Comparison of Maternal Nutrition in Second Trimester and Preconception Period: A Cross-Sectional Study

 

Behnood Farazmand1, Farnaz Vosough2*, Fereshteh Vosough3

1MD, Resident of General Surgery, Iran University of Medical Sciences, Tehran, Iran.

2MD, Tehran University of Medical Sciences, Tehran, Iran

3MD, Iran University of Medical Sciences, Tehran, Iran

*Corresponding Author E-mail:  farnaz.vosough@iran.ir

 

ABSTRACT:

Background and Objectives: Pregnancy is one of the most important moments in a woman's life. Maternal nutrition plays a critical role during this period. The aim of the present study was to evaluate and compare the nutritional status of pregnant women referring to the health centers of Tehran University of Medical Sciences in the second trimester and preconception period. Materials and Methods: In this cross-sectional study, 99 cases in the second trimester were chosen from the health centers located in the southern district of Tehran during 2015 to 2016. A semi-quantitative food frequency questionnaire was utilized to determine the nutritional status of pregnant women in the second trimester and the preconception period by interviewing and using data files. All the analyses were performed by SPSS software (version 15). P-values less than 0.05 were considered statistically significant. Results: In this study, the mean age of the subjects was 27.7±5.8 (age range: 18-48). The comparison of 18 nutrients showed that the consumption of 13 nutrients was significantly increased in the second trimester, compared to that in preconception period. The nutrients include calories (P<0.001), protein (P=0.007), carbohydrate (P<0.001), fat (P<0.001), vitamin A (P<0.001), vitamin B1 (P<0.001), vitamin B2 (P=0.026), vitamin B3 (P=0.001), vitamin B6 (P<0.001), vitamin E (P<0.001), Copper (Cu) (P<0.001), Iron (Fe) (P<0.003), and Zinc (Zn) (P<0.002). Conclusion: The requirement for calories, protein, carbohydrate, fat, and most of the nutrients, such as vitamin A, C, B1, B2, B3, B6, B12, Cu, Fe, and Zn were provided in the second trimester. However, the requirement for vitamin E intake was not provided in the second trimester. The improvement of maternal knowledge regarding nutrition would lead to healthy food choices, which can increase maternal and fetal health and decrease long-term complications.

 

KEYWORDS: Foodstuffs, Nutrition, Nutrients, Pregnancy.

 


INTRODUCTION:

Pregnancy is one of the most important moments in a woman's life. Maternal health and diseases during this period can affect the maternal quality of life and play an important role in fetal health and future generations 1. Maternal nutrition has an important effect on reproductive health and is considered essential for the optimization of pregnancy results before and during pregnancy 2. Various factors can influence maternal and fetal health that is directly related to nutritional status during pregnancy 3. However nutritional status during pregnancy is directly related to weight gain, and the natal birth weight is predictable based on the maternal       weight 4.

 

The accessibility and supply of nutrients to developing fetus depends on maternal nutritional status. Nutritional deficiencies during pregnancy can lead to reduced nutrient stores in mother's body, and in a more severe conditions result in fetal outcomes, such as  weight loss, prematurity, macrosomia, birth defects, increased likelihood for childhood obesity, and abortion 5. The maternal inadequate nutrition during this period can bring about an increase in the incidence of chronic diseases, such as hypertension, obesity, diabetes, and cardiovascular diseases in mother and neonate 6.

 

Therefore, good and adequate nutrition plays a main role on maternal and fetal health during pregnancy that cannot be ignored. The child's health depends mainly on fetal nutritional status; in addition, the prenatal development depends on mother's diet, especially during pregnancy 7. The key to preserve a healthy pregnancy and primary inhibition of maternal fetal complications is to establish healthy dietary habits 8.

