Effect Pregnancy

of

Low on and

Nutrient Obstetrical Offspring

PH.D.4 AND AMIVA K.
BOSE,

Intake

During

Performance

KALVAN

BAGCHI,

B.SC..

M.B.B.S.,

M.B.B.S.,

I).G.O.,

M.R.C.O.G.t

P
the been

REGNANCV

demands not
.

increased for past of the in mother investigations order to

nutrient but determine also have

in- premature forcarried body thethat to weight shortly and had calories had and had diet, had

births. term, was after 1945 a drop

Of of
.

the more

babies than winter onths m diet low point of Smith

who .500) in gin. reported of expectant of vitamin cent return rose of to Birth after available. the Peoples

were

take, offspring made

only Numerous the

observed the when

Downloaded from www.ajcn.org by guest on February 15, 2011

in

hungry the a of

correlation
nutritional their pregnancy cations nourished ous
as

between
status It disorders are seen women. of and the war, it world usually was more has

the
also amid Data

nutrient
been obstetric

intake
women suggested compliamong from calamities, these that during views. obstetrical and

and 1944
mothers of that I , 145 they mal- niacin van- women such better weights liberation Balfour,

pregnant

reached
and 34 gm.

about and A, the a the

offsprimig.

protein So per the again. they became

a day, of

associated riboflavin, amenorrhea. menstruation fallen when Ebbs and more his

deficiencies With started but food colleagues,

commonly collected during support observed significantly

parts
famine

For

example,

complications

increased

the
war-time European

Leningrad
food countries,

siege.
shortage

Similarly,
in abortion Holland and

during
and other to nutritional from the de-

theLeague of Health supplementation other that

obwomen

and of in a
death,

many the diet significant

others reported of pregnant reduction

births observations

resulted
neonatal

in

stetnical
countered shortage ficiency.

complications
; and The these the data were

were
attributed resulting collected

commonly

en-stillbirths,
food and toxemia

pneiiiature

of pregnancy.

These

point
these poor

up
diet

the
of can This like be

necessity
pregnant avoided becomes India, admitted, disorders

of
women and

supplementing
so more that pregnancy offspnimig
in

the

regions
showed

on
a

the

birth

weight
fall,

of

the

infants
due

also disorders
to produced. countries

healthy important malnutrition that and

significant

presumably

nutritional nv
ditions daily mature Stillbirths and 1,0)0)0) Fran
Health,
*

deficiency. reported
in bread births were Leningrad nation in was

where however,

is amenor-

that
1942, 400

during
when gm. and per

siege
the

con-widely
It rhea, trauma, general per shortage the premature must vitamin

prevalent. be pregnancy premature

average

deficiencies

rampant,
rose more term births Imistitute
India. Professor Gynaecologist, India. Journal of Clinical of

the
from 6.5 than mortality to

incidence
41.2 doubled rate and 08 3 of per Hygiene
and Matri Seva

of
cent. number, 90 for in was 1,000) and

pre- births

can
which

also
is to in births, the the

he
such siege the newborn basis

caused
strongly
war as

by
and famine.

psychological
during food Therefore, of stillbirths, low deficiency. birth explained the be acute

operative

calamities due increase of on

the for the

neonatal full

or

incidence and cannot of nutritional

abortions

All-India

Public weight entirely

Calcutta, Associate

Biochemistry Lohia

Nutrition; Sadan,

t Consulting Calcutta,
.lmerican

Other
must

contributory also be

factors considered.

in

the Antonov

environment stated
1962

Nutrition

586

Vol. 11,

December

Nutrient
that

Intake,
extreme shortage

Pregnancy
during

and
carry

Obstetrical
on its activities

Performance
with a much

587 restricted

in addition Leningrad
inadequate

to

the and

the
heating

siege,

the
in

housing
most

was cases labor

poor, the
to those

the intake iron,

of some

nutrients. vitamins
are important some Beaton,6

Increased and
examples in prove in an the phenomenon, to

absorption retention
of excellent cites significance
.

of of

increased

women
pregnancy

performed
. It

hard
is impossible, of

manual
malnutrition environmental

during nitrogen
phenomenon. of esting this

this

adaptive review interof and the

therefore, from factors.

