Maternal and fetal nutrition in south India

Lack of head sparing following third-trimester caloric restriction among Tanzanian Maasai

The reduction of food intake during pregnancy is part of many cultural and religious traditions around the world. The impact of such practices on fetal growth and development are poorly understood. Here, we examined the patterns of diet intake among Maasai pregnant women and assessed their effect on newborn morphometrics. We recruited 141 mother-infant pairs from Ngorongoro Conservation Area (NCA) in Northern Tanzania and quantified dietary intake and changes in maternal diet during pregnancy. We obtained measurements of body weight (BW) and head circumference (HC) at birth. We found that Maasai women significantly reduced their dietary intake during the third trimester, going from an average of 1601 kcal/day during the first two trimesters to 799 kcal/day in the final trimester. The greatest proportion of nutrient reduction was in carbohydrates. Overall, 40% of HC Z-scores of the NCA sample were more than 2 standard deviations below the WHO standard. Nearly a third of neonates classify as low birth weight (< 2500g). HC was smaller relative to BW in this cohort than predicted using the WHO standard. This contrasts markedly to a Tanzanian birth cohort obtained at the same time in an urban context in which only 12% of infants exhibited low weight, only two individuals had HC Z-scores < 2 and HC's relative to birth weight were larger than predicted using the WHO standards. The surprising lack of head sparing in the NCA cohort suggests that the impact of third trimester malnutrition bears further investigation in both animal models and human populations, especially as low HC is negatively associated with long term health outcomes.

Birth-weight differences at term are explained by placental dysfunction and not by maternal ethnicity. Study in newborns of first generation immigrants

Objective: The aim of the study was to investigate the influence of ethnicity and cerebroplacental ratio (CPR) on the birth weight (BW) of first generation Indo-Pakistan immigrants' newborns.Methods: This was a retrospective study in a mixed population of 620 term Caucasian and Indo-Pakistan pregnancies, evaluated in two reference hospitals of Spain and Italy. All fetuses underwent a scan and Doppler examination within two weeks of delivery. The influence of fetal gender, ethnicity, GA at delivery, CPR, maternal age, height, weight and parity on BW was evaluated by multivariable regression analysis.Results: Newborns of first generation Indo-Pakistan immigrants were smaller than local Caucasian newborns (mean BW mean= 3048 ± 435 g versus 3269 ± 437 g, p < .001). Multivariable regression analysis demonstrated that all studied parameters, but maternal age and ethnicity, were significantly associated with BW. The most important were GA at delivery (partial R² = 0.175, p < .001), CPR (partial R² = 0.032, p < .001), and fetal gender (partial R² = 0,029, p < .001).Conclusions: The propensity to a lower BW, explained by placental dysfunction but not by maternal ethnicity is transmitted to newborns of first generation immigrants. Whatever are the factors implied they persist in the new residential setting.

Birth-weight differences at term are explained by placental dysfunction and not by maternal ethnicity

OBJECTIVE

To investigate the influence of ethnicity, fetal gender and placental dysfunction on birth weight (BW) in term fetuses of South Asian and Caucasian origin.

METHODS

This was a retrospective study of 627 term pregnancies assessed at two public tertiary hospitals in Spain and Sri Lanka. All fetuses underwent biometry and Doppler examinations within 2 weeks of delivery. The influences of fetal gender and ethnicity, gestational age (GA) at delivery, cerebroplacental ratio (CPR) and maternal age, height, weight and parity on BW were evaluated by multivariable regression analysis.

