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보건교육사회적협동조합 사이트 그룹

공개·회원 10명
Hermann Fomichev
Hermann Fomichev

Indian Pregnt Nud Women

Conclusion: Our findings that pregnant American Indian women are not adhering to dietary recommendations is consistent with studies in other US populations. Identifying opportunities to partner with American Indian communities is necessary to ensure effective and sustainable interventions to promote access to and consumption of foods and beverages that support the adherence to recommended dietary guidelines during pregnancy.

indian pregnt nud women

The WHO estimates that 58% of the women in developing countries are anaemic2. The prevalence of anaemia among pregnant women in Karnataka State in India is 62.6%3. Iron deficiency is thought to be the most common cause of anaemia globally, accounting for more than half of anaemia cases in pregnancy1.

Iron, is an essential nutrient, which is required for haemoglobin synthesis, other than the normal well-being, whose demand increases highly during pregnancy and many times does not get supplied through the regular diet. This can be worsened by the loss of appetite during pregnancy4. Therefore the most suitable mass intervention for iron supplementation is administering Iron along with Folic acid in the form of tablets to pregnant women aimed at increasing the haemoglobin concentration, so that the level of anaemia at term could be reduced to the best possible extent5, 6, 7.

Most Ministries of Health in developing countries have policies to give pregnant women either iron by itself or combined with folic acid in tablet form (IFA tablets). The National protocols in India require the provision of 1 tablet containing 100 mg elemental iron and 0.5 mg folic acid for daily consumption to all women during pregnancy for 100 days.

Also our study observed that there are direct and indirect factors affecting the compliance levels. Those women, who are anaemic, had lesser level of compliance and the women who were above 25, and had second pregnancy were more compliant when compared to others. Single doses seemed to have higher IFA compliance levels. This study is very similar to a study conducted among low income group of women in USA during 2005, on pill count adherence to prenatal multivitamin/mineral supplement use in which the researchers reported that ethnicity, null-gravidity, smoking, educational and marital status affected compliance with prescribed medication13. This however needs further evaluation to determine the temporality of association. Add to that the perceived side effects, consciousness about the tablets provided, lack of clarity on the significance of IFA tablets. The present study area reflects a literate population and a prospectively developing region. Despite that there are factors which hinder the compliance of IFA tablets during pregnancy; thereby increasing the chances of skipping the doses. The present study highlights on high proportions of such beliefs and perceptions, similar to the Danish 2012 study14.

All participants in the study were drawn from among affluent women who were being referred to the obstetric department of hospitals for monthly check-up. This group of pregnant women was from better socioeducational level and paying more attention to their situation during entire course of pregnancy. Affluent mothers covered all the criteria of sample selection. To participate in the study, women had to meet the following inclusion criteria: (i) at least three sonography reports since second trimester to third trimester; (ii) ultrasound measurements of HC, BPD, AC, and FL; and (iii) singleton pregnancy. Exclusion criteria of sampling included: (i) any family history of congenital disease, (ii) suffering from chronic disease, and (iii) any complicated position of foetus during pregnancy. Written informed consent forms were collected from all the subjects, and the study was approved by medical manager of hospitals and ethical committee of the University of Pune. The research questionnaire was constructed with three sections: (i) demographic background, (ii) maternal gestational status and medical history of mother, and (iii) dietary data.

In a prospective study in India (25), birthweight, birth-length, head-circumference, and placental weight were directly associated with frequency of milk intake assessed at early gestation. Another prospective study on Canadian women (26) also showed a direct effect on birthweight only but no association was seen with birth-length or head-circumference. Moreover, finding from another study showed that intake of excess dietary protein throughout gestation caused lower birthweight, similar to animals fed the low-protein diet (6). The result of rodent studies (4-6) also indicated that increased protein intake during gestation has negative impact on birth parameters, although the findings are inconsistent. Epidemiological studies (1-3) observed that increased protein consumption during gestation leads to foetal growth retardation. High-protein diet increases dietary thermogenesis and allows less availability of energy that may relatively explain the induced lower birthweight (27). The possible reason emerged from experimental studies for growth retardation with low-protein diet might be lack of indispensible amino acid (28) that is associated with reduced nutrient supply (29,30). In addition, aberrant concentration of other metabolites and hormones, such as insulin, leptin, and IGF-I (30,31) might be a related factor for impairment of foetal growth with low-protein diet. It is also reported that increased serum IGF-I in milk enhanced the bone formation (32).

