Associations between socio-demographic characteristics of pregnant women and birth outcome: The Nutritional status of Expectant Mothers and their newborn Infants study.

BACKGROUND: Low socio-economic status is associated with poor birth outcomes, however, few studies on this topic have been conducted in South Africa. We determined associations between socio-demographic variables of pregnant women and birth outcome in their offspring. METHODS: This study was nested in a prospective cohort study conducted at an antenatal clinic at a regional hospital in Bloemfontein, South Africa. Questionnaires on socio-demographic information were completed on 682 pregnant women in a structured interview. Post-delivery, 331 participants provided the Road to Health Booklets for 347 infants, in which birth data were recorded. Associations between socio-demographic variables and birth outcome (defined as premature delivery or low length-for-age or low weight-for-length at birth) were investigated. Logistic regression with backward selection (p < 0.05) was used to select independent factors that were significantly associated with birth outcome. Variables with a p-value of <0.15 on bivariate analysis were considered for inclusion in the model. RESULTS: Poor birth outcome was observed in 36.3% (116/320) of women. The odds of experiencing poor birth outcome were lower for women who owned a stove versus those who did not (OR 0.11, 95% CI: 0.02-0.67), and higher for women with grade 8-10 (OR 5.84, 95% CI: 1.90-17.91) or grade 10-12 (OR 4.33, 95% CI: 1.50-12.49) as their highest level of education versus tertiary education. The odds of experiencing poor birth outcomes were also higher for those employed part-time (OR 2.55, 95% CI: 1.10-5.93) versus full-time and/or self-employed. CONCLUSION: Our findings confirm that the presence of basic amenities such as a stove, better education and employment improve the chances of better birth outcomes. Early screening of pregnant women for the identification of socio-demographic risk factors that may impact on birth outcome is recommended.

Reported health, social support, stress and associations with choline intake in pregnant women in central South Africa: the NuEMI study 2018-2019.

BACKGROUND: The health and well-being of pregnant women can influence pregnancy outcomes and are closely associated with social support and experiences of stress. Poor nutrition predisposes to poor health with choline intake affecting pregnancy outcome. This study determined reported health, social support, and stress and how these factors are associated with choline intake in pregnancy. METHODS: A cross sectional study was performed. Pregnant women in their second and third trimesters attending a high-risk antenatal clinic at a regional hospital in Bloemfontein, South Africa, were included. Trained fieldworkers obtained information during structured interviews using standardised questionnaires. Logistic regression with backward selection (p < 0.05) was used to select significant independent factors associated with choline intake. Variables with a p-value < 0.15 in bivariate analysis were considered for inclusion in the model. RESULTS: Median age and gestation in the sample (N = 682) were 31.8 years and 32.0 weeks, respectively. Most participants (84.7%) consumed less than the adequate intake (AI) of 450 mg of choline per day. Most participants (69.0%) were either overweight or obese. One in eight participants (12.6%) reported not having anyone that could help them in times of need, more than one third (36.0%) reported having unpayable debt and one in twelve (8.4%) reported experiencing physical abuse by their partners. Normotensive participants and those using anti-retroviral therapy (ART) (thus HIV-infected), were more likely to consume choline in amounts below the AI (p = 0.042 and p = 0.011, respectively). Logistic regression analysis showed that the odds of consuming choline in amounts below the AI were lower for participants that were not using ART versus those using ART, with an odds ratio of 0.53. CONCLUSION: HIV-infected participants were more likely to consume choline in levels below the AI. This vulnerable group should be the focus of targeted efforts to improve choline intake.

Nutrigenomics: Perceptions of South African Dietitians and General Practitioners.