RESULTS

Fetuses born in Sri Lanka were smaller than those born in Spain (mean BW = 3026 ± 449 g vs 3295 ± 444 g; P < 0.001). Multivariable regression analysis demonstrated that GA at delivery, maternal weight, CPR, maternal height and fetal gender (estimates = 0.168, P < 0.001; 0.006, P < 0.001; 0.092, P = 0.003; 0.009, P = 0.002; 0.081, P = 0.01, respectively) were associated significantly with BW. Conversely, no significant association was noted for maternal ethnicity, age or parity (estimates = -0.010, P = 0.831; 0.005, P = 0.127; 0.035, P = 0.086, respectively). The findings were unchanged when the analysis was repeated using INTERGROWTH-21^st fetal weight centiles instead of BW (log odds, -0.175, P = 0.170 and 0.321, P < 0.001, respectively for ethnicity and CPR).

CONCLUSION

Fetal BW variation at term is less dependent on ethnic origin and better explained by placental dysfunction. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Geographical variation in relationships between parental body size and offspring phenotype at birth

BACKGROUND

Size and body proportions at birth are partly determined by maternal body composition, but most studies of mother-baby relationships have only considered the effects of maternal height and weight on offspring birth weight, and few have examined the size of effects. Paternal size and body composition also play a role, primarily through the fetal genome, although few studies have investigated relationships with neonatal phenotype.

METHODS

Data from the UK, Finland, India, Sri Lanka, China, DR Congo, Nigeria and Jamaica were used to investigate the effects of maternal measures (derived at 30 weeks' gestation, n=16,418), and also paternal size (n=3,733) on neonatal phenotype, for singleton, live-born, term births.

RESULTS

After accounting for variation in maternal size and shape across populations, differences in neonatal phenotype were markedly reduced. Mother-baby relationships were similar across populations, although some were stronger in developing countries. Maternal height was generally the strongest predictor of neonatal length, maternal head circumference of neonatal head and maternal skinfold thickness of neonatal skinfolds. Relationships with maternal arm muscle area were generally weak. Effects of paternal height and body mass index were weaker than the equivalent maternal measurements in most studies.

CONCLUSIONS

Differences in maternal body composition account for a large part of the geographical variation in neonatal phenotype. The size of the effects of all maternal measures on neonatal phenotype suggests that nutrition at every stage of the mother's life cycle may influence fetal growth. Further research is needed into father-baby relationships and the genetic mechanisms that influence fetal growth.

Persistence of lower birth weight in second generation South Asian babies born in the United Kingdom

OBJECTIVE

To assess differences in birth weight between all first and second generation South Asian babies born in Southampton, and trends since 1957.

DESIGN

Retrospective, cohort study.

SETTING

Birth records for babies born in Southampton from 1957 to 1996 were searched to identify all babies born of South Asian origin (including from the Indian subcontinent, East Africa, and elsewhere).

MAIN OUTCOME MEASURES

All information recorded in the birth record about the mother and baby was extracted.

RESULTS

2395 full term (>37 weeks; mean birth weight 3110; 95%CI 3092 to 3129) singleton births were identified. Detailed analysis was restricted to mothers either born in the Indian subcontinent (India, Pakistan, or Bangladesh (1435)) or United Kingdom (283). Mean birth weight and % low birth weight (<2500 g) were 3133 g (95%CI 3108 to 3157) and 7.5%, for first generation babies and 3046 g (2992 to 3099) and 11.7% for second generation babies. There was no trend over time to increased average birth weight in either first or second generation babies. Adjusting for other factors that were statistically significantly related to birth weight (gender, gestational age, mother's age, maternal weight at 15 weeks, parity, and mother's ethnic group) did not alter the trends.

CONCLUSIONS

For that group in the UK who derive from the Indian subcontinent, average birth weight is significantly less than the national average. There has not been any increase in the average birth weight over the past 40 years, and the birth weight of babies of women who were born in the UK are no greater. The persistence of lower than desirable birth weight may result long term in higher than average rates of diabetes and heart disease in these groups.

