Sains Malaysiana 42(11)(2013): 1633–1640

Association between Maternal Food Group Intake and Birth Size

(Perkaitan antara Pemakanan Ibu Semasa Mengandung dengan Saiz Kelahiran Bayi)

S.L. LOY, M. MARHAZLINA & J.M. HAMID JAN^*

Nutrition Programme, School of Health Sciences, Universiti Sains Malaysia

16150 Kubang Kerian, Kelantan, Malaysia

Received: 16 April 2012/Accepted: 20 March 2013

ABSTRACT

Maternal nutrition is one of the dominant factors in determining fetal growth and subsequent developmental health for both mother and child. This study aimed to explore the association between maternal consumption of food groups and birth size among singleton, termed newborns. One hundred and eight healthy pregnant women in their third trimester, aged 19 to 40 years who visited the Obstetrics and Gynecology Clinic of Hospital Universiti Sains Malaysia completed an interviewed-administered, validated semi-quantitative food frequency questionnaire. The maternal socio-demographic, medical and obstetric histories and anthropometry measurements were recorded accordingly. The pregnancy outcomes, birth weight, birth length and head circumference were obtained from the medical records. The data were analyzed using multiple linear regression by controlling for possible confounders. Among all food groups, fruits intake was associated with higher birth weight (p=0.018). None of the food intake showed evident association with respect to birth length while only fruits intake was associated positively with head circumference (p=0.019). In contrast, confectioneries and condiments were associated with lower birth weight (p=0.013 and p=0.001, respectively). Also, condiments appeared to associate inversely with ponderal index (p=0.015). These findings suggest the potential beneficial effects of micronutrient rich food but detrimental effects of high sugar and sodium food on fetal growth. Such an effect may have long term health consequences to the lives of children.

Keywords: Birth weight; food frequency questionnaire; maternal intake; pregnancy

ABSTRAK

Pemakanan ibu adalah antara faktor utama dalam menentukan pertumbuhan dan kesihatan bayi dan ibu. Penyelidikan ini bertujuan untuk mengkaji perkaitan antara pemakanan ibu berdasarkan kepada kumpulan makanan dan saiz kelahiran bayi. Seratus lapan orang ibu mengandung yang berkunjung ke Klinik Obstetrik dan Ginekologi Hospital Universiti Sains Malaysia, berada dalam trimester ketiga kehamilan dan berumur 19–40 tahun telah ditemu duga dengan menggunakan borang soal selidik kekerapan pengambilan makanan yang telah divalidasi. Maklumat sosiodemografi, sejarah perubatan dan obstetrik serta pengukuran antropometri ibu direkodkan. Maklumat selepas kehamilan, berat bayi, panjang bayi dan lilitan kepala bayi diambil daripada rekod perubatan. Data dianalisis dengan kaedah regresi linear berganda. Antara semua kumpulan makanan, pengambilan buah-buahan mempunyai perkaitan dengan berat bayi yang lebih tinggi (p=0.018). Tiada kumpulan makanan yang menunjukkan hubung kait dengan panjang bayi, manakala hanya pengambilan buah-buahan mempunyai perkaitan positif dengan lilitan kepala (p=0.019). Sebaliknya, pengambilan konfeksi dan kondimen berkait dengan berat bayi yang lebih rendah (p=0.013 dan p=0.001). Pengambilan kondimen juga mempunyai perkaitan songsang dengan indeks ponderal (p=0.015). Keputusan ini menunjukkan bahawa pengambilan makanan mikronutrien tinggi membawa kesan baik manakala pengambilan makanan yang mengandungi gula dan garam tinggi membawa kesan buruk kepada pertumbuhan bayi. Kesan seperti ini mungkin akan mempengaruhi kesihatan kanak-kanak dalam jangka masa yang panjang.

Kata kunci: Berat lahir; kehamilan; kekerapan pengambilan makanan; pemakanan ibu

REFERENCES

Abu-Saad, K. & Fraser, D. 2010. Maternal nutrition and birth outcomes. Epidemiologic Reviews 32: 5-25.

Axelrod, L. 1991. Insulin, prostaglandins, and the pathogenesis of hypertension. Diabetes 40: 1223-1227.

Barker, D.J. 2004. The developmental origins of chronic adult disease. Acta Paediatrica Supplement 93: 26-33.

Barker, D.J., Godfrey, K., M., Osmond, C. & Bull, A. 1992. The relation of fetal length, ponderal index and head circumference to blood pressure and the risk of hypertension in adult life. Paediatric and Perinatal Epidemiology 6: 35-44.

