alexa Nutritional Status of Pregnant Women and Neonatal Health in the Maternity Wards of the City of Parakou in Benin

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Gynecology & Obstetrics

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Nutritional Status of Pregnant Women and Neonatal Health in the Maternity Wards of the City of Parakou in Benin

Vodouhe MV1, Adedemy JD1, Agueh VD2, Lafia Sabi Goni M1, Ogoudjobi OM3*, Salifou K1, Hounkpatin B3 and Perrin RX3
1Mother Child Department, University of Parakou, Benin
2Regional Institute of Public Health, Ouidah, Benin
3University of Abomey-Calavi, Benin
*Corresponding Author: Ogoudjobi OM, Faculty of Health Sciences, University of Abomey-Calavi, Benin, Tel: 22997563303, Email: [email protected]

Received Date: Apr 08, 2018 / Accepted Date: Apr 30, 2018 / Published Date: May 10, 2018

Abstract

Introduction: Few studies are interested to perinatal health in relation to the nutritional status of pregnant women in Sub-Saharan Africa. The objectives of this study were to determine the factors associated with newborn weight in the city of Parakou in 2017.
Methods: This was a descriptive and analytical prospective study conducted on 205 pregnant women and their newborns in the maternity wards of the city of Parakou from 1st July to 30th September, 2016. The authors have determined the Body Mass Index (BMI), the GWG, and the anthropometric profile of newborns. The Chi-square test and the prevalence ratios were used to compare the variables with the 0.05 p-value threshold.
Results: The prevalence of obese, overweight and lean pregnant women was respectively 9.8%, 21.5% and 9.3%. The proportions of pregnant women who had normal or high GWG were respectively 48.8% and 41.9%. Almost half the lean pregnant women (47.4%) had not reached a normal GWG. The prevalence of hypotrophic, normotrophic and hypertrophic newborns was respectively 7.8%, 27.8% and 64.4%. Newborn hypotrophy was associated with socio-economic well-being level (OR=21.1; p=0.000), BMI, GWG, and Physical Activity Level of pregnant women (p<0.05). Newborn hypertrophy was associated with obesity, excessive GWG, and low level of physical activity of pregnant women.
Conclusion: The nutritional status of the pregnant woman is associated with the weight of the newborn.

Keywords: Hypotrophy; Fetal macrosomia; Gestational weight gain; Nutritional status

Introduction

Low birth weight is associated with non-negligible perinatal morbidity risks and long-term high cardiovascular morbidity risk [1-3]. Thus, in recent years, some studies have shown that low birth weight is a predictive factor of delayed cognitive development, chronic disease development in adulthood [3]. There is a higher risk of cesarean delivery for low and high weight newborns compared to gestational age [1]. The Institute of Medicine revised its guidelines for gestational weight gain standards in 2009 [4]. Women with gestational weight gain (GWG) below the norm are at greater risk of giving birth to low weight newborns. In contrast, women with high GWG are at greater risk of giving birth to macrosomic or high weight newborn relative to gestational age [5]. Few studies in the literature are interested in neonatal health in relation to the nutritional status of the pregnant in Africa South of the Sahara. The objectives of this work were to evaluate the nutritional status of pregnant women and their newborns, and to determine the factors associated with the weight of newborns in the maternity wards of the city of Parakou in 2017.

Framework and Methods

We carried out a descriptive and analytical prospective study in the 7 public maternity hospitals and in the maternity ward of the departmental teaching hospital (CHUD) of the city of Parakou in northern Benin from 1st July to 30th September, 2016.

The study population consisted of pregnant women living in the city of Parakou, followed up during antenatal consultations (ANC) in the public maternity wards of this city and their newborns.

We included in this work pregnant women in the second or the third trimester of pregnancy who had come to ANC during the study period, who resided in Parakou during the survey period, who had a health card including their height and at least their weight in the first trimester of pregnancy and who had given birth in public maternity hospitals in this city during the study period.

We excluded the pregnant women who had refused to participate in the survey or whose weight in the first trimester of pregnancy had not been marked in their health card or who had been lost to follow-up during the survey.

We conducted a random convenience sampling of pregnant women who come to ANC in one of the public maternity wards in the city of Parakou.

The dependent variables were:

• The GWG determined by the difference between the weight of the pregnant woman at delivery and that recorded in the first trimester or before pregnancy. Recommended GWG intervals (kg) for the entire pregnancy based on Body Mass Index (BMI) were: 12.5-18 if BMI5].

