Dietary Diversity Score during Pregnancy is Associated with Neonatal Low Apgar Score: A Hospital-Based Cross-Sectional Study

Authors

  • Dan Yedu Quansah Public Health Research Group, Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
  • Daniel Boateng School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
  • Louis Boafo Kwantwi Department of Molecular Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
  • Anthony Owusu-Sekyere Department of Agricultural Science, University of Helsinki, Finland
  • A. Kofi Amegah Public Health Research Group, Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana

DOI:

https://doi.org/10.6000/1929-4247.2019.08.01.4

Keywords:

Dietary diversity score, Apgar score, Pregnancy, Cape Coast Metropolitan Hospital, Neonate.

Abstract

Background: Apgar score is an established index of neonatal well-being and development. Nutrition during pregnancy is an accepted risk factor for neonatal low Apgar score.

Objective: To investigate the association between dietary diversity score and low Apgar score.

Methods: This was a hospital based cross-sectional study. The study participants were 420 mothers who delivered and were attending the postnatal clinic at the Cape Coast Metropolitan Hospital. Mothers’ dietary information during pregnancy was assessed with a food frequency questionnaire. In reference to the FAOs women’s Dietary Diversity Score (DDS), the subjects were categorized into low, medium or high DDS. The primary outcome was Apgar score. Apgar scores < 5 were classified as low.

Results: The mean age (± standard deviation, SD) of subjects was 26.7 ± 5.7 years with a range of 17 to 45 years. The prevalence of low Apgar score among the study population was 16.9%. Majority of the study participants had a low DDS in relation to low Apgar score whereas 7.5% had high DDS. After adjusting for potential confounding factors, the odds of low Apgar score in the low DDS group was three times higher than those who had high DDS (Adjusted odds ratio, AOR= 3.10, 95% confidence interval, CI=1.23-4.48).

Conclusion: Dietary diversity score during pregnancy was associated with a low Apgar score in the study area. The results of this study reinforce the significance of adequate nutrition during pregnancy in the study area.

References

Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg 1953; 32(4): 260-7. https://doi.org/10.1213/00000539-195301000-00041

Apgar V. A proposal for a new method of evaluation of the newborn infant. In: Anesthesia and Analgesia 2015; pp. 1056-9. https://doi.org/10.1213/ANE.0b013e31829bdc5c

Hegyi T, Carbone T, Anwar M, Ostfeld B, Hiatt M, Koons A, et al. The apgar score and its components in the preterm infant. Pediatrics 1998; 101(1 Pt 1): 77-81. https://doi.org/10.1542/peds.101.1.77

American college of obstetrician and gynecology and American academy of Pediatrics. The Apgar Score. Comm Opin 644; (644).

American Academy of Pediatrics. The Apgar Score. Pediatrics 2015; 136(4): 819-22. https://doi.org/10.1542/peds.2015-2651

American Academy of Pediatrics and American Heart Association. Textbook of Neonatal Resuscitation. 6th ed. Elk Grove Village: American Academy of Pediatrics and American Heart Association 2011.

Li F, Wu T, Lei X, Zhang H, Mao M, Zhang J. The Apgar Score and Infant Mortality. PLoS One 2013; 8(7): 1-8. https://doi.org/10.1371/journal.pone.0069072

Kochanek KD, Murphy SL, Xu J, Tejada-Vera B. National Vital Statistics Reports - Deaths: Final Data for 2014. US Dep Heal Serv 2016; 65(4).

Hug L, Sharrow D, Sun Y, Marcusanu A, You D, Mathers C, et al. Trends in Child Mortality Child Mortality Report 2017. 2017

Muthayya S. Maternal nutrition & low birth weight - What is really important? Vol. 130, Indian Journal of Medical Research 2009; pp. 600-8.

Thorngren-Jerneck K, Herbst A. Low 5-minute Apgar score: A population-based register study of 1 million term births. Obstet Gynecol 2001; 98(1): 65-70. https://doi.org/10.1097/00006250-200107000-00012

Jacobsson B, Hagberg G, Hagberg B, Ladfors L, Niklasson A, Hagberg H. Cerebral palsy in preterm infants: A population-based case-control study of antenatal and intrapartal risk factors. Acta Paediatr Int J Paediatr 2002; 91(8): 946-51. https://doi.org/10.1111/j.1651-2227.2002.tb02860.x

Ondoa-Onama C, Tumwine JK. Immediate outcome of babies with low Apgar score in Mulago Hospital, Uganda. East Afr Med J 2003; 80(1): 22-9.

