Relationship between maternal body composition during pregnancy and infant’s birth weight in Nairobi informal settlements, Kenya

BMJ Nutrition, Prevention and Health, Volume 3, No. 2, Year 2020

Interprétation

Background Maternal nutrition depletion during pregnancy compromises fetal programming, and is a cause of adverse birth outcomes. Maternal body composition measurement using direct body composition assessment methods such as the deuterium dilution technique provides better prediction of birth outcomes as compared with commonly used techniques like anthropometry. This study assessed body composition of pregnant mothers in urban informal settlements in Nairobi, Kenya, and established the relationship between maternal body composition and infant birth weight. Methods Deuterium dilution technique was used to determine body composition, including total body water (TBW), fat-free mass (FFM) and fat mass (FM), among 129 pregnant women who were enrolled into the study in their first or second trimester. Descriptive statistics and regression analysis were applied using Stata V.13. Results The mean TBW, FFM and FM were 33.3 L (±4.7), 45.7 kg (±6.5) and 17.01 kg (±7.4), respectively. Both TBW and FFM were significantly related to maternal age and gestation/pregnancy stage during body composition assessment while FM was significantly associated with gestation stage during body composition assessment. TBW and FFM were significantly lower in younger mothers (<20 years) compared with older mothers (≥20 years). The mean birth weight was 3.3 kg±0.42 kg. There was a positive association between infant birth weight and maternal TBW (p=0.031) and FFM (p=0.027), but not FM (p=0.88). Conclusion Non-fat components of the body (TBW and FFM) have a positive association with birth weight. Therefore, interventions to improve optimal maternal feeding practices, to enhance optimal gains in FFM and TBW during pregnancy are recommended, especially among young mothers. The study was conducted in the Korogocho and Viwandani slums in Nairobi, settings characterised by poor access to basic amenities including portable water, waste disposal, health and education services.21–23 These settings also have poor housing, high levels of food insecurity and are exposed to high levels of unemployment, violence and teenage pregnancy.24 25 In addition, Kenyan urban informal settlements have higher infant mortality rates (75 in 1000 live births) compared with other subpopulations,26 and birth weight is a major cause of poor child health and deaths in the two settlements.20 21 A calculated sample of 129 women in their first and second trimesters were recruited to participate in this study, which was nested within a broader maternal infant and young child nutrition (MIYCN) study. The MIYCN study involved the follow-up of a cohort of over 1000 women from pregnancy until 1 year after delivery to determine the feeding practices and nutrition status of mothers and children in this cohort in the two slums.27 The MIYCN study was implemented from 2012 to 2014 within the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), which is run by the African Population and Health Research Center. NUHDSS has been in operation since 2002 and involves surveillance of the population living in Korogocho and Viwandani, to monitor their health and demographic outcomes.22 Systematic sampling was used to select the 129 pregnant women from the larger cohort of 1000 women recruited into the MIYCN study, whereby every eighth eligible mothers listed in the MIYCN study were recruited to participate in this study. The pregnant women who were sampled to participate in the study were contacted by the researcher, informed about the study and invited to a central place within the study community, where the deuterium dosing, saliva sample collection, anthropometric measurements (weight and height) and a face-to-face interview on socioeconomic, demographic, health and health-seeking behaviour and pregnancy characteristics were conducted. Their gestation stage at the time of body composition was established through the date of their last menstrual period as recorded in the mother and child booklet (issued during antenatal care (ANC) visits), and recall for those who did not have the mother and child booklet. The deuterium dilution procedures were carried out by a professional specialist trained on this technique by the International Atomic Energy Agency (IAEA), while the interviews were conducted by trained research assistants. Deuterium dosage and analysis for body composition of the pregnant mothers was done as described by the IAEA.14 The mothers were then followed up after delivery to collect their infant’s birth weight and sex, as recorded in the mother and child health booklet at delivery in the hospital. Stata V.13 (StataCorp, College Station, TX) was used for statistical analysis. Descriptive summary statistics were calculated for socioeconomic and demographic characteristics, and body composition measurements. The relationship between maternal characteristics (sociodemographic, economic, health), maternal body composition (TBW, FFM, FM) and infant’s birth weight was determined using linear regression analysis while controlling for potential confounders.

Résumé de l’IA

Study Justification:

– Maternal nutrition depletion during pregnancy can lead to adverse birth outcomes.
– Maternal body composition measurement using direct body composition assessment methods provides better prediction of birth outcomes.
– This study aimed to assess the body composition of pregnant mothers in urban informal settlements in Nairobi, Kenya, and establish the relationship between maternal body composition and infant birth weight.

