ABSTRACT
Dietary habit and weight gain during pregnancy are the two main modifiable factors influencing maternal and infant outcomes. The study was carried out to determine the food habits, dietary practices and anthropometric status of adolescent pregnant girls in Umuahia North Local Government Area of Abia State. The study was descriptive and cross-sectional in design. A multi-stage sampling technique was used to select a total of 170 respondents. Data on socio-demographic characteristics, obstetric characteristics, feeding habits, dietary practices, and anthropometric status of the respondents were collected using structured and validated questionnaire. The IBM SPSS version 23.0 computer programme was used to analyze the data. Descriptive statistics were computed for the continuous and categorized variables. Pearson correlation was used to analyze the relationship between dietary habits, dietary practices and anthropometric status of the pregnant girls which P judged at 0.05. Result from the study showed that more than half (96.5%) of the adolescent pregnant women were married while majority of them were Christians (96.5%), students and earned less than N 19,000 in a month (96.5%). Half (50.0%) of the women were in their second trimester, majority (60.6%) had given birth less than 2 times while only few (10%) had experienced miscarriage. However, majority (52.9%) of them consumed meals thrice daily while 30% skip their meals. More than half (52.9%) of the respondents consumed snacks while some (49.4%) mostly avoid meat. Majority of the respondents consumed fruits (96.5%) and vegpassGiven les (100%). Additionally, most (77.1%) of the respondents take dietary supplements. Slightly more than half (50.6%) of them mostly take only calcium supplements while 26.5% take multivitamin. Some (22.9%) of the women started consuming these supplements in their first trimester. Majority (94.7%) of the respondents were below the recommended weight gain by the Institute of Medicine. Result also revealed that there was no significant relationship between dietary supplement intake and anthropometric status of the respondents and selected dietary variables. Maternal age and dietary practices during pregnancy have a significant impact on the birth outcomes. There is need for a differentiated maternal and prenatal care to pregnant adolescents. Given that adolescent mothers pass through two phases of development simultaneously, adequate health measures are needed in order to prevent risks health and life, promote and maintain health and well-being of both mother and child.
TABLE OF CONTENTS
TITLE PAGE i
CERTIFICATION ii
DEDICATION iii
ACKNOWLEDGEMENT iv TABLE OF CONTENTS v
LIST OF TABLES vii
ABSTRACT ix
CHAPTER 1
INTRODUCTION
1.1 Background of the study 1
1.2 Statement of problem 3
1.3 Objectives of the study 5
1.3.1 General objective of the study 5
1.3.2. Specific objective of the study 5
1.4 Significance of the study 6
CHAPTER 2
LITERATURE REVIEW
2.1 Pregnancy during adolescence 7
2.2 Nutrient needs during pregnancy 8
2.2.1 Macronutrients and micronutrients during pregnancy 8
2.3 Improving nutrition during adolescent pregnancy 18
2.4 Physiological changes during pregnancy 21
2.4.1 Changes in body composition and weight gain 21
2.4.2 Changes in blood composition 22
2.4.3 Changes in taste 22
2.5 Factors affecting food habits and nutritional status of pregnant women 23
2.5.1 Smoking 23
2.5.2 Exclusion diets 23
2.5.3 Obesity 25
2.5.4 Previous bariatric surgery 25
2.5.5 Adolescence 26
2.5.6 Multiple and repeated pregnancies 26
CHAPTER 3
MATERIALS AND METHODS
3.1 Study design 28
3.2 Area of study 28
3.3 Population of the study 29
3.4 Sampling and sampling technique 29
3.4.1 Sample size determination 29
3.4.2 Sampling procedure 31
3.5 Preliminary activities 31
3.5.1 Preliminary visits 31
3.5.2 Training of research assistants 31
3.5.3 Ethical approval 32
3.5.4 Informed consent 32
3.6 Data collection 32
3.6.1 Questionnaire design 32
3.6.2 Questionnaire administration 33
3.6.3 Anthropometric measurement 33
3.6.3.1 Weight measurement 33
3.6.3.2 Height measurement 34
3.6.4 Dietary assessment 34
3.7 Data analysis 35
3.8 Statistical analysis 35
CHAPTER 4
RESULT AND DISCUSSION
4.1 Socio-demographic characteristics of the respondents 36