separate of the

the other

effects adverse

evidences mechanism

The
on it a

improvement
in national be an but the for years, will the No
where

of

these

indices
however, On the

by
other and (as food in

nutrient
stands

adaptive

pregnancy

Bose

supplementation snore might

pregnancy, basis. that is food prevalent shortage of chronic has incidence significantly of data
a majority

Bagchi7
hand, nonpregnant where socioeconomic

followed
women level

up

a
of

group
comparable

of
on

pregnant
age a diet and poor in

and

expected acute by population the be health such on below general apparently

strata

in

countries is war

subsisting

general
caused
by

malnutrition a state

not

calories,
on biochemical

protein stress
the the that of observed obvious occurring riboflavin stomatitis in

and

minerals.
revealed that

Clinical
despite

and

examinations had as same nonpregnant except and the

famine),

shortage adapted disorders and will

the
women in profiles

metabolic

of pregnancy,
clinical women. for deficiency glossitis, nonpregnant some in and

the
It mild the

pregnant
biochemical was manifesform were the of which

to itself

which

generally of higher, offspring are

of

Downloaded from www.ajcn.org by guest on February 15, 2011

pregnancy

surprising be tations fromangular also

similarly poorer.
countries

the

available

the
which of

pregnant
the values. obstetricians women in well spontaneous On diet the economic adequate require nutrient

women,

women content
In is
lower

subsist is the the

economic

diets the

in

pregnant
was adaption thewomen

women
that

were
some in

fairly
form pregnancy of

healthy.
nutritional protects the

It

far

recommended healthy

fact, that

impressions

perform

extremely

balanced gested
restricted

from diet. that of in

intake

the

deleterious In the past human

of

effect it has subsisting

for a

of an ill been sugon

long time

during labor other strata, in usually nutrient

pregnancy, is more hand, presumably content, a rule women

and than from

natural an the

beings
nutrients

exception. upper a often

power aptation
obcalorie

adaptation of
intake carried

develops human
has out already an the status. in this obstetrical worthwhile women subsisting and to on follow group, subsisting relatively There

gradually. organism
been on on a fair were but he to from a them of performance newborn pregnancy, and imifant. restricted up

Adto
male restricted state twenty makes study the lower incareno a of

consuming more

the

low

suggested.

stetnical plications.
the birth upper

interference
prolonged and

during
associated

labor, born
are bigger babies

which
with

is Pathaktm
corn- and female and

investigation

beggars observed women on their pregnant strata nutrients

However,
economic is weight higher

babies
strata than that to the the upper

to

women
and born

in diet
their their to pregnant

nutritional

women
also women be

in

the

lower

economic

strata.
body strata

It
stature

must comment
of It number was

performance.

remembered belonging

considered of

is usually

larger
mining baby. nutrition

this
the size The during

is

an and

important naturally
of

factor the
as

in of
in

weight

deter- economic the take of fully,

body throughout observe an

observation childhood

Thomson-that reflected intake consideration. of pregnant investigations women.

by
their

clinical
the observation entire obstetrical

and
period of
EXPERIMENT

biochemical

means,
to to

stature
tant pregnancy In

of the mother
than itself-needs years, the a

might
nutritional serious number

be a more

impor-

factor recent

during make

the

have The
adaptations of

been findings

carried out in suggest that

take possibly, place the in

The from

investigation the low

was socioeconomic

conducted strata

on

150 attending

women the

certain
pregnancy maternal

metabolic
as

which,

a result antenatal organism canmaternity

clinics
hospital.

of

Lohia
Clinical

Matni

Seva
examinations

Sadan,
were

588

Bagchi
TABLE

and
I

Bose

Details
Important No.

of the

Subjects
Average

of This

Investigation
Status

Nutrient

Economic

Intake

I
I

Nutrient Deficiencies Calories and protein Nil

Weight (lb.) 106 1 18

(monthly Rs. per 32 210

income head)
Housewife,

Professiomi

Deficient Adequate

150
50

98

pm ofessional

women, Housewife, women,

2% 82% 18%

: rofessional p

TABLE

Daily

Nutrient

Intake

of

Pregnant

Women

in

Different

Economic

Groups

I)escription Subjects

of

Calories

Protein
(gm.)

Fat
(gm.)

