IJCM  Vol.5 No.21 , December 2014
Effect of Maternal Nutrition and Dietary Habits on Preeclampsia: A Case-Control Study
ABSTRACT
Introduction: Preeclampsia is one of the most commonly encountered hypertensive disorders of pregnancy that accounts for 20% - 80% of maternal mortality in developing countries, including Ethiopia. For many years diet has been suggested to play a role in preeclampsia. However, the hypotheses have been diverse and often revealed inconsistent results across studies. Moreover, rarely were these hypotheses studied in Ethiopia. Therefore, this study aimed to explore whether the incidence of preeclampsia was related to nutrient or micronutrient deficiencies. Objectives: To describe the effect of nutrition and dietary habits on the incidence of preeclampsia. Methods: A facility based unmatched case-control study was conducted among 453 (151 cases and 302 controls) pregnant women attending antepartum or intrapartum care in public health facilities of Bahir Dar City Administration. Case-control incidence density sampling followed by interviewer administered face to face interview, measurement of mid-arm circumference (MUAC) and document review were conducted using a standardized and pretested questionnaire. Data entry and cleaning was done by Epi Info Version 3.5.3. The data were transported to SPSS Version 20 for analysis. Both bivariate and multivariate logistic regression analyses were applied. Backward stepwise unconditional logistic regression analysis was employed to determine the putative association of predictive variables with the outcome variable and to control for the effect of confounding variables. A P-value ≤ 0.05 was considered statistically significant at 95% confidence level throughout the study. Result: Those women having a MUAC value ≥ 25.6 cm were two times more likely than their counterparts to have preeclampsia (AOR = 2.49, 95% CI = 1.58, 3.94). Strikingly, higher odds of preeclampsia were found in women who reported to have taken coffee during pregnancy (AOR = 2.16, 95% CI = 1.32, 3.53). Similarly, those women who had anemia during the first trimester pregnancy were three times more likely than their counterparts to have incidence of preeclampsia (AOR = 2.80, 95% CI = 1.09, 7.21). The result in this study also revealed that taking fruit or vegetables during pregnancy was found to be protective of preeclampsia (AOR = 0.37, 95% CI = 0.19, 0.73, AOR = 0.45, 95% CI = 0.22, 0.91) respectively. In addition, folate intake during pregnancy has shown a significant independent effect on the prevention of preeclampsia in this study (AOR = 0.19, 95% CI = 0.10, 0.37). Conclusion and Recommendation: Vegetable and fruit consumption and folate intake during pregnancy are independent protective factors of preeclampsia. On the other hand, higher mid upper arm circumference, anemia and coffee intake during pregnancy are risk factors for the development of preeclampsia.

Cite this paper
Endeshaw, M. , Ambaw, F. , Aragaw, A. and Ayalew, A. (2014) Effect of Maternal Nutrition and Dietary Habits on Preeclampsia: A Case-Control Study. International Journal of Clinical Medicine, 5, 1405-1416. doi: 10.4236/ijcm.2014.521179.
References
[1]   Siddik-Sayyid, S.M. (2011) Preclampsia, a New Perspective. MEJ Anaesthesia, 21.

[2]   Rath, W. and Fischer, T. (2008) Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy. Deutsches Ärzteblatt International, 106, 733-738.

[3]   National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy (2000) Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. American Journal of Obstetrics and Gynecology, 183, S1-S22. http://dx.doi.org/10.1067/mob.2000.107928

[4]   Osungbade, K.O. and Ige, O.K. (2011) Public Health Perspectives of Preeclampsia in Developing Countries: Implication for Health System Strengthening. Journal of Pregnancy, 2011, Article ID: 481095.
http://dx.doi.org/10.1155/2011/481095

[5]   Lill, T., Per, M., Rolv, S. and Camilla, S. (2008) Previous Abortions and Risk of Preeclampsia. International Journal of Epidemiology, 37, 1333-1340. http://dx.doi.org/10.1093/ije/dyn167

[6]   Roberts, M.J. and Gammill, H.S. (2005) Preeclampsia: Recent Insights. American Heart Association, 46, 1243-1249.

[7]   Duley, L. (2009) The Global Impact of Preeclampsia and Eclampsia. Seminars in Perinatology, 33, 130-137.
http://dx.doi.org/10.1053/j.semperi.2009.02.010

[8]   WHO (2011) Recommendations for Prevention and Treatment of Preeclampsia and Eclampsia. Department of Maternal and Child Health.

