Browsing by Subject "Cesarean section"

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Nutrition during pregnancy and early infancy in urban and rural areas of Deyang region, Southwestern China
(2022) Gao, Haoyue; Birner, Regina
In the past years, China has made remarkable progress in achieving the Millennium Development Goals. However, there are still significant urban-rural disparities and regional differences in the main indicators of child nutrition, maternal and child health. Inadequate dietary intake with regard to certain macro- and micronutrients occurs among women during the reproductive period. Despite the efforts that have been made to promote breastfeeding in China since the 1990s, there is still a very low prevalence of exclusive breastfeeding during the first six months of life. Therefore, the purpose of this observational study was to assess dietary intake and identify risk factors for nutritional inadequacy in pregnant women and to assess the current situation of infant feeding practices during the postpartum hospital stay in urban and rural settings of the study area in China. Between 2010 and 2012, cross-sectional sampling was used in two urban hospitals and five rural clinics randomly selected in the Deyang region. A total of 203 pregnant women in the third trimester and 204 pairs of mothers and newborns were recruited on the basis of informed consent during antenatal clinic sessions and in postnatal wards respectively. Semi-structured interviews on anthropometric and socio-demographic information were conducted for both the pregnant women and postpartum mothers. In addition, data on 24-h dietary recalls of pregnant women, birth outcomes and infant feeding practices of postpartum mothers were collected. Prior to pregnancy, 26.3% of the pregnant women were found to be underweight, while only 5.1% were overweight, based on self-reported pre-pregnancy weight. The women’s overall dietary energy intake during the third trimester originated excessively from fat, was low in carbohydrates, and reached the lower limits for protein. Compared to rural areas, women living in urban areas had significantly higher reference nutrient intake fulfilment levels for energy, fat, protein, vitamin A, Zn, Fe, Ca and riboflavin. The likelihood of pregnant women following certain traditional food recommendations such as avoiding beef, mutton, fish etc. was higher in rural than in urban areas. Both the short-term (e.g. gestational weight gain) and long-term nutritional status (e.g. height) of the mothers affected the birth outcomes (e.g. type of delivery). The decision for a Caesarean Section (CS) was not only related to medical/obstetrical issues but also nutritional and social demographic factors. The short stature of mothers, excessive gestational weight gain, larger-sized newborns, higher educational level or older ages of mothers were significantly positively related to the probability of CS. Although almost all of the mothers started breastfeeding after childbirth, the high prevalence of CS delayed initiation of breastfeeding. Due to the widespread use of infant formula, the prevalence of exclusive breastfeeding (EBF) was only 8.0 % one week after delivery. Regardless of prelacteal feedings, almost exclusive breastfeeding (AEBF) was 34.5%. Breastfeeding initiation within two days after birth was positively associated with AEBF, whereas smaller newborns, mothers with higher education level, mothers lack of knowledge about the importance of colostrum were negatively associated with AEBF. As most mothers lacked knowledge of the lactation physiology, higher formal education was often not related to a better knowledge of breastfeeding. In conclusion, culturally sensitive nutrition education sessions are necessary for both urban and rural women. Special attention must be given to the nutritional status, especially of rural women, before or, at the latest, during pregnancy. Personalized nutritional guidance for expectant mothers should be based on comprehensive consideration of all aspects, such as dietary intake, place of origin (rural vs. urban), body height, and gestational weight gain etc. Better guidance for the gestational weight gain of Chinese mothers needs to be established. Although disparities between urban and rural areas exist, the situation of infant feeding is inadequate in both settings. The high prevalence of CS, the mothers’ poor knowledge of the physiology of breast milk production, the mothers’ lack of breastfeeding confidence, the widespread advertising of breast milk substitutes, and the changing perception of the function of breasts, may influence the unfavorable breastfeeding behavior observed in the study area. In order to prevent CS and to promote breastfeeding, education about the complications and disadvantages of CS especially among mothers with higher education, older childbearing age, and primiparas needs to be strengthened. Supporting adequate maternal nutrition during the reproductive period and creating a good breastfeeding environment requires the efforts of the whole society.