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Indian Journal of Community Medicine

Nutritional Status of Rural Pregnant Women

Author(s): Vartika Saxena, V.K. Srivastava, M.Z. Idris, U. Mohan, V. Bhushan

Vol. 25, No. 3 (2000-07 - 2000-09)

Upgraded Dept. of Social and Preventive Medicine, K.G's Medical College, Lucknow-226003.

Abstract:

Research questions: 1. What is the prevalence of undernourishment among rural pregnant women? 2. What is the overall nutritional status of rural pregnant women?

Objectives: 1. To assess the nutritional status of pregnant women attending rural antenatal clinic. 2. To assess the prevalence of different grades of anaemia among rural pregnant woman attending the antenatal clinic. 3. To estimate the average weight gain during the course of pregnancy.

Study design: Longitudinal descriptive study.

Setting: Study was performed at 3 rural antenatal clinics in Sarojini Nagar Block of Lucknow district.

Participants: 400 pregnant women registered and followed up at above mentioned clinics for the study.

Study variables: Body mass index, vitamin and mineral deficiencies, weight gain, caloric intake, hemoglobin level.

Statistical analysis: Percentages.

Results: Overall 23.3% women were having BMI <18.5 Kg/m2, 38% women were found to be anaemic (Hb<11 gm/dl). Average weight gain during pregnancy was recorded to be 6.6 Kg. 29.5% women were found to be taking inadequate diet.

Keywords : Maternal nutritional status, BMI, Weight gain, Haemoglobin level.

Introduction:

The nutrition and health status of women is important both for the quality of their lives and for the survival and healthy development of their children, yet relatively little attention has been given on this area; further women should not be considered solely with respect to their reproductive roles as mothers, adequate nutrition is a human right for all and the nutritional benefits to women's social and economic capabilities need to be viewed as goals (UNICEF 1997)1. In recent years renewed emphasis through different governmental programmes (ICDS, RCH etc.) have been given to improve the nutritional status of mother, so the present study was planned to assess the maternal nutritional status in rural area. The results of the study are expected to provide baseline for developing suitable interventional strategy for further improvement.

Material and Methods:

The present study was conducted in the community development block, Sarojini Nagar, which is a field practice area of Upgraded Department of Social and Preventive Medicine, K.G's Medical College, Lucknow. It is situated on Lucknow-Kanpur Highway, 20 Km. from the college. The study was performed during Sept. 98-Oct. 99.

A statistically suitable sample of 400 pregnant women, based on prevalence of anaemia in the region as 50% was considered adequate for the study. These women were randomly chosen from the women attending antenatal clinics at Primary Health Centre Sarojini Nagar and Experimental Teaching Health Sub-Centres at Mati and Banthara of Rural Lucknow. Only those women who were having less than 28 weeks of gestational age at the time of registration were registered for the study. All the women were clinically examined. Their height was measured upto nearest of 1 cm., and weight upto nearest of 0.5 Kg. Haemoglobin level was estimated by Sahli's method. Dietary intake was assessed by oral questionnaire method for one dietary cycle. The same procedure was repeated on subsequent visits of pregnant women till termination of pregnancy.

The haemoglobin level less than 11 gm/dl at the time of registration was used for classification of undernutrition2. Prevalence of iron deficiency and iodine deficiency were assessed on the basis of pallor in the lower conjunctiva and presence of neck swelling diagnosed as goitre using the criteria for the diagnosis of goitre3,4.

As the present study was clinic based and women up to 28 weeks of gestational age were registered, although, all the women were to be followed up at four weekly interval for the assessment of weight gain, some women defaulted hence follow-up of all women at periodic interval was not possible.

Results:

Table I: Distribution of pregnant women according to clinical signs and symptoms of vitamin and mineral deficiency (n=400).

Deficiency status No. of
pregnant
women
Percentage
No deficiency 240 60.0
Vit. A deficiency 08 2.0
Vit. B deficiency 49 12.3
Vit. C deficiency 67 16.7
Iron defiiency anemia 147 36.7
Iodine deficiency 06 1.5

Table I shows that on the basis of clinical signs and symptoms (36.3%) women were found to be having iron deficiency, 2.0% women reported history of night blindness, 1.5% women had shown clinical evidence of iodine deficiency.

Table II: Distribution of pregnant women in relation to their BMI at the time of registration.

Gestational
age
(in weeks)
Total no.
of women
Level of BMI Kg/m2
<18.5 No. (%) 18.5-25.0 No. (%) >25.0 No. (%) Mean BMI
≤12 13 5 (38.5) 8 (61.5) 0 (0) 19.8
13-16 75 24 (32.0) 50 (66.7) 1 (1.31) 20.9
17-20 116 28 (24.1) 85 (73.3) 3 (2.6) 21.8
21-24 101 19 (18.8) 75 (74.3) 7 (6.9) 22.5
2-28 95 17 (17.9) 72 (75.8) 6 (6.3) 2.7
Total 400 93 (23.3) 290 (72.5) 17 (4.3) 20.5

Overall 23.3% women were having BMI <18.5 Kg/m2. Majority of women (72.5%) were having BMI in the range of 18.5-25.0 Kg/m2.

Table III: Trimester-wise distribution of pregnant women and their haemoglobin level at the time of registration.

Trimester No. of
preg.
women
Haemoglobin level (gm/dl)
<6.5 6.5-8.0 8-11 >11
First 13 0 (0.0) 1 (7.7) 4 (30.8) 8 (61.5)
Second 292 7 (2.4) 31 (10.6) 71 (24.3) 183 (62.7)
Third (upto 28 weeks only) 95 8 (8.4) 14 (14.7) 16 (16.8) 57 (60.0)
Total 400 15 (3.7) 46 (11.5) 91 (22.8) 248 (62.0)

Figures in parentheses are percentages

In the present study 38% women were found to be suffering from anaemia. Out of which 3.7% women were severely anaemic (Hb <6.5 gm/dl), 22.8% and 11.5% women were suffering from mild and moderate degree of anaemia respectively.