Berti, C., Decsi, T., Dykes, F., Hermoso, M., Koletzko, B., Massari, M., Moreno, L.A., Serra-Majem, L. & Cetin, I. 2010. Critical issues in setting micronutrient recommendations for pregnant women: An insight. Maternal Child Nutrition 6(S2): 5-22.

Borazjani, F., Kulkarni, S.S. & Ahmadi, K. 2011. Impact of maternal factors on birth parameters in urban affluent pregnant women. Pakistan Journal of Nutrition 10: 325-327.

Christian, P. 2010. Micronutrients, birth weight, and survival. Annual Review of Nutrition 30: 83-104.

Cottrell, E.C. & Ozanne, S.E. 2008. Early life programming of obesity and metabolic disease. Physiology & Behavior 94: 17-28.

DeFronzo, R.A. & Ferrannini, E. 1991. Insulin resistance. A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care 14: 173-194.

Doyle, W., Crawford, M., Wynn, A. & Wynn, S. 1989. Maternal nutrient intake and birth weight. Journal of Human Nutrition and Dietetics 2: 415-422.

Fall, C.H.D. 2006. Developmental Origins of Cardiovascular Disease, Type 2 Diabetes and Obesity in Humans: Early Life Origins of Health and Disease. Eurekah.com and Springer Science + Business Media.

Fowles, E.R. 2004. Prenatal nutrition and birth outcomes. Journal of Obstetric, Gynecologic, & Neonatal Nursing 33: 809-822.

Gunderson, E.P. & Abrams, B. 2000. Epidemiology of gestational weight gain and body weight changes after pregnancy. Epidemiologic Reviews 22: 261-274.

Harding, J.E. 2001. The nutritional basis of the fetal origins of adult disease. International Journal of Epidemiology 30: 15-23.

Institute of Medicine (IOM). 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: National Academies Press.

Kanade, A.N., Rao, S., Kelkar, R.S. & Gupte, S. 2008. Maternal nutrition and birth size among urban affluent and rural women in India. Journal of the American College of Nutrition 27: 137-145.

Kim, Y.J., Hong, Y.C., Lee, K.H., Park, H.J., Park, E.A., Moon, H.S. & Ha, E.H. 2005. Oxidative stress in pregnant women and birth weight reduction. Reproductive Toxicology 19: 487-492.

Kuskowska-Wolk, A., Karlsson, P., Stolt, M. & Rossner, S. 1989. The predictive validity of body mass index based on self-reported weight and height. International Journal of Obesity 13: 441-453.

Lagiou, P., Tamimi, R. M., Mucci, L.A., Adami, H.O., Hsieh, C.C. & Trichopoulos, D. 2004. Diet during pregnancy in relation to maternal weight gain and birth size. European Journal of Clinical Nutrition 58: 231-237.

Law, C.M., Egger, P., Dada, O., Delgado, H., Kylberg, E., Lavin, P., Tang, G-H., von Hertzen, H., Sheill, A.W. & Barker, DJP. 2001. Body size at birth and blood pressure among children in developing countries. International Journal of Epidemiology 30: 52-57.

Lenders, C.M., Hediger, M.L., Scholl, T.O., Khoo, C.S., Slap, G.B. & Stallings, V.A. 1994. Effect of high-sugar intake by low-income pregnant adolescents on infant birth weight. Journal of Adolescent Health 15: 596-602.

Lenders, C.M., Hediger, M.L., Scholl, T.O., Khoo, C.S., Slap, G.B. & Stallings, V.A. 1997. Gestational age and infant size at birth are associated with dietary sugar intake among pregnant adolescents. Journal of Nutrition 127: 1113-1117.

Lin, P.H., Aickin, M., Champagne, C., Craddick, S., Sacks, F.M., McCarron, P., Most-Windhauser, M.M., Rukenbrod, F. & Haworth, L. 2003. Food group sources of nutrients in the dietary patterns of the DASH-Sodium trial. Journal of the American Dietetic Association 103: 488-496.

Loy, S.L., Marhazlina, M., Nor Azwany, Y. & Hamid Jan, J.M. 2011. Development, validity and reproducibility of a food frequency questionnaire in pregnancy for the Universiti Sains Malaysia birth cohort study. Malaysian Journal of Nutrition 1: 1-18.

Mackerras, D. 1996. Energy adjustment: The concepts underlying the debate. Journal of Clinical Epidemiology 49: 957-962.

Mahmud, A.B. & Sallam, A.A. 1999. Analysis of birth weight data from the Malaysian Family Life Survey II. Asia-Pacific Journal of Public Health 11: 71-76.

Mathews, F., Yudkin, P. & Neil, A. 1999. Influence of maternal nutrition on outcome of pregnancy: Prospective cohort study. British Medical Journal 319: 339-343.