• In newborns, birth weights were classified using the intrauterine growth curves of Alihonou [6] which is a Beninese local reference curve for classifying newborns as hypotrophic (GA weight curve below the 10th percentile), normotrophic (GA weight curve between the 10th and the 90th percentile), and hypertrophic (GA weight curve above the 90th percentile) as defined by Clausson et al. [4].

The independent variables were: gestational age (GA), maternal Body Mass Index (BMI), physical activity level (PAL), social and economic well-being level (SEWL), obstetric characteristics (parity).

The GA was determined on the basis of the date of the last menstrual period when it was known or on the basis of the first trimester ultrasound. But when the GA was obtained by both methods, we used the age of the ultrasound for analysis. The mother's nutritional status was assessed in the first trimester of pregnancy by her Body Mass Index (BMI=Weight/height in square metres in kg/m2). A BMI 7].

Physical activity levels were classified into six categories according to Ambroise M. classification: Table 1 [8].

Categories PAL (Physical Activity Level) Activities
A 1 Sleep, nap, rest in lying position
B 1.5 Sitting: eating, TV, microcomputer, video games, board games, reading, writing, office work, sewing, transport
C 2.2 Standing: toilet, small displacement in the home, cooking, housework, laboratory work, selling, driving  gears
D 3.0 Walking, gardening or equivalent, gymnastics, yoga
E 3.5 High intensity professional activities, plastering, auto repair
F 5 Sport, intense professional activities: earthmoving, forestry

Table 1: Classification of physical activity level.

Data were collected through individual interviews and health cards exploitation, using a survey sheet.

Treatment and analysis of the data

Double data entry was done using Epi Data 3.1 software. Univariate and multivariate analytical descriptive statistics were generated by the SPSS 21 software. The quantitative variables were expressed on average with standard deviation and the qualitative variables in percentage. In the univariate analysis, the Chi-square test the exact one of Fischer was used for the comparison of percentages. The strength and intensity of the association were estimated by the odd-ratio with a 95% confidence interval.

Ethical considerations

The consent of Borgou/Alibori Health Departmental Direction and the management team of the various maternity hospitals were obtained. All participants received detailed information about the study and gave their consent.

Results

Characteristics of pregnant women

A total of 205 pregnant women were included in the study. The pregnant women were aged 16 to 43 years with a mean age of 26.6 ± 5.4 years. Those aged 25-29 accounted for 30.7% of the sample. Over two thirds of the study populations were married women (88%). Half of the pregnant women (50.7%) had no education and 6.3% had a university degree. Seventy-five pregnant women (36.6%) had a high socio-economic well-being level.

The prevalence of obese, overweight, or lean pregnant women were respectively 9.8% (20/205), 21.5% (45/205), and 9.3% (19/205) (Table 2).

  Lean Normal Overweight Obese Total  
  n=19 % n=121 % n=45 % n=20 % n % p
Age (years)                     0.000
15-19 5 27.8 11 61.1 1 5.6 1 5.6 18 100.0  
20-24 2 3.5 35 61.4 17 29.8 3 5.3 57 100.0  
25-29 7 11.1 45 71.4 8 12.7 3 4.8 63 100.0  
30-34 3 6.0 19 38.0 16 32.0 12 24.0 50 100.0  
≥35 2 11.8 11 64.7 3 17.6 1 5.9 17 100.0  
Parity                      
Nullipara 11 21.6    34 66.7 4 7.8 2 3.9 51 100.0  
Primipara 2 4.2 35 72.9 10 20.8 1 10.4 48 100.0  
Multipara 6 5.7 52 49.1 31 29.2 17 16.0 106 100.0  
SEWL*                     0.000
Low 10 58.8 6 35.3 1 5.9 0 0.0 17 100.0  
Average 8 7.0 68 59.6 27 23.7 11 9.6 114 100.0  
High 1 1.4 47 63.5 17 23.0 9 12.2 74 100.0  
GWG**                     0.000
Insufficient 9 47.4 8 42.1 0 0.0 2 10.5 19 100.0  
Normal 6 6.0 71 71.0 18 18.0 5 5.0 100 100.0  
Excessive 4 4.7 42 48.8 27 31.4 13 15.1 86 100.0  
*SEWL: Socio-Economic Well-being Level
**GWG: Gestational Weight Gain

Table 2: Distribution of pregnant women according to their age, socio-economic level, Gestational Weight Gain based on their nutritional status (N=205).

The proportions of pregnant women with normal or high GWG were respectively 48.8% (100/205) and 41.9% (86/205). GWG was significantly related to the nutritional status of pregnant women before pregnancy (p=0.000). Indeed a proportional increase of the GWG with the BMI of the pregnant women had been noted (Table 2).