Table IV: Average weight gain of pregnant women throughout the pregnancy (n=400).

Gestational age
(in weeks)
Number
of
women
Average weight
(Kg)±SD
Av. weight
gain/month(Kg)
Newly
registered
Followed
up
Total
5-8 2 0 2 44.0±1.3 -
9-12 11 0 11 44.5±1.3 0.5
13-16 75 0 75 44.8±0.9 0.8
17-20 116 43 159 45.4±1.7 1.4
21-24 101 97 198 46.0±1.3 2.0
25-28 95 63 158 46.7±2.3 2.7
29-32 0 152 152 47.5±3.0 3.5
33-36 0 157 157 48.3±2.6 4.3
37-40 0 73 73 49.4±1.9 5.4
40-42 0 11 11 50.6±2.3 6.6

Average weight gain among those delivering upto 40 weeks and beyond was 5.4 Kg and 6.6 Kg respectively.

Table V: Distribution of pregnant women according to their status of dietary intake.
Status Calories(KCal)
No.(%)
Protein(gm)
(No.(%)
Iron(mg)
No.(%)
Adequate RDA±10% 282 (70.5) 302 (75.5) 256 (64.0)
Deficient >10% of RDA 118 (29.5) 98 (24.5) 144 (36.0)
Total 400 (100.0) 400 (100.0) 400 (100.0)

Overall 29.5% women were not taking adequate calories.

Discussion:

The present study was performed in community development block Sarojini Nagar which is the field practice area of Upgraded Department of Social and Preventive Medicine, K.G. Medical College, Lucknow regularly visited by teachers, residents, interns and undergraduate students, which resulted into marked improvement in health status of the area. 38.5% women registered during first trimester were having BMI <18.5 kg/m2, this could be compared with pre-pregnancy BMI as weight gain during first trimester is negligible. Mean BMI of the women registered from 13 to 28 week should be interpreted as attainment of BMI during subsequent course of pregnancy. NNMB (1998) reported 48.2% and IASDS (1995) reported 29.7% women to be in the category of BMI <18.5 kg/m2 (IASDS, 1999)5. The stunted women were more in the study (28.5%) in comparison to 17% reported by IASDS, UP (1995)5. This could be because of our failure to change attitude of rural people over women's nutrition since her childhood period. Although average weight gain of 6.6 Kg was recorded up to 42 weeks of pregnancy, but majority of women gained weight in the range of 5-6 kg. As maternal fat deposition has been found to be much more responsible to weight gain fluctuation than birth weight (Dwinen 1987)6. Thus if very little weight is gained by mother, less maternal fat is deposited and foetal weight is relatively protected. While this may benefit birth weight in the short term, it may not be sufficient to avoid poor growth and development of infant because the infant may still suffer later, if lactation capacity is compromised by such a lack of maternal fat deposition (Allen, L.H. 1992)7. In poor socio-economic condition of rural women inadequate weight gain may also lead to maternal depletion syndrome, if further pregnancies are not checked in time. So lot of emphasis is needed for adequate weight gain.

Present study reported 38% anaemic women (Hb <11 gm/dl) which is certainly better than the reported national figure of 40-80% by different authors8,9, perhaps showing the impact of iron and folic acid tablets provided to them. In the present study 29.5% women were taking less calories than recommended, because of many socio-economic reasons as illiteracy, poverty and wrong belief that less dietary intake will ease the delivery, requiring sincere efforts for improving overall quality of life of these rural areas.

Conclusion and Recommendations:

Thus it can be concluded that area needs a community based strategy for the improvement of maternal nutritional status. Moreover, nutritional needs of women should be taken care of since her childhood and masses should be educated to remove gender bias so that women can hold human right of adequate nutrition for all.

References:

  1. UNICEF, Nutrition Series 97-002 improving adolescent and maternal nutrition. An overview of benefits and options, 1997.
  2. Sood SK, U Rusia: Ann of Nat Acad of Med Sci, India. 1986; 22(4): 235.
  3. Singh R, Prasad BG, Teotia SPS: Nutritional status of rural population in Gauri, Lucknow District. Part I Ann. Indian Acad. Med. Sci., 1971; 1: 1-21.
  4. Singh R, Prasad BG, Teotia SPS: Diet survey in village Gauri in Lucknow district. Part II: Ann. Indian Acad. Med. Sci. 1971; 7: 203-17.
  5. Institute of Applied Statistics and Development Studies: Nutritional status of women and children in Uttar Pradesh, department of women and child development U.P. 1999; 12-3.
  6. Dwinen IVGA: Energy requirement of pregnancy. An integration of the longitudinal data from the five country study. Lancet ii, 1987; 1131-3.
  7. Allen LH, Backstrand JR, Chavez A, Petto GH: People cannot live by tortillas alone. The results of the Mexico Nutrition CRSP. Human Nutrition Collaborative Research Support Program, USAID Washington DC, 1992.
  8. Gopalan C, Kaur S: Women and Nutrition in India. Nutrition Foundation of India. Special Publication Series No.9, 1989.
  9. Sharma RK, Cooner PPS, Sekhon AS, Dhaliwal DS, Singh K: A study of effect of maternal nutrition on incidence of low birth weight. In. J. Comm. Med. 1999; 24(2): 39-43.
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