Highlights:

– The study found that non-fat components of the body (total body water and fat-free mass) have a positive association with birth weight.
– Younger mothers (

Force de la preuve

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study used a direct body composition assessment method (deuterium dilution technique) to measure maternal body composition, which provides more accurate predictions of birth outcomes compared to commonly used techniques like anthropometry. The study also included a sample size of 129 pregnant women and applied regression analysis to establish the relationship between maternal body composition and infant birth weight. However, the abstract does not provide information on potential confounders that were controlled for in the analysis. To improve the strength of the evidence, the abstract could include a discussion of the limitations of the study and suggestions for future research to address these limitations.

Abstrait

The study was conducted in the Korogocho and Viwandani slums in Nairobi, settings characterised by poor access to basic amenities including portable water, waste disposal, health and education services.21–23 These settings also have poor housing, high levels of food insecurity and are exposed to high levels of unemployment, violence and teenage pregnancy.24 25 In addition, Kenyan urban informal settlements have higher infant mortality rates (75 in 1000 live births) compared with other subpopulations,26 and birth weight is a major cause of poor child health and deaths in the two settlements.20 21 A calculated sample of 129 women in their first and second trimesters were recruited to participate in this study, which was nested within a broader maternal infant and young child nutrition (MIYCN) study. The MIYCN study involved the follow-up of a cohort of over 1000 women from pregnancy until 1 year after delivery to determine the feeding practices and nutrition status of mothers and children in this cohort in the two slums.27 The MIYCN study was implemented from 2012 to 2014 within the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), which is run by the African Population and Health Research Center. NUHDSS has been in operation since 2002 and involves surveillance of the population living in Korogocho and Viwandani, to monitor their health and demographic outcomes.22 Systematic sampling was used to select the 129 pregnant women from the larger cohort of 1000 women recruited into the MIYCN study, whereby every eighth eligible mothers listed in the MIYCN study were recruited to participate in this study. The pregnant women who were sampled to participate in the study were contacted by the researcher, informed about the study and invited to a central place within the study community, where the deuterium dosing, saliva sample collection, anthropometric measurements (weight and height) and a face-to-face interview on socioeconomic, demographic, health and health-seeking behaviour and pregnancy characteristics were conducted. Their gestation stage at the time of body composition was established through the date of their last menstrual period as recorded in the mother and child booklet (issued during antenatal care (ANC) visits), and recall for those who did not have the mother and child booklet. The deuterium dilution procedures were carried out by a professional specialist trained on this technique by the International Atomic Energy Agency (IAEA), while the interviews were conducted by trained research assistants. Deuterium dosage and analysis for body composition of the pregnant mothers was done as described by the IAEA.14 The mothers were then followed up after delivery to collect their infant’s birth weight and sex, as recorded in the mother and child health booklet at delivery in the hospital. Stata V.13 (StataCorp, College Station, TX) was used for statistical analysis. Descriptive summary statistics were calculated for socioeconomic and demographic characteristics, and body composition measurements. The relationship between maternal characteristics (sociodemographic, economic, health), maternal body composition (TBW, FFM, FM) and infant’s birth weight was determined using linear regression analysis while controlling for potential confounders.

Matériaux

N/A

Innovations

Based on the study titled “Relationship between maternal body composition during pregnancy and infant’s birth weight in Nairobi informal settlements, Kenya,” the recommendation to improve access to maternal health is to implement interventions that focus on improving optimal maternal feeding practices to enhance optimal gains in fat-free mass (FFM) and total body water (TBW) during pregnancy, especially among young mothers. Here are the strategies to achieve this:

1. Nutrition education and counseling: Provide comprehensive nutrition education and counseling to pregnant women, emphasizing the importance of consuming a balanced diet for healthy weight gain and optimal fetal development. This can be done through antenatal care visits, community health programs, and mobile health platforms.

2. Access to nutritious food: Ensure that pregnant women, particularly those in urban informal settlements, have access to affordable and nutritious food. This can be achieved through initiatives such as community gardens, food subsidies, and partnerships with local farmers and markets.

3. Maternal healthcare services: Strengthen maternal healthcare services in urban informal settlements by improving access to antenatal care, skilled birth attendants, and postnatal care. This includes ensuring the availability of essential maternal health supplies and equipment.

4. Empowerment and support for young mothers: Implement programs that empower and support young mothers, providing them with information, resources, and mentorship to make informed decisions about their health and the health of their infants. This can be done through peer support groups, youth-friendly health services, and targeted interventions for adolescent mothers.