 

The sufficient knowledge of nutritional intake during pregnancy and dietary recommendations can help women to achieve a healthy weight gain in this period 9. In fact, several studies have been performed regarding the amount of nutrients used during pregnancy; however, no study was carried out on the differences between maternal diets in preconception period and during the pregnancy and the effective factors in this regard. Moreover, the aim of the present study was to investigate the nutritional status of pregnant women referring to health centers of Tehran University of Medical Sciences and compare the results with the nutritional status in preconception period. Mary Lucita studied maternal stress and maternal and foetal outcome. Pregnancy is a period of excitement, expectancy, anxiety and even fear for the pregnant woman. Findings revealed that the number of family members was significantly related to the level of maternal stress and that as the number of children increased, the maternal stress also increased10. Ikeyi et al. studied effects of age and gestational stages associated with protein energy malnutrition (PEM) on some biochemical indices of some pregnant women in Enugu metropolis of Nigeria. The results show that Calcium negatively and significantly correlated with gestational stage of pregnancy in trimesters (r = -0.288, p<0.05) and correlated positively and significantly with serum total protein (r = + 0.681, p<0.05) and creatinine (r = + 0.0356, p<0.05)11. Monalisa studied oral health in pregnancy. The result showed most pregnant women did not go for dental care during their pregnancy; among those who reported having problem, one half did not get dental care. Comparatively extraction of tooth and mobile tooth seem to be present in a larger population of pregnant women, whereas red swollen gums and abscess are seem to be present in a lesser population12. Radhakrishnan studied about advanced maternal weight. Pregnancy with obesity is high risk, and it causes substantial feto-maternal morbidity and mortality. Obese mothers are at higher risk for perinatal complications including stillbirth, neonatal death, low Apgar scores, fetal distress, macrosomia, presence of meconium, shoulder dystocia, neural tube defects such as spinabifida and congenital anomalies. Postpartum weight retention leads to postpartum maternal obesity and greater increases in body weight before subsequent pregnancies and contributes to intergenerational cycle of obesity13. Mahmood Waffa studied complications of parenteral nutrition in neonates. Findings from this study were able to provide information regarding parenteral nutrition in promoting weight gain and risks of complications in preterm neonates between ELBW, VLBW and LBW. Closer monitoring of effectiveness and safety of parenteral nutrition must be performed to ensure that complications can be reduced in the clinical setting14. Nguyen et al. studied knowledge of child nutrition when breastfeeding. The results revealed that the mothers reported better knowledge of the consumption and frequency of more healthy food supplements. There was a lack of knowledge about nutrition among the mothers with children less than two years of age. The course demonstrated effectiveness in every aspect of nutritional knowledge, tested in the post-test15. Nagarnaik et al. studied an assessment of chemical and nutritional analysis of some food samples in urban city. The results showed the% Daily Value for protein ranged between 8.18 to 26.14 %. , fat content in the range of 16.6 to 59.49 %, carbohydrate in the range of 14.58 to 24 40 %. In case of edible oils SFA, PUFA, and MUFA were calculated. A relationship between saturated and polyunsaturated FA content was determined and expressed as P/S index16. Hait et al. studied Heavy metal levels in selected leafy vegetables obtained from Local market of Dharmjaigarh, Chhattisgarh, India. The heavy metal levels as micronutrients like Iron (Fe), copper (Cu) and Zinc (Zn) were determined using Digital spectrometer in three different samples of leafy vegetables, purchased from Dharmjaygarh market in Raigarh district of Chhattisgarh. The daily human intakes of metals have also been calculated which were observed below recommended values by the FAO/WHO17. Sree and Indirani studied evaluation of the nutrients concentration in the ground water samples near hospital areas. Ground water samples were collected during premonsoon (March, April, May) and Monsoon.  (June, July, August) seasons.  The presence of nutrients like Nitrate - Nitrogen, Ammonia - Nitrogen, Phosphate, Sulphate, and Fluoride was also analyzed18. Saikia et al. studied microbial and biochemical analysis of fresh fruits, vegetables and packaged drinks. The biochemical tests that they performed were protein estimation by Bronsted Lowry method, pH and microbial tests where methylene blue dye reduction test gave us the contamination levels and the test to check the zone of inhibition19.

 

MATERIAL AND METHODS:

Study Population:

In this cross-sectional study, 8 health centers were randomly selected among the municipal health centers located in the southern district of Tehran, affiliated to Tehran University of Medical Sciences, Iran. This study was conducted on a total of 15 pregnant women in the second trimester chosen form each center during 2015to 2016. The exclusion criteria were known underlying diseases, including diabetes, hypothyroidism, hyperthyroidism, hypertension, and organ failure. According to a study conducted by Khajavishojaii et al. and the tendency of more than 70% of the pregnant women to change the diet during pregnancy 20, the sample size was calculated as 99 women.

