Ellen Bonnie
H. Morse,3 E.
of the nutritional status of pregnant with adult pregnant women. II. and dietary findings” 2
Ph.D.,
Robert
P. Clarke,4
M.S.,
ABSTRACT nutrients and
B. Merrow,5
M.Ed.
and
Weight, triceps and subscapular skinfold measurements, and mean intakes of calories were evaluated for 102 pregnant women in four age groups. The increase
weight
during
ments.
Comparison
years,
had higher
the two
the antepartum
older
intakes
groups.
carbohydrate,
intake ascorbic 1422
There to level
and 25
32. The
20-24
acid, most among
of iron acid 1428,
significantly intake
The
two
no significant
of education.
higher
than higher
finding
the two
fat, carbohydrate. two
older
for
anthropometric
younger
groups,
calcium,
groups
phosphorus,
had higher
mean
groups
had
among
of age, the subjects those
having
private
that
of the
than
the higher age
mean
groups
attending
for
and iron
intakes
while
group.
18
19
than
of vitamin period. protein,
of the
of the
the low-cost
physicians, clinic
intakes any
I I in
measure-
12-- 17 and
of them significantly so. In the postpartum age groups for mean intakes of calories, older
Regardless
significantly
significant showed
differences
A, there fat,
remaining
nutrients
with
clinic
had a mean
the latter
had a mean
Am.
J. Clin.
Nutr.
28:
197S.
In the fall of 1969, a study was initiated comparing the nutritional status of pregnant women under 20 years with those 20 years and older. Volunteers were referred by members of the Department of Obstetrics and Gynecology of the University of Vermont Medical College. school nurses and guidance counselors, a low-cost outpatient clinic, and a home for unwed mothers. The attempt was made to enroll only primigravidae by the 12th week of gestation. It was soon found advisable to extend the time to the 20th week and later in a few cases, and to include women with one or two previous pregnancies, because of the difficulty of locating adolescents and women from the lowest income levels early in pregnancy. Of the 102 participants, 24 of the 30 who attended the lowcost clinic were between 12 and 19 years. All 13 at the home for unwed mothers were age 12 to 19 years. Of 59 women having private physicians, 45 were age 20 to 32 and only 14 were age 12 to 19. The American
means
pi’otein,
ascorbic differences
were
was the only group
of calories,
or phosphorus.
nutrients. respect
period
of antepartum
thiamin, niacin, and were no significant
1422
Susan
Thibault6
Journal
ofClinical
Nutrition
Methods A nthropometric Weight in kilograms and triceps and subscapular skinfold measurements in millimeters using a Lange caliper were recorded at 4-week intervals on the morning of the blood sample. Weight was taken without shoes or sweaters. Height in centimeters was recorded at about the 28th week antepartum and once postpartum. Dietary The dietary data, taken by staff nutritionists, were collected by means of biweekly 24-hour recalls of everything including vitamin and/or mineral supplements eaten on the preceding day. The recall method was selected in perference to others. Since several records from each participant were collected, dependence on only one record was avoided. It has been considered as reflecting data more characteristic of the subject’s nor1
From
the School
of Home
Economics,
University
of
Vermont, Burlington. Vermont Agricultural Experiment Station Journal Article No. 343. 2Supported in part by Grant no. 12141009895 of the Agricultural Research Service, USDA, Washington, D.C. 3 Professor and Nutritionist. Research Associate. Associate Nutritionist. 6 Technologist.
28:
DECEMBER
1975,
pp.
1422-
1428.
Printed
in U.S.A.
