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Assessment of the Nutritional Status and Eating Habits of Pregnant Women in Rural Areas (Case of the City of Man)

SORO Lêniféré Chantal , GNANWA Mankambou Jacques, KOUADIO Kouakou Kouassi Armand, ANIN-ATCHIBRI ANIN LOUISE
American Journal of Food and Nutrition. 2022, 10(2), 50-56. DOI: 10.12691/ajfn-10-2-3
Received July 09, 2022; Revised August 15, 2022; Accepted August 23, 2022

Abstract

Diet is an important factor for the smooth running of pregnancy and the growth of the fetus. It is the most decisive if a good adequacy of food intake to needs is respected. During our study, 90 pregnant women were interviewed in the city of Man. This is a qualitative study whose variables included in the survey are social status, professional and cultural status, state of health, food consumption, food habits, food restrictions. The results of the survey revealed that the majority of the women surveyed, i.e. 53.33%, were between 20 and 29 years old, 40 % of them were between 15 and 19 years old and only 6.67 % had the between 30 and 33 years old. The percentage of women with a normal BMI (Body Mass Index) is 76.67 % and those with overweight have a rate equivalent to 16.67%. The results of eating habits reveal that 70 % of pregnant women consume fruit and 30% do not. Regarding vegetables, 93% consume them and 7% do not consume them. The results of the survey revealed that 3.33% of respondents respect the PNNS recommendation (consume 3 meals a day) but 96.67% consume more than three meals a day, which can lead to risks of obesity. All these results describe that the food ration of the women surveyed in the city of Man is rich in fruits, vegetables, proteins, only the number of meals consumed by these women is higher than normal. This may be due to women's lack of awareness regarding diet during pregnancy. Poor consumption of a balanced diet could lead to poor weight gain during pregnancy, increasing the risk of premature delivery, low birth weight and birth defects.

1. Introduction

Diet during pregnancy is recognized as one of the environmental factors that can have an impact on maternal health, influencing fetus and children’s development and health across the whole life course 1. Thus the identification of the factors that influence food choices is crucial for the assessment of the needs of the population and in particular for pregnant women. Indeed, maternal nutrition is essential as it forms the fundamental basis for a successful pregnancy. Therefore, the dietary habits of pregnant women are important for the proper progression of pregnancy and the development and health of the fetus 2. According Odiwuor et al. 3 during pregnancy, diets should be balanced in terms of macronutrients and micronutrients. It is also reported that, the daily energy requirements for healthy women of normal weight and who have a moderately active lifestyle, increase during pregnancy and are based on the trimester of the fetus 4. Thus, recommendations regarding the calorific value of pregnant women’s diets aim to prevent the development of obesity 5. As the pregnancy progresses, the woman’s need for protein increases, peaking in the third trimester. The appropriate intake of protein in the diet supports the protein biosynthesis needed to supply the needs of maternal tissues, the placenta, and the growing fetus 5. The total fat intake, especially in the first trimester of pregnancy, should not increase signifcantly 5. Studies conducted so far indicate the particular importance of micronutrients during pregnancy 6. Others several studies also show that dietary imbalance can lead to malnutrition. Thus, in developing countries, more than 2 billion people, mainly women and children, suffer from nutritional deficiency caused by the absence of one or more important micronutrients 7, 8. In Côte d'Ivoire, about 71% of pregnant women suffer from anemia. Malnutrition, in terms of protein and calories, is clearly evident in many parts of the Africa. Malnutrition particularly affects all women in rural areas. Another form of malnutrition results in the dislike of certain foods present in some pregnant women such as meat, vegetables, milk and dairy products which are rich in essential nutrients 9. The WHO 10 in its food and nutrition policy action plan, has broken down several areas of action, the most crucial of which is that of encouraging a healthy start in life such as promoting healthy nutrition. Adequate and safe food for pregnant women in order to improve maternal health and reduce its mortality rate by three quarters between 1990 and 2015. The problem posed in this study is to identify the factors that determine malnutrition in pregnant women in rural areas rural. Our study aims to study the prevalence of malnutrition in pregnant women in the prenatal period by determining their socio-economic profile, their dietary practices and their dietary restrictions.