 

Study Protocol:

In this study, a semi-quantitative nutrition questionnaire was used to determine the nutritional status of pregnant women in the second trimester and the preconception period by interviewing and using their data files. The information regarding the independent variables that can affect the nutritional status of the person, including maternal age, the parental level of education, tendency to delivery mode, pregnancy status, the number of deliveries, nutritional intake, and maternal weight and height was collected. The food and micronutrient groups for the samples were obtained by FP2 software.

 

Statistical Analysis:

The descriptive data were summarized as mean, standard deviation, and percentage. Data normality was checked prior to data analysis using one-Sample Kolmogorov-Smirnov Test. In order to analyze the data, a significant difference was observed using student's t-test and the significance of the mean differences between the nutrients in both preconception period and second trimester were evaluated by means of paired sample t-test. The relationship between the amounts of nutrient intake during preconception period and second trimester with the independent variables was investigated using the student's t-test, analysis of variance, and Pearson correlation coefficient. All the analyses were performed by SPSS software (version 15). P-values less than 0.05 were statistically considered significant.

 

Ethical considerations:

The study protocol was reviewed and approved by the ethics committees of Tehran University of Medical Sciences.

 

RESULTS:

In this study, the pregnant women participated with the age range of 18 to 48 and the mean age of the subjects was 27.7±5.8. Table 1 tabulates the mean values of other variables, such as weight, height, the number of deliveries, hemoglobin, hematocrit, and fasting blood sugar and table 2 presents the abundance and relative frequency of the qualitative variables.

 

 


 

Table 1. Mean and standard deviation of quantitative variables among study population

Variable

Age

(year)

Parity

Gravidity

Weight (kg)

Height (cm)

Hemoglobin (g/dl)

Hematocrit (mg/dl)

Fasting blood sugar (mg/dl)

Mean

27.7

-

-

70.9

160.9

12.8

37.6

88.2

Median

27

1

2

71

160

12.8

37.8

85

Standard deviation

5.8

-

-

10.9

4.9

1.43

3.91

14.8

 


Table 2. The abundance and relative frequency of qualitative variables

Variable

Number

Percentage

Mother's educational level

Illiterate

23

23.2

Junior high school

29

29.3

Diploma

35

35.4

Associate degree

2

2.0

Bachelor degree

9

9.1

Master degree

1

1.0

Total

99

100.0

Father's educational level

Illiterate

17

17.2

Junior high school

31

31.3

Diploma

38

38.4

Associate degree

3

3.0

Bachelor degree

8

8.1

Master degree

2

2.0

Total

99

100.0

Mother's birth rank in family

1

45

45.5

2

30

30.3

3

11

11.1

4

6

6.1

5

4

4.0

No answer

3

3.0

Total

99

100

Pregnancy planning

Yes

72

72.7

No

25

25.3

No answer

2

2.0

Total

99

100

Tendency to delivery mode

Cesarean section

55

55.6

Vaginal

44

44.4

Total

99

100.0

The results of food consumption demonstrated that 63.6% of the pregnant women consumed meat during preconception period, which decreased to 52.2% in the second trimester. Among the cases, 55.6% consumed milk during preconception period, which increased to 64.6% in the second trimester. It was reported that 60.6% of the subjects consumed vegetable during preconception period, which increased to 61.6% during the second trimester. Out of all the subjects, 1% never consumed vegetable during preconception period, which increased to 2% in the second trimester.

 

It was observed that 61.6% of the participants consumed fruits in preconception period, which increased to 66.7% in the second trimester. Out of all the pregnant women, 32.3% never consumed tea during preconception period, which increased to 42.4% in the second trimester (Table 3). The amount of food consumption did not change in 27.3% of the cases during the second trimester, compared to that during preconception period (Table 4).