4.2 Obstetric characteristics of the respondents 39
4.3 Food habits of the respondents 41
4.4 Dietary practices of the respondents 45
4.5 Frequency of consumption of food by respondents 49
4.6 Anthropometric status (gestational weight gain) of the respondents 55
4.7 Relationship between dietary habits and anthropometric status
of the respondents 58
CHAPTER FIVE
CONCLUSION AND RECOMMENDATION
5.1 Conclusion 61
5.2 Recommendation 61
REFERENCES 63
APPENDIX 80
LIST OF TABLES
Table 4.1 Socio-demographic characteristics of the respondents 37
Table 4.2 Obstetric characteristics of the respondents 40
Table 4.3a Food habits of the respondents 43
Table 4.3b Food habits of the respondents 44
Table 4.4 Dietary practices of the respondents 46
Table 4.5a Frequency of consumption of food by respondents 51
Table 4.5b Frequency of consumption of food by respondents 53
Table 4.6a Anthropometric status (gestational weight gain) of the respondents 56
Table 4.6b Gestational weight gain of the respondents 57
Table 4.7 Relationship between dietary habits and anthropometric status
of the respondents 60
CHAPTER 1
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Adolescent pregnancies are a global problem that occurs in high, middle, and low income countries. Around the world, adolescent pregnancies are more likely to occur in marginalized communities, commonly driven by poverty and lack of education and employment opportunities (United Nations Food Protection Agency UNFPA, 2015). However, for some adolescents, pregnancy and childbirth are planned and wanted while in some contexts, girls may face social pressure to marry and, once married, to have children (Grieger and Clifton, 2014). Each year, about 15 million girls are married before the age of 18 years, and 90% of births to girls aged 15 to 19 years occur within marriage (United Nation International Children Emergency Fund UNICEF, 2009; UNFPA, 2015).
Adolescence has been described as the period of life between 10 and 19 years of age in which profound and dramatic biological, emotional and cognitive maturity is attained (Brown, 2008; Buxton, 2014). It has been indicated that adolescents are particularly vulnerable to nutrient inadequacies as their bodies undergo various physiological changes, and as they become more socially independent, which often impacts negatively on their dietary intakes (Norton et al., 2003; Jennings et al., 2010).
Pregnancy is a period of anabolism, or building (Bhutta et al., 2017). Pregnant adolescents bodies are in building mode as they are building the tissue (Beradi, 2016). To this end, it is critical that adolescents should be getting more calories, more macro nutrients (protein, carbohydrates and fats) and more micronutrients (vitamins and minerals) than they would normally need (Beradi, 2016). Pregnant adolescents should choose the right foods, monitor their weight gain to ensure that they are not gaining too much or too little. As a result, foods to be included in their diets should contain protein, omega 3 fatty acid, vitamin D, zinc, calcium rich foods, vitamin B12 and iron-rich foods (Madhavi and Singh, 2011). What to limit (avoid or minimize) include: alcohol, caffeine, (aim for less than 300mg per day), cured meats, artificial sweeteners, high sugar intake, using cravings to justify poor food habits; foods to completely avoid include: raw or undercooked animal foods such as meat, seafood and eggs, mackerel, tobacco (Berardi, 2016).
Tanentsap and Adegboye (2011) reported that improving adolescents physical health during pregnancy and after birth have increased in recent years. This may be due to the focus of Governments around the world on the issue as a result of increasing maternal obesity rates and a greater understanding of the impact of maternal obesity and gestational weight gain on pregnancy outcomes for mother and baby (Goldberg, 2002). Dietary components have been suggested as the most important elements to support antenatal and postnatal adolescents to maintaining a healthy weight (Goldberg, 2002). Campaigns to reduce weight in postnatal adolescents and women have been found to be of benefit when combining physical activity with dietary advice than with dietary components alone (Bertz et al., 2012).