Carbohydrates
(gm)

Calcium
(gm.)

Iron
(mg.)

vitamin
(lU.)

Thiamine (mg.)

Riboflavin (mg )

Ascorbic
Acid (mg.)

Downloaded from www.ajcn.org by guest on February 15, 2011

Pregnant higher
strata

women economic women

in
2,760 86 52 472 1.3 27.6 4,600 2.6 2.1 72

Pregnant

in
1.920
. .

low economic strata Recommended values for pregnancy . .

48

29

331
. . .

0.51

58.5 15

2,520 6
,

0.74

0.33 2
.

21 100

600

85

50

1.5

000

TABLE

HI

Percentage Total Investigated (no.) tneco50

tn-

Incidence

of

Different

Nutritional

Deficiencies

Description Subjects

of

Angular Stomatitis

Glossitis

Bleeding Gums

Phrynoderma

Cramps Calf
Tenderness

and Anemia*
(C)

(%)

(%)

(%)

(%)

Pregnant mester) nomic

Pregnant

women ( third in higher strata

women (third

3.5

4.5

Nil

2.5

46

mester)
nomic *Hemoglobin

in
strata

lower

eco150 6 gm. 8 3 2 3 88

level

below

10

made
morning Dietary

at

the were
data

hospital obtained were and first

and

blood for elicited

samples biochemical by an oral by

drawn

in the weight and

of placenta, infant hemoglobin to obtain to the

adequate fifty pregnant

weight level. comparable high diet, confined of the economic similar

women

and

condition values strata data

who

of

infant,

analysis. questionhome

In order

from subsisting were

subjects on a collected
private pa-

name

method

later

The subjects routine clinical the tory

visited the check-ups

visits. belonging hospital every fortnight forfairly and were then confined in
from

checked

were

hospital. A careful record was of confinement, the condition

and the newborn. The fully collected : dietary

body level, ment weight, maternal and duration
serum

following
intake, and cord level, serum

records
nutritional

kept of the histients of the placenta gives

and the

were particulars

in nursing subjects

homes. of this

Table i investiga-

were

care-

status, acid confineof ascorbic

tion.

protein hemoglobin of labor,

ascorbic nature

The
l)y

data

about
Advisory

the

dietary

intake recommended
of the

were
by

obtained the
Coun-

questionnaire

method,
Committee

blood

acid, Nutrition

Indian

Nutrient

Intake,

Pregnancy
TABLE

and
IV

Obstetrical

Performance

589

Nature

of

Confinement

amid

Other

Allied

Data

in

Different

Economnic

Group

Description
Subject

of

Average Weight
Before Confinement

Subjects Requiring Obstetrical

Interference

Average Duration
of Labor

Weight of Newborn
(lb.)

Weight

of

Placenta
(lb.)

(lb.)
Pregnant lVomen

(%)
in Low Economic Strata

Pnimigranda 2ndto4thpara 5th para and

118 121

1 Nil

15

hr., 20 mm. 12 hr.,

6.22 6.42

1.08 1.1

more

126

Nil

15 mm. 12 hr.,
36 mm.

6.31

1 .0

Pregnant

llomen

in

High

Economic

Strata

Downloaded from www.ajcn.org by guest on February 15, 2011

Pnimigranda 2mid to 4th para

129
136

20
12

17 hr.,
36 mm. 15 hr., 10 mm.

6.76
6.88

1. 1 1.01

NOTE:
dl

Puerperium

uncomplicated

in

all.

of Medical information, subjects in

Research. measured order to

concerning

To obtain more accurate the low economic strata utensils were shown to the the recommended values. help them to give reliable inascorbic acid is of a higher
their food intake. Pasnicha9

was The

only

50 It

per must

cent of that

of

deficiency

magnitude. this intake connection are

formation

also

be values

remembered of nutrient

in

all on

has shown that, obtained by this obtained and King ascorbic method estimated by weighing

used method the

judiciously, can be foodstuffs.

the information the as reliable as that Serum by the reaction. by the of protein method Serum colonimetnic Hellige.

