The effect of prenatal maternal nutrition and eating habits on low birthweight in the Gaza Strip: a case-control study

Abstract

BackgroundPoor prenatal nutrition is recognised as an important cause of low birthweight, defined as a weight of less than 2·5 kg at birth. We aimed to assess the association between prenatal maternal nutrition and delivery of infants with low birthweight in the Gaza Strip. Methods446 women were selected in a ratio of 1:1 during May–June and July–August, 2007, from attendants of Al-Tahrier Hospital and Shifa Medical Centre, respectively. Cases were all women who delivered live singleton infants with a weight of less than 2·5 kg. Matched controls were mothers who delivered single live newborns weighing 2·5 kg or more during the first 24 h after their respective cases were identified. We computed univariately unadjusted matched odds ratios (mOR) and 95% CIs with conditional logistic regression. Univariate and multivariate logistic regression were used with analyses completed in two integrated steps. In model 1, we analysed prenatal predictors that remained after stepwise backward selection at univariate p value <0·20. In model 2, we analysed the significant variables from model 1 and other principal confounding factors (parents’ education, occupation, and residence by districts’ distribution), stress, income, consanguinity, and body-mass index). Maternal nutritional status and eating habits were assessed subjectively by asking mothers about their appetite during pregnancy, number of meals, time space between meal ingestion and caffeine intake (tea and coffee), quality of the ingested food, and tea and coffee consumption. FindingsThe findings showed independently adjusted significant linear trend for increased odds of low birthweight with poor (mOR 3·80, 95% CI 1·65–8·74) and moderate (2·28, 1·20–4·33) maternal appetite status, and diminished frequency of eating meat during pregnancy(women who ate meat fewer than three times a month and once a week had, respectively, 4·25 times [95% CI 1·70–10·6] and 2·77 times [1·42–5·38] higher risk of low birthweight compared with who consumed meat two or more times a week). Likewise, short time (<1 h) between maternal meal ingestion and tea consumption (mOR 2·48, 95% CI 1·14–5·41), and high intake of coffee (≥2 cups a day; 2·48, 1·14–5·41) were independently associated with increased likelihood of low birthweight after adjustment for principal confounders. InterpretationOur results suggest that several maternal nutritional factors are associated with low birthweight in the Gaza Strip. Such associations might have implications for clinical antenatal work, especially since the identified exposures are modifiable. Emphasis should be given to educational health strategies combined with concrete developmental policies aiming to improve the socioeconomic conditions that determine the presence of diverse health-damaging exposures. FundingNone.