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Which Of The Following Is A Characteristic Of Body Weight Changes Associated With Pregnancy?

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Maternal nutritional capability and gestational weight gain and their associations with birth outcomes among Vietnamese women

BMC Pregnancy and Childbirth volume 19, Article number:468 (2019) Cite this article

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Abstruse

Background

During pregnancy, a mother'southward nutritional needs increase to meet the added nutrient demands for fetal growth and development. An enhanced understanding of adequate nutrition and sufficient weight proceeds during pregnancy can guide evolution of policies and strategies for maternal nutrition intendance, actions that will ultimately promote amend pregnancy outcomes. In a sample of pregnant women in Vietnam, this report characterized maternal nutrition condition and gestational weight proceeds at a mid-pregnancy baseline, so examined the association of these variables with specific birth outcomes.

Methods

The study used baseline data from a randomized, controlled trial that compared pregnant Vietnamese women who received a nutritional intervention group with those who received only standard dietary counseling (control grouping). At baseline (26–29 weeks gestation), mothers' dietary reports were collected, and intake of x macro- and micronutrients was estimated; data for baseline gestational weight gain was collected for all significant women enrolled into the study (due north = 228). This analysis too used weights, lengths, and head circumferences at nativity for infants of mothers in the command group.

Results

At baseline, 95% of the pregnant women had concurrent inadequacies for more five nutrients, and virtually half had concurrent inadequacies for more than than 10 nutrients. Almost ii-thirds of the pregnant women did not run into recommendations for gestational weight gain. We found a pregnant, inverse association between the number of nutrient inadequacies and gestational weight gain (overall p ≤ 0.045). Later adjusting for potential confounders, gestational weight gain was positively associated with birth weight, length at birth, birth weight-for-age z-score and length-for-historic period z-score (all p ≤ 0.006).

Conclusions

Our findings raise business organisation over the loftier proportion of pregnant women in Vietnam who have multiple concurrent nutrient inadequacies and who fall short of meeting recommended gestational weight gain standards. To ensure better birth outcomes in this population, policies and strategies to improve the status of maternal nutrition are profoundly needed.

Trial registration

The trial was retrospectively registered at clinicaltrials.gov on December 20, 2013, registration identifier: NCT02016586.

Peer Review reports

Background

Pregnancy is a crucial time for women to be well-nourished. The added nutrient demands of fetal growth and development must be met in lodge to ensure optimal birth and growth outcomes. A suboptimal maternal diet and inadequate gestational weight gain during pregnancy increase adventure for agin wellness outcomes for both mother and kid [ane,ii,3,4,v].

Inadequate macronutrient intake is common amidst pregnant women in some Asian countries, and certain micronutrient deficiencies are also frequent. Nutrients of particular concern include atomic number 26, zinc, folate, vitamin A, vitamin D, iodine, and calcium, which play significant roles in maternal health and fetal development [6,7,8,9,10,11]. Food inadequacies during pregnancy can impair fetal growth, which can in plough increase risk for low weight at nascence or modest-for-gestational-age and preterm deliveries [12,xiii,14,xv,sixteen]. Inadequate nutrient intakes during this time may likewise atomic number 82 to reprogramming within fetal tissues, which is associated with increased gamble for non-communicable chronic diseases in adulthood [5, 17,18,19,20]. Thus, for meaning women who have difficulty achieving recommended nutrient intake through usual nutrition alone, information technology is strategic to intervene with supplements containing protein, energy, and other nutrients.

Suboptimal weight gain during pregnancy has also been reported as highly prevalent in studies of other Asian populations [21,22,23,24]. Results of such studies found significant associations between inadequate gestational weight gain and poor pregnancy outcomes [21,22,23,24,25,26,27,28,29,thirty]. Findings from a contempo meta-assay showed that inadequate gestational weight gain was associated with increased hazard of preterm nativity by 70% (95% CI: 32 to 120%) and increased risk of delivering a small-for-gestational-age infant by 53% (95% CI: 44 to 64%) [26]. Farther, such small infants may experience nutritional shortfalls owing to failure to initiate breastfeeding. Dietary inadequacy in infants tin can pb to impaired growth and cognitive development in childhood, and even to adverse metabolic consequences in adulthood [31,32,33]. Strategies aimed to promote appropriate weight proceeds during pregnancy have the potential to meliorate birth outcomes, and these strategies may as well generate significant intergenerational benefits [32, 34,35,36,37].