2. Material and Methods

2.1. Study Framework

This is a retrospective questionnaire survey. This survey was carried out in the city of Man on 90 pregnant women who voluntarily answered a questionnaire. The data was collected using the frequency questionnaire, which we formulated and organized in stages including several elements such as: Personal information, professional situation, marital status, dietary habits and dietary restrictions. Women's dietary habits were interpreted and described with the help of the daily consumption frequency of the three African food groups 11. The energy groups (breads, cereals, tubers and fats), builder (meat, dairy products and substitutes) and protector (fruits and vegetables) were thus explored.

2.2. Determination of Body Mass Index (BMI)

Body Mass Index (BMI) using formula of Quételet 12.

(1)
2.3. Statistical Analysis

Data processing was done using EXCEL, SPSS and WORD software. Data were entered using Excel software and then exported to Statistical Package for the Social Sciences software 13. The statistical analysis of the results was carried out on the EXCEL and SPSS software which was used on the one hand for the presentation of the graphs and tables and on the other hand, for the calculation of the percentages and averages.

3. Results and Discussion

3.1. Sociodemographic Characteristics of Pregnant Women Surveyed

Our study aims to assess the prevalence of malnutrition in pregnant women in the prenatal period by determining their socio-economic profile, their dietary practices and their dietary restrictions. With regard to the socio-demographic profile, the results revealed that the majority of the women surveyed, i.e. 53.33 %, were between 20 and 29 years old, 40 % of them were between 15 and 19 years old and only 6.67 % were between 30 and 33 years old (Figure 1). These results are slightly similar to those obtained by 14 where 64.51 % of the pregnant women surveyed were between 20 and 29 years old and 12.9 % between 30 and 40 years old. 62.65 % of the women were educated and 36.66 % of them were illiterate (Figure 2). This would be explained by the fact that the schooling rate in Côte d'Ivoire is increasing. This rate is clearly close to the 39.7 % 15 on studies carried out in Bamako. In our sample, 66.67% of respondents lived with family and 33.33% lived alone (Figure 3). From the latter, we divided it according to the number of children. We found different forms of parity which are Primiparous with a percentage of 63.33% and Multiparous with a percentage of 33.66% (Figure 4). The high rate of women living with a family could be explained by the fact that the majority of these women were young. This result is accordance of those reported by Dadi and Desyibelew 16. These authors revealed that most the study participants were married and are living with a family. Regarding the body mass index (BMI) which was used to assess the nutritional status of the women surveyed in the city of Man. The percentage of women with a normal BMI is 76.67%, the percentage of undernourished women is 6.67% (Table 1). Those with overweight have a rate equivalent to 16.67%. These results are different from those of Abdelhakh 17 or the majority of respondents were overweight (42.59%).

