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Maternal anemia and underweight as determinants of pregnancy outcomes: cohort study in eastern rural Maharashtra, India.

ABSTRACT: OBJECTIVES:To study the trend in the prevalence of anaemia and low BMI among pregnant women from Eastern Maharashtra and evaluate if low BMI and anaemia affect pregnancy outcomes. DESIGN:Prospective observational cohort study. SETTING:Catchment areas of 20 rural primary health centres in four eastern districts of Maharashtra State, India. PARTICIPANTS:72?750 women from the Nagpur site of Maternal and Newborn Health Registry of NIH's Global Network, enrolled from 2009 to 2016. MAIN OUTCOME MEASURES:Mode of delivery, pregnancy related complications at delivery, stillbirths, neonatal deaths and low birth weight (LBW) in babies. RESULTS:Over 90% of the women included in the study were anaemic and over a third were underweight (BMI <18?kg/m2) and with both conditions. Mild anaemia at any time during delivery significantly increased the risk (Risk ratio; 95% confidence interval (RR;(95%?CI)) of stillbirth (1.3 (1.1-1.6)), neonatal deaths (1.3 (1-1.6)) and LBW babies (1.1 (1-1.2)). The risks became even more significant and increased further with moderate/severe anaemia any time during pregnancy for stillbirth (1.4 (1.2-1.8)), neonatal deaths (1.7 (1.3-2.1)) and LBW babies (1.3 (1.2-1.4)).,. Underweight at anytime during pregnancy increased the risk of neonatal deaths (1.1 (1-1.3)) and LBW babies (1.2;(1.2-1.3)).The risk of having stillbirths (1.5;(1.2-1.8)), neonatal deaths (1.7;(1.3-2.3)) and LBW babies (1.5;(1.4-1.6)) was highest when - the anaemia and underweight co-existed in the included women. Obesity/overweight during pregnancy increased the risk of maternal complications at delivery (1.6;(1.5-1.7)) and of caesarean section (1.5;(1.4-1.6)) and reduced the risk of LBW babies 0.8 (0.8-0.9)). CONCLUSION:Maternal anaemia is associated with enhanced risk of stillbirth, neonatal deaths and LBW. The risks increased if anaemia and underweight were present simultaneously. TRIAL REGISTRATION NUMBER:NCT01073475.

SUBMITTER: Patel A

PROVIDER: S-EPMC6089300 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Maternal anemia and underweight as determinants of pregnancy outcomes: cohort study in eastern rural Maharashtra, India.

Patel Archana A Prakash Amber Abhijeet AA Das Prabir Kumar PK Gupta Swarnim S Pusdekar Yamini Vinod YV Hibberd Patricia L PL

BMJ open 20180808 8

<h4>Objectives</h4>To study the trend in the prevalence of anaemia and low BMI among pregnant women from Eastern Maharashtra and evaluate if low BMI and anaemia affect pregnancy outcomes.<h4>Design</h4>Prospective observational cohort study.<h4>Setting</h4>Catchment areas of 20 rural primary health centres in four eastern districts of Maharashtra State, India.<h4>Participants</h4>72 750 women from the Nagpur site of Maternal and Newborn Health Registry of NIH's Global Network, enrolled from 2009 ...[more]

PMID: 30093518

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Project description:Dietary adequacy and diversity during the lactation period are necessary to ensure good health and nutrition among women and children. Behavioral interventions pertaining to health and nutrition counselling during pregnancy and lactation are critical for awareness about dietary diversity. The issue assumes salience for marginalized communities because of the Covid-19 pandemic and associated economic and societal disruptions. This paper assesses the dietary patterns among 400 lactating mothers in the tribal-dominated district of Palghar in Maharashtra, India in 2020. The study is based on primary data regarding consumption of 10 food groups among women across 10 food groups based on 24-hour recall period. The primary outcome variable was binary information regarding Minimum Dietary Diversity defined as consumption from at least 5 food groups. Econometric analysis based on multilevel models and item-response theory is applied to identify food groups that were most difficult to be received by mothers during the early and late lactation period. We find that the daily diet of lactating mothers in Palghar primarily consists of grains, white roots, tubers, and pulses. In contrast, the intake of dairy, eggs, and non-vegetarian food items is much lower. Only Half of the lactating women (56.5 percent; 95% CI: 37.4; 73.8) have a minimum diversified diet (MDD). The prevalence of lactating women with MDD was higher among households with higher income (73.1 percent; 95% CI: 45.2; 89.9) than those in lower income group (50.7 percent; 95% CI: 42.3; 58.9). Lactating Women (in early phase) who received health and nutrition counseling services are more likely (OR: 2.37; 95% CI: 0.90; 6.26) to consume a diversified diet. Food groups such as fruits, meat, poultry, fish, nuts, and seeds were among the rare food items in daily diet. The dietary pattern lacking in fruits, nuts, and heme (iron) sources indicates more significant risks of micronutrient deficiencies. The findings call for improving dietary diversity among lactating mothers, particularly from the marginalized communities, and are driven by low consumption of dairy products or various fruits and vegetables. Among the different food items, the consumption of micronutrient-rich seeds and nuts is most difficult to be accessed by lactating mothers. Also, diet-centric counseling and informing lactating mothers of its benefits are necessary to increase dietary diversity for improving maternal and child nutrition.

Project description:BackgroundUndernutrition among under five children in India is a major public health problem. Despite India's growth in the economy, the child mortality rate due to undernutrition is still high in both urban and rural areas. Studies that focus on urban slums are scarce. Hence the present study was carried out to assess the prevalence and determinants of undernutrition in children under five in Maharashtra, India.MethodsA community-based cross-sectional study was conducted in 16 randomly selected clusters in two districts of Maharashtra state, India. Data were collected through house to house survey by interviewing mothers of under five children. Total 2929 mothers and their 3671 under five children were covered. Multivariate logistic regression analysis was carried out to identify the determinants of child nutritional status seperately in urban and rural areas.ResultsThe mean age of the children was 2.38?years (±SD 1.36) and mean age of mothers was 24.25?years (± SD 6.37). Overall prevalence of stunting among children under five was 45.9%, wasting was 17.1 and 35.4% children were underweight. Prevalence of wasting, stunting and underweight were more seen in an urban slum than a rural area. In the rural areas exclusive breast feeding (p?<?0.001) and acute diarrhea (p?=?0.001) were associated with wasting, children with birth order 2 or less than 2 were associated with stunting and exclusive breast feeding (p?<?0.05) and low maternal education were associated with underweight. Whereas in the urban slums exclusive breast feeding (p?<?0.05) was associated with wasting, sex of the child (p?<?0.05) and type of family (p?<?0.05) were associated with stunting,and low income of the family (p?<?0.05) was associated with underweight.ConclusionsFactors like sex of the child, birth order,exclusive breast feeding,economic status of the family, type of family,acute diarrhea and maternal education have influence on nutritional status of the child. Improvement of maternal education will improve the nutritional status of the child. Strategies are needed to improve the economic status of the community.Trial registrationTrial registration number: CTRI/2017/12/010881 ; Registration date:14/12/2017. Retrospectively registered.

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Maternal anemia and underweight as determinants of pregnancy outcomes: cohort study in eastern rural Maharashtra, India.

Publications

Maternal anemia and underweight as determinants of pregnancy outcomes: cohort study in eastern rural Maharashtra, India.

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