To our knowledge, data are limited on maternal nutritional status during pregnancy and its association with birth outcomes in developing countries such as Vietnam. The objectives of the present study were to (1) report adequacy of maternal nutrition and gestational weight gain at baseline (26–29 weeks gestation) among all the pregnant women enrolled in this Vietnamese report, and to (ii) examine the association of these factors with specific birth outcomes (infant weight, length, and head circumference or the related z-scores for each) for baby's whose mothers were in the standard care (control) group.

Better agreement of associations between markers of maternal nutrition status and infant birth outcomes tin can guide development of advisable prenatal nutrition policies, guidelines, and practices for better outcomes to pregnancy.

Methods

Study design and population

The present study analysed a subset of data collected in a prior report, which has been described previously [38]. Briefly, the total written report was a prospective, randomized, open-label, parallel-grouping, multi-center design. It was conducted in 20 customs medical stations and district hospitals beyond four Northern provinces in Vietnam betwixt October 2013 and April 2015. Study eligibility requirements for women were: salubrious and pregnant, xx–35 years of age, kickoff-time mothers with singleton pregnancies, at 26 to 29 weeks of gestation, and with pre-pregnancy body mass index (BMI) < 25.0 kg/g2 (not overweight or obese).

For the original report, a full of 228 singleton mothers took part in a randomized controlled trial with two groups: Intervention - daily maternal nutritional supplementation containing macronutrients and a variety of micronutrients starting from baseline (26–29 weeks gestation) to 12 weeks postpartum plus a breastfeeding support plan (intervention group) or (B) Control - standard-of-care handling, including fe and folic acrid supplementation until commitment. For the nowadays analysis, nosotros included data on mothers' socio-demographic characteristics, nutritional capability, and gestational weight gain at baseline; we included data on infants' weights, lengths, and head circumferences at nascency.

Maternal characteristics and nutritional condition

Descriptive maternal characteristics were collected at baseline. Socio-demographics included questions on maternal age, and highest education qualification. Economic status was determined past constructing a wealth index based on asset ownership from an inventory of household assets [39].

Maternal nutritional status was assessed using anthropometric measurements and dietary intake. Cocky-reported pre-pregnancy weight or the earliest measured weight in the offset trimester from hospital tape was recorded. In addition, measured superlative, weight, and mid-upper arm circumference were collected at baseline. Standing pinnacle and weight were measured using a meridian and weight scale (Horse Head Brand TZ-120). Body mass alphabetize (kg/m2) was calculated by dividing weight (kg) by acme squared (m2) and maternal underweight was defined every bit having a pre-pregnancy BMI < 18.5 kg/thousand2 [40, 41]. Gestational weight proceeds during the first and second trimesters was calculated past subtracting pre-pregnancy weight from weight at 26 to 29 weeks and this was compared with the Plant of Medicine (IOM) recommended gestational weight gain to decide whether the pregnant women met the IOM recommendation based on their pre-pregnant BMI and the recommended weight proceeds at the particular trimester of their pregnancy [40]. Mid-upper arm circumference was measured from the upper left arm using a measuring tape and a cut-off of < 23.0 cm was considered suboptimal nutritional status [42]. Dietary intake was collected at baseline by trained research staff using a standardized 24-h call back method. Nutrient adequacy was defined as 77% of the 2016 recommended daily assart (RDA) for Vietnam [43] as the cutoff value [44]. Nosotros chose this benchmark and cutoff because the estimated average requirement (EAR) is available for some (merely not all) nutrients in Vietnam.

Nascence outcomes

Medical records were used to obtain information on delivery mode (vaginal or caesarean), likewise equally gestational age, infant'southward weight, length, and caput circumference at birth. The weight and length of the infant were obtained using a Seca 232 measuring rod. The head circumference was determined by measuring tape. World Health Organization (WHO) Child Growth Standards were used to calculate the sex-age-specific z-scores for infant's weight, length, and head circumference [45]. Small-for-gestational-age was defined as birth weight and/or birth length at to the lowest degree ii standard deviations below the mean level for sex and gestational age [46].

Statistical assay

Maternal characteristics and nutrient inadequacies of all participants (n = 226) were presented as arithmetic means and standard deviations for continuous variables; categorical data were presented equally numbers and percentages.

A simple linear regression model was used to examine the association at baseline of each unmarried food and every bit concurrent nutrient inadequacies (grouped every bit ≤five, 6–10, and 11–fifteen inadequate nutrients) with gestational weight gain at 26 to 29 weeks in all participants (north = 226).