calculated

the

basis

of
because

raw

foods.
will of the be

The
less destructive

actual
than action of of The deficiencies

intake
the stated of nutritional pregnancy and different

of

its fractions were determined and Wootton#{176} based on biuret acid of by Roe the was and standard
RESULTS

vitamins, of values cooking was The status are

therefore, processes. results during presented of of the in an

determined Kuether.1 method

Hemoglobin

assessment trimester
in.

third Table nutritional

manifestations of in by of the pregnant intake with that strata of and diet economic the proteins. by is with the the case women of strata In of most the Indian nutrients

The two the Advisory Medical comparing mnended belonging a diet especially the women quate deficiencies protein,

average groups values are

daily presented recommended

intake

the in
with Council

the
two

number
groups the women the Table just of of duration the parity economic subgroups, the
Iv,

of
do feature

subjects
not is of the low average low the

showing
differ nutritional economic intake of weight their duration and nature to some the been to their the of comparative

these
much Another . absence deficiencies strata, nutrients. of of the parity,

in

the

TableII along

Nutrition women On . the the subjects consume nutrients,

interesting of of in In jects nature weight On the presented. ade- and minor on lower three in

Committee Research the values, to which other in in that hand, the almost in the higher all some average the of actual it is low for

manifestation in very the before confinement,

con sub-

recom- sidering

apparent economic in calories

confinement, placenta the

is deficient the the

labor, are depend in the into and

newborn confinement extent, subjects divided parity,

consumed

Since of of

labor, the strata according

nutrients,

women, have

vitamins. intake

59()

Bagchi
TABLE

and
V

Bose

Bmochemmcal Maternal Serum Protein (gm. %, mean)

Data

on Whole Acid mean)

Mother

and

Infants

Description Subjects

of

Maternal Ascorbic (mg. %,

Cord Blood Ascorbic Acid (mg. %, mean)

Maternal Hemoglobin (gmn %, mean)

Infant Hemoglobin (gm. %, meat,)

Pregnant

women

in

low

economic
to 40th Pregnant economic to40thweek

strata,
week women strata, in

38th
6.1 high 38th 6.3 1.06 2.68 10.8 16.9 1.04 2.87 9.7 17.2

those The strata

in number with

the

higher of is from women much strata. the obstetrical

economic in the complications greater In lower in are low were presentation class the The parities consistently from stillbirths There weight All econoniic a the interference,

strata higher requiring than fact, the of

into economic in a total

two. groups was whereas the Similarly, ascorbic of levels, strata,

is

negligible 48 latter difference and reflects the the acid the

although gm. was in cord the of the

the protein receiving

former per 86 ascorbic

group day gin. blood acid of

consuming

interference lower 13(1 only subjects The two The required cord upper were in economic observed Premature served cant between in the difference of women in and reasons economic two cases a economic uterine economic women two were

maternal of saturation

Downloaded from www.ajcn.org by guest on February 15, 2011

blood state

economic remaining normal also case ; majority duration in less the was of the the infants other were no the than of group of whereas of of

which

required delivered for in brow

the
manner. in interest. prolapse in

infants, maternal economic

is not strata
whereas strata is level an on actual this cent under in slightly of as this, suffering of value giving type of of the workers,

significant level is 9.6 gIn.

that 10.8. in decreases reduction who aspect, can that low 10 majority from in slightly The in also drawing level in the workers is the under the women be as have believe regarded in It

in
per

the
cent

two

groups. in the
on the

The
thelow average, that

hemoglobin

in women
in generally this does the

obstetrical groups the

interference

women is but in conducted that as pregnancy

high stated the not

which economic due thehemoglobin cases indicate labor Various lower gations that 10 group. any not placenta In obthe the of strata cent, of marked in this signifi- value were classified majority the thus nutritional intake gin. value women is basis

interference

to

hemodilution

concentration. investia normal deficiency. strata, the and, can economic 10) gin. picture of having be considered conclusions. in ; it is the also born two noteto a per on be in level and of

inertia. of different is women or group. in two the groups.

strata the births either

per

indicating economic gm. per of anemia, higher above different question women to any infants same level in has cent women

whereas

found
those

to
born was 6.8

be
to

healthy
women to in body group the weight is be the

but
in 6.4 higher of also

the
the pounds the

birth
lower as economic pregnant in obtained and was

weight
economic compared strata. women this

strata to The in the In analysis are during pregnancy. serum low in gm. women per nection.

found

a completely anemia. hemodilution protein before or less hemoglobin by

pounds latter Table of the It protein

higher

relevant data

con-a low by The

respect hemoglobin is more that obtained the

biochemical from The is strata the to maternal interesting of economic difference is 6. 1 gm. high The

blood

mother blood fortieth to per note women

newborn drawn of the whereas it the is that in week

groups worthy to that the women

presented.

is comparable infants

thirty-eighth concentration in the

in parts

ent
6.3 two As

the higher economic of the world.

