by using consecutive sampling technique. Written informed consent was obtained from the participants to document voluntary and informed participation. Participant’s right to privacy was protected through condentiality pledge. Data was collected by interviewing them as per interview schedule. They were asked to recall previous day food intake. Diet calculation was done in consultation with the dietician.
The collected data was analysed using descriptive and inferential statistics by calculating the frequency, percentage, mean, standard deviation and chi-square. subjects (95.8%) had no history of any medical disorder. Only 2 (1.7%) subjects had history of hypothyroidism during pregnancy. Calculation of nutrient intake by using 24-hour recall method and diet calculation is depicted in table.1. This reveals that energy intake of majority of the subjects i.e. 448 (93.1%) was less as compared to the recommended value during pregnancy (2580 kcal). Only 33 (6.9%) subjects had consumed calories more than 2580 kcal/ day with mean ± S.D. of 1706.2 ± 63.1 kcal/ day. On the other hand, the carbohydrate intake (phytates- inhibitor of iron absorption) of maximum of the subjects i.e. 393 (81.7%) was more than the recommended value of 175 gram/ day with the mean ± S.D of 255.3 ± 23.9 gram/ day.
The recommended protein intake during pregnancy is 78 g/day. However, the protein intake of most of the subjects (92.7%) was less than the recommended amount with the median value of 49.9 g/day. Iron intake of 97.7 % subjects was less than 35 mg/day (the recommended value) with the mean ± S.D of 14.6 ± 9.3 mg/day. Similarly, the vitamin C (enhancer of iron absorption) intake among majority of the subjects i.e. 385 (80 %) was ≤ 59 mg/day with the median value of 32.4 mg/day (almost half of the required value). Only 20 % subjects had vitamin C intake of more than equal to 60 mg/day. Almost all (99.4 %) the subjects had folic acid intake less than the recommended value i.e. < 500 µg/day. The mean value of folic acid intake was 59.2 ± 7.7 µg/day among the subjects. This amount was very less as compared to t he r ecommended amount during pregnancy. In the same manner, the vitamin B 12 intake of maximum of the subjects i.e. 450 (93.6 %) was less than 1.2 µg (recommended value) with the mean ± S.D of 0.9 ± 3.6 µg. However, the fat intake among 83 % subjects was ≥ 30 mg/day with the median value of 47.4 g/ day.
Table 1 : Daily nutrient intake of the subjects
N= 481
Nutrient consumed n % Mean ± SD Median
|
(Recommended Value/day) Energy (2580 Kcal)
- “ 2579
- “ 2580
Carbohydrates (175 grams)
- “ 174
- “ 175
Proteins (78 grams)
- “ 77
- “ 78
Fats (30 grams)
- “ 29
- “ 30
Vitamin C (60 mg)
448 93.1
33 6.9
88 18.3
393 81.7
446 92.7
35 7.3
82 17.0
399 83.0 53.13 ± 4.3 47.4
- “ 59
- “ 60
Iron (35 mg)
- “ 34
- “ 35
Folic acid (500 µg) a. “ 499
- “ 500
Vitamin B12 (1.2 µg) a. “ 1.1
- “ 1.2
385 80.0
96 20.0
470 97.7
11 2.3
478 99.4
3 0.6
450 93.6
31 6.4
32.6 ± 2.7 32.4
14.6 ± 9.3 13.4
59.2 ± 7.7 46.7
0.9 ± 3.6 0.4
Signicantly higher percentage of participants consumed recommended amount of calories in upper class as compared to other socio-economic classes higher percentage of participants consumed recommended amount of proteins in upper class as compared to other socio-economic classes (p<0.001 as per ϰ2 test) as depicted (p<0.001 as per ϰ2 test). Signicantly
in table 2.
