Correction: Pathirathna et al. Maternal Compliance to Recommended Iron and Folic Acid Supplementation in Pregnancy, Sri Lanka: A Hospital-Based Cross-Sectional Study. Nutrients 2020, 12, 3266.

In the original publication [...].

Maternal Compliance to Recommended Iron and Folic Acid Supplementation in Pregnancy, Sri Lanka: A Hospital-Based Cross-Sectional Study.

Iron deficiency anaemia during pregnancy is a common public health problem that negatively affects maternal and newborn health. This study aims to identify the rate of maternal compliance with the recommended iron and folic acid (IFA) supplementation during pregnancy and to identify factors associated with maternal compliance and non-compliance. A hospital-based cross-sectional study was conducted among 703 women at 0-4 days postpartum. The prevalence of anaemia at the initial antenatal clinic (ANC) visit and at the third trimester were 20.8% and 44.9%, respectively. The rate of IFA supplementation compliance during pregnancy was 80.1%. Forgetfulness (66.9%) was the major reason for non-compliance, followed by side effects (15.7%). Maternal employment [OR (95%CI): 1.7 (1.00-2.89)], history of a low birth weight infant [OR (95%CI): 0.4 (0.19-0.9)] and history of anaemia [OR (95%CI): 0.4 (0.12-0.98] were significantly associated with maternal compliance with IFA supplementation. Only 26.6% of the participants adhered to dietary recommendations during the period when IFA supplements were provided. The rate of maternal compliance with IFA supplementation was high. However, the prevalence of maternal anaemia during pregnancy was also high, which was presumably due to poor dietary compliance despite high IFA supplementation compliance.

Effects of Physical Activity During Pregnancy on Neonatal Birth Weight.

We assessed the prevalence of adherence to the American College of Obstetricians and Gynecologists (ACOG) recommendations regarding physical activity during pregnancy among Sri Lankan women and explored the relationship between physical activity during pregnancy and neonatal birth weight. In total, 141 pregnant women (gestational age, 18-24 weeks) were included from October to December 2015 and followed up until delivery. A validated questionnaire regarding physical activity during pregnancy was administered in the second and third trimesters. Activities were grouped by type (household/caregiving, occupational, transportation, sports/exercise, and inactivity) and intensity {sedentary [<1.5 metabolic equivalents (METs)], light intensity [1.5-2.9 METs], moderate intensity [3.0-6.0 METs], and vigorous intensity [>6.0 METs]}. Women were categorised as active or inactive based on the ACOG recommendations. In total, 79.1% and 45.2% of women met the guidelines in the second and third trimesters, respectively. The overall time spent and total energy expenditure was significantly higher in the second trimester (p < 0.001). We found no relationship between physical activity during pregnancy and neonatal birth weight. This study indicates that a considerable reduction of time and total energy expenditure occur as pregnancy progresses. Physical activity during pregnancy does not appear to significantly affect neonatal birth weight.

Effects of Prenatal Tobacco and Wood-Fuel Smoke Exposure on Birth Weight in Sri Lanka.

Low birth weight is a key public health problem in many developing countries, including Sri Lanka. Indoor air pollution from tobacco smoke and kitchen-fuel smoke are among the major contributors to low birth weight, factors of which there are little awareness of in Sri Lanka. We evaluated the effect of passive smoking and kitchen-fuel smoke exposure on birth weight. Seventy-six pregnant women were included in the study. Data were collected by questionnaire, and exposure assessment was conducted using a breath carbon monoxide monitor. Women exposed to second-hand tobacco smoke daily had a significantly lower mean gestational age at delivery (mean ± standard error [SE]: 38.0 ± 0.5 weeks) than women who were exposed to second-hand tobacco smoke only once a week (mean ± SE: 39.3 ± 0.3 weeks) (p < 0.05). Women who were exposed to tobacco smoke every day delivered neonates with significantly lower mean birth weight (mean ± SE: 2703 ± 135 g) than women who were only exposed once a week (mean ± SE: 3125 ± 147 g) (p < 0.05). A one-minute increase in cooking time in a kitchen without a chimney increased women's expired air carbon monoxide concentration by 0.038 ppm (p = 0.006). Long-term exposure to wood-fuel smoke in a kitchen without a chimney can increase the risk of inhaling high concentrations of carbon monoxide.

Impact of Second Trimester Maternal Dietary Intake on Gestational Weight Gain and Neonatal Birth Weight.

Poor maternal nutrition is a major contributor to the high incidence of low birth weight deliveries in developing countries. This study aimed to assess the impact of second trimester maternal dietary intake on gestational weight gain and neonatal birth weight. A longitudinal study was conducted in a tertiary care hospital in Sri Lanka. Participants were 141 pregnant women at 18-24 weeks gestation who were followed up until delivery. Maternal dietary intake was assessed using a validated Food Frequency Questionnaire at 21.1 ± 1.8 gestational weeks. Gestational weight gain was examined at the end of 28 weeks gestation and at the end of pregnancy. Energy and nutrient intakes were calculated using NutriSurvey 2007 (EBISpro, Willstaett, Germany) nutrient analysis software, modified for Sri Lankan foods. The mean total gestational weight gain of women with low carbohydrate intake (229-429 g/day) was 2.2 kg less than that of women with moderate carbohydrate intake (430-629 g/day) (95% confidence interval (CI) 0.428-4.083 kg; p = 0.016). Similarly, babies of women with low carbohydrate intake were 312 g lighter compared with those of women with a moderate carbohydrate intake (95% CI 91-534 g; p = 0.006). Our results suggest that second trimester maternal carbohydrate intake has significant impacts on total gestational weight gain and neonatal birth weight.

Comparison of properties of new sources of partially purified inulin to those of commercially pure chicory inulin.

Newly developed inulin powders were prepared from roots of Asparagus falcatus (AF) and Taraxacum javanicum (TJ) plants grown in Sri Lanka. Inulin content, analyzed by enzymatic spectrophotometric as well as high-performance liquid chromatographic methods, showed that AF and TJ inulin powders contain 65.5% and 45.4% (dry wt) inulin, respectively, compared with 72% dry wt in the commercially available chicory inulin. Treating the AF and TJ inulin powders using ion exchange techniques significantly (P < 0.05) reduced their contents of micro (Zn, Cu, Mn, Fe) and macro (Na, K, Ca, Mg) elements. Enzymatic hydrolysis of inulin into fructose and glucose by fructanase, and FT-IR analyses proved that the developed AF and TJ inulins have characteristic molecular composition similar to commercial inulin. TJ inulin contained significantly (P < 0.05) greater amounts of total phenolics (4.37 mg GAE/g), total flavonoids (2.79 mg QE/g), and antioxidant capacity (833.11 mM TE/g) than AF inulin, which contained 1.33 mg GAE/g of total phenolics, 0.43 mg QE/g of total flavonoids, and 406.26 mM TE/g antioxidant capacity. The current study suggests that the newly developed inulin from AF and TJ roots could be used as an alternative commercial source of inulin for the food industry.