Multiple regression analyses were used to appraise the clan of diverse factors with nascence outcomes (birth weight, length, head circumference, birth weight-for-age z-score, length-for-age z-score, and head circumference-for-age z-score) in the command group but (n = 113). These factors (at baseline) included mother's age, educational level, economic status, gestational weight gain, food inadequacies, energy intake, energy-adjusted macronutrient intake, and babe'due south gestational historic period at birth and sex.

The modelling process for multiple regression analyses was started with the bivariate analysis in which the association between a single factor and the nascency outcome was examined. Factors with p-values < 0.2 from preliminary models were included in the final model. Mother's historic period, gestational age of infant at nascence, and babe's sexual practice are known to influence birth outcomes, so these three variables were also included in the final multiple regression models. The adjusted estimates and the 95% conviction interval derived from the last models were reported. All variables that were included in the models were defined a priori, and collinearity was examined in all the models. Information from the original intervention group were not included in any of the analyses for nascence outcomes, as those mothers received maternal nutritional supplementation and breastfeeding back up during the report, which significantly improved birth outcomes [38].

Birth outcomes were compared between study groups using analysis of covariance (ANCOVA) to control for misreckoning factors, including treatment group, mother's age, mother's nutritional condition at baseline, socioeconomic status, gestational historic period and infant's gender.

SAS version 9.3 (SAS Institute, Cary, NC, U.s.) was used for all statistical analyses. All statistical tests were two-sided and p < 0.05 was considered statistically meaning.

Results

Maternal characteristics

Of the 228 mothers enrolled into the study, 226 women were successfully randomized to either the intervention group (due north = 113) or the control group (n = 113) and were included in an intention-to-treat assay [38]. Every bit shown in Table 1, the mean (±SD) age of the mothers was 24.0 (±ii.ix) years erstwhile, and the mean (SD) self-reported pre-pregnancy BMI was nineteen.2 (±1.8) kg/mtwo, increasing to 22.2 (±2.two) kg/thousand2 by 26 to 29 weeks of gestation. Approximately one-3rd of the women (32.7%) were underweight, defined as pre-pregnancy BMI < 18.5 kg/mtwo prior to pregnancy and 4.0% of them remained underweight at 26 to 29 weeks of gestation. Almost ii-thirds of the women did non see the gestational weight proceeds recommended by the IOM at the mid-pregnancy interval of 26 to 29 weeks gestation. At this time, 29.2% of the mothers also had suboptimal nutritional condition, as defined past mid-upper arm circumference < 23.0 cm.

Table 1 Baseline characteristics of all mothers (n = 226)a

Full size table

Food inadequacy at 26 to 29 weeks of gestation

At the baseline data collection (26–29 weeks gestation), 95% of all the significant women in this study (n = 226) had concurrent inadequacies for more than five nutrients, and approximately ane in ii (44%) had inadequacies for more than ten nutrients (Table 1). The fifteen nutrients that were included in this assay were protein, calcium, atomic number 26, zinc, vitamins A, D, E, C, B1, B2, B3, B5, B6, B9, and B12 (Table 1). Hateful (SD) free energy and nutrient intakes (without prenatal supplements) at 26 to 29 weeks of gestation in all report participants can be constitute in Table 2.

Table 2 Food intake at 26 to 29 weeks of gestation in all study participants (n = 226)a

Full size table

Figure 1 shows the percentage of pregnant women with inadequate nutrient intake at baseline (26 to 29 weeks gestation). Over three-quarters of the pregnant women did not encounter the acceptable intakes for energy, fat, carbohydrate, calcium, atomic number 26, zinc, vitamins A, D, E, B2, and folate at baseline.

Fig. 1
figure 1

Percentage of pregnant women with inadequate intake (< 77% RDA) for selected nutrients at 26 to 29 weeks gestation in all participants (n = 226)

Full size paradigm

There was a significant inverse human relationship between the number of food inadequacies (≤5, 6–ten, xi–15) and gestational weight gain at 26 to 29 weeks (overall p = 0.045; data non shown). Pairwise comparisons showed that mothers who had half dozen–10 nutrient inadequacies had lower gestational weight gain at 26 to 29 weeks than did those with ≤5 nutrient inadequacies (mean difference = − ane.05 kg, 95% CI: − ii.63, 0.53; p = 0.192), although this difference did not achieve statistical significance. Mothers who had 11–15 nutrient inadequacies had significantly lower gestational weight gain at 26 to 29 weeks than mothers who had ≤five food inadequacies (mean divergence = − 1.71 kg, 95% CI: − 0.11, − three.xxx; p = 0.036). Gestational weight gain was positively correlated with the intakes of energy, carbohydrate, protein, calcium, atomic number 26, vitamin C, vitamin B2, vitamin B5, and vitamin B6 (all p ≤ 0.030) in univariate analyses (information not shown).