Table 2 : Association between energy intake and protein intake with the socio- economic status of the study subjects
| Nutrient | Socio- economic status | X2(df) p | ||||
| Lower n=5 n(%) | Upper Lower n=112
n(%) |
Lower Middle n=210
n(%) |
Upper Middle n=143
n(%) |
Upper n=11 n(%) | ||
| Energy (kcal) “2579
“2580 |
4 (80) 1(20) |
106(94.6) 6 (5.4) |
199 (94.8) 11 (5.2) |
132 (92.3) 11 (7.7) |
7 (63.6) 4 (36.4) |
17.75
(4) <0.001 |
| Protein (g)
“77 “78 |
4(80)
1(20) |
102(91.1)
10(8.9) |
196 (93.3)
14(6.7) |
136 (95.1)
7(4.9) |
8 (72.7)
3(27.3) |
9.49
(4) <0.05 |
Higher percentage of working pregnant women (8.8%) consumed required amount of vitamin B12 than housewives (6.1) as shown in table.3. Though the difference was statistically not signicant. Other nutrients did not have any signicant association with any of socio demographic variables.
Table 3 : Association between vitamin B12 intake with the occupational status of subjects
| Occupational status | Working n=57
n(%) |
Housewives n=424
n(%) |
X2 (df) p |
| Vitamin B 12
“1.1 “1.2 |
52(91.2)
5( 8.8) |
398(93.9)
26( 6.1) |
0.58 (1) 0.446 |
Discussion:
Maternal nutritional status during pregnancy will affect the outcomes for the mother and the baby. Maintaining good nutrition and a healthy diet during pregnancy is critical for health of the mother and unborn child.6 The ndings of the present study reveal that majority of the subjects (86.7%) were in the age group of 21-30 years. Two-third study subjects resided in rural area (64.9%), belonged to Hindu religion (63.6%) and had normal Body Mass Index (64.2%). Only 24.7% subjects were non- vegetarian. Educational status of half of the subjects (53.4%) was graduation and above in spite of that 88.1% were housewives. Most of them (82.5%) were living in joint family and 43.7% were from lower middle socio- economic class. A study conducted by the study subjects. Similarly, a study conducted by Jung YM, Chol MJ8 shows the association between employment status of the pregnant women with protein and vitamin B12; income with energy, fats and Stravik M et al2 had reported that majority of subjects were in the age group of 26-30 years like present study. But half of them (52 %) had normal BMI (18.5-24.9 kg/m2), most of them resided in rural area and educational status of 71% of the subjects was graduation and above similar to the ndings of the present study.
The nutrient requirements are country specic and determined by various environmental, personal and dietary factors. The results of the present study show that the intake of energy, proteins, iron, vitamin C ( enhancer of iron absorption), folic acid (important in prevention of neural tube defects) and vitamin B12 among majority of the subjects were less than the recommended values but the intake of carbohydrates and fats (inhibitors of iron and other nutrients absorption) was in excess as compared to the recommended values. The results are supported by a study conducted by Aiguo Ma et al7 among Chinese pregnant women which unfolds that carbohydrate intake among the subjects was more but the intake of energy, proteins, iron, vitamin C and vitamin B12 intake was less as compared to the required amount.
The gures of the present study highlight the signicant association between the socio- economic status of the subjects with energy and protein intake. Intake of vitamin B12 was signicantly associated with the occupational status of also with vitamin C and vitamin B12.
Conclusion:
It is concluded from the results of present study that diet consumed by pregnant women constitutes the low level of nutrients than recommended for a pregnant woman. Only the major nutrient requirement i.e. energy and protein was consumed up to recommended level. The nutrients vital during pregnancy such as folic acid the decit of which can lead to neural tube defect among the foetus, iron which can have serious consequences if progress to anaemia and vitamin C -the enhancer for iron absorption were also lesser than recommended. The signicant association of upper socioeconomic status and better intake of protein and energy was observed. So, it is important for nurses and other health care professionals to assess the nutritional status of the pregnant women and provide nutritional education and counselling by considering the individual socio- demographic perspectives.
References:
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