Lovel, Hermione; (1996) Maternal nutrition status and foetal outcome, and customs and practices in pregnancy and lactation affecting nutrition in Sri Lanka. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Data were collected on 1025 women in a cross-sectional clinic based study in rural Mawanella (Central Province) and in urban Greater Colombo. A longitudinal study was undertaken of a further 525 mothers seen in antenatal clinics and their neonates born at Kandy hospital (Central Province). Indicators of nutritional status used were maternal height, maternal weight, antenatal weight, antenatal BMI, non-pregnant BMI, MUAC, anaemia <8g/dl indicated by copper sulphate solution. Indicators of pregnancy outcomes used were maternal postnatal BMI, birthweight, birth length, neonatal head, ponderal index, asymmetric growth, and weight/length. The population was heterogeneous with a large range of height (32 cm in the urban and 36 cm in the rural). Babies of taller mothers were significantly heavier and longer yet mothers of all heights had babies of similar ponderal index suggesting all babies could be considered equally well-grown. Five height specific fetal growth charts were developed from the height specific median weights found at 20 weeks pregnancy in social class 1-3. IUGR defined by birthweight less than the 10th centile ranged from 2.35 kg on the Short chart to 2.6 kg on the Tall chart. This suggests that some babies born weighing <2500 g are not growth-retarded but well grown for their mother's height. Height appropriate fetal growth monitoring can help alert midwives and obstetricians to what size of baby is to be expected for a particular height and weight of mother. Population characteristics of factors known to be associated with IUGR are described. Paternal smoking occurred in half the study families. More than half (55%) of the non-pregnant women in Mawanella and Colombo (N = 346) had a very low BMI (< 18.8). An antenatal (8/9 months) MUAC of 22.4cm will predict an antenatal BMI <23 at 8/9 months pregnancy with positive and negative predictive values of 87% and 75%. From comparison of routine data and the study measures, recommendations are made to improve routine anthropometric measurements and assessment of growth for gestational age antenatally and neonatally. Field applications of key anthropometric procedures and anaemia assessment are described.

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