5. Community engagement and awareness: Engage the community, including community leaders, local organizations, and community health workers, to raise awareness about the importance of maternal health and the specific interventions recommended in the study. This can be done through community meetings, health campaigns, and media outreach.

Implementing these recommendations is expected to improve access to maternal health, leading to better maternal nutrition, optimal gains in FFM and TBW during pregnancy, and ultimately improved birth outcomes for infants.

AI Innovations Description

The recommendation to improve access to maternal health based on the study is to implement interventions that focus on improving optimal maternal feeding practices to enhance optimal gains in fat-free mass (FFM) and total body water (TBW) during pregnancy, especially among young mothers. This can be achieved through the following strategies:

1. Nutrition education and counseling: Provide comprehensive nutrition education and counseling to pregnant women, with a focus on the importance of consuming a balanced diet that promotes healthy weight gain and optimal fetal development. This can be done through antenatal care visits, community health programs, and mobile health platforms.

2. Access to nutritious food: Ensure that pregnant women, especially those living in urban informal settlements, have access to affordable and nutritious food. This can be achieved through initiatives such as community gardens, food subsidies, and partnerships with local farmers and markets.

3. Maternal healthcare services: Strengthen maternal healthcare services in urban informal settlements by improving access to antenatal care, skilled birth attendants, and postnatal care. This includes ensuring the availability of essential maternal health supplies and equipment.

4. Empowerment and support for young mothers: Implement programs that empower and support young mothers, including providing them with information, resources, and mentorship to make informed decisions about their health and the health of their infants. This can be done through peer support groups, youth-friendly health services, and targeted interventions for adolescent mothers.

5. Community engagement and awareness: Engage the community, including community leaders, local organizations, and community health workers, to raise awareness about the importance of maternal health and the specific interventions recommended in the study. This can be done through community meetings, health campaigns, and media outreach.

By implementing these recommendations, it is expected that access to maternal health will be improved, leading to better maternal nutrition, optimal gains in FFM and TBW during pregnancy, and ultimately improved birth outcomes for infants.

AI Innovations Methodology

To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be used:

1. Selection of study population: Identify a similar population to the one studied in the original research, such as urban informal settlements with poor access to basic amenities and high levels of food insecurity. Ensure that the population includes a mix of young and older mothers.

2. Sample size determination: Calculate the required sample size based on the desired level of statistical power and significance level. Consider factors such as the expected effect size and the variability of the outcome measures.

3. Intervention implementation: Implement the recommended interventions, including nutrition education and counseling, access to nutritious food, strengthening of maternal healthcare services, empowerment and support for young mothers, and community engagement and awareness. Ensure that the interventions are implemented consistently and according to the original recommendations.

4. Data collection: Collect data on the implementation of the interventions, including the number of pregnant women who received nutrition education and counseling, the availability and accessibility of nutritious food, the improvement in maternal healthcare services, the participation and engagement of young mothers in empowerment programs, and the level of community awareness about maternal health.

5. Outcome measurement: Measure the impact of the interventions on access to maternal health by assessing indicators such as maternal feeding practices, maternal body composition (e.g., TBW and FFM), and birth outcomes (e.g., infant birth weight).

6. Statistical analysis: Analyze the collected data using appropriate statistical methods, such as regression analysis, to determine the relationship between the implemented interventions and the measured outcomes. Control for potential confounders, such as maternal age, socioeconomic status, and gestational age.

7. Interpretation of results: Interpret the results of the statistical analysis to determine the impact of the implemented interventions on improving access to maternal health. Assess the significance and magnitude of the observed effects.

8. Reporting and dissemination: Prepare a report summarizing the findings of the simulation study, including the methodology, results, and conclusions. Disseminate the findings to relevant stakeholders, such as policymakers, healthcare providers, and community organizations, to inform decision-making and program planning.

By following this methodology, it is possible to simulate the impact of the main recommendations from the original study on improving access to maternal health in a similar population. The results of the simulation study can provide valuable insights for designing and implementing effective interventions to improve maternal health outcomes.

Auteur

Dima Health

Statistics:

Citations: 2

Identifiers:

DOI: 10.1136/bmjnph-2019-000060

Research Areas:

Community Interventions, Disparities, Environmental, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health

Study Countries:

Kenya

Study Design:

Cohort Study, Cross Sectional Study

Study Approach:

Quantitative

Participants Gender:

Female

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