[9]   Ngoc, N.T.N., Merialdi, M., Abdel-Aleem, H., Carroli, G., Purwar, M., Zavaleta, N., et al. (2011) Causes of Stillbirths and Early Neonatal Deaths: Data from 7993 Pregnancies in Six Developing Countries. Bulletin of the World Health Organization, 84, 699-705. http://dx.doi.org/10.2471/BLT.05.027300

[10]   Polyzos, N.P., Polyzos, I.P., Zavos, A., Valachis, A., Mauri, D., Papanikolaou, E.G., Tzioras, S., Weber, D. and Messinis, I.E. (2010) Obstetric Outcomes after Treatment of Periodontal Disease during Pregnancy: Systematic Review and Meta-Analysis. BMJ, 341, c7017. http://dx.doi.org/10.1136/bmj.c7017

[11]   Edmonds, D.K. (2007) Dewhurst’s Textbook of Obstetrics & Gynaecology. Blackwell Publishing Asia Pty Ltd., Melbourne. http://dx.doi.org/10.1002/9780470753354

[12]   Abdella, A. (2010) Maternal Mortality Trend in Ethiopia. Ethiopian Journal of Health Development, 24, 115-122.

[13]   Owiredu, W., Ahenkorah, L., Turpin, C., Amidu, N. and Laing, E. (2012) Putative Risk Factors of Pregnancy-Induced Hypertension among Ghanaian Pregnant Women. Medical and Biomedical Sciences, 1, 62-76.

[14]   Tebeu, P.M., Foumane, P., Mbu, R., Fosso, G., Biyaga, P.T. and Fomulu, J.N. (2011) Risk Factors for Hypertensive Disorders in Pregnancy: A Report from the Maroua Regional Hospital, Cameroon. Journal of Reproduction & Infertility, 12, 227-234.

[15]   Cnossen, J.S., Leeflang, M.M., de Haan, E.E., Mol, B.W., van der Post, J.A., Khan, K.S. and Ter Riet, G. (2007) Accuracy of Body Mass Index in Predicting Pre-Eclampsia: Bivariate Meta-Analysis. BJOG: An International Journal of Obstetrics & Gynaecology, 114, 1477-1485. http://dx.doi.org/10.1111/j.1471-0528.2007.01483.x

[16]   Wolf, M., Shah, A., Jiminizekimble, R., Sauk, J., Ecker, J. and Thadnai, R. (2004) Differential Risk of Hypertensive Disorders of Pregnancy among Hispanic Women. Journal of the American Society of Nephrology, 15, 1330-1338.
http://dx.doi.org/10.1097/01.ASN.0000125615.35046.59

[17]   Rasmussen, S. and Irgens, L.M. (2007) Pregnancy-Induced Hypertension in Women Who Were Born Small. Hypertension, 49, 806-812.

[18]   Luo, B. and Ma, X. (2013) Risk Factors for Preeclampsia: A Case-Control Study. Hypertension in Pregnancy, 32, 432-438.

[19]   Rosenberg, T.J., Garbers, S., Lipkind, H. and Chiasson, M.A. (2005) Maternal Obesity and Diabetes as Risk Factors for Adverse Pregnancy Outcomes: Differences among 4 Racial/Ethnic Groups. American Journal of Public Health, 95, 1545-1551.

[20]   Xiong, X., Buekens, P., Fraser, W.D., Beck, J. and Offenbacher, S. (2006) Periodontal Disease and Adverse Pregnancy Outcomes: A Systematic Review. BJOG: An International Journal of Obstetrics & Gynaecology, 113, 135-143.

[21]   Robillard, P.Y., Hulsey, T.C., Alexander, G.R., Keenan, A., de Caunes, F. and Papiernik, E. (1993) Paternity Patterns and Risk of Preeclampsia in the Last Pregnancy in Multiparae. Journal of Reproductive Immunology, 24, 1-12.
http://dx.doi.org/10.1016/0165-0378(93)90032-D

[22]   Agrawal, S. and Walia, G.K. (2010) Prevalence and Risk Factors for Pre-Eclampsia in Indian Women: A National Cross Sectional Study. South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi.

[23]   Sibai, B., Dekker, G. and Baumert, M. (2005) Pre-Eclampsia. The Lancet, 365, 785-799.
http://dx.doi.org/10.1016/S0140-6736(05)17987-2

[24]   Qiu, C., Williams, M.A., Leisenring, W.M., Sorensen, T.K., Frederick, I.O., Dempsey, J.C. and Luthy, D.A. (2003) Family History of Hypertension and Type 2 Diabetes in Relation to Preeclampsia Risk. Hypertension, 41, 408-413.