Nativity outcomes by study groups

The mean (SD) gestational historic period at birth for control and intervention group was 39.i (±1.6) weeks and 39.1 (±one.3) weeks, respectively, infant's nascence weight was 3044 (±385) grand and 3153 (±347) k, respectively, birth length was 48.7 (two.25) cm and 49.0 (±i.7) cm, respectively, and nascency head circumference was 32.8 (±1.64) cm and 33.i (±1.3) cm, respectively (Tabular array 3). The infants in the intervention grouping had significantly higher nascence weight than did those in the command grouping (p = 0.0346). There were no significant differences in birth length and birth head circumference between the two groups.

Tabular array iii Nascence outcomes by study group

Full size tabular array

Factors associated with nascence outcomes in the control group

Table 4 shows the factors that are associated with nascence weight, length, and head circumference, too every bit birth weight-for-age z-score, length-for-historic period z-score, and head circumference-for-age z-score in the command group only from the multiple linear analysis (north = 110). Later adjusting for mother's age at enrollment, gestational age at birth, and infant'due south gender, gestational weight proceeds at 26 to 29 weeks was strongly associated with birth weight (adjusted estimate = 42.nine g; 95% CI: 17.5, 68.3), nascency length (adjusted judge = 0.23 cm; 95% CI: 0.07, 0.39), birth weight-for-historic period z-score (adjusted estimate = 0.x; 95% CI: 0.04, 0.15), and birth length-for-age z-score (adjusted estimate = 0.12; 95% CI: 0.04, 0.21) (all p ≤ 0.006). Similarly, education level was positively associated with nascence weight (p = 0.029), head circumference (p = 0.046), birth weight-for-age z-score (p = 0.008), and a tendency was found for birth length (p = 0.072), nativity length-for-age z-score (p = 0.076), and birth caput circumference-for-age z-score (p = 0.061).

Table 4 Factors associated with birth outcomes in the command group (n = 110)a

Total size table

Comparing of nascency outcomes between report groups

We also included some previously published results comparison the birth outcomes between the control and the intervention groups from the original randomized controlled trial for easy reference; that trial evaluated the effects of an improved perinatal nutrition care regimen on birth outcomes [38]. Nativity outcomes were compared between study groups using assay of covariance (ANCOVA) to control for confounding factors, including treatment group, mother'south age, mother'south nutritional condition at baseline, socioeconomic status, gestational historic period and infant's gender. The infants in the intervention had significantly college nativity weight (p = 0.0312), birth weight-for-age z-score (p = 0.0141), and head circumference-for-age z-score (p = 0.0487), compared with the control (Table 5).

Table v Comparing of birth outcomes between study groups

Full size table

Discussion

In this report, we examined the nutritional status of meaning women in Vietnam, specially the association of maternal diet status variables with nativity outcomes. Our findings showed striking results—one in three women was underweight prior to pregnancy, and 1 in two pregnant women had concurrent inadequacies for more than ten nutrients at 26 to 29 weeks of gestation. Results also indicated that approximately two-thirds of the significant women did not meet the recommended gestational weight gain, as advised by the IOM. There was a proportional relationship between nutrient inadequacies and gestational weight gain, i.e., a higher number of food inadequacies was associated with lower gestational weight gain at 26 to 29 weeks. Gestational weight proceeds at 26 to 29 weeks was strongly positively associated with birth weight and length in the control grouping after adjusting for potential confounders.

Our study findings are consistent with previous studies, which reported a prevalence of underweight ranging from twenty to 40% among women of reproductive age in Asian countries such as Mainland china [23], Japan [27] and Vietnam [24, 25, 29, 47,48,49,l]. 2 recent meta-analyses reported that maternal underweight was significantly associated with increased risks for preterm nascence by 13 to 30%, having an infant with depression nascence weight past 66 to 67%, and pocket-sized for gestational age by 67 to 85% [41, 51]. Similar findings had been reported in several other reviews, and these findings could be in function due to fetal growth restriction as a upshot of nutrient inadequacies [29, xxx, 32, 52, 53].