3.2. Eating Habits

In the urban or rural environment, pregnant women more frequently consumed vegetables, milk and dairy products, sea fish and wholemeal cereal product. Previous studies have shown that the effect of consuming different foods on birth outcomes varies according to the stage of pregnancy. Thus, the results obtained concerning the eating habits of the women surveyed, revealed that 56.67% of women had no eating problems and 43.33 % of women had a eating problem (Table 2). The number of meals that are consumed by the women who give birth each day indicates whether this consumption is insufficient, sufficient or even more than the norm. This survey covered 96.67 % of pregnant women who eat four or more meals a day, 3.33 % of women eat three meals a day and 0 % of pregnant women eat one to two meals a day (Figure 5). The results of the survey revealed that 3.33% of respondents meet the NHNP (National Health Nutrition Program) recommendation (consume 3 meals a day) but, 96.67% consume more than three meals a day, which can lead to risks of obesity. Our results are different from the results obtained by Monwanou 18, where the majority of women met the recommendation of NHNP (48.66%). The results also show that 70 % of them consume fruit and 30 % do not (Figure 6). Concerning vegetables, 93% consume them and 7 % do not consume them for reasons of degouts, allergies and restrictions (Figure 7). Based on our results, we find that more than half of the women surveyed consume dairy products (57%) and 43% do not (Figure 8). We can therefore say that a large number of women respect the recommendations of the NHNP in the consumption of dairy products. Our results were lower than that of another study performed by Emara 19. who indicated that 42.7% ate red meat two to three times per week and 36.7 % of pregnant women ate chicken three to four times per week. Meanwhile consistent with our study, the majority of them rarely practice sport during pregnancy. Also, disagreeing with our results half of the women (50.0%) reported eating fruits and vegetables rarely per week, and a partially equal percentage drank one cup of milk per day (48.7%). This finding in the same line with Zelalem et al. 20 study in Addis Abeba who reported that 204 (50.2%) were in line with meat (protein foods), 172 (42.4%) in line with dairy products, and 187 (46.1%) in line with vegetable servings. Less than half (44.1%) of the pregnant women reported eating at least two fruits per day. Starches are part of a healthy diet for individuals and an essential source of energy for the body. Starches are one of the three main types of carbohydrates and belong to the category of complex carbohydrates, where starches are a good source of energy. In addition to being a major source of a range of nutrients in our diet, such as fiber, calcium, iron and B vitamins 21. Through this survey, women who consume starch at each meal have a percentage of 100% (Figure 9). This result is not surprising, as the Man region is known for its high level of starch production and also for its culinary identity. Throughout the year the products (starches) are available, hence the supply of food does not pose a problem. We also know that our bodies need protein, especially for pregnant women, because protein is used to build the fetus. The results reveal that parturient consumption for red meat is 7 % more than 3 times a week, 28 % 1-2 times a week and 65% does not consume red meat. As for white meat (poultry) 2% more than 3 times a week, 18% 1-2 times a week and 80% does not consume poultry. Fish, 0% do not consume fish, 55% consume fish 1-2 times a week and 45% consume fish more than 3 times a week (Figure 10). There is a great lack of meat and fish consumption as a result of the NHNP recommendations. Indeed, this could be explained by the hormonal context of pregnancy, which would lead to a better perception of tastes and smells, because some women had disgusts on the other hand others cravings 22. Contrary to our results, Suliga 23 reported that the diet of women from the rural environment was poorer from the aspect of quality, compared to the diet of pregnant women living in the urban areas. The differences in the mode of nutrition among the inhabitants of urban and rural areas in Poland, on the one hand, are due to a greater attachment to the traditional way of nutrition and smaller susceptibility to the beneficial nutritional changes 24, and on the other hand, greater impoverishment in rural areas and, in consequence, smaller possibilities to satisfy nutritional needs 25. Rural inhabitants more frequently than urban inhabitants mentioned the necessity to resign, for financial reasons, from the purchase of such groups of foods as: fish and fish products (24 % of rural households), confectionery (18%), stimulants (17%), meat and poultry (16%), as well as fruits and fruit products (14%) 13. In addition, for women with dietary bans, their rate is 37% while 63% have no dietary bans (Figure 11). These results are somewhat similar to the results of Abdelhakh 17. who also found that the number of women with no difficulties was higher than those with difficulties. All these results describe that the food ration of the women surveyed in the city of Man is rich in fruit, vegetable, protein. Only, the number of meals consumed by these women is higher than normal. This may be due to women’s lack of awareness of nutrition during pregnancy. For this reason, a study on delivery of prenatal health education and pregnancy outcomes in Baatan concluded that prenatal education had a significant relationship with pregnancy outcomes and, therefore, prenatal education must be an essential component in upholding the overall health status for pregnant women 26. This is an indication that a healthy pregnancy starts with proper nutrition to bring out positive pregnancy outcomes. A study to determine level of nutrition awareness showed that it would be desirable to set up an awareness raising program with the aim of increasing the level of education of pregnant women in terms of eating behaviour and nutrition status 27. Another study concluded that nutrition education could improve knowledge and practices of women during pregnancy and that attention should be given to promote nutrition education or eating habits during the Ante-natal clinic (ANC) visits for pregnant women 28. All the studies reviewed here indicate that nutrition education has positive and significant effects on nutrient intake and pregnancy outcomes and supports this study that found significant effects of nutrition education on nutrient intake and pregnancy outcomes. It is essential, therefore, that the health system recognize nutrition education as a need and priority area for women who are pregnant. Thus, several studies show that dietary counselling interventions aimed at increasing dietary intakes are most successful in increasing birth weight 7, 29. This is why Young et al. 30 recommends that nutrition education and counselling programs and support to women should be introduced early in pregnancy to optimize infant birth outcomes.