This history matters. It matters because it continues to affect Native maternal and infant health outcomes. It matters because today Native American women continue a rich legacy of advocating for the health and well-being of their communities. At a congressional briefing session on Native maternal and reproductive health earlier this year, Native experts advocated policy changes such as the repeal of the Hyde Amendment. They insisted that the Indian Health Service be held accountable for providing quality health care to tribal members. They called for greater resources for community and grassroots organizations that are already providing culturally oriented maternal and reproductive health care.

Estimating total body fat in public hospitals using gold-standard measurements such as air displacement plethysmography (ADP), deuterium oxide dilution, or dual-energy X-ray absorptiometry (DXA) is unaffordable, and it is challenging to use skinfold thickness. We aimed to identify the appropriate substitute marker for skinfold thickness to estimate total body fat in pregnant women and infants.

The study is part of a prospective cohort study titled MAASTHI in Bengaluru, from 2016 to 19. Anthropometric measurements such as body weight, head circumference, mid-upper arm circumference (MUAC), and skinfold thickness were measured in pregnant women between 14 and 36 weeks of gestational age; while measurements such as birth weight, head, chest, waist, hip, mid-upper arm circumference, and skinfold thickness were recorded for newborns. We calculated Kappa statistics to assess agreement between these anthropometric markers with skinfold thickness.

Mid-upper arm circumference and birth weight can be used as markers of skinfold thickness, reflecting total body fat in pregnant women and the infant, respectively. These two anthropometric measurements could substitute for skinfold thickness in low- and middle-income urban India settings.

It is essential to screen obesity in public facilities using appropriate but realistic methods to assess total body fat in the body. Hence, using total skinfolds for assessing body composition is a quick, convenient, relatively inexpensive method across all ages. However, this requires rigorous training and expertise. In addition to the possibility of high Intra- and inter-observer variability in using the calipers [19], multiple readings in at least three sites are necessary to obtain reliable skinfold thickness. This will not be possible in most public facilities, which are otherwise understaffed, overcrowded, and offer no privacy. It is difficult to ensure frontline health workers have the necessary training and reduce intra- and inter-observer variability in millions of health workers. Therefore, we aimed to assess the validity and determine appropriate cut-off levels of several anthropometric markers as alternatives for total skinfolds in pregnant women and newborn infants in a prospective cohort study.

Standing height and weight were measured using the portable stadiometer (SECA 213) and digital weighing scale (Tanita). We recorded weight to the nearest 100 gram with minimal clothing and barefoot. The height was read to the nearest 0.1 cm. Mid-upper arm circumference (MUAC) was measured for the left arm using circumference tape (Chasmors WM02). The women were asked to sit/stand with their back to the measurer, and the elbow flexed at about 90 degrees. The tip of the acromion (the point of the shoulder) and the olecranon processes were palpated and marked with a skin pencil. The distance between these two points was measured by a flexible measuring tape, and a point midway between these two processes was marked on the skin. This midpoint marked the vertical level at which the circumference was measured with the arm hanging by the side. The measuring tape was placed around the upper arm such that the tape was horizontal to the surface. It was ensured that the tape rested firmly against the skin but not pulled too tight to cause indentation of the skin surface [21]. Two readings for each anthropometric measurement were recorded. Head Circumference (HeadC) was measured using Chasmors WM02.

There is a need to use feasible and accurate nutritional status indicators in pregnant women and newborn children to identify adiposity, an independent cardiometabolic risk factor. The burgeoning epidemic of obesity impacts all age groups and negatively impacts the life course and generations. Our results indicate that MUAC higher than 29.2 cm can serve as a suitable alternative to total skinfolds-based assessments for obesity screening in pregnancy in resource-constrained public health facilities. Similarly, a birth weight cut-off of 3.45 kg can be considered for classifying obesity among newborns.


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