COMMENTS

strata

in

differ-

economic cent.

cent strata

between

mentioned

earlier

in

this

paper,

the

Nutrient

Intake,

Pregnancy

and
role an created

Obstetrical
of in to a the found has the questioned pregnant undetermined the new large in

Performance
placenta, in gear, the is array placenta to the woman sense, comisidering quite effect the the protein Beaton basis nutrients in pregnancy has been suggested different He of
extreme

591 organ the all have perform. of the from on

can

present investigation to determine how

inadequate

was pregnant adapt their are

undertaken women themselves life and in The 150) strata pregnant and strata, women of in must be the the how their

in order living on during these nutritional and result fifty show during offspring two groups. on of women wo-

an regulating not at of

especially metabCerand isiany Beaassumimig umialtered fact what stated pregin nutritional the that as clear.

pregnancy,

diet phase if at their of all, the based low in the and significantly of

this olism adap- tainly, enzymes theyet ton this that in

crucial tations, status, health investigation, in men the nancy not In this the

hormones

reflected

obstetrical offspring. on

performance

functions

validity reniains

socioeconomic higher status the condition different it

a nutritional she before lack

except

economic of

that physiologically preg- she are that

nancy,

is of
under

nutritional

was the explained

pregnancy.

further nutrition
conditions,

connection

mentioned

that be

omi of of

of

a or

change a

the
ficient customed In and moderate

women
diet to they then fact,

who
during this were reproducing deficiency.

were
type born, in The of

subsisting
pregnancy diet brought a state effect, since of had

on
their up, therefore,

the
been

demetabolism
acadaptation. birth. Retention
of

Downloaded from www.ajcn.org by guest on February 15, 2011

as known

a result for that this a

matured chronic is as as famine, that state metabolic whatever

metabolic time.6

alterations

long

retention
creased is metabolic the hormonal investigations of mechanism requirement

appeared
excretion economy alterations control point in of pregnant protein. to of

to
of

be
protein, utilization. are

accomplished
reflecting That known. to these due Mi adaptive minimize possibly

by
an to these the in-

certainly
shortage usually flood human chronic changes nutrients The that Aberdeen nutrition
son

different
causing seen or war organism deficiency in are findings of
.

from
an such It subsisting might to of was this based unable weight the diets occur.

that
acute

of

an

acute

food decreased

deficiency is possible in make on a

when

calamities

are the

also women

nutritional

order available.

economize investigation on to performance. of of evidence his

The
confirm studies underThomiishows women relate in in concerned vestigators. reviewed general gations,
is in

physiological
women

and
as subject and based the efficiency that
can be

nutritional
far as has Duncan.4 on of significantly absorbed these iron during in later fact vitamin iron

adaptation
metabolism is

pregnant

Thomson5 He to obstetrical : The that

has
The by that
so of iron

been
Hytten

confirmed

by
recently

several
been is investiabsorption pregintake. increased iron There

in-

concluded

agreement,

conclusively

pregnant

can
quality, of intake of the present siderable is much of ever, tance highlight actions the

vary

widely,
without

in
clinically

quantity
obvious

as
The as not is dietary subjects,

well
impairment nutrient

as

increased

amounts nancy

reproductive of Thomsons other

processes. subjects investigators values. therefore, since severe in all these in in flexibility human of body. the these

without increased reported been

any in

increase calcium the the of

well far result of

as below of restriction

those Similarly, has the conclinical nancy.15

absorption stages that deficiencies of the

also preg-

many

was The

recommended investigation, interest, more results do of in not the the nutrition nature. of

Considering manifestations

are
grossly sume creased

so

rare
inadequate that

in
possibly

pregnant
diet, the of of a large utilization these extent, the

women
one tissues of findings, might

living
also resort the

on
preto vitamins

a
in-

although howthe only metabolic

a chronic The

investigations, any the way They Pregnancy pregnancy.

economy implications

minimize

impor- also. The rethose is future, a and the of near the lack dietary of

which
will,

are
to

certain

to come in
results

explain

stress

period

in

a human

life.

