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Indian Journal of Community Medicine

Energy Consumption during Pregnancy & its Relationship to Birth Weight - A Population Based Study From Rural Punjab

Author(s): R.K. Sachar*, Navjit Kaur**, R.K. Soni*, Ramnik Dhot*, Hari Singh*

Vol. 25, No. 4 (2000-10 - 2000-12)

*Deptt. of Community Medicine. ** Formerly of Deptt. of Community Medicine & Deptt. of Obs. & Gynae. Dayanand Medical College & Hospital, Ludhiana

Abstract:

Research question: What is the caloric intake of pregnant women in rural Punjab?

Objectives: (a) To study the caloric intake of pregnant women in rural Punjab. (b) To ascertain the energy deficit and to find out the correlation, if any, between the birth weight and energy intake/deficit.

Study design: Longitudinal study.

Participants: Pregnant women in third trimester.

Sample size: 202 pregnant women out of which 180 completed the study.

Study variables: Age, parity, socio-economic score, energy consumed, energy deficit and birth weight.

Statistical analysis: Co-efficient of correlation, regression analysis.

Results: A population based study on 180 pregnant women from rural Punjab showed their energy consumption during pregnancy to be inadequate (mean intake 1700 289.5 kcal/day) and consequently the deficit to be high (mean deficit 364.1 306.4 Kcal/day). No socio-economic gradient in energy consumption was observed. The incidence of low birth weight babies born to these women was 23.3%. The frequency of low birth weight decreased with increasing energy consumption. The co-efficient of correlation between birth weight and energy consumed/deficit was of a high degree (r=0.587 and -0.624 for energy consumed/deficit respectively). Regression equations showed that 42% of variations in birth weight were explained by the energy consumption and consequent deficit.

Keywords: Energy consumption, Birth weight, Energy deficit, Rural area, Pregnant female.

Introduction:

As you enter the state of Punjab on the GT Road coming from Ambala district in Haryana, a signboard greets you saying, "Welcome to the granary of India", yet it is surprising that a report of the state health department puts the proportion of low birth weight (LBW) babies to be 20.4% for the year 19911. Amongst the web of multiple causes of LBW, maternal nutrition both during and before pregnancy plays a vital role. The consequences of LBW do not need elucidation. Studies done earlier by the same author2 have shown the caloric intake of the pregnant women in rural Punjab to be 1820 Kcal/day. Other authors have also shown the caloric intake of pregnant women in this country to be much below the recommended intake3,4. Since these studies were done more than a decade ago, it was planned to study the present day caloric intake of pregnant women in rural Punjab to ascertain the energy deficit and to find out the correlation, if any, between the birth weight and the energy intake/deficit.

Material and Methods:

The study was undertaken in the rural field practice area of Dayanand Medical College and Hospital, Ludhiana. In this area, comprising of ten villages, the registration of pregnancy is hundred percent and women receive home based maternal care through the health workers of the training centre. All pregnant women registered during the first half of 1995 were enrolled. A total of 202 pregnant women were thus identified in their 3rd trimester, of which 180 completed the study. Out of the remaining 22 women, 8 refused to weigh their babies, 2 pregnancies turned out to be twin pregnancies, 12 women were lost to follow-up as they had gone to their maternal homes for the delivery.

The energy requirement of these women was calculated on the basis of their basal energy expenditure (BEE) which was calculated by the Harris Benedict Equation. To this BEE (after correction for sleeping hours), 6% was added to cover dietary induced thermogenesis (specific dynamic action of meals) and 30,50 and 100% were added for sedentary, moderate or strenuous activity respectively5. Allowance was made for the gravid state.

The energy which the mother was taking was calculated by a three day dietary recall. The quantity of the food intake was assessed by measuring in containers of known volume/weights. The caloric content of various food items was calculated from a standard published food composition table6.

An hour to hour inventory of the activity of the mother was made. The socio-economic status was calculated using the modified Udai-Pareek scale7 which has been widely used in many other studies8.

The village health worker was provided with a list of expectant mothers who were near their expected date of delivery. All new borns were weighed to the nearest 50gms. using a standard balance within 48 hours of delivery.

Results:

Table I: Value of different variables of study population.

Variable Mean±SD Range Lower
quartile
Upper
quartile
Skewness
Age (in years 25.2±4.5 16-40 22 28 0.85
Parity 1.5±1.15 0-6 1 2 0.92
Socio-economic score 24.0±5.8 12-27 19.5 29 16
Energy consumed (Kcal/day) 1700±289.5 900-2500 1513.5 1873 -0.1
Energy deficit (Kcal/day) 364.1±306.4 0-1779 126 509.5 1.2
Birth weight (Kgs) 2.7±0.5 1.6-4 2.5 3 0.3

Table I shows the values of different variables which are comparable with any standard text on the subject. The mean caloric intake was found to be 1700 289.5 Kcal/day and the mean deficit was 364.1 306.4 Kcal/day.

Table II: Distribution of the pregnant women according to energy consumed.
Energy consumption Kcal/day No. of women Percentage
<1500 44 24.4
1500-2000 117 65.0
2001-2500 19 10.6
>2500 - -
Total 180 100

None of the women consumed more than 2500 Kcal/day,* majority of women consumed less than 2000 calories.

Table III: Distribution of women in different socio-economic groups according to energy consumption. (n=180)

Socio-economic group* Energy consumption (Kcal/day)
<1500 Col.% 1500-2000 Col.% >2000 Col.%
Low
(n=10)
5 11.4 5 4.3 - -
Row %
Lower middle
(n=59)
(50.0)
14
31.8 (50.0)
39
33.3 6 31.6
Row %
Upper middle
(n=63)
(23.7)
15
34.1 (66.1)
42
35.9 (10.2)
6
31.6
Row %
High
(n=48)
(23.8)
10
22.7 (66.7)
31
26.5 (9.5)
7
36.8
Row % (20.8) (64.6) (14.6)

X2=0.76; df=2 NS (for the purpose of statistical analysis the first two SES groups have been merged and the energy intake has been taken as <1500 & >1500.
*Groups on the basis of score according to MUP scale. Low <15, lower middle 16-21, upper middle 22-28, High >28.