Downloaded from https://academic.oup.com/ajcn/article-abstract/28/12/1422/4716610 by University of Glasgow user on 14 February 2019
Comparison adolescents Anthropometric
ANTHROPOMETRIC
AND
Results
and discussion
A nthropometric Table total
I
group
TABLE Adjusted
I mean
findings presents of
adjusted
women
at
an thropometric
means eight
measur
of
the
antepartum ements
Wei g ht . k g
FINDINGS
1423
and three postpartum time periods. With no interaction of time and age present. analysis of variance showed no significant difference among the four age groups for either weight or the two skinfold measurements. The only significant change over time was that of increased weight during the antepartum pend. Dietary
findings
Table 2 presents the adjusted mean antepartum intakes of each of the four age groups for all nutrients calculated. Table 3 is a similar presentation of the postpartum means. No interaction was found between age and time for any nutrient, either antepartum or postpartum. The significant differences are indicated in the tables. Since there were no significant changes over the eight antepartum periods for any nutrient, and only one change among the three postpartum periods, these data are not tabulated here. The only change, ascorbic acid intake, is mentioned in the results for that vitamin. Kilocalories The mean antepartum caloric intakes of the two younger groups were both significantly higher than those of the two older groups (Table 2). None were as high as the 1973 Recommended Dietary Allowances (RDA) for pregnancy in their respective age groups which range from 2,300 for women 23 and over, to 2,700 for girls I I 14 (6). In view
-
by ti me periods
No records
Triceps skinfold.mm
No. records
Subscapular skinfold,mm
No. records
A niepartum weeks 14 15- 18 19-22 23-26 27-30 31 - 34 35-38 39-40 Postpartum
58.7± 58.5 ± 60.3 ± 62.6 ± 63.7± 65.6 ± 67.9± 66.5±4.11
1.30* 1.18 1.01 1.00 1.01 1.03 1.11
61 73 98 100 98 94 82 6
17.9±0.95 17.5 ± 0.86 17.8 ± 0.74 18.0 ± 0.73 18.0±0.74 17.9 ± 0.75 17.5 ±0.80 15.2±3.00
61 73 98 100 98 94 82 6
14.6± 1.07 14.1 ± 0.97 14.6 ± 0.83 15.2 ± O.1t2 15.4±0.83 15.8 ± 0.85 15.5 ±0.91 11.7±3.37
61 73 98 100 98 94 81 6
61.4± 58.2 58.9
1.63 1.19 0.96
34 63 98
16.9± 1.30 16.2 ± 0.95 16.2 ± 0.76
34 63 98
15.4± 1.41 13.3 ± 1.03 14.4 ± 0.83
34 63 98
days l4 15-25 38 -58 *
Standard
measurements
error not
± ±
of the mean. significant.
Antepartum Postpartum
increase changes
in weight not
significant
over
time for
any
is significant measurement.
at P
-
0.000:
changes
in other
Downloaded from https://academic.oup.com/ajcn/article-abstract/28/12/1422/4716610 by University of Glasgow user on 14 February 2019
mal eating habits than written records of food weighed or measured at the time of eating. The latter procedures tend to influence the person to change eating habits. Fasting blood samples were obtained the morning of the first recall and on alternate recalls thereafter. The scheduled selection of days of the week was randomized as much as possible without involving weekend appointments. The interviewer used paper templates. rulers, measuring cups and spoons, and occasionally actual food to estimate the size of portions eaten which was then converted into weight in grams. The food intake was assessed for calories, protein, fat, carbohydrate, calcium, phosphorus, iron, vitamin A, thiamin, riboflavin, preformed niacin, and ascorbic acid, using the 1963 revision of Agriculture Handbook No. 8 (l). The estimation of nutrients in newer ready-to-eat foods and home prepared foods has been described in detail elsewhere (2, 3). For statistical analysis of the data, the women were divided into four age groups, 12 17, 18-19, 20-24, and 25-32 years. A two-way classification analysis of variance for disproportionate data (samples of unequal sizes) was performed using means for each nutrient adjusted for age or time to test the null hypothesis that no interaction was present and no difference existed among the four age groups or among eight antepartum periods of 4 weeks each or three divisions of a 6- to 8-week postpartum period (4). When no significant interaction but the probability of a significant difference equal to or less than 0.05 was indicated, Scheff#{233}’stest was applied to the data to determine the significance of the difference between individual age groups (4). The biochemical findings from analysis of the blood samples, and a more detailed description of the statistical methods are reported in Part I of this series (5).
DIETARY
1424
MORSE
ET
of this fact it is not surprising that there were no significant differences among group means of skinfolds and no significant change in skinfold over time. Compared to the work of other investigators, the means of the younger groups approximated the mean of 2,155 kcal reported by McGanity et al. (7) for pregnant girls age 12-19. The Vermont means were considerably higher than the mean of 1,871 ± 474 reported by King et al. (8) and that of 1,808 kcal reported by Seiler and Fox (9) both for pregnant adolescents. The means of antepartum caloric intake of the two older groups were very close to the highest monthly mean in the fourth month, 1,971 ± 485, reported in Beal’s longitudinal study of 54 women having 95 pregnancies and a mean age of 27 (10). There were no significant differences among age groups in the postpartum period (Table 3). King et al. (8) reported a postparturn mean of 1,682 ± 373 for adolescents, considerably lower than those of the Vermont teenagers.
mean
daily
antepartum
Protein,
nutrient
intake
of four
g
89.7
Carbohydrate,g
259.2 e,e2 1,332 ci 1,410
mg
Phosphorus,
mg
mg
Vitamin
A, lU
Thiamin,
mg
Riboflavin, Niacin,mg Ascorbicacid,
Standard
±
6.50
±
37.2
±
39.7
error
subscripts I , 2, etc. row, as determined
of mean.
The
letters
to identify pairs. indicate by Scheff#{233}’s test.
2532 339 45.9 2.48 2.44 5.78 33.1
1,322 e 76.9 f 12,157
±
35.3
±
4.46
3.22
±
±
3.92 ± 0.159 29.9± 1.52 e, 170 ± 8.44 h31i4 e
=P
levels