[25]   Brantsaeter, A.L., Haugen, M., Samuelsen, S.O., Torjusen, H., Trogstad, L., Alexander, J., et al. (2009) A Dietary Pattern Characterized by High Intake of Vegetables, Fruits, and Vegetable Oils Is Associated with Reduced Risk of Preeclampsia in Nulliparous Pregnant Norwegian Women. The Journal of Nutrition, 139, 1162-1168.

[26]   Cynthia, V. and Max, W. (2001) Relationship of Twin Zygosity and Risk of Preeclampsia. American Journal of Obstetrics & Gynecology, 185, 819-821. http://dx.doi.org/10.1067/mob.2001.117352

[27]   Torjusen, H., Lieblein, G., Næs, T., Haugen, M., Meltzer, H.M. and Brantsæter, A.L. (2012) Food Patterns and Dietary Quality Associated with Organic Food Consumption during Pregnancy; Data from a Large Cohort of Pregnant Women in Norway. BMC Public Health, 12, 612. http://dx.doi.org/10.1186/1471-2458-12-612

[28]   Wen, S.W., Champagne, J., White, R.R., Coyle, D., Fraser, W., Smith, G., Fergusson, D. and Walker, M.C. (2013) Effect of Folic Acid Supplementation in Pregnancy on Preeclampsia: The Folic Acid Clinical Trial Study. Journal of Pregnancy, 2013, Article ID: 294312.

[29]   Schoenaker, D.A., Soedamah-Muthu, S.S. and Mishra, G.D. (2014) The Association between Dietary Factors and Gestational Hypertension and Pre-Eclampsia: A Systematic Review and Meta-Analysis of Observational Studies. BMC Medicine, 12, 157. http://dx.doi.org/10.1186/s12916-014-0157-7

[30]   Torjusen, H., Brantsæter, A.L., Haugen, M., Alexander, J., Bakketeig, L.S., Lieblein, G., et al. (2014) Reduced Risk of Pre-Eclampsia with Organic Vegetable Consumption: Results from the Prospective Norwegian Mother and Child Cohort Study. BMJ Open, 4, Article ID: e006143. http://dx.doi.org/10.1136/bmjopen-2014-006143

[31]   den Heijer, M., Koster, T., Blom, H., Bos, G.M.J., Briët, E., Reitsma, P.H., et al. (1996) Hyperhomocysteinemia as a Risk Factor for Deep-Vein Thrombosis. England Journal of Medicine, 334, 759-762.

[32]   Fanga, R., Dawsona, A., Lohsoonthorna, V. and Williamsa, M.A. (2009) Risk Factors of Early and Late Onset Preeclampsia among Thai Women. Asian Biomedicine, 3, 477-486.

[33]   Meltzer, H.M., Brantsæter, A.L., Nilsen, R.M., Magnus, P., Alexander, J. and Haugen, M. (2011) Effect of Dietary Factors in Pregnancy on Risk of Pregnancy Complications: Results from the Norwegian Mother and Child Cohort Study. American Journal of Clinical Nutrition, 94, 1970S-1974S. http://dx.doi.org/10.3945/ajcn.110.001248

[34]   den Heijer, M., Koster, T., Blom, H.J., Bos, G.M., Briet, E., Reitsma, P.H., Vandenbroucke, J.P. and Rosendaal, F.R.. (1996) Hyperhomocysteinemia as a Risk Factor for Deep-Vein Thrombosis. New England Journal of Medicine, 334, 759-762. http://dx.doi.org/10.1056/NEJM199603213341203

[35]   Dodd, J.M., O’Brien, C. and Grivell, R.M. (2014) Preventing Pre-Eclampsia—Are Dietary Factors the Key? BMC Medicine, 12, 176. http://dx.doi.org/10.1186/s12916-014-0176-4

[36]   Bakker, W.W., Donker, R.B., Timmer, A., van Pampus, M.G., van Son, W.J., Aarnoudse, J.G., et al. (2007) Plasma Hemopexin Activity in Pregnancy and Preeclampsia. Hypertension in Pregnancy, 26, 227-239.
http://dx.doi.org/10.1080/10641950701274896

[37]   Yakub, M., Iqbal, M.P. and Iqbal, R. (2010) Dietary Patterns Are Associated with Hyperhomocysteinemia in an Urban Pakistani Population. The Journal of Nutrition, 140, 1261-1266. http://dx.doi.org/10.3945/jn.109.120477

[38]   Haberg, S., London, S., Stigum, H., Nafstad, P. and Nystad, W. (2009) Folic Acid Supplements in Pregnancy and Early Childhood Respiratory Health. Archives of Disease in Childhood, 94, 180-184.
http://dx.doi.org/10.1136/adc.2008.142448

[39]   Modder, J. and Fitzsimons, K. (2010) Management of Women with Obesity in Pregnancy. Centre for Maternal and Child Enquiries (CMACE) and the Royal College of Obstetricians and Gynaecologists (RCOG) Joint Guideline.

