The nutritional status of pregnant women in relation to alcohol consumption during pregnancy, and

286 Pages·2004·12.15 MB·English

THE NUTRITIONAL STATUS OF PREGNANT WOMEN IN
RELATION TO ALCOHOL CONSUMPTION DURING PREGNANCY,
AND PREGNANCY OUTCOME

Ingrid Klinger

Thesis presented to the Department of Human Nutrition in the Faculty of Health Sciences of
Stellenbosch University in partial fulfilment of the requirements for the degree of Masters in
Nutrition

Study leaders: Prof Demetre Labadarios
Prof Denis Viljoen
Mrs Debbi Marais

Confidentiality: Grade A

December 2004
ii

DECLARATION OF AUTHENTICITY

I, Ingrid Klinger, hereby declare that the work contained in this thesis is my own original
work and that I have not previously, in its entirety or in part, submitted it at any university for
a degree.

Signature: Date:
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SUMMARY

Introduction: Heavy alcohol consumption during pregnancy is teratogenic.49-51 A woman’s
nutritional requirements increase during pregnancy.4 The dangers of heavy drinking in the
presence of malnutrition may put the fetus at a further disadvantage to normal development
and life.

Objectives: To determine the nutritional status of pregnant women in relation to alcohol
consumption during pregnancy, and pregnancy outcome. To relate the combined effect of
maternal alcohol consumption and nutritional status to pregnancy outcome.

Study design: Prospective, longitudinal and cohort.

Study population: Pregnant women attending Hanover Park MOU for pre-natal care. They
were classified as subjects (heavy drinkers) or controls (light drinkers or abstainers), and 15
pairs were matched according to race, parity and gestational age at the onset of their
participation in the study.

Methodology: A skilled FARR worker determined the alcohol consumption of the
individuals through a validated questionnaire, whilst the investigator gathered the study data
blinded to the participants’ alcohol consumption status. The investigator conducted three
interviews with the pregnant individuals. Anthropometrical, clinical and biochemical
investigations were done and questionnaires completed to determine dietary intake, socio-
demographics, health and eating habits.

An experienced FARR paediatrician examined the newborns, assessing their anthropometric
status, health and the presence of any alcohol-related signs.

Results: The nutritional status of the matched subjects and controls did not differ
significantly in terms of dietary intake, anthropometric or clinical assessment. There were
significant differences between the 2 groups’ serum vitamin A values (p<0.0097). Significant
associations were found between the mother and newborn data; specifically energy intake and
gestational age at birth (p<0.0083), MUAC and birth weight (p<0.04), and weight gain and
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weight for age (p<0.0056). The participants’ energy intake also had a significant correlation
with their weight gain during pregnancy (r=0.0389, p<0.01). The prevalence of FAS in the
total population was 6.67%; a finding that confirms previously reported data in nearby
Wellington, Western Cape.49

Conclusion: Some mothers’ good nutritional status did not protect their offspring against
alcohol’s teratogenic effects. Nutritional status did have a few statistical significant effects on
pregnancy. However, the investigator is of the opinion that the few significant findings were
not enough to accept or reject the hypothesis; therefore, making the results inconclusive.
v

OPSOMMING

Inleiding: Swaar alkoholgebruik tydens swangerskap is teratogenies.49-51 Vroue se
voedingsbehoeftes verhoog met swangerskap.4 Die gevare van swaar alkoholgebruik in die
teenwoordigheid van wanvoeding mag die fetus verhoed om normal te ontwikkel en groei.

Doelwitte: Om die voedingstatus van swanger vroue te bepaal in verhouding met
alkoholgebruik tydens swangerskap, en die swangerskapsuitkoms. Asook om die
gekombineerde effek van die moeder se voedingstatus en alkoholgebruik op haar
swangerskapsuitkoms te bepaal.

Studie-ontwerp: Prospektief, longitudinaal en kohort.

Studiepopulasie: Swanger vroue wat Hanover Park MOU besoek vir voorgeboorte sorg.
Hulle is of as toetslinge (swaar drinkers) of as kontroles (ligte drinkers of geheelonthouers)
geklassifiseer, en 15 pare is gepaar na aanleiding van ras, pariteit en gestasionele ouderdom
by die aanvang van deelname aan die studie.

Metodologie: ‘n Ervare SAVN lid het die individue se alkoholgebruik bepaal deur middel
van ‘n gevalideerde vraelys. Die navorser was geblind vir die individue se alkoholgebruik.
Die navorser het drie onderhoude gevoer met elke individu. Antropometriese, kliniese en
biochemiese ondersoeke is gedoen. Vraelyste is voltooi om dieetinname, gesondheid, sosio-
demografiese en eetgewoonte- inligting te versamel.

‘n Ervare SAVN pediater het alle pasgeborenes ondersoek om hulle antropometriese status,
gesondheid en die teenwoordigheid van enige alkohol-verwante tekens te bepaal.

