The Nutritional Status Of Pregnant Women And Its Effects On Gestational Outcomes In Urban And Suburb Of Guangzhou

BackgroundAs an important stage in early life, people pay much attention to the pregnancy for a long time. During this period, mother and fetal are vulnerable to the influence of various factors. While, pregnancy nutrition is one of the critical factors which affects the health of pregnant women and growth of their infants.The effect of pregnancy nutrition on mother and infant in the short-term mainly reflected in terms of gestational outcomes. The unreasonable nutrition during pregnancy may cause the increase of pregnancy complications, and other adverse gestational outcomes like macrosomia and the low birth weight infant. The effect of pregnancy nutrition in the long-term mainly reflected in fetal health in adulthood. The numerous epidemiologic researches suggest that there is a intimate connection between the nutritional status in early life and adult metabolic diseases. Therefore, to ensure the appropriate nutrition in early life has the positive function to the maternal and infant health, and to prevent the incidence of metabolic diseases in the later life.At present, the relationship between nutrition during pregnancy and gestational outcomes is still uncertain. As far as the dietary nutrition is concerned, the relationship between energy and most of the other nutrients with pregnancy outcomes remains controversial. Moreover, our country has not established the guidelines of gestational weight gain for pregnant yet. We still reference to the United States’ IOM revised pregnancy weight gain recommendation in2009for guidance. Consequently, we urgently need to carry out the investigation of pregnancy weight gain across the country, and then to provide the data support for developing our country’s recommendation.With the rapid development of our country’s economy, the nutritional status during pregnancy has changed a lot than the past. It is necessary to rejudge maternal current nutritional status. In recent years, some related research had been carried out in different areas, but there are some differences between each research. Besides, there is lack of such research in South China. So, in order to provide the nutritional guidance for pregnant women to get the good pregnant outcomes, our team group carry out this research as a whole to assess the present nutritional status from dietary nutrition, anthropometric measurements and blood biochemical nutrition level, and explicit the relationship between maternal nutritional status during pregnancy with gestational outcomes in Guangzhou.PurposeThe purpose of this survey is to investigate the current nutritional status of pregnant women in Guangzhou, while find out the shortcomings and give reasonable suggestions. With the following of the respondents and their neonates from pregnancy until delivery, get the statistics of related pregnancy outcomes, such as the neonatal birth weight, delivery mode and pregnancy complications. To explicit the influence of pregnancy nutrition on the gestational outcomes and then provide the scientific basis for obtaining the good gestational outcomes with reasonable nutrition guidance during pregnancy.Methods533healthy singleton pregnant women during the third trimester were selected as the participants in both urban and suburb of Guangzhou. The data was collected from pregnancy until delivery with retrospective questionnaires one by one. Dietary data was obtained by the24hour dietary recall method for3consecutive days. Anthropometric measurements were get form all the respondents and their neonates. blood samples of pregnant women were collected predelivery for detecting their nutrient biological parameters. At last,469available questionnaires were collected, including236urban area and233suburbs.426maternal blood samples were collected, including413haemolysis-free samples for being detected.Using EpiData3.1to establish the database, and analyzing the dietary data with special software. All the statistics were analyzed by SPSS13.0. The statistical analysis method mainly includes descriptive, t-test, chi-square, one-way ANOVA, multiple linear regression and binary Logistic regression analysis.Results1. The activity during pregnancy. In our survey,38.5%of women never work or did farm work,16.2%never did housework and7.5%never went out for activities. Most of women in urban area took up daily chores less than1hour (42.6%), however, women in suburb always did house work longer than1hour a day(63.4%). Compared with suburbs, women who didn’t attend the outdoor activities was significantly higher in urban area.2. The dietary nutritional status during pregnancy2.1The dietary status. Women ate much more in the second and third trimester compared with pre-pregnancy generally. But the diet structure was still unreasonable. In the third trimester, pregnant consumed adequate cereals. Animal food like meat, poultry and fish were taken excessively, especially for meat for more than1/2of the recommended dietary intake. But less egg was consumed, with the average daily consumption of36.84g. Although, most of women took vegetables (95.1%) and fruits (75.3%) every day, the average daily consumption of them during late pregnancy were insufficient, with intakes of329.60g and172.53g