Nosotros are concerned that a large proportion of meaning women in the nowadays study did non have acceptable intakes for a number of primal nutrients that are critical to maternal and infant health—calcium, iron, zinc, vitamins A, Bs, D, and E. These observations are consequent with previous studies reporting high prevalence of micronutrient deficiencies [47, 48, 54] and insufficient intakes of fe, zinc, folate, vitamin B12, and vitamin A [48, 55] among women of reproductive age or those who are pregnant in Vietnam, particularly amid those living in suburban or with lower socio-economic status. When the results are taken together, it appears that the diet for the bulk of Vietnamese women falls short of many essential nutrients and multiple nutrient inadequacies often coexist. This observation highlights the importance of improving the intake of a significant number of nutrients in this population group, in addition to the routine iron and folic acid supplementation as part of the standard care. Nutrient requirements increment significantly during pregnancy to support fetal growth and evolution. Inadequate food intakes during this time may lead to reprogramming within fetal tissues, which could potentially increase the infant's chance of not-communicable chronic diseases in adulthood [5, 17,xviii,19,xx]. Contempo evidence has shown that dietary interventions during pregnancy significantly improved birth outcomes, especially among women who were malnourished during pregnancy or who had a suboptimal diet [1, 2, 12, 15, 16, 56, 57].

Suboptimal weight proceeds during pregnancy and low nascence weight tin can have long-lasting effects on the child. The present written report results reinforce the positive clan betwixt gestational weight proceeds at 26 to 29 weeks and infant's birth weight and length. Numerous studies have consistently demonstrated the efficacy of dietary interventions during pregnancy in lowering the incidence of preterm nascency, depression birth weight, and pocket-sized for gestational historic period and this effect appears to be more pronounced among women who are undernourished during pregnancy [1, ii, 4, 36, 57]. In addition, factors such equally poor maternal nutritional status earlier and during pregnancy, infant's low nativity weight and small for gestational age, accept been suggested to adversely affect the growth and cognitive evolution of the offspring [3, 58, 59], and whatsoever increase in nascence weight within the normal range has the potential to amend these outcomes afterwards adjusting potential confounders. Therefore, the provision of free energy, macronutrient, and micronutrient intakes such equally maternal nutritional supplementation to the mothers who accept inadequate gestational weight gain during the start and second trimesters could be an effective fashion to meet nutrient needs and to optimize birth outcomes [i, 15, 30, 34, 53, 57]. Indeed, the present written report showed that maternal nutritional supplementation in conjunction with breastfeeding back up significantly improved infant's birth weight, weight-for-age z-score, and caput circumference-for-age z-score compared to the control grouping (all P ≤ 0.049) [38].

The strength of the electric current report is that it includes the mensurate and reports on a comprehensive range of demographic, anthropometric, and dietary variables, which advances our understanding of the furnishings of these variables on birth outcomes. Previous research findings showed an association between maternal nutritional condition and nascence outcomes, admitting the outcome was mainly on nascence weight. The current written report extends knowledge in this area past determining the human relationship of various maternal nutritional indices with birth length and birth caput circumference in addition to nativity weight. Gestational weight proceeds at 26 to 29 weeks was positively associated with infant's nativity weight and birth weight-for-age z-score every bit well as nascency length and birth length-for-age z-score. This finding suggests that depression birth length could exist a sensitive nascency outcome parameter that is associated with inadequate gestational weight gain in a population group with high prevalence of suboptimal maternal nutritional status. Farther research is warranted to confirm this finding.

This study has limitations. First, we did not measure the mother's weight at commitment, hence the full gestational weight gain could not exist determined. Previous studies examining the association betwixt total gestational weight gain and birth outcomes reported similar findings [21, 23, 27, 28], and a contempo report reported that maternal weight gain during early pregnancy (≤ 20 weeks) and mid pregnancy (21–29 weeks) had a stronger influence on fetal growth and birth outcomes compared to weight gain in later pregnancy (≥ 30 weeks) [24]. Second, using recall pre-pregnancy weight for computing pre-pregnancy BMI may be subject to recall biases. Third, we used the earliest weight measure in the first trimester equally a proxy for pre-pregnancy weight in those subjects (five.2%) who could non recall pre-pregnancy weight. This may underestimate the prevalence of underweight in meaning women. Finally, the electric current study was the secondary analysis utilizing the baseline data from a randomized controlled trial that was designed to evaluate the impact of an improved perinatal diet care program on breastfeeding, birth and growth outcomes. Hence, the sample size was relatively small, which may limit the generalizability of the results. Future research with larger sample size and wider population groups is warranted to elucidate the underlying mechanisms and the potential roles for maternal nutrition care in optimizing pregnancy outcomes.

