Preconception Maternal Mentoring for Improved Fetal Growth among Indonesian Women: Results from a Cluster Randomized Controlled Trial.

The prevalence of stunting in young children is associated with poor growth during the prenatal and early postnatal periods. A maternal mentoring program was developed for Indonesian women to improve birth outcomes. A cluster-randomized controlled trial (CRCT) was conducted in three sub-districts of the Special Region of Yogyakarta, Indonesia. A total of 384 eligible participants were randomly allocated to either an intervention (received the maternal mentoring program and standard care; n = 189) or control (received standard care only; n = 195) group. The maternal mentoring program provided preconception health education; health monitoring; and text message reminders for preconception women. Fetal growth was measured between gestational weeks 27 and 30 using the estimated fetal weight generated from ultrasonographic measurements. Birth weight was measured within 24 h of birth. A structured questionnaire captured women's demographics, pregnancy readiness, and body mass indexes (BMIs). After adjustment, fetal weight was 14% (95% CI: 5.1-23.0) higher in the intervention group than in the control group, and the average weight-for-length Z-score at birth was 0.16 (95% CI: 0.04-0.30) higher in the intervention group than in the control group. The maternal mentoring program was associated with improved fetal growth and birth weight in this population and should be considered for scale-up to other settings, nationally and globally.

Impact of maternal dietary carbohydrate intake and vitamin D-related genetic risk score on birth length: the Vitamin D Pregnant Mother (VDPM) cohort study.

BACKGROUND: Our objectives were to investigate the relationship between maternal vitamin D status and IGF-1 levels in healthy Minangkabau pregnant mothers and their impact on newborn anthropometry outcomes and to examine whether this relationship was modified by dietary intake using a nutrigenetic approach. METHODS: Healthy singleton pregnant mother and infant pairs (n = 183) were recruited. We created three genetic risk scores (GRSs): a six-SNP GRS based on six vitamin D-related single nucleotide polymorphisms (SNPs) involved in the synthesis of vitamin D (vitamin D-GRS), a two-SNP GRS using SNPs in VDR genes (VDR-GRS) and a four-SNP GRS using SNPs from DHCR7, GC, CYP24A1 and CYP2R1 genes (non-VDR GRS). The effect of the GRSs on IGF-1, vitamin D and newborn anthropometry and the interaction between the GRSs and dietary factors were tested using linear regression analysis. RESULTS: The vitamin D- and non-VDR GRSs were significantly associated with lower 25(OH)D concentration (p = 0.005 and p = 0.001, respectively); however, there was no significant association with IGF-1, and newborn anthropometry outcomes. However, there was a significant interaction of VDR-GRS with carbohydrate intake on birth length outcome (Pinteraction = 0.032). Pregnant mothers who had higher carbohydrate intake (405.88 ± 57.16 g/day) and who carried ≥ 2 risk alleles of VDR-GRS gave birth to babies with significantly lower birth lengths compared to babies born to mothers with < 2 risk alleles (p = 0.008). CONCLUSION: This study identified a novel interaction between VDR-GRS and carbohydrate intake on birth length outcome. These findings suggest that reducing the intake of carbohydrates during pregnancy, particularly for those who have a higher genetic susceptibility, might be an effective approach for preventing foetal growth abnormalities.

Association between pre-pregnancy body mass index and gestational weight gain on pregnancy outcomes: a cohort study in Indonesian pregnant women.

BACKGROUND: Pre-pregnancy BMI (PP BMI) and gestational weight gain (GWG) are prominent anthropometric indicators for maternal nutritional status and are related to an increased risk of adverse pregnancy outcomes. This study aimed to determine the factors affecting total GWG, PP BMI and pregnancy outcomes among pregnant women in West Sumatra, Indonesia. METHODS: This observational analysis was conducted among healthy women in the Vitamin D Pregnant Mother (VDPM) cohort study. A total of 195 pregnant women and their newborn babies were enrolled, and information regarding their socio-demographic characteristics, obstetric history, dietary intake and anthropometric data were assessed through direct interviews. Furthermore, the Institute of Medicine (IOM) 2009 guidelines were used to obtain the total GWG. RESULTS: PP BMI was used to categorise the 195 pregnant women as overweight/obese (43.1%), normal (46.7%) and underweight (10.2%). There were 53.3%, 34.4% and 12.3% of women who had inadequate, adequate and excessive GWG, respectively. The multinomial logistic regression model indicated that overweight or obese women at the pre-pregnancy stage were 4.09 times more likely to have an excessive rate of GWG (AOR = 4.09, 95% CI: 1.38-12.12, p = 0.011) than those whose weight was normal. Furthermore, women with excessive GWG were 27.11 times more likely to have a baby with macrosomia (AOR = 27.11, 95% CI: 2.99-245.14) (p = 0.001) and those with inadequate GWG were 9.6 times more likely to give birth to a baby with low birth weight (LBW) (AOR = 9.60, 95% CI; 0.88-105.2) (p = 0.002). CONCLUSIONS: This study demonstrates that the malnutrition status prior to pregnancy and inadequate or excessive GWG status during pregnancy as significant risk factors for developing adverse pregnancy outcomes. These findings highlight the importance of providing information, preconception counselling and health education on weight management for healthy pregnancies.

Correlation between Knowledge about Anemia, Iron, and Folate Consumption with Anemia Status among Premarital Women in Bantul Regency, Yogyakarta.

Anemia is a condition in which the number of red blood cells or hemoglobin levels in the blood is less than normal. Anemia remains a major problem for global public health. The World Health Organization (WHO) estimates that anemia affected more than 1.62 billion people worldwide. Data from National Health Survey (Riskesdas) in 2013 shown that anemia prevalence was 21.7%. Yogyakarta Health Profile showed that the prevalence of anemia women of reproductive age has increased from 22,45% to 28,1% between 2010 and 2014, while in Bantul was 20% indicating a moderate public health problem. The objective of this study was to determine the correlation between knowledge, iron intake, and folate intake with anemia status among women of reproductive age in Bantul Regency.: This research used cross sectional method. The samples were selected by using probability sampling method with simple random sampling technique by lottery and specifying inclusion and exclusion criteria. Data was analyzed with Chi-square test using SPSS. The results showed that there was no correlation between knowledge level and anemia status. Anemia status was significantly correlated with iron intake, but not with folate intake. Conclusion: Anemia was associated with iron intake among women of reproductive age.