Background: Maternal nutrition during pregnancy is essential for desired birth outcome. The present study was conducted to gather information regarding neonatal outcome in relation to pregnant women’s meals during pregnancy in tribal, rural communities.

Methodology: Community-based cross-sectional analytic study included all 3905 pregnant tribal women residing in 100 villages who delivered over 2 years and consented to participate in the study. Face-to-face interviews of participants regarding their everyday meals and neonatal outcome in relation to maternal diet during pregnancy were conducted for 15-30 minutes using semi-structured questionnaire.

Results: Of 3905 women interviewed, majority (44.5%) belonged to ≥20-≤29 years, were illiterate (48.6%), agricultural labourers (46.2%), belonged to lower economic class (41.0%), and had one or two previous childbirths (54.7%). Of all participants, 55.4% had three meals a day, 31.2% four meals a day, and 13.4% had two meals per day. Most of the women who had 3-4 meals, irrespective of type of diet (vegetarian or mixed) had better neonatal outcomes including term live births, AGA babies, and neonatal birthweight >2-2.5Kg. The maximum term stillbirths were in mothers who had two meals a day (2.1%). Addition of eggs and milk to their daily diet improved the neonatal outcome.

Conclusion: In present study, 55.4% had three meals, all-inclusive every day, 31.2% four meals a day, and 13.4% had two meals per day. Neonatal outcomes were found to be significantly associated with number of meals consumed during pregnancy. No significant association was found with the type of meals (vegetarian or mixed), though adding eggs and milk to daily diet improved neonatal outcomes.

• Baby weight
• Gestation Diet
• Meals
• Neonatal outcome
• Rural.

Chhabra S, Kumar N (2024) Neonatal Outcome in context of Pregnant Women’ Meals in Remote Villages - A Community Based Study. Med J Obstet Gynecol 12(2): 1190.

Maternal nutrition during pregnancy is crucial for healthy birth outcome and also significantly influences the child’s long- term health and disease risk [1].The maternal diet before and during pregnancy plays a vital role in shaping fetal development and determining birth outcomes. It has been reported that maternal dietary patterns may influence the risk of preterm birth, with healthier diets potentially reducing both overall and spontaneous preterm birth rates [2,3]. Numerous studies have demonstrated that inadequate maternal nutrition during pregnancy can result in adverse birth outcomes and long- term detrimental effects on fetal development including poor fetal growth, low birthweight (LBW) and short- and long-term infant morbidity and mortality [4-6]. A study conducted among Norwegian mothers found that maternal diet significantly influenced birth weight and impacted the likelihood of delivering babies who were small or large for gestational age (SGA or LGA) [7]. It has been suggested that maternal nutrition is a crucial and modifiable risk factor with significant public health implications, offering a key opportunity to reduce adverse birth outcomes, especially in low-income and developing populations [8]. Rural women with limited resources often struggle to access adequate nutrition. While they may lack formal knowledge of nutritional science, they possess worldly wisdom about the importance of consuming extra food during critical times.

Objective

The present community-based cross-sectional study was conducted to gather information regarding neonatal outcomes in relation to maternal diet during pregnancy in women residing in remote villages in a forestry, and hilly region of India.

Study Design

Community-based cross-sectional analytic study.

Study setting and duration

The study was conducted in a total of 100 tribal villages in remote rural, forestry, and hilly regions over two years. These villages were around the village with the health facility, the study centre.

Inclusion criteria

All antenatal women aged ≥20 years were selected from each village and willing to undergo a personal interview were enrolled as study participants.

Exclusion criteria

Non-pregnant, adolescent girls, unmarried, and not willing to be a part of the study were excluded.

Sample size

No sample size calculation was done as all the women who delivered in the selected villages during the study period were included, except for a few who migrated.

