Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Introduction :
The health status of women in peri-urban areas has been influence by the
South African political transition. Despite some progress, maternal and child
mortality rates are still unacceptably high. A mother’s nutritional status is one
of the most important determinants of maternal and birth outcomes. The
Institute of Medicine’s pre-pregnancy Body Mass Index (BMI) method is not
always appropriate to use in a peri-urban setting as many women attend their
first antenatal clinic later on in their pregnancy. Two alternative methods, the
gestational BMI (GBMI) and the gestational risk score (GRS), have been used
elsewhere to screen for at risk pregnancies, but have not been used in a
South African peri-urban setting. Furthermore, examining socio-economic
variables (SEV) aids in the explanation of the impact of social structures on an
individual. Risk factors can then be established and pregnant women in these
higher risk groups can be identified and given additional antenatal clinic
appointments and priority during labour.
Aim:
The first aim was to investigate the strength of the GBMI and GRS methods
for predicting birth outcomes and maternal morbidities. The second aim was
to investigate the relationships between SEV, GBMI and maternal morbidities.
Methods:
This was a sub-study of the Philani Mentor Mothers Study. A sample of 103
and 205 were selected for investigating the prediction methods and SEV
respectively. Maternal anthropometry, gestational weeks and SEV were
obtained during interviews before birth. Information obtained was used to
calculate GBMI and GRS and to assess the SEV. Birth outcomes were
obtained from the infant’s clinic cards and maternal morbidities were obtained
from interviews two days after the birth. Results
No significant association was found between GBMI and birth outcomes and
maternal morbidities. A significant positive association was found between
GRS and birth head circumference percentile (r=0.22, p<0.05). The higher
the GRS, the higher the risk of an infant spending longer time in the hospital
(Kruskal Wallis X2 = 4, p<0.05). A significant positive association was found
between GBMI and the following SEV factors; age (r=0.33, p<0.05), height
(r=0.15, p<0.05), parity (r=0.23, p<0.05), income (r=0.2, p<0.05), marital
status (X2 = 9.35, p<0.05), employment (U=2.9, p<0.05) and HIV status
(U=2.54, p<0.05). No statistically significant relationships were found
between gestational hypertension and gestational diabetes mellitus and SEV.
Conclusion:
From the findings of this sub-study there were some promising results,
however it is still unclear as to which method is the most appropriate to predict
adverse birth outcomes and maternal morbidity. It is recommended that the
GBMI and GRS once-off methods be repeated in a larger population to see if
there are more parameters that could be predicted. Women who were older,
shorter, married, had more pregnancies, HIV negative and had a higher socioeconomic
status tended to have a greater GBMI. This can lead to adverse
birth outcomes and increases the risk of women developing maternal
morbidities and other chronic diseases later in their life. Optimal nutrition and
health promotion strategies targeting women before conception should be
implemented. / AFRIKAANSE OPSOMMING: Inleiding:
Die gesondheidstatus van vroue in semi-stedelike areas is beïnvloed deur die
Suid-Afrikaanse politiese oorgang. Ten spyte van ’n mate van vooruitgang is
die sterftesyfers vir moeders en kinders steeds onaanvaarbaar hoog. ‘n
Moeder se voedingstatus is een van die mees belangrike bepalende faktore
van moeder- en geboorteuitkomste. Die Instituut van Geneeskunde se voorswangerskap
Liggaamsmassa Indeks (LMI) metode is nie altyd toepaslik om
te gebruik in ‘n semi-stedelike opset nie aangesien baie vroue hul eerste
voorgeboorte-kliniek eers later in hul swangerskap bywoon. Twee
alternatiewe metodes, die swangerskap LMI (SLMI) en die swangerskap risiko
telling (SRT) is al elders gebruik as sifting vir hoë risiko swangerskappe, maar
is nog nie gebruik in ‘n Suid-Afrikaanse semi-stedelike opset nie. Vervolgens
kan ‘n ondersoek na sosio-ekonomiese veranderlikes (SEV) help om die
impak van maatskaplike strukture op ‘n individu te verduidelik. Risiko faktore
kan dan vasgestel word en swanger vroue wat in hierdie hoër risiko groepe
val kan geïdentifiseer word. Dié vroue kan addisionele voorgeboorte-kliniek
afsprake ontvang asook voorkeurbehandeling tydens die geboorteproses.
Doelstellings:
Die eerste doelstelling was om die sterkte van die SLMI en SRT metodes te
ondersoek as voorspellers van geboorte uitkomste en moeder-morbiditeite.
Die tweede doelstelling was om die verhoudings tussen SEV, SLMI en
moeder-morbiditeite te ondersoek.
Metodes:
Hierdie projek was ‘n sub-studie van die Philani Mentor Moeders Studie. ‘n
Steekproefgrootte van 103 en 205 was geselekteer om onderskeidelik die
voorspeller metodes en SEV te ondersoek. Die moeder se antropometrie,
swangerskap weke en SEV was verkry gedurende onderhoude voor
geboorte. Informasie ingewin was gebruik om die SLMI en SRT te bereken en
om die SEV te ondersoek. Geboorteuitkomste was verkry vanaf die babas se kliniekkaarte en moeder-morbiditeite was verkry tydens onderhoude twee dae
na die geboorte.
Resultate:
Geen betekenisvolle assosiasie was gevind tussen SLMI, geboorteuitkomste
en moeder-morbiditeite nie. ‘n Betekenisvolle positiewe assosiasie was
gevind tussen SRT en die geboorte kopomtrek persentiel (r=0.22, p<0.05).
Hoe hoër die SRT, hoe hoër die risiko dat ‘n baba langer in die hospitaal sou
bly (Kruskal Wallis X2=4, p<0.05). ‘n Betekenisvolle positiewe assosiasie was
gevind tussen SLMI en die volgende SEV faktore: ouderdom (r=0.33, p<0.05),
lengte (r=0.15, p<0.05), pariteit (r=0.23, p<0.05), inkomste (r=0.2, p<0.05),
huwelikstatus (X2=9.35, p<0.05), besit van ‘n identiteitsdokument (U=1.75,
p<0.05), werkstatus (U=2.9, p<0.05) en MIV status (U=2.54, p<0.05). Geen
statisties beduidende verhoudings was gevind tussen swangerskap
hipertensie, swangerskap diabetes mellitus en SEV nie.
Gevolgtrekking
Sommige bevindinge van hierdie sub-studie dui op belowende resultate,
alhoewel dit steeds nie duidelik is watter metode die mees toepaslike is om
ongewenste geboorteuitkomste en moeder-morbiditeit te voorspel nie. Dit
word aanbeveel dat die SLMI en SRT eenmalige metodes herhaal word in ‘n
groter populasie om te sien of daar meer parameters is wat voorspel kan
word. Vroue wat ouer, korter, getroud, meer swangerskappe, MIV negatief en
‘n hoër sosio-ekonomiese status gehad het was geneig om ‘n hoër SLMI te
hê. Dit kan lei tot ongewenste geboorteuitkomste en verhoogde risiko om
moeder-morbiditeite en ander chroniese siektes later in hul lewe te ontwikkel.
Optimale voeding en gesondheidsbevordering strategieë wat vroue teiken
voor bevrugting behoort geïmplementeer te word.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/5235 |
| Date | 12 1900 |
| Creators | Davies, Hilary |
| Contributors | Visser, Janicke, Tomlinson, Mark, University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition. |
| Publisher | Stellenbosch : University of Stellenbosch |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | Unknown |
| Type | Thesis |
| Format | Various pagings |
| Rights | University of Stellenbosch |
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