Dassah ET, Odoi AT, Opoku BK. Stillbirths and very low Apgar scores among vaginal births in a tertiary hospital in Ghana: a retrospective cross-sectional analysis. BMC Pregnancy Childbirth 2014; 14(1): 289. https://doi.org/10.1186/1471-2393-14-289

Odd DE, Rasmussen F, Gunnell D, Lewis G, Whitelaw A. A cohort study of low Apgar scores and cognitive outcomes. Arch Dis Child Fetal Neonatal Ed 2008; 93(2): F115-20. https://doi.org/10.1136/adc.2007.123745

Sun Y, Vestergaard M, Zhu JL, Madsen KM, Olsen J. Paternal age and Apgar scores of newborn infants. Epidemiology 2006; 17(4). https://doi.org/10.1097/01.ede.0000220690.43455.22

Fiala JE, Egan JF, Lashgari M. The influence of body mass index on pregnancy outcomes. Conn Med 2006; 70(1): 21-3.

Fall CHD, Yajnik CS, Rao S, Davies A a, Brown N, Farrant HJW. Micronutrients and Fetal Growth. J Nutr 2003; 133(4): 1747S.1756S.

Wardlaw K, Gordon M, Kessel A MA. Perspective in nutrition. 5th editio. Washington, DC 2002; p. 32-39.

Salustiano EMA, Campos JADB, Ibidi SM, Ruano R, Zugaib M. Low Apgar scores at 5 minutes in a low risk population: maternal and obstetrical factors and postnatal outcome. Rev Assoc Med Bras 2012; 58(5): 587-93. https://doi.org/10.1590/S0104-42302012000500017

Ahmad MO, Kalsoom U. Effect of Maternal Anaemia on APGAR Score of Newborn. J Rawalpindi Med Coll 2015; 19(3): 239-42.

Odd DE, Doyle P, Gunnell D, Lewis G, Whitelaw A, Rasmussen F. Risk of low Apgar score and socioeconomic position: A study of Swedish male births. Acta Paediatr Int J Paediatr 2008; 97(9): 1275-80. https://doi.org/10.1111/j.1651-2227.2008.00862.x

Christensen J, Pedersen HS, Kjaersgaard MIS, Parner ET, Vestergaard M, Sørensen MJ, et al. Apgar-score in children prenatally exposed to antiepileptic drugs: a population-based cohort study. BMJ Open 2015; 5(9): e007425. https://doi.org/10.1136/bmjopen-2014-007425

Straube S, Voigt M, Jorch G, Hallier E, Briese V, Borchardt U. Investigation of the association of Apgar score with maternal socio-economic and biological factors: An analysis of German perinatal statistics. Arch Gynecol Obstet 2010; 282(2): 135-41. https://doi.org/10.1007/s00404-009-1217-7

Almeida NKO, Pedreira CE, Almeida RMVR. Impact of maternal education level on risk of low Apgar score. Public Health 2016; 140: 244-9. https://doi.org/10.1016/j.puhe.2016.04.009

Chen M, Mcniff C, Madan J, Goodman E, Davis JM, Dammann O. Maternal obesity and neonatal Apgar scores. J Matern Neonatal Med 2010; 23(1): 89-95. https://doi.org/10.3109/14767050903168440

Lee HS, Kim MS, Kim MH, Kim YJ, Kim WY. Iron status and its association with pregnancy outcome in Korean pregnant women. Eur J Clin Nutr 2006; 60(9): 1130-5. https://doi.org/10.1038/sj.ejcn.1602429

Gresham E, Byles JE, Bisquera A, Hure AJ. Effects of dietary interventions on neonatal and infant outcomes: a systematic review and meta-analysis 1 - 3. Am J Clin Nutr 2014; 100(2): 1298-321. https://doi.org/10.3945/ajcn.113.080655

Ghana Statistical Service. 2010 Population and Housing Census. 2010 Popul ation and Housing Census. Natl Anal Rep 2013; 305-37.

Ghana Statistical Service. Ghana Demographic Health Survey. Ghana Stat Serv 2015; 530.