Data collection

After the institutional ethical committee’s approval and informed consent from the participants, socio-demographic features of all the participants including age, education, occupation, and economic status were collected by a research assistant (trained nurse midwife) and were recorded on a pre- designed data collection tool, semi-structured questionnaire with open and close-ended questions. In-depth face-to-face interviews of the study subjects regarding their everyday meals and neonatal outcomes in relation to maternal diet during pregnancy were conducted. Each interview was conducted for around 15- 30 minutes, maintaining confidentiality and privacy in an area convenient to participants and the trained research assistant. Participants were not allowed to fill out the tool themselves. Villages were visited five days a week to follow each pregnant woman and continuity of information. Women’s pregnancy details were recorded by asking them and seeing records which they had.

Statistical analysis

The data was statistically analysed using Statistical Package for the Social Sciences (SPSS) software version 21.0. The numerical data was presented as numbers and percentages and categorical variables as frequencies or rates wherever needed.

Of 3905 pregnant women interviewed, the majority (44.5%) belonged to the ≥20-≤29 years of age, illiterate (48.6%), worked as agricultural labourers (46.2%), belonged to lower economic class (41.0%), and had one to two previous childbirths (54.7%). Of these 3905 pregnant women, 2163(55.4%) had meals three times a day, followed by 1220(31.2%) four times a day, and the remaining 522(13.4%) had only two meals per day. Women between ≥20-≤29 years of age, educated up to secondary/higher secondary, agricultural laborers by occupation, belonging to upper middle class and primigravida took four meals a day during pregnancy (p<0.05). Table I depicts the sociodemographic features of pregnant women in relation to their daily intake of meals (Table I).

Table I: Sociodemographic features of pregnant women in relation to number of daily meals consumed.

*MEALS- Rice, Chapati (Jawar, Maize, Sargam) and Pulses, Potato Vegetable

Of the total 3905 women interviewed, 1339(34.3%) were purely vegetarian, 405(10.0%) had eggs in their meals, and 1824(46.7%) had mixed diets of vegetarian and non-vegetarian. Only 337 women (8.6%) included milk in their daily diet during. Most pregnant women who included eggs and milk in their daily diet were graduates and belonged to the upper and upper middle class. Table II depicts the sociodemographic features of women in relation to the type of daily dietary intake (Table II).

Table II: Sociodemographic features of pregnant women in relation to the type of daily diet consumed.

*MEALS: Rice, Chapati (Jawar, Maize, Sargam) and Pulses, Potato Vegetable

Of all the 3905 women delivered, 3170(81.2%) had term births, and 735(18.8%) preterm births. Most women with term births had three meals a day (58.6%), followed by those who had four meals a day (31.1%). The minimum number of term live births was observed in women who had only two meals daily (10.3%). Furthermore, when compared in terms of appropriate for gestational age (AGA), and small for gestational age (SGA), it was observed that of 3170 term births, 1776(56.0%) babies were AGA, and 1394(44.0%) were SGA. Of these 1776 AGA babies, 1758(99.0%) were live births and 18(1.0%) were still births (SB). Most of the live-term AGA babies were born to mothers who had four meals a day (57.7%), while the maximum number of SB was observed in mothers who had only two meals a day (2.1%), statistically Significant difference (P Value<0.05). Similarly of 1394 SGA babies, 1352(97.0%) were live births and 42(3.0%) were SBs. The majority of live births in SGA were in women taking 3-4 meals a day, whereas the maximum number of SB in women who had only two meals daily (5.2%). When compared among 735 preterm births, 446(60.7%) women had AGA babies and 289(39.3%) had SGA babies. Of these 446 AGA babies, 425(95.3%) were live births and 21(4.7%) SBs. Most of the live preterm AGA babies were born to mothers who had four meals a day (74.4%). Similarly of 289 SGA babies, 240(83.0%) were live births, and 49(17.0%) SBs. The majority of live births in preterm SGA were in women taking 2-3 meals a day, and also those of women who had two meals daily had more often SBs. Maternal daily dietary intake was significantly associated with neonatal outcomes, especially in term births. The neonatal outcomes in preterm births were not significantly associated with the number of meals consumed by the mother daily. Table III depicts the relationship between the daily number of meals consumed by the mother with the neonatal outcomes (Table III).