 

 

 

 

 

 

 

Table 3. Frequency of food intake in preconception period and second trimester

Variation

Preconception period Number (%)

Second trimester

Number (%)

Meat

Always

10 (10.1)

12 (12.1)

Mostly

63 (63.6)

52 (52.5)

Sometimes

26 (26.3)

35 (35.4)

Never

-

-

Milk

Always

5 (5.1)

7 (7.1)

Mostly

55 (55.6)

64 (64.6)

Sometimes

38 (38.4)

28 (28.3)

Never

1 (1.0)

-

Vegetable

Always

8 (8.1)

5 (5.1)

Mostly

60 (60.6)

61 (61.6)

Sometimes

30 (30.3)

31 (33.3)

Never

1 (1.0)

2 (2.0)

Fruits

Always

19 (19.2)

19 (19.2)

Mostly

61 (61.6)

66 (66.7)

Sometimes

19 (19.2)

14 (14.1)

Never

-

-

Tea

Never

32 (32.3)

42 (42.4)

One h before or two h after food

41 (41.4)

35 (35.4)

Others items

26 (26.3)

22 (22.2)

 

Table 4.Comparison of relative abundance of food consumption in second trimester and preconception period

Variable

Number

Percentage

Amount of food consumption

Increased

27

27.3

Decreased

31

31.3

Unchanged

41

41.4

Folic acid intake

No

4

4.1

Yes

93

93.9

Sometimes

2

2.0

Iron supplements intake

No

13

13.1

Yes

84

84.8

Sometimes

2

2.1

 

 

Table 5 tabulates the results regarding the consumption of 41 foodstuffs, including meat, chicken, liver, water lemon, egg, sausage, grain, bread, pasta, rice, and biscuits in the second trimester and preconception period among the study population. Nutrition analysis was performed utilizing FP2 software (Table 6).

 

 

 

 


 

Table 5. Mean and standard deviation of daily food intake in second trimester and preconception period

Foodstuff (gr)

Preconception period

Second trimester

Mean difference

P-value

Mean

Standard deviation

Mean

Standard deviation

Water melon

21.5

17.6

32.4

17.9

10.9

0.000

Pasta

5.9

3.5

6.3

4.5

0.4

0.045

Rice

3.0

1.2

3.3

1.2

0.3

0.002

Cheese

20.9

10.6

22.7

12.5

1.8

0.028

Chips

4.6

5.6

6.1

5.7

1.5

0.046

Puff

4.2

3.5

5.1

3.8

0.9

0.041

Yogurt

16.8

9.5

18.1

9.8

1.3

0.008

Ice cream

9.3

7.7

14.5

10.0

-5.2

0.001

Raw vegetables

14.3

7.6

16.5

9.6

2.2

0.001

Lettuce

12.3

6.0

13.8

6.8

1.2

0.001

Pumpkin

7.0

5.1

8.0

5.7

1.0

0.025

Onion

7.8

5.7

9.2

7.8

1.4

0.042

Citrus

40.8

22.0

35.7

23.0

-5.1

0.011

Seeds

11.1

8.4

13.8

11.1

2.7

0.004

Fat (cream, butter, and oil)

9.2

5.7

9.9

5.7

0.7

0.026

Meat

14.3

11.2

15.3

12.5

1.0

0.130

Chicken

13.3

9.1

13.3

7.5

0.0

0.985

Fish

6.6

4.9

6.5

4.94

-0.1

0.529

Liver

5.1

4.6

4.4

3.5

-0.6

0.064

Sausage

4.3

3.7

4.6

11.8

2.1

0.274

Egg

9.2

4.8

9.0

4.5

-0.2

0.513

Grain

11.0

5.2

13.7

16.1

2.7

0.081

Bread

4.1

3.1

3.7

1.1

-0.4

0.174

Biscuits

8.9

10.7

9.8

12.8

0.9

0.202

Cookie

8.6

6.1

9.3

6.0

0.7

0.221

Jams

13.5

7.6

13.4

7.7

-0.1

0.510

Honey

12.8

7.4

13.7

8.1

0.9

0.203

Chocolate

12.4

12.0

12.6

11.8

0.2

0.772

Soda

10.9

13.3

12.6

13.3

1.7

0.292

Tea

51.1

23.9

50.9

26.3

-0.2

0.898

Milk

19.5

9.9

19.5

10.1

0.0

1.000

Whey

4.8

3.6

5.0

4.0

0.2

0.503

Cooked Vegetables

8.8

4.6

8.5

4.7

-0.3

0.677

Carrots

8.7

6.2

9.0

5.9

0.3

0.661

Tomatoes

9.6

4.5

21.2

106.0

11.6

0.299

Potatoes

9.8

5.2

10.2

5.9

0.4

0.106

Garlic

8.8

8.8

8.8

8.7

0.0

0.947

Fruit Juice

11.3

6.8

11.0

5.5

-0.3

0.667

Other fruits

17.5

11.5

17.6

11.5

0.1

0.727

Nuts

9.8

5.3

10.0

5.7

0.2

0.452

 