Moreover,

theof

correlation

between

592
surveys stetrical Possibly, our approach in requirement and these the might to the pregnancy. nutritional of lead status pregnant to question of

Bagchi
and obwomen. of nutritional

and
8.

Bose
PATHAK,

C.
intakes

L.
in the

Nutritional
of calories, tropics.

adaptation proteins, Am. of J. dietary amid 1958. lactating Clin.

to

low Nutrition,

dieand

performance

tary minerals

vitamins

a reorientation

6: 151,

1958.
S.

9.

PASRIcHA,

A survey
poor, pregnant Al.

intake

in women.

group
Indian 10.
and the staff of KING,

of J. Medical

Res., 46: 605,

WOOTTON,

ACKNOWLEDGMENT

E. J. and
:

I. D. P.
p.

Micro-analysis.
58. London, 1956.

We
Lohia
dtmning

are
Matni the

grateful
Seva course

to

the

authorities

In

Biochemistry,

Sadan

for

their

help

and

cooperation

J. 11.
ROE,

of investigation.

& A. Churchill, Ltd. J. H. and KUETHER,

of of ascorbic the dehydroascorbic 1943. acid 2,4-dinitnophenvl

C.
in acid.

A.
whole

The determinablood J.
and

tion through
REFERENCES

and denivaChem.,

urine

hydrazine Biol.

tive born Pettiest., of

and

1. ANTONOV,
Leningrad
2. SMITH, Holland

A.

N. in The

Children 1942. J. effect

pregnancy

during

the

siege

of 12. in

147:399,
BEATON, adaptation

30 : 250,
wartime
its

1947.
starvation Am.

G.
in

H.

Nutritional
pregnancy.

physiological

C. A.
upon

In in 1960.

Proceedings panel

5th iv,

products.

International p. 33. 13.

HUNScHER,

Congress Washington,

Nutrition,

J.

Obst.

& W.

Gynec., M., W. iron

53:

3.

BALFOUR,

599, 1947. HAHN, P. F.,

T. absorptmon pregnancy, and in

Downloaded from www.ajcn.org by guest on February 15, 2011

BALE,

POMMERENKE,

WHIPPLE,

W. G.
and 1942.

F., H.
condihemo-

H.
the 1935.

B.
during 579, 14. and 15.

N. and

MACY,

A. , HUMMELL, F. I. G. Metabolism
cycle. J.

C. , ERICKSON,
of Nutrition, women 10:

Radioactive tions; chromnatosis. 4. EBBS, normal

clinical 15,

reproductive

anemia Med., 76:

J.

Exper.

HYTTEN, anaemia to Abstr.

COONS,

F.
normal &

E. and DUNCAN,
in the pregnant physiological Rev., 26:855,

D. L.
woman changes. 1956.

Iron
and

deficiency
its Nutrition relation

5.

J. H., TISDALL, F. F. and SCOTT, W. A. The influence of pre-natal diet on the mother child. J. Nutrition, 22: 515, 1941. THOMSON, A. M. Diet in relation to the course and outcome of pregnancy. Brit J. Nutrition, 13:
509, 1959.

6. BEATON,

7.

H., BEAR.E, J., Rvu, M. H. and E. W. Protein metabolism in the pregnant rat. J. Nutrition, 54: 291, 1954. BOSE, A. K. and BAGCHI, K. Nutritional adaptatiomi in pregnancy. J. Indian Al. A.,38: 334, 1962.
MCHENRY,

G.

16.

C. M. and BLUNT, K. Retention of mtrogen, calcium, phosphorus and magnesium by pregnant women. J. Biol. C/scm., 86:1, 1930. DUCKWORTH, J. and WARNOCK, G. M. The magnesium requirements of man in relation to calcium requirements, with observations on the

adequacy
Abstr. &

of

diets

in

common

use.Nutrition

Rev., 12:

167, 1942.