4. Conclusion

Adequate and balanced diets before and during pregnancy are essential to meet nutritional needs and are positively associated with maternal and fetal health. Our study asked a sample of 90 pregnant women of different ages and trimesters to identify eating habits in pregnant women. Malnutrition in pregnant women can negatively affect child development in the early years, it can also increase the risk of obesity, diabetes and other metabolic complications such as liver disease. Micronutrient deficiencies during pregnancy can negatively affect the baby. To prevent malnutrition during pregnancy, a balanced diet can help a pregnant woman enjoy a safe pregnancy for herself and her fetus, pregnant women should eat plenty of fruits and vegetables to get vitamins, minerals and fibres. The diet should also include healthy protein sources such as fish, eggs, legumes, beans and poultry. Not to mention starchy foods such as corn semolina, pasta, noodles, bread and potatoes to meet the increased need for carbohydrates.

Acknowledgments

We thank the pregnant women of the city of Man who kindly lent themselves to the investigation.

Conflicts of Interest

The authors report no financial or any other conflicts of interest in this work.

Abbreviations

NHNP (National Health Nutrition Program), ANC (Ante-natal clinic), BMI (Body Mass Index).

References

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In article      View Article  PubMed
 
[2]  Kominiarek MA, Rajan P. Nutrition recommendations in pregnancy and lactation. Med Clin North Am, 100: 1199-1215, 2016.
In article      View Article  PubMed
 
[3]  Odiwuor, A. F., Kimiywe, J., Waudo, J. Effectiveness of nutrition education on nutrient intake and pregnancy outcomes in MIGORI COUNTY, WESTERN KENYA. African Journal of Food Agriculture, Nutrition and Development, 22 (1): 19271-19284, 2022.
In article      View Article
 
[4]  Rafał Kocyłowski, Iwona Lewicka, Mariusz Grzesiak, Zuzanna Gaj, Anna Sobańska, Joanna Poznaniak, Constantin von Kaisenberg, Joanna Suliburska. Assessment of dietary intake and mineral status in pregnant women, Archives of Gynecology and Obstetrics 297:1433-1440, 2018.
In article      View Article  PubMed
 
[5]  Marangoni F, Cetin I, Verduci E. Maternal diet and nutrient requirements in pregnancy and breastfeeding. An Italian consensus document. Nutrients, 8: 16-29, 2016.
In article      View Article  PubMed
 
[6]  Koletzko B, Bauer CP, Bung P. German national consensus recommendations on nutrition and lifestyle in pregnancy by the ‘Healthy Start—Young Family Network’. Ann Nutr Metab, 63: 311-322, 2013.
In article      View Article  PubMed
 
[7]  Girward A., O Olude. Nutrition Education and Counselling provided during Pregnancy: Effects on maternal neonatal and child Health outcomes. Peadiatr Perinat epidemiol, 26 (1): 191-204, 2012.
In article      View Article  PubMed
 
[8]  Schultink W., Eggers R., Chalterjee S. Accelerating Universal Health Coverage in Kenya – How do we get there? A Review, 2018.
In article      
 