Mikkelsen, T.B., Osler, M., Orozova-Bekkevold, I., Knudsen, V.K. & Olsen, S.F. 2006. Association between fruit and vegetable consumption and birth weight: A prospective study among 43,585 Danish women. Scandinavian Journal of Public Health 34: 616-622.

Moore, V.M., Davies, M.J., Willson, K.J., Worsley, A. & Robinson, J.S. 2004. Dietary composition of pregnant women is related to size of the baby at birth. Journal of Nutrition 134: 1820-1826.

National Coordinating Committee on Food and Nutrition (NCCFN). 2005. A Report of the Technical Working Group on Nutritional Guidelines: Recommended Nutrient Intakes for Malaysian. Kuala Lumpur: Ministry of Health Malaysia.

Norkhafizah, S., Norsa’adah, B., Zainuddin, S.L.A., Sosroseno, W. & N. Hazlina, N.H. 2004. Higher incidence of low birth weight infants among Malay women with peridontitis in Kota Bharu, Kelantan. Jurnal Kesihatan Masyarakat. Isu khas: 1-3.

Olsen, S.F., Halldorsson, T.I., Willett, W.C., Knudsen, V.K., Gillman, M.W., Mikkelsen, T.B., Olsen, J. & The NUTRIX Consortium. 2007. Milk consumption during pregnancy is associated with increased infant size at birth: Prospective cohort study. American Journal of Clinical Nutrition 86(4): 1104-1110.

Petridou, E., Stoikidou, M., Diamantopoulou, M., Mera, E., Dessypris, N. & Trichopoulos, D. 1998. Diet during pregnancy in relation to birthweight in healthy singletons. Child: Care, Health and Development 24: 229-242.

Phillips, D.I., Barker, D.J., Hales, C.N., Hirst, S. & Osmond, C. 1994. Thinness at birth and insulin resistance in adult life. Diabetologia 37: 150-154.

Ramon, R., Ballester, F., Iniguez, C., Rebagliato, M., Murcia, M., Esplugues, A., Marco, A., de la Hera, M.G. & Vioque, J. 2009. Vegetable but not fruit intake during pregnancy is associated with newborn anthropometric measures. Journal of Nutrition 139(3): 561-567.

Rao, S., Yajnik, C.S., Kanade, A., Fall, C.H., Margetts, B.M., Jackson, A.A., Shier, R., Joshi, S., Rege, S., Lubree, H. & Desai, B. 2001. Intake of micronutrient-rich foods in rural Indian mothers is associated with the size of their babies at birth: Pune Maternal Nutrition Study. Journal of Nutrition 131(4): 1217-1224.

Saker, M., Soulimane Mokhtari, N., Merzouk, S.A., Merzouk, H., Belarbi, B. & Narce, M. 2008. Oxidant and antioxidant status in mothers and their newborns according to birthweight. European Journal of Obstetrics & Gynecology and Reproductive Biology 141: 95-99.

Stotland, N.E., Caughey, A.B., Lahiff, M. & Abrams, B. 2006. Weight gain and spontaneous preterm birth: The role of race or ethnicity and previous preterm birth. Obstetrics and Gynecology 108: 1448-1455.

Tee, E.S., Ismail, M.N., Mohd Nasir, A. & Khatijah, I. 1997. Nutrient Composition of Malaysian foods. 4th ed. Kuala Lumpur: Malaysian Food Composition Database Programme c/o Institute for Medical Research.

Thorsdottir, I., Torfadottir, J.E., Birgisdottir, B.E. & Geirsson, R.T. 2002. Weight gain in women of normal weight before pregnancy: Complications in pregnancy or delivery and birth outcome. Obstetrics and Gynecology 99: 799-806.

U.S. Department of Agriculture. Agricultural Research Service, 2009. Nutrient Data Laboratory Home Page, retrieved from USDA: http://www.ars.usda.gov/ba/bhnrc/Ndl.

van der Maten, G.D. 1995. Low sodium diet in pregnancy: Effects on maternal nutritional status. European Journal of Obstetrics & Gynecology and Reproductive Biology 61: 63-64.

Watson, P.E. & McDonald, B.W. 2010. The association of maternal diet and dietary supplement intake in pregnant New Zealand women with infant birth weight. European Journal of Clinical Nutrition 64: 184-193.

Willett, W. 1998. Nutritional Epidemiology. 2nd ed. New York: Oxford University Press.

Willett, W.C., Howe, G.R. & Kushi, L.H. 1997. Adjustment for total energy intake in epidemiologic studies. American Journal of Clinical Nutrition 65: 1220S-1228S; discussion 1229S-1231S.

*Corresponding author; email: hamidjan@kb.usm.my