Conclusions

Findings from our study showed that nutrient inadequacies during pregnancy are prevalent amid Vietnamese women, often occurring every bit concurrent inadequacies of multiple nutrients. Maternal underweight prior to pregnancy and women not coming together recommended gestational weight gain were also frequent in our Vietnamese study population.

Our results underscore the need for building policies and implementing public health initiatives aimed to better dietary quality among girls and women of reproductive age. In particular, prenatal nutrition care must promote optimal gestational weight gain among significant women. Such steps are necessary to improve both short- and long-term health outcomes for mothers and their children.

Availability of data and materials

The data that support the findings of this report are bachelor from Abbott Nutrition, but restrictions apply to the availability of these data, which were used nether license for the current study, and then are non publicly bachelor. Information are still available from the authors upon reasonable request and with permission of Abbott Nutrition.

Abbreviations

BMI:

Body mass index

CI:

Conviction interval

IOM:

Plant of Medicine

WHO:

World Wellness Organization

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Acknowledgements

We thank all the women and infants for their delivery in taking part in this report. We also thank the study team of Abbott Nutrition and the study team of the National Institution of Nutrition, Ha Nam, Hai Phong, Ninh Binh, and Thai Nguyen Provinces for their assistance during the report.

Funding

This study was funded and supported by Abbott Nutrition. Abbott Nutrition was involved in the report design, information collection and analysis, and preparation of the manuscript.

Writer information

Affiliations

  1. Micronutrient Enquiry and Application, National Establishment of Nutrition, 48B Tang Ba Ho, Hai Ba Trung District, Ha Noi, Vietnam

    Nga Thuy Tran

  2. Clinical Nutrition, National Institution of Nutrition, 48B Tang Ba Ho, Hai Ba Trung District, Ha Noi, Vietnam

    Lam Thi Nguyen

  3. Statistical Services, Cognizant Technologies Solution Pvt. Ltd, Hiranandani Business Park, Mumbai, 400076, India

    Yatin Berde

  4. Abbott Nutrition Enquiry and Development Asia-Pacific Eye, 20 Biopolis Mode, Unit 09-01/02 Centros Building, Singapore, 138668, Singapore

    Yen Ling Low, Siew Ling Tey & Dieu Thi Thu Huynh

Contributions

DTTH and YLL designed the study. TTN and NTL reviewed and provided inputs on the study design and methodology. TTN and NTL were responsible for subject recruitment and information collection. SLT, DTTH, TTN, NTL, YB and LYL contributed in information analysis and interpretation. SLT and DTTH drafted the manuscript. All authors critically reviewed the manuscript and approved the final version submitted for publication.

Corresponding author

Correspondence to Dieu Thi Thu Huynh.

Ethics declarations

Ethics approval and consent to participate

The report was approved by the Independent Ethics Committees of the National Establishment of Nutrition and the Ministry of Health in Vietnam. Informed written consent was obtained from each mother at baseline. The infant'due south parents signed and dated the informed consent class within 48 h of delivery for the infant'southward participation in the study. The study was performed in accordance with the upstanding principles that had their origin in the Announcement of Helsinki.

Consent for publication

Not applicable.

Competing interests

SLT, YLL and DTTH are employees of Abbott Diet. YB is an employee of Cognizant Technologies Solution Pvt. Ltd., a Contract Enquiry Organisation providing statistical services to Abbott Diet.

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Tran, N.T., Nguyen, L.T., Berde, Y. et al. Maternal nutritional adequacy and gestational weight proceeds and their associations with birth outcomes among Vietnamese women. BMC Pregnancy Childbirth 19, 468 (2019). https://doi.org/10.1186/s12884-019-2643-6

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  • DOI : https://doi.org/10.1186/s12884-019-2643-6

Keywords

  • Maternal nutritional condition
  • Gestational weight gain
  • Nutritional adequacy
  • Nativity outcomes

Source: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2643-6

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