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[12]  Bray GA. Obesity: definition, diagnosis and disadvantages. Med J Aust. 142:52, 1994.
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[13]  SPSS, Systat Inc. Systat pour Windows, Version 7.0.1, and Registered of SPSS Inc. 1997.
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In article      
 
[20]  Zelalem A, Endeshaw M, Ayenew M. Effect of nutrition education on pregnancy-specific nutrition knowledge and healthy dietary practice among pregnant women in Addis Ababa. Clinics in Mother and Child Health, 14(3): 265-69, 2017.
In article      View Article
 
[21]  Bourdon, E. Reproductibilité de la mesure des débits de glucose plasmatique après un repas riche en glucides. Mémoire de master, faculté des études supérieures, université de Montréal, 2008, 300p.
In article      
 
[22]  Nikièma L., Vocuma A., Sondo B., Martin-prével Y. Déterminants nutritionnels de l’anémie chez la femme enceinte et issue de la grossesse en milieu urbain au Burkina Faso. Revue Science et technique, Sciences de la santé, 33(1): 53-68, 2010.
In article      
 
[23]  Suliga, E. Nutritional behaviours of pregnant women in rural and urban environments. Annals of Agricultural and Environmental Medicine, 22, (3): 513-517, 2015.
In article      View Article  PubMed
 
[24]  Kirschner H, Kosińska I, Narojek L. Changes in nutritional behavior in Poland in the nineties. Pol J Publ Health, 112: 313-319, 2002.
In article      
 
[25]  Social Diagnosis. Objective and Subjective Quality of Life in Poland. Czapiński J, Panek T (Eds). The Council for Social Monitoring, Warsaw 2012; 2011, 178p.
In article      
 
[26]  Liu X, Behrman JR, Stein AD, Adair LS, Borja JB, Manangela FS, Matorell R, Norris SA, Linda MR, H Sachdev. Prenatal Care and Child Growth and Schooling in four Low and Medium Income Countries. PLOS ONE, 12(2): 171-199, 2017.
In article      View Article  PubMed
 
[27]  Brugada A. B. Delivery of Prenatal Health Education and Pregnancy Outcomes in selected Aeta Tribes in Bataan. MJN, 3 (1): 23-33, 2011.
In article      
 
[28]  Zgheib C, Matta J and Y Sacre. Evaluation of Food behaviour and Nutritional Status of Pregnant Women resident in Kesewan. Journal of Pregnancy and Child Health, 4: 331, 2017.
In article      View Article
 
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In article      
 
[30]  Young M., Nguyen PH, Addo Y, Nguyen S, Martorell R and R Usha. Timing of Gestational Weight Gain on Foetal Growth and Infant Size at Birth in Vietnam. 2017.
In article      View Article  PubMed
 
[31]  Bulduk EÖ, Bulduk S, Coşkun BB. Efects of dietary advice on insulin-like growth factors among healthy newborns. Arch Gynecol Obstet. 2017.
In article      View Article  PubMed
 
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Published with license by Science and Education Publishing, Copyright © 2022 SORO Lêniféré Chantal, GNANWA Mankambou Jacques, KOUADIO Kouakou Kouassi Armand and ANIN-ATCHIBRI ANIN LOUISE

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

Cite this article:

Normal Style
SORO Lêniféré Chantal, GNANWA Mankambou Jacques, KOUADIO Kouakou Kouassi Armand, ANIN-ATCHIBRI ANIN LOUISE. Assessment of the Nutritional Status and Eating Habits of Pregnant Women in Rural Areas (Case of the City of Man). American Journal of Food and Nutrition. Vol. 10, No. 2, 2022, pp 50-56. http://pubs.sciepub.com/ajfn/10/2/3
MLA Style
Chantal, SORO Lêniféré, et al. "Assessment of the Nutritional Status and Eating Habits of Pregnant Women in Rural Areas (Case of the City of Man)." American Journal of Food and Nutrition 10.2 (2022): 50-56.
APA Style
Chantal, S. L. , Jacques, G. M. , Armand, K. K. K. , & LOUISE, A. A. (2022). Assessment of the Nutritional Status and Eating Habits of Pregnant Women in Rural Areas (Case of the City of Man). American Journal of Food and Nutrition, 10(2), 50-56.
Chicago Style
Chantal, SORO Lêniféré, GNANWA Mankambou Jacques, KOUADIO Kouakou Kouassi Armand, and ANIN-ATCHIBRI ANIN LOUISE. "Assessment of the Nutritional Status and Eating Habits of Pregnant Women in Rural Areas (Case of the City of Man)." American Journal of Food and Nutrition 10, no. 2 (2022): 50-56.
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[1]  Borge T.C., Aase H., Brantsæter A.L., Biele G. The importance of maternal diet quality during pregnancy on cognitive and behavioural outcomes in children: A systematic review and meta-analysis. BMJ, 24: 167-177, 2017.
In article      View Article  PubMed
 
[2]  Kominiarek MA, Rajan P. Nutrition recommendations in pregnancy and lactation. Med Clin North Am, 100: 1199-1215, 2016.
In article      View Article  PubMed
 
[3]  Odiwuor, A. F., Kimiywe, J., Waudo, J. Effectiveness of nutrition education on nutrient intake and pregnancy outcomes in MIGORI COUNTY, WESTERN KENYA. African Journal of Food Agriculture, Nutrition and Development, 22 (1): 19271-19284, 2022.
In article      View Article
 
[4]  Rafał Kocyłowski, Iwona Lewicka, Mariusz Grzesiak, Zuzanna Gaj, Anna Sobańska, Joanna Poznaniak, Constantin von Kaisenberg, Joanna Suliburska. Assessment of dietary intake and mineral status in pregnant women, Archives of Gynecology and Obstetrics 297:1433-1440, 2018.
In article      View Article  PubMed
 
[5]  Marangoni F, Cetin I, Verduci E. Maternal diet and nutrient requirements in pregnancy and breastfeeding. An Italian consensus document. Nutrients, 8: 16-29, 2016.
In article      View Article  PubMed
 
[6]  Koletzko B, Bauer CP, Bung P. German national consensus recommendations on nutrition and lifestyle in pregnancy by the ‘Healthy Start—Young Family Network’. Ann Nutr Metab, 63: 311-322, 2013.
In article      View Article  PubMed
 
[7]  Girward A., O Olude. Nutrition Education and Counselling provided during Pregnancy: Effects on maternal neonatal and child Health outcomes. Peadiatr Perinat epidemiol, 26 (1): 191-204, 2012.
In article      View Article  PubMed
 
[8]  Schultink W., Eggers R., Chalterjee S. Accelerating Universal Health Coverage in Kenya – How do we get there? A Review, 2018.
In article      
 
[9]  Barker D. The développement origins of chronic adult diseases. 50 prix DANONE international de nutrition, communication personnelle. 2005.
In article      
 
[10]  WHO, Commission de réduction de la mortalité maternelle et néonatale: plan d’action 2008-2012; 2008, 125p.
In article      
 
[11]  Dos-Santos A, Damon M. Manuel de nutrition africaine. Paris: Éditions Karthala, 1987.
In article      
 
[12]  Bray GA. Obesity: definition, diagnosis and disadvantages. Med J Aust. 142:52, 1994.
In article      View Article  PubMed
 
[13]  SPSS, Systat Inc. Systat pour Windows, Version 7.0.1, and Registered of SPSS Inc. 1997.
In article      
 
[14]  Wankeu Nicolette ENMEGNE. Etude de l’alimentation des femmes enceintes et allaitant vues en consultation au CS Com de Koulouba en commune III du district de Bamako en 2020 Thèse, 2020, 109 p.
In article      
 
[15]  Djakaridja Traoré. Au CSCom de Koulouba dans la commune III du district de Bamako, 2010, 33p.
In article      
 