Table 6. Mean and standard deviation of daily nutrient intake using FP2 software

Type of nutrients

Preconception period

Second trimester

Mean difference

P-value

Mean

Standard deviation

Mean

Standard deviation

Calories (Kcal)

2151.5

688.6

2308.5

700.3

156.9

0.000

Protein (gr)

80.8

25.2

83.8

25.7

3.0

0.007

Carbohydrate (gr)

386.9

139.1

415.7

137.1

28.8

0.000

Fiber (gr)

20.7

7.2

20.9

6.8

0.2

0.762

Fat (gr)

33.2

9.6

37.4

10.7

4.2

0.000

Vitamin A (µ)

841.6

846.4

931.5

438.0

89.9

0.000

Vitamin B1 (mg)

2.34

0.8

2.5

0.8

0.16

0.000

Vitamin B2 (mg)

2.1

0.6

2.2

0.64

0.1

0.026

Vitamin B3 (mg)

20.6

7.5

21.7

7.1

1.1

0.001

Vitamin B6 (mg)

1.5

0.4

1.9

0.6

0.4

0.000

Vitamin B12 (µ)

3.3

2.3

3.4

1.1

0.1

0.417

Folacin (µ)

279.7

76.8

279.3

86.4

-0.4

0.675

Vitamin C (mg)

135.7

49.0

133.4

68.7

-2.3

0.719

Vitamin E (mg)

5.1

1.6

5.4

1.6

0.3

0.000

Calcium (mg)

875.5

239.5

896.9

0.3

21.4

0.088

Copper (mg)

1.9

0.6

2.0

0.6

0.1

0.000

Iron (mg)

19.9

7.4

20.8

7.1

0.9

0.003

Zinc (mg)

10.8

3.1

11.2

3.2

0.4

0.002

Percentage of daily protein calorie

15.1

1.6

14.4

1.4

-0.7

0.000

 


According to the results, the consumption of 14 foodstuffs significantly increased in the second trimester, compared to that in the preconception period. These foodstuffs included water melon (P=0.000), pasta (P=0.045), rice (P=0.002), cheese (P=0.028), yogurt (P=0.008), chips (P=0.046), puff (P=0.041), ice cream (P=0.001), pumpkin (P=0.025), raw vegetables (P=0.001), lettuce (P=0.001), onion (P=0.042), seeds (P=0.004), and fat types (i.e., cream, butter, and  oil) (P=0.026). Citrus consumption significantly decreased in the second trimester, compared to that in the preconception period (P=0.011).

 

The comparison of 18 nutrients showed that the consumption of 13 nutrients significantly increased in the second trimester than that during the preconception period, including calories (P<0.001), protein (P=0.007), carbohydrate (P<0.001), fat (P<0.001), vitamin A (P<0.001), vitamin B1 (P<0.001), vitamin B2 (P=0.026), vitamin B3 (P=0.001), vitamin B6 (P<0.001), vitamin E (P<0.001), Copper (Cu) (P<0.001), Iron (Fe) (P<0.003), and Zinc (Zn) (P<0.002).

 

The mean value of daily protein calorie was 15±1.6 in preconception period; furthermore, it was reported as 14.3±1.4 with a significant decrease in the second trimester (P<0.001). The consumption of vitamin C did not significantly decrease in the second trimester, compared to that during the preconception period (P=0.719). The consumption of fiber (P=0.045) and vitamin B6 (P=0.044) had a significant difference according to the age of mother in preconception period.

