Abstract
BackgroundTo assess the maternal characteristics and nutritional status according to body mass index (BMI) at 6–14 weeks of gestation and to examine the relationship between maternal nutritional status in early pregnancy and its impact on neonatal birth weight.MethodsThe investigation was conducted from April 2011 to June 2012 in Dhaka, Bangladesh. A total of 498 primigravida pregnant women participated in the study; women with known diabetes or previous gestational diabetes (GDM) were excluded. Maternal demographic details, pregnancy history and anthropometric measurements were obtained from the mother at the recruitment (6–14 weeks), 2nd visit between 24 and 28 week of gestation and 3rd visit at delivery. Cord venous blood samples of newborns (n = 138) were collected immediately after delivery for blood glucose, insulin, lipid profile, leptin and micronutrients including serum folate, ferritin, homocysteine, vitamin D, and vitamin B12.ResultsThe prevalence at 6–14 weeks of pregnancy of anemia (Hb, < 11 g/dl), vitamin D deficiency (< 30 nmol/l), vitamin B12 deficiency (< 200 pg/ml), high homocysteine level (> 15 μmol/l), folate deficiency (< 3 ng/ml) and iron deficiency (ferritin < 13 ng/ml) were 19.5, 46.4, 15.1, 1.2, 0.4, and 12.7% respectively. GDM was found in 18.4% women. The prevalence of GDM was higher in overweight women (28.1%) than underweight (16.7%) and normal weight women (16.0%: p < 0.05). The incidence of low birth weight (LBW) and preterm delivery were 11.6 and 5.8% respectively and was not related to maternal BMI at 6–14 weeks of pregnancy. Maternal height was positively (p = 0.02), and homocysteine was negatively associated with neonatal birth weight (p = 0.02). In addition, the newborn’s cord serum folate was positively (p = 0.03) and cord triglyceride was negatively (p = 0.03) associated with neonatal birth weight.ConclusionMultiple maternal micronutrient deficiencies were present in early pregnancy. Maternal BMI in early pregnancy was not related to preterm deliveries or LBW. LBW was associated with lower folate, elevated cord triglyceride concentrations of the neonates and mother’s height and increase in maternal homocysteine levels. The data has important implications for pregnancy care in Bangladesh and other similar communities.
Highlights
To assess the maternal characteristics and nutritional status according to body mass index (BMI) at 6– 14 weeks of gestation and to examine the relationship between maternal nutritional status in early pregnancy and its impact on neonatal birth weight
All the anthropometric indices, systolic and diastolic blood pressure were significantly lower in underweight women
Lower levels of fasting plasma glucose, 2 h plasma glucose and triglyceride at baseline were observed among underweight compared to overweight mothers (p < 0.05)
Summary
To assess the maternal characteristics and nutritional status according to body mass index (BMI) at 6– 14 weeks of gestation and to examine the relationship between maternal nutritional status in early pregnancy and its impact on neonatal birth weight. Maternal undernutrition during pregnancy results in intrauterine growth restriction (IUGR) which is associated with increased perinatal morbidity and mortality. These children have an increased risk for development of metabolic syndrome in adult life [1, 2]. The inner cell mass which develops as the fetus and the outer cell mass become the placenta These developmental process is influenced by nutrition and hormones [3, 4]. Maternal undernutrition at the time of conception have shown fewer cells in the inner cell mass in experimental animal studies, which is associated with reduced birth weight and postnatal growth, altered organ/body weight ratios and the development of chronic diseases as type 2 diabetes (T2DM), hypertension (HTN), coronary artery disease (CAD) etc. They have shown that exposure to malnutrition, especially in late gestation, is linked to impaired glucose tolerance, while exposure in early gestation is linked to atherogenic lipid disorders and obesity [7,8,9]
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