Table III shows that none of the pregnant women consumed more than 2000 Kcal/day in lower socio-economic group (LSEG), while 50% of the LSEG women consumed energy less than 1500 Kcal/day. 66.1% pregnant women of lower middle group and 66.7% pregnant women of upper middle class consumed energy between 1500-2000 Kcal/day. No statistically significant socio-economic gradient was seen in energy consumption.

Table IV: Distribution according to energy consumption/day and birth weight.

Energy consumed (Kcal/day) Birth weight (gms)
<2500 Col.% >2500 Col.% Total Col.%
<1500
%Row%
29
(65.9)
z=12.06*
69.1 15
(34.1)
10.9 44
(100)
24.4
1500-2000
Row%
12
(10.3)
z=5.75*
28.6 105
(89.7)
76.1 117
(100)
65
2001-2500
Row%
1
(5.3)
z=10.78*
2.3 18
(94.7)
13.0 19
(100)
10.6
>2500 0 0 0 0 0 0
Total 42(23.3) 100 138(76.7) 100 180(100) 100

*Significant, p<0.01

As the energy consumption increased, the frequency of low birth weight decreased and the difference was found to be statistically significant. For the purpose of statistical analysis a proportion of 23.3% of newborns being low birth weight was taken as a standard as was observed in the present study. Further, state health department1 also reported the frequency of low birth weight in Punjab to be around 21%. Hence taking this as a standard proportion, the proportion of low birth weights in different sub-groups of women classified on the basis of energy consumption were compared using the standard error of proportion.

The correlation coefficient (r) of birth weight with energy consumed and deficit was observed to be 0.587 and -0.624 (p<0.01).

The regression equation for estimation of birth weight was worked out to be, Y=0.32+3.98, Enr (R2=36.23%), Y=3.18-1.08, dft (R2=38.95%) and Y=2.166+0.0005, Enr-0.0007, dft (R2=42.06%), where Y=birth weight, Enr.=energy consumed and dft.=energy deficit.

Discussion:

From the foregoing observations it will be noticed that in a developed state like Punjab, which has the second highest per capita income in the country9, the diets of the pregnant women even today are much below the recommended standards. None of the women was consuming the 2500 kcal/day as recommended by ICMR4. The mean energy consumption was 1700 289.5 kcal/day with a quarter of women consuming 1513.5 kcal/day and only one quarter consuming 1873 kcal/day. Earlier studies2-4 have also shown the dietary intake of women to be around this much. The disturbing aspect is that while today, in Punjab, in many sections of the society, overnutrition with its consequent sequelae is posing to be a problem, the diets of rural pregnant women, irrespective of the social class remain deficient in energy. This, when viewed in the light of the high degree of correlation between energy intake/deficit during pregnancy and birth weight, which in the present study also has been observed to be of high degree (r=0.587 for energy intake and -0.624 for energy deficit) has wider ramifications.

The incidence of low birth weight in the present study was quite high accounting for nearly a quarter of all births. It is well known that birth weight is an important determinant of survival of babies, particularly in the first year of life. Further, the regression equation shows that the energy intake and energy deficit explain 36.23% and 38.95% variation in birth weight when considered singly and in combination they explain 42.06% of the variation. Energy supplementation during pregnancy even in the third trimester has been reported to improve birth weights10. The present study further strengthens the case for energy supplementation of pregnant women either directly through supplementary feeding or through intensive nutrition health education. The authors have already shown2 that the latter i.e. intensive nutrition health education can improve the dietary intake of pregnant women. Regular use of this approach in antenatal care is further reiterated.

References:

  1. Punjab Health Profile, Deptt. of Health and Family Welfare, Govt. of Punjab. 1994-95. Chandigarh: 15.
  2. Sachar RK, Sachar U: Nutrition education during pregnancy by village health workers. World Health Forum 1991; 12: 202-3.
  3. Pachouri S, Marwah SM: Socio-economic factors in relation to birth weight. Indian Paediatrics 1970: 7(8): 462-8.
  4. Indian Council of Medical Research: Maternal Malnutrition, its effects on fetal nutrition. ICMR Bulletin, 1977; 7(12): 1-6.
  5. Margo Denke, Jean & Wilson: In Harrison's Principles of Internal Medicine (1998) 14th Edition. Eds. Fauci, Braunwald, Isselbacher. The McGraw - Hill Companies, Inc. USA: 446.
  6. Indian Dietetic Association Chandigarh Chapter; Post Graduate institute of Medical Education and Research, Chandigarh.
  7. Pareek U, Trivedi G, 1979: Manual of the socio-economic status scale (Rural). Manasayan; 32, Netaji Subhash Marg, Delhi-6.
  8. Sachar RK, Harinder Singh, Hari Singh, RK Soni, Balraj Dhiman, PJS Gill, Ramnik Dhot, N. Raizada: A study of self-esteem and its correlates amongst adolescent girls (9-19 years) in rural Punjab. Ind. Jr. of Preventive and Social Medicine 1997; 28(3&4): 65-73.
  9. The Hindustan Times 27th Dec. 1995.
  10. Lechtig Aaron, Habich JP, Delgado Hernan, Klein RE, Charles Y, Reynaldo Mairorell: Effect of food supplementation during pregnancy on birth weight. Paediatric. 1975; 56(4): 508-19.
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