[16]  Dadi, A.F., Desyibelew, H.D. Undernutrition and its associated factors among pregnant mothers in Gondar town, Northwest Ethiopia. PLOS ONE, 14(4): 1-11, 2019.
In article      View Article  PubMed
 
[17]  Adelhakh hassan. La prévalence de la malnutrition chez la femme enceinte. Mémoire de fin d’étude, science alimentaire, faculté des sciences de nature et de la vie, université Abdelhamid Ibn Badis, Mostaganem, 2019, 300p.
In article      
 
[18]  Monwanou I. Nutrition des femmes enceintes et santé néonatale. Faculté des Sciences Economiques et de Gestion. Université d’Abomey-Calavi, Bénin, 2014, 12 p.
In article      
 
[19]  Emara H. Effect of Nutrition Education Package on Pregnant Women Knowledge and Healthy Dietary Practice. IOSR Journal of Nursing and Health Science, 8: 38-44, 2019.
In article      
 
[20]  Zelalem A, Endeshaw M, Ayenew M. Effect of nutrition education on pregnancy-specific nutrition knowledge and healthy dietary practice among pregnant women in Addis Ababa. Clinics in Mother and Child Health, 14(3): 265-69, 2017.
In article      View Article
 
[21]  Bourdon, E. Reproductibilité de la mesure des débits de glucose plasmatique après un repas riche en glucides. Mémoire de master, faculté des études supérieures, université de Montréal, 2008, 300p.
In article      
 
[22]  Nikièma L., Vocuma A., Sondo B., Martin-prével Y. Déterminants nutritionnels de l’anémie chez la femme enceinte et issue de la grossesse en milieu urbain au Burkina Faso. Revue Science et technique, Sciences de la santé, 33(1): 53-68, 2010.
In article      
 
[23]  Suliga, E. Nutritional behaviours of pregnant women in rural and urban environments. Annals of Agricultural and Environmental Medicine, 22, (3): 513-517, 2015.
In article      View Article  PubMed
 
[24]  Kirschner H, Kosińska I, Narojek L. Changes in nutritional behavior in Poland in the nineties. Pol J Publ Health, 112: 313-319, 2002.
In article      
 
[25]  Social Diagnosis. Objective and Subjective Quality of Life in Poland. Czapiński J, Panek T (Eds). The Council for Social Monitoring, Warsaw 2012; 2011, 178p.
In article      
 
[26]  Liu X, Behrman JR, Stein AD, Adair LS, Borja JB, Manangela FS, Matorell R, Norris SA, Linda MR, H Sachdev. Prenatal Care and Child Growth and Schooling in four Low and Medium Income Countries. PLOS ONE, 12(2): 171-199, 2017.
In article      View Article  PubMed
 
[27]  Brugada A. B. Delivery of Prenatal Health Education and Pregnancy Outcomes in selected Aeta Tribes in Bataan. MJN, 3 (1): 23-33, 2011.
In article      
 
[28]  Zgheib C, Matta J and Y Sacre. Evaluation of Food behaviour and Nutritional Status of Pregnant Women resident in Kesewan. Journal of Pregnancy and Child Health, 4: 331, 2017.
In article      View Article
 
[29]  SUN Movement. Improving Nutrition and Health for Pregnant and Lactating Women. Brief on Nutrition and Health integration across Reproductive, maternal, New-born, Child and Adolescent Health Continuum, 2016.
In article      
 
[30]  Young M., Nguyen PH, Addo Y, Nguyen S, Martorell R and R Usha. Timing of Gestational Weight Gain on Foetal Growth and Infant Size at Birth in Vietnam. 2017.
In article      View Article  PubMed
 
[31]  Bulduk EÖ, Bulduk S, Coşkun BB. Efects of dietary advice on insulin-like growth factors among healthy newborns. Arch Gynecol Obstet. 2017.
In article      View Article  PubMed
 
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