Maternal smoking and body composition of the newborn

The influence on neonatal anthropometry of maternal cigarette smoking in pregnancy was investigated in 933 parous women. Anthropometric growth parameters including skinfold measurements were studied in the newborns. After adjustment for maternal age, pre-pregnancy weight, height and pregnancy weight gain, smoking had a clear dose-dependent negative effect on all anthropometric characteristics in the infant. In contrast to the results obtained in other investigations, the reduced birth weight of the infants of smoking mothers was not found to be primarily due to a reduction in lean body mass; nor was fat deposition found to be reduced. Fetal anthropometry was also negatively affected in infants born to mothers who stopped smoking during pregnancy.

Update of growth percentiles for infants born in an Australian population

Growth percentiles require periodic revision because of changes in the ethnic mix of a population and socioeconomic factors. Anthropometric measurements were derived from singleton livebirths, without lethal malformations, from 22 completed weeks' gestation, at the Mercy Hospital for Women, Melbourne, from 1980 to 1989 (49,429 infants). Infants were included if reasonable assessment of gestation was available. Birth-weight percentiles were derived for the study group, male and female infants separately and for infants whose mothers were born in South-East Asia (Vietnam, Laos and Cambodia). Percentile charts for length, head circumference and ponderal index were also prepared. When compared with the intrauterine birth-weight growth curves reported by Kitchen et al (4) there was generally an elevation of all percentiles. Male infants were larger than female infants. Infants delivered by mothers born in South-East Asia were smaller than the study group as a whole, although the 10th percentiles for birth-weight were similar to the study group especially from 36-39 weeks' gestation. Periodic review of local standards is required to correctly categorize newborn infants' growth characteristics; factors such as sex of the infant and ethnic origin of the mother should be considered.

The good body: when big is better

An important cultural question is, "What is a 'good'--desirable, beautiful, impressive--body?" The answers are legion; here I examine why bigger bodies represent survival skill, and how this power symbolism is embodied by behaviors that guide larger persons toward the top of the social hierarchy. bigness is a complex concept comprising tallness, boniness, muscularity and fattiness. Data show that most people worldwide want to be big--both tall and fat. Those who achieve the ideal are disproportionately among the society's most socially powerful. In the food-secure West, fascination with power and the body has not waned, but has been redefined such that thinness is desired. This apparent anomaly is resolved by realizing that thinness in the midst of abundance--as long as one is also tall and muscular--still projects the traditional message of power, and brings such social boons as upward mobility.

Smoking in pregnancy: associations with skinfold thickness, maternal weight gain, and fetal size at birth

Skinfold thickness is an index of subcutaneous fat, and certain maternal conditions during pregnancy affect the skinfold thicknesses of the baby. A study was performed to investigate the effect of smoking on skinfold thickness, maternal weight gain, and fetal size at birth. A total of 452 mothers with normal singleton pregnancies were groups as: non-smokers, light-to-moderate smokers, or heavy smokers. Maternal age, height, parity, and duration of pregnancy were similar in the three groups. Heavy smokers gained significantly less weight than non-smokers, but there was no significant difference in skinfold thickness. Babies born to smokers had lower birth weights and smaller head circumferences and were shorter than those born to non-smokers, but skinfold thicknesses were similar. The presence of a normal layer of subcutaneous fat in babies whose mothers smoked suggests that fetal growth retardation is not caused by nutritional deficiencies.

Fetal growth and parental consanguinity

Anthropometric measurements made on 322 newborn infants in South India were related to parental consanguinity. Uncle-niece and first-cousin marriages were common and the average coefficient of inbreeding was as high as 0·0329. The measurements (weight, length, head circumference, and triceps and subscapular skinfold thicknesses) of the uncle-niece groups (52 infants) were smaller than those of the first-cousin group (61 infants) which in turn were smaller than the nonconsanguineous group (196 infants). Statistical significance (P<0·01) was only recorded between the weights of the three groups (means 2650·4, 2794·1, and 2833·8 g) and between the lengths of the uncle-niece group and the nonconsanguineous group (means 46·92 and 47·79 cm). There were no social class or residential differences between the groups. We conclude that there are likely to be recessive genes present in the population, slightly retarding fetal growth.