The evaluation of Pearson correlation coefficient showed the linear relationship between the nutrient consumption rates, which were calories (R=0.212), carbohydrate (R=0.221), vitamin B1 (R=0.198), vitamin B3 (R=0.203), Cu (R=0.231), Fe (R=0.218), and maternal age. The mean reduction of daily protein calorie rate had a significant relationship with maternal education level in the second trimester, compared to that in preconception period  (P<0.001). The mean value of daily protein intake in illiterate cases reduced from 14.9±1.6 in preconception period to 14.3±1.1 in the second trimester. However, the mean of daily protein intake significantly decreased with paternal education level in the second trimester, compared to that in preconception period (P<0.001). The mean value of fat consumption had a significant relationship with paternal education level in preconception period (P=0.005).

 

The comparison of the mean differences between fat and the educational level based on the paternal education level in preconception period was performed using post hoc test. According to the results of post hoc analysis, fat mean values between illiterate and master degree groups,  junior high school and master degree groups, as well as diploma and master degree groups were reported as 15 (P=0.024), 12.6 (P=0.030), and 3 (P=0.004), respectively.

 

Based on the results of the present study, the mean values of daily protein intake between illiterate/junior high school and junior high school/associate degree groups were obtained as 2.3 (P=0.035) and 3 (P=0.035), respectively. The paternal education level demonstrated significant differences with vitamin C consumption and the daily protein intake calories (P=0.035).

 

Post hoc analysis was used in order to compare the mean values of vitamin C and daily protein intake calories according to the paternal education level in the second trimester. Based on the results, Mean value of vitamin C was not statistically significant, while the mean value of daily protein intake calories was statistically significant (P=0.000). The mean values of daily protein intake calories between illiterate and associate degree groups, high school and associate degree groups, as well as diploma and associate degree groups were reported as 2.5±0.4 (P=0.02), 2.7±0.4 (P=0.017), 2.2±0.3 (P=0. 04), respectively.

 

The significant difference between the number of deliveries and nutrient consumption was not demonstrated in the second trimester and preconception period. The type of delivery and nutrient consumption had a significant difference with vitamin B12 (P=0.037) and Cu (P=0.037) in preconception period. However significant differences were reported regarding delivery mode and nutrient consumption with calories, protein, carbohydrate, vitamin B3, vitamin B12, Cu, and Fe in the second trimester (P<0.05). The mean value of nutrient consumption was higher in the C-section group, compared to the vaginal group.

 

DISCUSSION:

The present study evaluated the mean differences between 41 kinds of foodstuff and 18 types of nutrients consumed daily in the second trimester and preconception period. The results of the present study showed higher variations in the mean values of foodstuff and nutrient consumption in the second trimester, compared to those in preconception period. The mean values of 14 foodstuff consumption out of 41 food items, such as water melon, pasta, rice, cheese, yogurt, chips, puff, ice cream, pumpkin, raw vegetables, lettuce, onion, seeds, and fats group (cream, butter, oil) have significantly increased in the second trimester, compared to those in preconception period.

 

In addition, citrus consumption had a significant decrease in the second trimester, compared to that in preconception period. The increased consumption of pasta and rice can be a source of B-group vitamins. Ice cream, yogurt, and fat group are sources of proteins and vitamin A. Vitamin C and vitamin A can be found in pumpkin, raw vegetables, lettuce, and onion. However, the mean reduction of citrus consumption was probably due to seasonal changes in the second trimester.

 

If the mean of 18 nutrients consumption in this study was two-third of the recommended values by dietary allowances, it could be concluded that this occurred in the second trimester. In general, calorie requirements were calculated by multiplying the weight by 35 to which 300 kcal is added in preconception period 21. A pregnant woman needs nearly 600 kcal for daily activities to ensure the normal growth of the fetus 22.

 

Hui et al.23 and Irles et al.24 reported that received calorie should increase gradually during pregnancy. Furthermore, the regular diet of pregnant women lacks calcium, iron, folic acid, and dietary fiber, in spite of the presence of an extra amount of animal protein and fat. Moreover, the results of this study indicated that the mean value of received calories in the second trimester increased more significantly, compared to that in preconception period (P=0.000). According to the mean age of pregnant women, the average calorie requirement was considered as 2781.5 kcal, which showed that the calorie requirement was provided during pregnancy.