FAO and FHI 360. Minimum Dietary Diversity for Women- A Guide to Measurement 2016; p. 82.

Rao S, Yajnik CS, Kanade A, Fall CHD, Margetts BM, Jackson AA, et al. Intake of Micronutrient-Rich Foods in Rural Indian Mothers Is Associated with the Size of Their Babies at Birth: Pune Maternal Nutrition Study. J Nutr 2001; 131(4): 1217-24. https://doi.org/10.1093/jn/131.4.1217

Moore VM, Davies MJ, Willson KJ, Worsley A, Robinson JS. Dietary Composition of Pregnant Women Is Related to Size of the Baby at Birth 1,2. J Nutr 2004; 134: 1820-6. https://doi.org/10.1093/jn/134.7.1820

WHO. Obesity: Preventing and managing the global epidemic - Technical Report Series 894. Technical Report Series 894. 2000.

IBM Corp. Released. IBM SPSS Statistics for Windows, Version 22.0. 2011. 2011.

Knudsen VK, Orozova-Bekkevold IM MT, et al. Major dietary patterns in pregnancy and fetal growth. Eur J Clin Nutr 2008; 62: 463-470. https://doi.org/10.1038/sj.ejcn.1602745

Cetin I, Laoreti A. The importance of maternal nutrition for health. J Pediatr Neonat Individ Med 2015; 4(2): 1-11.

Sharma M, Mishra S. Effects of Maternal Health and Nutrition on Birth Weight of Infant. Int J Sci Res 2014; 3(6): 855-8.

Kolte D, Sharma R, Vali S. Correlates between micronutrient intake of pregnant women and birth weight of infants from central India. Internet J Nutr Wellness 2009; 8(2): 5.

Zerfu TA, Umeta M, Baye K. Dietary diversity during pregnancy is associated with reduced risk of maternal anemia , preterm delivery , and low birth weight in a prospective cohort study , in rural Ethiopia. Am J Clicnial Nutr 2016; 2011(1): 1482-8. https://doi.org/10.3945/ajcn.115.116798

Trivedi DJ, Shindhe V, Rokhade CJ. Influence of maternal nutrition status during pregnancy on developmental outcome in first 30 days of independent neonatal life. Int J Clin Biochem Res 2016; 3(4): 371-5.

Kitajima M, Oka SYI, et al. Maternal serum triglyceride at 24-32 weeks’ gestation and newborn weight in nondiabetic women with positive diabetic screens. Obs Gynecol 2001; 97: 776-80. https://doi.org/10.1016/S0029-7844(01)01328-X

Rahi E, Baneshi M, Mirkamandar E, Maghsoudi S, Rastegari, Azam. A Comparison between APGAR Scores and Birth Weight in Infants of Addicted and Non-Addicted Mothers. Addict Heal 2011; 3(1-2): 61-7.

Abubakari A, Kynast-Wolf G, Jahn A. Maternal determinants of birth weight in Northern Ghana. PLoS One 2015; 10(8): 1-15. https://doi.org/10.1371/journal.pone.0135641

Ali F, Thaver I, Khan SA. Assessment of dietary diversity and nutritional status of pregnant women in Islamabad, Pakistan. J Ayub Med Coll Abbottabad. 2014; 26(4): 506-9.

Watson-Jones D, Weiss HA, Changalucha JM, Todd J, Gumodoka B, Bulmer J, et al. Adverse birth outcomes in United Republic of Tanzania--impact and prevention of maternal risk factors. Bull World Health Organ 2007; 85(1): 9-18. https://doi.org/10.2471/BLT.06.033258

González R, Rupérez M, Sevene E, Vala A, Maculuve S, Bulo H, et al. Effects of HIV infection on maternal and neonatal health in southern Mozambique: A prospective cohort study after a decade of antiretroviral drugs roll out. PLoS One 2017; 12(6): 1-17. https://doi.org/10.1371/journal.pone.0178134

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Published

2019-03-01

How to Cite

Quansah, D. Y., Boateng, D., Kwantwi, L. B., Owusu-Sekyere, A., & Amegah, A. K. (2019). Dietary Diversity Score during Pregnancy is Associated with Neonatal Low Apgar Score: A Hospital-Based Cross-Sectional Study. International Journal of Child Health and Nutrition, 8(1), 26–34. https://doi.org/10.6000/1929-4247.2019.08.01.4

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