A dietary and clinical survey of pregnant women with particular reference to toxaemia of pregnancy

Abstract

An individual dietary survey of 111 primiparae was carried out in Bristol during 1947. Compared with a group studied by McCance in 1938, these women were getting twice as much milk, more bread, potatoes, vegetables and fish; they were getting less meat, butter and margarine. 84 % were taking supplements of vitamins A and D.Compared with the N.R.C. standard for pregnant women the diets were very poor, not one reaching the standard. It is felt that the N.R.C. standard for pregnant women is set too high. Compared with the standard for sedentary women there were deficiencies in vitamins B and C, the most marked being in nicotinic acid (74% of diets). As a group they appeared to be well nourished, only 8 % had a Hb below 80% and only one a plasma protein below 5·5 g./100 c.c.; there were no stigmata usually attributable to nutritional deficiencies. The only complication of note was toxaemia, which occurred in 15% of cases. The only deficiency in the diet common to all cases of toxaemia was in nicotinic acid. The mean intake of nicotinic acid was 2·0 mg. lower in the toxaemic group than the mean intake of nicotinic acid in the normal subjects. This difference was statistically significant. Evidence is presented which suggests that deficiency of nicotinic acid or vitamin B6 may be a predisposing factor in the production of toxaemia of pregnancy. The main cause of defective nutrition appears to be ignorance and not lack of money, this is an additional reason for the promotion of an intensive nutritional education programme.The appointment of dietitians to ante-natal clinics is stressed as an important step in promoting education in nutritional matters during pregnancy.The use and abuse of recommended allowances in pregnancy is discussed and the following diet is suggested as a reasonable practical allowance for pregnant women: calories, 2500; protein, 1·5 g. per kg. body weight; calcium, 1·5 g.; iron, 15 mg.; vitamin A, 3500 units (pre-formed); vitamin D, 800 units; vitamin B1; 1·5 mg.; riboflavin, 2·0 mg.; nicotinic acid, 14 mg.; vitamin C, 50 mg.