 

The amount of daily protein recommended to adults is 0.8 g/kg/bw 25, which is 25 g during pregnancy26. Maslova et al. reported that maternal protein intake, especially from animal sources increased during pregnancy 27. In another study carried out by Maslova et al., it was demonstrated that there was a significant relationship between maternal protein intake during pregnancy with the recommended fetal metabolic rate, which is necessary for the embryo growth 26. In the present study, the amount of daily protein intake in pregnant women was 81.72 g, considering that the average consumption in the second trimester increased significantly, compared to that in preconception (P=0.007). The subjects consumed 63.6% meat during preconception period, which decreased to 55.6% during pregnancy. However, an increase in the protein intake revealed that it was provided from sources other than meat.

 

Regarding the fact that higher educational level represents higher income and level of awareness; however, in the present study, protein consumption did not only increase based on parental level of education, while it decreased among the participants with higher educational level and more awareness. This awareness is not related to the consumption of important food groups, such as proteins.

 

The recommended fat requirement is about 20% to 35% of daily calories 28. Sween et al. demonstrated that increasing excess fat during pregnancy can enhance the risk of preeclampsia in mothers; therefore, it should be noted that the amount of fat intake increases during pregnancy and it should not be more than regular amount29. The results of this study indicated that the mean value of fat consumption in the second trimester increased significantly, compared to that in preconception period (P=0.000).

 

The recommended amount of carbohydrates is about 45% to 65% percent of daily calories 30. Renault et al. showed that higher amount of carbohydrate intake during pregnancy combined with impaired glucose tolerance is postulated to result in high birth weight, which is linked to subsequent metabolic diseases 30. Blood glucose concentrations are impressed by individual's glucose tolerance and the amount and quality of consumed carbohydrates. Then, a decrease in carbohydrate intake or an enhancement in carbohydrate quality in terms of glycemic response may decrease the risk of fetal overgrowth among women with reduced glucose tolerance 21. Based on the results of the present study it was demonstrated that the mean of carbohydrate consumption in the second trimester increased significantly, compared to that in preconception period (P=0.000).

 

The results of this study showed that the consumption of vitamin A, B1, B2, B3, B6, B12, C, Ca, Zn, Cu, and acid folic increased significantly in the second trimester, compared to preconception period. Vitamins play an important role in supporting the structural and functional improvement of the fetal brain. According to the evidences, it is suggested that folate and the metabolically related B-vitamins are critical for brain health during pregnancy 32.

 

It is demonstrated that maternal folate status throughout pregnancy may influence the neurodevelopment and behavior of the offspring 33. Folate and vitamin C are indirectly involved in deoxyribonucleic acid methylation, which in turn is considered one of the epigenetic mechanisms that may underlie fetal programming. Based on the literature, it was concluded that folate and the related B group-vitamins play an important role in fetal health during pregnancy 34.

 

The results of this study and previous studies revealed that the quantity and quality of nutrition during pregnancy is of particular importance. Nutrition improves maternal weakness, which can lead to pregnancy complications, including intrauterine growth restriction, low birth weight, abortion, and premature birth 35. The role of good nutrition indicates that there is a positive linear relationship between weight gain during pregnancy and fetal weight. Furthermore, the body mass index of mother before pregnancy can be independent of maternal weight gain during pregnancy and impress the fetal weight 36.

 

CONCLUSION:

The results of the present study revealed the need for calories, protein, carbohydrate, fat, and most of the nutrients, such as vitamin A, C, B1, B2, B3, B6, B12, Cu, Fe, and Zn provided in the second trimester. However, the requirement for vitamin E intake was not provided in the second trimester. Folic acid consumption was not enough in the second trimester and 93.9% of the pregnant women consumed folic acid along with supplementary intake. It seemed that special training for nurses was necessary and could be organized in form of holding workshops in centers that pregnant women referred to regarding pregnancy care or through group media; however, the best way was face-to-face learning. The improvement of maternal nutrition knowledge would lead to healthier food choices, which increase maternal and fetal health, thereby decreasing long-term complications.

 

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Received on 31.12.2018          Modified on 16.01.2019

Accepted on 29.03.2019        © RJPT All right reserved

Research J. Pharm. and Tech. 2019; 12(5):2233-2240.

DOI: 10.5958/0974-360X.2019.00372.X