Abstract
BackgroundMaternal physical and mental health during pregnancy are key determinants of birth outcomes. There are relatively few prospective data that integrate physical and mental maternal health measures with birth outcomes in low- and middle-income country settings. We aimed to investigate maternal health during pregnancy and the impact on birth outcomes in an African birth cohort study, the Drakenstein Child Health Study.MethodsPregnant women attending 2 public health clinics, Mbekweni (serving a predominantly black African population) and TC Newman (predominantly mixed ancestry) in a poor peri-urban area of South Africa were enrolled in their second trimester and followed through childbirth. All births occurred at a single public hospital. Maternal sociodemographic, physical and psychosocial characteristics were comprehensively assessed. Multivariable linear regression models were used to explore associations between maternal health and birth outcomes.ResultsOver 3 years, 1137 women (median age 25.8 years; 21% HIV-infected) gave birth to 1143 live babies. Most pregnancies were uncomplicated but gestational diabetes (1%), anaemia (22%) or pre-eclampsia (2%) occurred in a minority. Most households (87%) had a monthly income of less than USD 350; only 27% of moms were employed and food insecurity was common (37%). Most babies (80%) were born by vaginal delivery at full term; 17% were preterm, predominantly late preterm. Only 74 (7%) of babies required hospitalisation immediately after birth and only 2 babies were HIV-infected. Food insecurity, socioeconomic status, pregnancy-associated hypertension, pre-eclampsia, gestational diabetes and mixed ancestry were associated with lower infant gestational age while maternal BMI at enrolment was associated with higher infant gestational age. Primigravida or alcohol use during pregnancy were negatively associated with infant birth weight and head circumference. Maternal BMI at enrolment was positively associated with birth weight and gestational diabetes was positively associated with birth weight and head circumference for gestational age. Smoking during pregnancy was associated with lower infant birth weight.ConclusionSeveral modifiable risk factors including food insecurity, smoking, and alcohol consumption during pregnancy were identified as associated with negative birth outcomes, all of which are amenable to public health interventions. Interventions to address key exposures influencing birth outcomes are needed to improve maternal and child health in low-middle income country settings.
Highlights
Maternal health during pregnancy is a key determinant of birth outcomes and child health, with accumulating evidence that the roots of chronic illness may be influenced by prenatal exposures.[1,2,3] Optimizing maternal physical and mental health and reducing potentially harmful exposures during pregnancy are key to promoting child health and to reducing chronic illness
Socioeconomic status, pregnancy-associated hypertension, pre-eclampsia, gestational diabetes and mixed ancestry were associated with lower infant gestational age while maternal BMI at enrolment was associated with higher infant gestational age
In low and middle income countries (LMICs), child survival has been the major focus of health systems
Summary
Maternal health during pregnancy is a key determinant of birth outcomes and child health, with accumulating evidence that the roots of chronic illness may be influenced by prenatal exposures.[1,2,3] Optimizing maternal physical and mental health and reducing potentially harmful exposures during pregnancy are key to promoting child health and to reducing chronic illness. Prospectively or comprehensively investigated the impact of physical and mental health during pregnancy on birth outcomes and subsequent infant health. In LMIC settings, pregnant women may have high intensity exposure to many potentially harmful risk factors to their own health and to that of their child such as HIV, hazardous alcohol use, or tobacco smoke exposure.[5, 6] Poverty associated environmental factors such as poor housing or crowded living conditions may exacerbate exposure risk.[7] Maternal malnutrition has been linked to a number of poor fetal and birth outcomes including neural tube defects, preterm delivery, and low birth weight.[8, 9] Food insecurity reflects inaccessibility to food and encapsulates the psychological impact of worrying about having enough food. We aimed to investigate maternal health during pregnancy and the impact on birth outcomes in an African birth cohort study, the Drakenstein Child Health Study
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