respectively. In everyday, only50.60%of women consumed dairy, even more,9.9%of women took soybeans and its products. The average daily consumption of dairy and soybeans and its products were178.53g and6.50g per person respectively. Women in the suburbs consumed much more cereals than the urban area, but the intakes of fruits, poultry and dairy were much fewer, P<0.001.In the third trimester, the intakes of energy and other nutrients were imbalance. Women in the suburbs took much more energy and carbohydrate than the urban area. While, the intakes of animal protein, heme-iron, dietary fiber, calcium, vitamin A, vitamin E, riboflavin, vitamin C from suburban women were significantly lower than urban women, P<0.01. Although women in late pregnancy took enough energy and most of the nutrients referenced to the DRIs, the intakes of calcium, iron and riboflavin only accouted for52.32%,69.72%and74.71%respectively of the recommended dietary intake. The intakes of iron mainly derived from plant sources. The heme-iron took up80.08%of the total iron intake. In addition,85.3%of women took nutritional supplements during pregnancy, and the calcium supplements were consumed by most of the pregnant women (77.6%).2.2The serum biochemical indices. The gestational anemia accounted for33.5%in the coming ante partum. Pregnant women in the urban area (28.4%) suffered a lower anemia prevalence than suburbs (38.6%), P<0.05. Most of the pregnant women’s TG, CHO, LDL-C and HDL-C level exceeded the normal adult reference threshold value, which accounted for94.4%、82.9%、59.8%、88.6%, respectively.2.3The gestational weight gain. The average gestational weight gain was15.04kg (4.0-31.Okg). And women who gave birth to normal weight infant had an average weight gain of14.92kg(4.0～29.0kg). As according to be grouped by the pre-pregnancy body mass index(BMI), women who was low pre-pregnancy weight gained15.73kg during pregnancy,14.97kg for normal weight women and13.32kg for overweight and obese women. The gestational weight gain of pre-pregnant overweight and obese group was significantly lower than low and normal weight group, P<0.001. Multiple linear regression analysis showed that the duration of doing housework was negative with gestational weight gain. The dietary intake affected the gestational weight gain. The more dietary fat and iron intakes, the more gestational weight gain would get. However, pregnant gestational weight gain was negatively associated with women’s calcium supplementation during pregnancy.3. The relationship between dietary nutritional status during pregnancy and gestational outcomes3.1The gestational outcomes.52.1%of the pregnant women choose the vaginal delivery, while47.9%of women choose the cesarean section. The average birth weight of newborns was3230.46g (2280-4580g), and birth length was49.60cm (42.0～55.0cm). The proportion of low birth weight and macrosomia was2.3%and3.4%, respectively. The incidence rate of small-for-gestational-age (SGA) and large-for-gestational-age (LGA) was4.9%and19.2%, respectively.41.58%suffered from pregnancy complications, mainly including gestational anemia (33.5%) and abnormal amniotic fluid (5.3%).3.2The relationship beteen nutritional status during pregnancy and gestational outcomes. Our research showed that Neonatal birth weight was positively associated with the women’s dietary intakes of calcium and iron during late pregnancy, pre-pregnancy BMI, gestational weight gain.The logistic regression analysis showed that when energy intake was less than90%RNI, the rate of SGA increased. While women who took iron supplementation during pregnancy and higher intake of vitamin C in the third trimester were associated with lower rate of gestational anemia, especially when the intake was more than120%RNI, the prevalence rate significantly decreased. Besides, vitamin E intake of less than80%RNI was the risk factor for the incidence of abnormal amniotic fluid. In addition, women who were overweight or obese pre-pregnancy would have a higher incidence of LGA, macrosomia and cesarean section. With the gestational weight gain of more than15.0kg, the incidence of LGA increased, and that more than21.0kg, the incidence of macrosomia increased.Conclusion1. Although women consume varieties of food during pregnancy in urban and suburb of Guangzhou, the consumption of all kinds of food is imbalance. The intakes of meat, poultry and fish are high, especially the meat. Women consume insufficient vegetable, fruit and eggs. And the intakes of dairy, soybeans are very low. Energy and most dietary nutrient are adequate, but the intakes of calcium, iron, riboflavin are insufficient. The prevalence of gestational anemia in Guangzhou is still high, but is much lower than the national average rate.2. The pre-pregnancy BMI is related to the gestational weight gain. And women who are overweight or obese before pregnancy would get a lower gestational weight gain. The appropriate physical activity and reasonable nutrition during pregnancy is beneficial to control the overweight growth.3. The nutritional factors during pregnancy affect fetal growth. Adequate intakes of dietary energy, calcium, iron, vitamin C and vitamin E, keeping normal pre-pregnancy BMI, maintaining gestational weight gain less than15kg are all the beneficial factors for preventing adverse pregnancy outcomes.