TABLE III: Relationship between the number of maternal diets and their composition with neonatal outcomes

MEALS: Rice, Chapati (Jawar, Maize, Sargam) and Pulses, Potato vegetable

SGA: Small for gestational age; AGA: Appropriate for gestational age

women consuming mixed diet with non-vegetarian food daily or occasionally, 1489(81.6%) had term births and 335(18.4%) preterm births. It was observed that consumption of eggs and milk was associated with more live births and lesser SB in women with term SGA babies and preterm AGA and SGA babies. Hence, the number of with balanced nutrition was more important for better neonatal outcomes. Table III depicts the relationship between the number of maternal diets and their composition with neonatal outcomes (Table III).

When compared with neonatal birthweight, of 3905 births, 71(1.8%) had birthweight <1Kg, 106(2.7%) had birthweight between ≥1-<1.5Kg, 224(5.7%) between ≥1.5-< 2Kg, 1560(39.9%) between ≥2-<2.5Kg, and 1944(49.8%) ≥2.5Kg. Most of the women who gave birth to babies with birthweight <1Kg to <2Kg had two meals a day, whereas the majority of women who gave birth to babies with birthweight >2Kg had 3-4 meals a day. It was observed that consumption of eggs and milk was associated with a neonatal birthweight of >2 Kg. Moreover, no significant difference was observed in terms of neonatal birthweight in women consuming a purely vegetarian diet or a mixed (non- vegetarian) diet. Hence, the number of diets with balanced nutrition was more important for neonatal birthweight. Table IV depicts the relationship between the number of maternal diets and their composition with neonatal birthweights (Table IV).

TABLE IV: Relationship between the number of maternal diets and their composition with neonatal birthweights

*MEALS: Rice, Chapati (Jawar, Maize, Sargam) and Pulses, Potato vegetable

Overall of 3905 pregnant women interviewed, 55.4% had three meals every day, 31.2% four times a day, and the remaining 13.4% had only two meals per day. Most of the women who had 3-4 meals irrespective of the type of diet (vegetarian or mixed) had better neonatal outcomes including term live births, AGA babies, and neonatal birthweight >2-2.5Kg. Addition of eggs and milk to their diet further improved the neonatal outcome. Furthermore, a significant relation was observed between socio- demographic features like age, education, occupation, economic status, and parity on the maternal dietary intake and its impact on neonatal outcomes.

In the present study, it was found that among the 3,905 pregnant women interviewed, 55.4% consumed three meals per day, 31.2% had four meals per day, and 13.4% had only two meals per day. Women who included eggs and milk in their daily diet were predominantly graduates and belonged to the upper or upper-middle class. The study revealed that the majority of live- term AGA babies were born to mothers consuming four meals daily, while the highest number of term SB occurred among mothers consuming only two meals daily. Similarly, most live preterm AGA babies were born to mothers with four meals a day. Furthermore, incorporating eggs and milk into the daily diet significantly improved neonatal outcomes. However, no notable difference was observed in neonatal outcomes based on dietary type (pure vegetarian versus mixed with non-vegetarian). Therefore, providing nutrition education to rural women can be crucial in raising awareness about the importance of a balanced diet during pregnancy and its positive impact on neonatal outcomes even with low resources.

The study provided insights into the dietary patterns of women, though specific details regarding the exact quantity and quality of the consumed foods were not available. Additionally, other potential influencing factors, while likely affecting all participants, were not analyzed. A key strength of the study is its focus on rural women, making it a community-based investigation into how their meals impacts neonatal outcomes.

• The present study was conducted after approval of the Ethics Committee and informed consent from the participants.
• Conflict of interest: The authors have no conflict of interest to declare.
• Funding and acknowledgement: Authors are grateful to the Indian Council of Medical Research, New Delhi for funding the research part in villages and to rural communities for their valuable support and cooperation.

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