Dietary patterns and diet quality during pregnancy and low birthweight: The PRINCESA cohort

Although the isolated effects of several specific nutrients have been examined, little is known about the relationship between overall maternal diet during pregnancy and fetal development and growth. This study evaluates the association between maternal diet and low birthweight (LBW) in 660 pregnant women from the Pregnancy Research on Inflammation, Nutrition,& City Environment: Systematic Analyses (PRINCESA) cohort in Mexico City. Using prior day dietary intake reported at multiple prenatal visits, diet was assessed prospectively using a priori (Maternal Diet Quality Score [MDQS]) and a posteriori (dietary patterns extracted by factor analysis) approaches. The association between maternal diet and LBW was investigated by logistic regression, controlling for confounders. Adherence to recommended guidelines (higher MDQS) was associated with a reduced risk of LBW (OR, 0.22; 95% confidence interval [0.06, 0.75], P < .05, N = 49) compared with the lowest adherence category (reference group), controlling for maternal age, education, height, marital status, pre- pregnancy body mass index, parity, energy intake, gestational weight gain, and preterm versus term birth; a posteriori dietary patterns were not associated with LBW risk. Higher adherence to MDQS was associated with a lower risk of having an LBW baby in this sample. Our results support the role of advocating a healthy overall diet, versus individual foods or nutrients, in preventing LBW.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155934/1/mcn12972_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155934/2/mcn12972.pd

Quality of nutritional care during pregnancy: folic acid and vitamin D supplementation

Backgrounds: Folic acid (FA) and vitamin D supplementation is recommended during pregnancy. Quality nutritional care during pregnancy should include the supplementation of these vitamins. Therefore, the aim of this study was to assess the quality of nutritional care regarding supplementation during pregnancy in primary health care units in six states of Mexico (Estado de México, Oaxaca, Yucatán, Chihuahua, Veracruz and Chiapas). Methods: A mixed study was conducted. An indicator (formed by two sub-indicators) to assess the quality of nutritional care focused on FA and vitamin D supplementation in pregnancy was developed and validated. To assess the quality of care, a sample of 97 health units (HUs) was estimated considering the total number of HUs in the selected states. To ensure the representativeness of the following strata: rurality, care for the indigenous population, and size of the HU; at least one unit was assigned to each stratum by simple random sampling. A trained team performed a random sample of 30 pregnancy clinical records in each HU; the records and the nutritional control cards were reviewed to assess whether the recommendations of the indicator were met. The percentage of compliance with the indicator was estimated. It was considered that an evaluated record complied with the indicator if it complied with its two sub-indicators. A traffic light system was used to present the results: good quality was considered as green (compliance ≥90%); poor quality as yellow (compliance 71% - 89%) and bad quality as red (compliance ≤70%). In addition, semi-structured interviews were conducted with health professionals and an observation guide was applied in health units. Results: A total of 95 HU were assessed. Of the 794 cases evaluated, only one met the two sub-indicators. A bad quality of nutritional care focused on supplementation during pregnancy was observed in the six states and in all HUs. It was identified that most HUs did not have a nutritionist and doctors and nurses recognized that they did not have the knowledge to give nutritional recommendations. Conclusions: It is necessary to implement actions aimed at improving the capacities of health professionals regarding the quality of nutritional care

Incidence of fetal macrosomia according to maternal and newborn characteristics.

Incidence of fetal macrosomia according to maternal and newborn characteristics.</p

National and state incidence of fetal macrosomia, Mexico 2020.

National and state incidence of fetal macrosomia, Mexico 2020.</p

FM incidence in live births in Mexico at the state level in males, 2020.

FM incidence in live births in Mexico at the state level in males, 2020.</p

Relative risk (RR) of macrosomia by state, Mexico, 2020.

Relative risk (RR) of macrosomia by state, Mexico, 2020.</p

FM incidence in live births in Mexico at the state level in females, 2020.

FM incidence in live births in Mexico at the state level in females, 2020.</p

Low quality of maternal and child nutritional care at the primary care in Mexico: an urgent call to action for policymakers and stakeholders

Abstract Background Maternal and child malnutrition represents a public health problem in Mexico Primary care (PC) is responsible for introducing women and children under five to the health system, detecting diseases on time, and providing medical services, including pharmacological treatment if necessary. Providing these services with quality is essential to improve maternal and child health. This study evaluated the quality of nutritional care during preconception, pregnancy, postpartum, infancy, and preschool age at the PC health units across six Mexican states between 2020 and 2021. Methods We conducted a cross-sectional study with a mixed approach in units of the Secretary of Health to assess the quality of nutritional care during preconception, pregnancy, postpartum, childhood, and preschool age. The level of quality was calculated by the percentage of compliance with 16 indicators that integrated a Quality Index of Maternal and Child Nutritional Care (ICANMI, by its Spanish acronym). Compliance by indicator, by life stage, and overall was categorized using the following cut-off points: poor quality (≤ 70%), insufficient quality (71-89%), and good quality (≥ 90%). The perceptions of the barriers and facilitators that affect maternal and child nutrition were evaluated through semi-structured interviews with health professionals (HP) and users. All qualitative instruments were developed with a gender and intercultural perspective. Results Considering the whole sample studied, maternal and child nutritional care quality during the five life stages evaluated was bad (compliance: ≤12%), reflected in the ICANMI, which had a compliance of 8.3%. Principal barriers identified to providing high-quality nutritional care were the lack of knowledge and training of health professionals, shortages of equipment, medicine, personnel, and materials, the disappearance of the social cash transfer program Prospera, the absence of local indigenous language translators to support communication between doctor and patient, and the persistence of machismo and other practices of control over women. Conclusions These findings underscore the need for initiatives to improve the quality of nutritional care in PC facilities across Chihuahua, State of Mexico, Veracruz, Oaxaca, Chiapas, and Yucatan. It is necessary for government and health authorities, along with various stakeholders, to collaboratively devise, implement, and assess intercultural and gender-oriented policies and programs geared towards ensuring the health infrastructure and enhancing the training of health professionals to diagnose and treat the prevalence and occurrence of diverse forms of malnutrition in both maternal and child populations

Additional file 1 of Low quality of maternal and child nutritional care at the primary care in Mexico: an urgent call to action for policymakers and stakeholders

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