Introduction Although investigations into the emerging field of nutrigenomics are relatively limited and more research in this field is required, experts agree that there is potential for it to be incorporated into health care practice. If health care professionals can promote healthy dietary behaviour based on nutrigenomic testing, it can assist in addressing the health consequences of poor diet and lightening the strain on the South African health care system. Methods Registered dietitians (RDs) and general practitioners (GPs) registered with the Health Professions Council of South Africa (HPCSA) who obtained their qualification in South Africa (SA), were eligible to participate in this cross-sectional study. Participants were identified using convenience and snowball sampling. A self-administered electronic survey using EvaSys Software® was completed by those that agreed to participate. Results Nearly all RDs (97.3%), but less than a third of GPs (30.4%), had heard of the term nutrigenomics. Approximately three-quarters of RDs (74.7%) and GPs (73.9%) had or would personally consider undergoing genetic testing. More than forty percent (43.5%) of RDs ranked direct-to-consumer (DTC) genetic testing companies as the most equipped, while 31.8% of GPs ranked RDs as the most equipped to provide patients with nutrigenomic services. Both RDs and GPs ranked similar reasons as 'strongly agree' for why consumers were motivated to make use of nutrigenomic services, which included 'motivated by a desire to prevent or manage disease' (56.7%), 'prevent a disease based on family history' (65.9%), 'control health outcomes based on family history' (54.9%), and 'improve overall health-related quality of life' (48.6%). Cost concerns were reported as the greatest barrier to implementing nutrigenomic services (75.7%). Other barriers included confidentiality issues (47.8%) and moral concerns (37.3%). Greater individualisation of diet prescription (66.5%), stronger foundations for nutrition recommendations (62.4%), and dietary prescriptions that would manage or prevent certain diseases more effectively (59.0%) were all perceived as benefits of including nutrigenomics in practice. Discussion/Conclusion This study identified perceived consumer motivators and barriers that might affect the willingness to seek nutrigenomic services in SA. In addition, the need for more nutrigenomic training opportunities, including the planning of personalised diets based on genetic testing results and interpretation of results was confirmed. However, both RDs and GPs felt that the emerging field of nutrigenomics needs further development before it can be applied effectively in routine private and public health care in SA.

Sociodemographic Indicators, Household Food Security and Associations with Choline Intake in Pregnant Women: The NuEMI Study.

Higher sociodemographic status is associated with adequate nutrient intake and food security. Adequate choline intake is vital during pregnancy to support fetal development. In this cross-sectional study, information was obtained from 682 pregnant women attending an ante-natal clinic in Bloemfontein, South Africa. Sociodemographic indicators that were bivariately significantly associated with a choline intake below the adequate intake level (AI) included a higher household density ratio, no access to own flush toilets at home, household not owning a refrigerator or microwave, as well as a lower level of education. Approximately one-third of participants were severely food-insecure. Logistic regression analysis, adjusted for energy intake, showed that household overcrowding increased the odds of a choline intake below the AI (OR 1.71).

Choline intake and associations with egg and dairy consumption among pregnant women attending a high-risk antenatal clinic in South Africa: the NuEMI study.

BACKGROUND: The importance of adequate choline intake during pregnancy has been well documented, but low intake is common. Total choline intake, main food sources of choline, as well as associations between choline intake and egg and dairy consumption were determined in a sample of pregnant women attending the high-risk antenatal clinic at a regional hospital in Bloemfontein, South Africa. METHODS: A cross-sectional study design was used. Trained fieldworkers collected dietary intake data using a validated quantified food frequency questionnaire (QFFQ), after which all food items were matched to foods in the USDA Database for the Choline Content of Common Foods (Release 2) to quantify choline intake. Logistic regression with backward selection (p < 0.05) was used to determine whether egg and dairy consumption were independently associated with a choline intake below the adequate intake (AI) level. RESULTS: The median daily intake of choline was 275 mg (interquartile range 185 mg - 387 mg) (N = 681). Most participants (84.7%) consumed less than the AI of 450 mg/day for choline. Meat and meat products, cereals, eggs and dairy contributed mostly to choline intake. Food items that contributed most to choline intake included full-cream milk, maize porridge, brown bread, deep-fried potatoes and deep-fried dough (vetkoek). A choline intake below the AI was significantly associated with lower egg and dairy intakes (p < 0.0001 and p = 0.0002 respectively). CONCLUSION: Most pregnant women in the current study had choline intakes below the AI. It is recommended that public health messaging targeted at pregnant women promote the consumption of foods that can significantly contribute to choline intake, such as eggs and dairy.