[40]   Mahomed, K., Williams, M.A., Woelk, G.B., Jenkins-Woelk, L., Mudzamiri, S., Longstaff, L. and Sorensen, T.K. (1998) Risk Factors for Pre-Eclampsia among Zimbabwean Women: Maternal Arm Circumference and Other Anthropometric Measures of Obesity. Paediatric and Perinatal Epidemiology, 12, 253-262.

[41]   Derbyshire, E. (2009) Can Anthropometric and Body Composition Measurements during Pregnancy Be Used to Predict Preeclampsia Risk? Current Women’s Health Reviews, 5, 225-229.
http://dx.doi.org/10.2174/157340409790069934

[42]   Silva, D.A.S., Petroski, E.L. and Peres, M.A. (2012) Is High Body Fat Estimated by Body Mass Index and Waist Circumference a Predictor of Hypertension in Adults? A Population-Based Study. Nutrition Journal, 11, 112.
http://dx.doi.org/10.1186/1475-2891-11-112

[43]   Ali, A.A., Rayis, D.A., Abdallah, T.M., Elbashir, M.I. and Adam, I. (2011) Severe Anaemia Is Associated with a Higher Risk for Preeclampsia and Poor Perinatal Outcomes in Kassala Hospital, Eastern Sudan. BMC Research Notes, 4, 311.

[44]   Rohilla, M., Raveendran, A., Dhaliwal, L.K. and Chopra, S. (2010) Severe Anaemia in Pregnancy: A Tertiary Hospital Experience from Northern India. Journal of Obstetrics and Gynaecology, 30, 694-696.
http://dx.doi.org/10.3109/01443615.2010.509821

[45]   Lee, A.I. and Okam, M.M. (2011) Anemia in Pregnancy. Hematology/Oncology Clinics of North America, 25, 241-259.
http://dx.doi.org/10.1016/j.hoc.2011.02.001

[46]   Spaans, F., de Vos, P., Bakker, W.W., van Goor, H. and Faas, M.M. (2014) Danger Signals from ATP and Adenosine in Pregnancy and Preeclampsia. Hypertension, 63, 1154-1160.

[47]   Sharbaf, F.R., Dehghanpour, P., Shariat, M. and Dalili, H. (2013) Caffeine Consumption and Incidence of Hypertension in Pregnancy. Journal of Family and Reproductive Health, 7, 3.

[48]   Bakker, R., Steegers, E.A., Obradov, A., Raat, H., Hofman, A. and Jaddoe, V.W. (2010) Maternal Caffeine Intake from Coffee and Tea, Fetal Growth, and the Risks of Adverse Birth Outcomes: The Generation R Study. The American Journal of Clinical Nutrition, 91, 1691-1698. http://dx.doi.org/10.3945/ajcn.2009.28792

[49]   Shamsi, U., Hatcher, J., Shamsi, A., Zuberi, N., Qadri, Z. and Saleem, S. (2010) A Multicenter Matched Case Control Study of Risk Factors for Preeclampsia in Healthy Women in Pakistan. BMC Women’s Health, 10, 14.
http://dx.doi.org/10.1186/1472-6874-10-14

[50]   Zenebe, W., Hailemariam, S. and Mirkuzie, W. (2011) Hypertensive Disorders of Pregnancy in Jimma University Specialized Hospital. Ethiopian Journal of Health Sciences, 21, 147-154.

[51]   Lardoeyt, R., Vargas, G., Lumpuy, J., García, R. and Torres, Y. (2013) Contribution of Genome-Environment Interaction to Pre-Eclampsia in a Havana Maternity Hospital. MEDICC Review, 15, 22-29.

[52]   McCarthy, F., O´Keeffe, L. and Khashan, A. (2013) Association between Maternal Alcohol Consumption in Early Pregnancy and Pregnancy Outcomes. Obstetrics and Gynecology, 122, 830-837.
http://dx.doi.org/10.1097/AOG.0b013e3182a6b226

 
 
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