Food habits are an integral part of a persons lifestyle, and are related to other behavioral patterns and a recurrent behavior, not determined by heredity (French and Larson, 2001). Food habits are acquired by frequent repetition or physiological exposure, so that they have nearly or completely become involuntary (French and Larson, 2001). According to European Food Information Council Review (2014), food habit comprises of psychological and sociological aspects as well as factors that guide food habit and includes taste preference, sensory attributes, cost, availability, convenience, cognitive restraint and cultural familiarity in addition to environmental cues. These food habits are not only the characteristic and repetitive way to provide oneself with nourishment, but also ways to simultaneously attain social and economic goals and once formed, they tend to control food-related behavior, and are slow to change (Schwimmer et al., 2003). Healthy eating is important in adolescent pregnancy, not only because of their nutritional needs, but also habits formed early in ones life, will most likely be carried into adulthood. Caris Live Science Report (2014) on pregnancy, diet and nutrition recommends that pregnant adolescents should choose a variety of healthy foods and beverages to provide the important nutrients a baby needs for growth and development. The key pregnancy nutrients include; more calcium, folic acid, iron and protein (Grieger and Clifton, 2014). Eating healthy during pregnancy is one of the best things a mother can do for her baby, since the food they eat is their baby’s main source of nutrition (Madhavi and Singh, 2011). Hovdenak and Haram (2012) had shown that vitamin supplementation can improve pregnancy outcomes and reduce nausea and morning sickness.
1.2 STATEMENT OF PROBLEM
According to United Nations International Children Emergency Fund (UNICEF) (2009), more than half a million adolescent pregnant women die from causes that are related to pregnancy and childbirth. Adolescent pregnancy has been considered a major contributor to maternal and child mortality worldwide and is a major public health concern (WHO, 2014). Nearly 4 million newborns die within 28 days of birth, millions more suffer from disability, diseases, infection and injury (Lim et al., 2012). The main nutritional issues facing these adolescents include maternal under- and over-nutrition and deficiencies of key micronutrients, such as iron, folate, calcium, vitamin D and vitamin A which are needed by pregnant women (Holick, 2008). Consequently, poor obstetric outcomes, such as anemia, neural tube defects (NTDs), rickets, low birth weight (LBW) and maternal and neonatal mortality are common in Sub-Saharan Africa (Lartey, 2008). However, it is unknown to what extent the nutritional deficiencies and pregnancy complications are occurring in Nigeria, and other countries of Sub-Saharan Africa (Johnson et al., 2013).
Poor nutritional status and sub-optimal pre- and ante-natal care are common in developing countries, often resulting in pregnancy complications and poor obstetric outcomes among pregnant adolescents (Hampshire et al., 2004). Pregnant adolescents in Sub-Saharan Africa which Nigeria belong to are at particular nutritional risk as a result of poverty, food insecurity, political and economic instabilities, frequent infections, and frequent pregnancies (Lartey, 2008). Malnutrition during pregnancy yield both short and long-term effects on the health of an infant by programming the infants development and associated with risk of non-communicable diseases such as obesity, type 2 diabetes, hypertension and cardiovascular disease in later life (Isolauri, 2011; Koletzko et al., 2012). Malnourished mothers are more vulnerable to diseases, encounter more miscarriages and give birth to underweight children whose survival is at risk (Chasi, 2009).
The poor nutrition situation pertaining to pregnant female adolescents in certain under-developed countries affords opportunities for this study on the nutritional status of pregnant adolescent women. These statistics above showed why it is important that the major avoidable causes of maternal mortality and adverse pregnancy outcome are eliminated by looking into the food habits and the dietary practices of adolescent pregnant women in Umuahia North Local Government Area of Abia State.
1.3 OBJECTIVES OF THE STUDY
1.3.2 General Objective of the Study
The general objective of the study is to determine the food habits, dietary practices and anthropometric status of adolescent pregnant women in Umuahia North Local Government Area of Abia State.
1.3.2. Specific Objective of the Study
The specific objectives of this study are to:
i. Assess the socio-economic/demographic characteristics of the respondents
ii. Determine the obstetric characteristics of the respondents.
iii. Assess the food habits and dietary practices of adolescent pregnant women
iv. Evaluate the anthropometric characteristics of the adolescent women using Institute of Medicine (IOM) guideline for gestational weight gain
v. Determine the relationship between dietary habits and anthropometric status of the respondents.
1.4 SIGNIFICANCE OF THE STUDY
The recommendations from this study can serve as a guideline for maternal and child health workers and nutritionists in creating public health awareness towards dietary practices and food habits of adolescent pregnant women. Information from this study will also provide an insight to policy makers/programmers thereby serving as a baseline data for further studies that are related to dietary practices and food habit of adolescent pregnant women.
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