Publication: HAEMOGLOBIN, HbA1c LEVEL AND NUTRITIONAL STATUS OF PREGNANT MOTHERS ON HAEMATINICS AND ITS ASSOCIATION WITH BIRTH WEIGHT OF NEONATES AMONG SELECTED URBAN B40 POPULATION GROUP: A PROSPECTIVE COHORT STUDY
Date
2023
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Publisher
International Medical University
Abstract
Introduction: The current efforts to reduce the prevalence of anaemia have been widely practised among the primary healthcare facilities in Malaysia, such as prenatal haematinics and nutrition education. Although there have been several studies on anaemic status generally among pregnant mothers, none have been conducted specifically among urban B40 pregnant mothers in Malaysia.
Objective: This study aims to determine the effect of antenatal haematinics on maternal haemoglobin and the association between maternal haemoglobin, HbA1c level, dietary intake, and total gestational weight gain among B40 pregnant mothers.
Method: This was a prospective cohort study in which eligible pregnant mothers belonging to the B40 strata were recruited from a health clinic in Kuala Lumpur, Malaysia. Sociodemographic information was collected from all the participants. Pregnant mothers were followed up with at least 3 prenatal visits, including baseline, first follow-up (16-19 weeks), second follow-up (24-26 weeks) and third follow-up (34-36 weeks). Routine assessments of haemoglobin, HbA1c, anthropometry, blood pressure, 24-hour dietary recall and compliance to haematinics were obtained for each follow-up. Data analysis was performed using Statistical Packages for Social Science (SPSS) version 28.
Result: A total of sixty-two pregnant mothers were recruited. Most of them (>80%) had normal HbA1c level during pregnancy. After haematinics were provided, the maternal mean haemoglobin significantly decreased by 1 g/dL from baseline to third follow-up (p<0.001); and a significant increased by 0.6 g/dL was observed from second follow-up to third follow-up (p<0.001). Despite the significant decreased in haemoglobin across the follow-up visits, the mean haemoglobin at each follow-up was considered normal. Less than one-third of the B40 pregnant mothers had anaemia at 36 weeks of pregnancy. Majority (87.1%) delivered normal weight babies. Most of them (>60%) did not get adequate energy, carbohydrates, and micronutrients (iron, folate, vitamin B12, zinc and vitamin C) from their daily diet however the majority (>90%) had adequate protein intake and high-fat diets. Most of them (48.4%) had normal pre-pregnancy body mass index. Those with a normal pre-pregnancy body mass index had the highest proportion (56.7%) of inadequate weight gain. Total gestational weight gain was found to be positively correlated with energy, protein, and fat intake (energy intake, r=0.289, p<0.05; protein intake, r=0.352, p<0.01; fat intake, r=0.251, p<0.05). Maternal age had a positive linear relationship with birth weight 0.3g (95%CI: 0.004, 0.051g)., p=0.021. Household income less than RM3970 had a negative relationship with birth weight 0.3g (95%CI: -0.551, -0.021g)., p=0.035. Maternal haemoglobin level had a negative linear relationship with birth weight -0.2 g (95%CI: -0.370, -0.017g), (p=0.029). Maternal dietary iron intake had a positive linear relationship with birth weight 0.5 g (95%CI: 0.006, 0.105g), (p=0.020).
Conclusion: The provision of haematinics during pregnancy is beneficial in optimising or maintaining a healthy level of haemoglobin among the studied B40 pregnant mothers. Higher intake of energy, protein and fat was positively correlated with total gestational weight gain. The study also found that maternal age, monthly household income, maternal haemoglobin and dietary iron intake were the significant predictors of birth weight. Increased maternal age and dietary iron intake increased the birth weight. Increased mean haemoglobin level throughout the pregnancy and income level less than RM3,970 decreased the birth weight. The babies born in this cohort must be followed up until their second year of life to study their growth pattern.
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Keywords
Hemoglobins, Nutritional Status, Hematinics, Infant, Newborn