Resultate: Die voedingstatus van die gepaarde toets-en kontrolegroepe het nie beduidend
verskil in terme van dieetinname, antropometriese of kliniese evaluering nie. Daar was ‘n
beduidende verskil tussen die 2 groepe se serum vitamien A vlakke (p<0.0097). Beduidende
assosiasies is gevind tussen die moeder en pasgebore se data; naamlike tussen energie-inname
en gestasionele ouderdom by geboorte (p<0.0083), bo-armomtrek en geboortegewig
(p<0.0056), en gewigstoename tydens swangerskap en die baba se gewig vir ouderdom
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(p<0.0056). Die deelnemers se energie-inname het ook ‘n beduidende positiewe korrelasie
met hul gewigstoename tydens swangerskap gehad (r=0.0389, p<0.01). Die prevalensie van
FAS in die totale populasie was 6.67%; wat ook gevind is onlangs in die nabygeleë
Wellington, Weskaap.49

Gevolgtrekking: Sommige moeders se goeie voedingstatus het nie hul kinders teen alkohol se
teratogeniese effekte beskerm nie. Voedingstatus se effek op swangerskapsuitkoms was
statisties beduidend in ‘n paar gevalle. Tog is die navorser van mening dat daar nie genoeg
beduidende bewyse is om die nulhipotese te aanvaar of verwerp nie; dus is die gevolgtrekking
onopgelos.
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TABLE OF CONTENTS

Page
Declaration of authenticity ii
Abstract iii
Opsomming v
Table of contents vii
List of abbreviations xii
List of tables xiv
List of figures xvii
List of appendices xix
Acknowledgements xx

1. INTRODUCTION 1

1.1 The importance of a good maternal nutritional status regarding 1
pregnancy outcome
1.1.1 The effect of maternal malnutrition on pregnancy outcome 2
1.1.1.1 Macronutrients 5
1.1.1.2 Vitamins 5
1.1.1.3 Minerals 9
1.1.2 Improving maternal nutritional status and pregnancy outcome 16

1.2 Physiological changes during pregnancy that influences nutrition 18
1.2.1 Changes that affect absorption and utilisation of nutrients 18
during pregnancy
1.2.2 Changes that affect nutrient intake during pregnancy 19

1.3 Alcohol and its effect on maternal nutritional status, pregnancy 20
and pregnancy outcome
1.3.1 The effect of alcohol on maternal nutritional status 20
1.3.2 The effect of alcohol on pregnancy 22
1.3.2.1 The potential mechanisms of alcohol’s teratogenic effect on 22
pregnancy
viii
1.3.2.2 Critical periods of exposure to alcohol during pregnancy 23
1.3.2.3 Fetal Alcohol Syndrome 25
1.3.3 The possible synergistic effect of maternal alcoholism and 27
maternal malnutrition on pregnancy

1.4 Cigarette smoking 29

1.5 Problem identification and motivation 30

2. METHODOLOGY 31

2.1 Aim of the study 31

2.2 Objectives 31

2.3 Hypotheses 31

2.4 Approval for the study 31

2.5 Study design 32

2.6 Study area 32

2.7 Study population 32
2.7.1 Selection of the study population 32

2.8 Methods schedule 35

2.9 Methods 37
2.9.1 Questionnaires 37
2.9.1.1 Socio-demographics 37
2.9.1.2 Health 37
2.9.1.3 Dietary assessment 38
ix
2.9.2 Anthropometric assessment 39
2.9.3 Clinical assessment 41
2.9.4 Biochemical assessment 42
2.9.4.1 Biochemical assessment methodology 42
2.9.5 Assessment of the newborn 43

2.10 Pilot study 45

2.11 Research study 46
2.11.1 Times and dates 46
2.11.2 Area 46
2.11.3 Sample 46
2.11.4 Procedure 46

2.12 Analysis of data 47
2.12.1 Statistical analysis 47
2.12.2 Analysis of dietary data 47
2.12.3 Anthropometric data processing 48
2.12.4 Biochemical analysis 50
2.12.5 Newborn anthropometric assessment 51

3. RESULTS 53

3.1 Sample 53

3.2 Questionnaire 54
3.2.1 Socio-demographics 54
3.2.2 Health history 55
3.2.3 Obstetric history 55
3.2.4 Lifestyle 55
3.2.5 Food security 56
3.2.6 Eating habits influenced by pregnancy 57
x
3.3 Dietary intake 59

3.4 Anthropometric results 72
3.4.1 Nutritional status distribution according to anthropometric 72
measurements

3.5 Biochemical data 74
3.5.1 Biochemical data distribution 74

3.6 Clinical signs 77

3.7 Newborn data 79
3.7.1 Newborn statistics 79

3.8 Analysis of selected data of the pregnant women 81
3.8.1 Dietary data 81
3.8.2 Biochemical data 84

3.9 Analysis of selected data of the newborns 87
3.9.1 Newborn data 87
3.9.2 Newborn data compared to the mother’s questionnaire data 89
3.9.3 Newborn data compared to the mother’s dietary data 92
3.9.4 Newborn data compared with the mother’s anthropometric 96
data

4. DISCUSSION 98

5. CONCLUSION 105

6. LIMITATIONS AND RECOMMENDATIONS 107

7. REFERENCES 108