Nutritional status of pregnant women

BMI was significantly associated with the pregnant women age (p=0.000), Socio-Economic Well-being Level (p=0.000), parity (p=0.009), GPG (p=0.000) (Table 2).

There were more cesarean in obese or overweight pregnant women than in normal weight pregnant women: 25%; 24.4% versus 7.4% (p=0.003) (Table 3).

  Vaginal delivery Caesarean Total p
n=178 % n=27 % N %
Nutritional status (N=205)             0.003
Obese 15 75.0 5 25.0 20 100.0  
Overweight 34 75.6 11 24.4 45 100.0  
Normal 112 92.6 9   7.4 121 100.0  
Lean 17 89.5 2 10.5 19 100.0  
GWG (N=205) *             0.000
Excessive 66 76.7 20 23.3 86 100.0  
Normal 93 93.0 7 7.0 100 100.0  
Insufficient 19 100 0 0.0 19 100.0  
*GWG : Gestational Weight Gain

Table 3: Distribution of pregnant women according to mode of delivery and nutritional characteristics.

State of newborns

The proportions of hypotrophic, normotrophic and hypertrophic newborns were respectively 7.8% (16/205), 27.8% (57/205) and 64.4% (132/205).

Newborn hypotrophy was associated with low levels of socioeconomic well-being (p=0.000), low BMI of pregnant women (p=0.000), GWG (p=0.000), Physical Activity Level (p=0.000) and GA (p=0.000) (Table 4).

  Hypotrophic Normotrophic      
  N=16 % N=57 % OR 95 % IC p
Age (years)             0.069
15-19 6 37.5 5 8.8 7.2 0.8 -79.4  
20-24 3 18.8 16 28.1 1.3 0.1-11.7  
25-29 5 31.2 21 36.8 1.4 0.2-12.7  
30-34 2 12.5 12 21.0 1    
≥ 35 0 0.0 3 5.3 - -  
Educational level             0.427
Not  in school 10 62.5 27 47.4 1.7 0.3- 9.5  
Primary 3 18.8 9 15.8 1.6 0.2 -13.3  
Secondary 3 18.8 14 24.6 1    
University 0 0.0 7 12.3 -    
SEWL*             0.000
Low 10 62.5 3 5.3 21.1 3.7-139.8  
High 0 0.0 16 28.0 -    
Average 6 37.5 38 66.7 1    
Nutritional status             0.000
Obese 2 12.5 1 1.8 18.0 0.9-623  
Overweight 0 0.0 7 12.3 - -  
Lean 9 56.3 4 7.0   20.3 3.7-125  
Normal 5 31.2 45 78.9 1    
GWG**             0.000
Excessive 1 6.2 1 1.7 26.5 1.2-594.6  
Insufficient 13 81.3 3 5.3 114.8 17.4-759.6  
Normal 2 12.5 53 93.0 1    
PAL***             0.000
B 0 0.0 2 3.5 - -  
C 16 100.0 16 28.1 - -  
D 0 0.0 24 42.1 - -  
E 0 0.0 15 26.3 - -  
Gestational age             0.000
Premature 7 43.8 1 1.8 42.0 4.6-383.2  
Post term 0 0.0 2 3.5 - -  
Forward 9 56.3 54 94.7 1    
*SEWL: Socio-Economic Well-being Level; **GWG: Gestational Weight Gain;
***PAL: Physical Activity Level

Table 4: Distribution of hypotrophic or normotrophic newborns according to the main sociodemographic characteristics of mothers.

Newborn hypertrophy was proportionally associated with obesity (p=0.003), high GWG (p=0.000), and low physical activity of pregnant women (p=0.000) (Table 5).

