An investigation into the most appropriate prediction method for birth outcomes and maternal morbidity, and the influence of socioeconomic status in a group of preganant women in Khayelitsha, South Africa

Davies, Hilary (2010-12)

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2010.

Thesis

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.

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