  Hypertrophic Normotrophic      
  N=132 % N=57 % OR 95 % IC p
Age (years)             0.485
15-19 7 5.3 5 8.8 1    
20-24 40 30.3 16 28.1 1.8 0.4 -6.5  
25-29 37 28.0 21 36.8 1.3 0.3 -4.5  
30-34 34 25.8 12 21.1 2.0 0.5-7.6  
≥ 35 14 10.6 3 5.3 3.3 0.6 -18.1  
Educational level             0.137
Not in school 67 50.8 27 47.4 2.9 0.8 -9.4  
Primary 33 25.0 9 15.8 4.3 1.1 -15.9  
Secondary 26 19.7 14 24.5 2.2 0.6-7.7  
University 6 4.5 7 12.3 1    
SEWL             0.092
Low 4 3.0 3 5.3 0.7 0.1-3.5  
High 59 44.7 16 28.1 2.0 1.0-4.0  
Average 69 52.3 38 66.6 1    
Nutritional status             0.003
Obese 17 12.9 1 1.8 10.6 1.4 -82.6  
Overweight 37 28.1 7 12.3 3.3 1.3-8.0  
Lean 6 4.5 4 7.0 0.9 0.2 -3.5  
Normal 72 54.5 45 78.9 1    
GWG             0.000
Excessive 85 64.4 1 1.8 95.8 12.8-715.5  
Insufficient 0 0.0 3 5.3 -    
Normal 47 35.6 53 98.2 1    
PAL             0.000
B 92 69.7 2 3.5 230 35.4-493.2  
C 31 23.5 16 28.1 9.7 2.4-38.5  
D 6 4.5 24 42.1 1.3 0.2-5.7  
E 3 2.3 15 26.3 1    
*SEWL: Socio-Economic Well-being Level; **GWG: Gestational Weight Gain;
***PAL: Physical Activity Level

Table 5: Distribution of hypertrophic and normotrophic newborns based on socio-demographic, nutritional and anthropometric characteristics of mothers.

Perinatal mortality was significantly associated with low BMI (15.8%, p=0.038), and low GPG (26.3%, p=0.000) (Table 6).

  Total Perinatal Mortality  
  (N) n % (n/N) P
Nutritional status        
Obese 20 0 0,0  
Overweight 45 1 2,2  
Normal 121 4 3,3  
lean 19 3 15,8  
GWG*       0,000
Excessive 86 1 1,2  
Insufficient 19 5 26,3  
Normal 100 2 2,0  
*GWG : Gestational Weight Gain

Table 6: Distribution of Perinatal mortality based on nutritional characteristics of mothers.

Discussion

The prevalence of overweight, obesity and thinness in pregnant women was respectively 21.5%, 9.8% and 9.3%. A previous study reported higher prevalence of overweight and obesity in the capital city of our country respectively 30.6%, 18% [9]. The prevalence of obesity in pregnant women is higher in developed countries where obesity is a public health problem: in France 9.9% [10], Canada 16% [11], United Kingdom [12]. The very different eating habits and lifestyles in these countries may explain this difference.

The proportions of pregnant women who had high or low GWG were respectively 41.9% and 9.3%. These proportions of high and low GWG were lower than those observed by Crane and al [13] in Canada, respectively 52.3% and 17.1%. A study in Taiwan found lower proportions of high GWG and higher proportions of low GWG respectively 27.3% and 27.7% [14]. In our series, insufficient GPG was associated with perinatal mortality. Like Goldstein [15] we found that when GWG is not within recommended limits, it is associated with others perinatals complications (neonatal hypotrophy, neonatal hypertrophy).

In our series, obese or overweight pregnant women were at greater risk of delivering by cesarean section. Several studies had shown that obese and overweight pregnant women were more at risk of delivering by cesarean section [9,16]. Dempsey [16] in the United States had shown that a BMI greater than 30 multiplied by three to six the risk of cesarean section. They explained this by a higher risk of preeclampsia, fetal macrosomia and dynamic dystocia leading to cesarean section.

Our results showed that birth weight increased significantly with BMI (p=0.003): Obese or overweight pregnant women had a higher risk of giving birth to hypertrophic newborns. Several studies had also shown that overweight women were more likely to deliver newborns whose weight is over their gestational age weight [7,17,18]. We found in our series that lean pregnant women were more likely to give birth to hypotrophic newborns. Several studies have reported that the frequency of hypotrophic newborns was very low in obese women compared to normal weight women [7,19].

In our series, birth weight was significantly related to GWG (p=0.000). It increased when the GWG became important. Thus, pregnant women with high GWG were more likely to give birth to newborns of high weight. In contrast, pregnant w

omen who had not reached the recommended GWG were more likely to give birth to hypotrophic newborns. Several authors had agreed with the results reported in our work [13,17]. Viswanathan et al. [17] also found that women who do not achieve the recommended GWG during pregnancy are at risk of giving birth to a premature, gestational-age or low weight newborn.

References

Citation: Vodouhe MV, Adedemy JD, Agueh VD, Goni MLS, Ogoudjobi OM, et al. (2018) Nutritional Status of Pregnant Women and Neonatal Health in the Maternity Wards of the City of Parakou in Benin. Gynecol Obstet 8: 471. DOI: 10.4172/2161-0932.1000471

Copyright: © 2018 Vodouhe MV, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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