Seasonality of antenatal care attendance, maternal dietary intake, and fetal growth in the VHEMBE birth cohort, South Africa
Loading...
Date
Authors
Fahey, Carolyn A.
Chevrier, Jonathan
Crause, Madelein
Obida, Muvhulawa
Bornman, Maria S. (Riana)
Eskenazi, Brenda
Journal Title
Journal ISSN
Volume Title
Publisher
Public Library of Science
Abstract
BACKGROUND : Seasonality of food availability, physical activity, and infections commonly occurs within
rural communities in low and middle-income countries with distinct rainy seasons. To better
understand the implications of these regularly occurring environmental stressors for maternal
and child health, this study examined seasonal variation in nutrition and health care
access of pregnant women and infants in rural South Africa.
METHODS : We analyzed data from the Venda Health Examination of Mothers, Babies and their Environment
(VHEMBE) birth cohort study of 752 mother-infant pairs recruited at delivery from
August 2012 to December 2013 in the Vhembe District of Limpopo Province, the northernmost
region of South Africa. We used truncated Fourier series regression to assess seasonality
of antenatal care (ANC) attendance, dietary intake, and birth size. We additionally
regressed ANC attendance on daily rainfall values. Models included adjustment for sociodemographic
characteristics.
RESULTS : Maternal ANC attendance, dietary composition, and infant birth size exhibited significant
seasonal variation in both unadjusted and adjusted analyses. Adequate frequency of ANC
attendance during pregnancy (4 visits) was highest among women delivering during the
gardening season and lowest during the lean (rainy) season. High rainfall during the third trimester was also negatively associated with adequate ANC attendance (adjusted OR =
0.59, 95% CI: 0.40, 0.86). Carbohydrate intake declined during the harvest season and
increased during the vegetable gardening and lean seasons, while fat intake followed the
opposite trend. Infant birth weight, length, and head circumference z-scores peaked following the gardening season and were lowest after the harvest season. Maternal protein
intake and ANC 12 weeks did not significantly vary by season or rainfall.
CONCLUSIONS : Seasonal patterns were apparent in ANC utilization, dietary intake, and fetal growth in rural
South Africa. Interventions to promote maternal and child health in similar settings should
consider seasonal factors.
Description
S1 Fig. Construction of rainfall estimates using Climate Hazards Group InfraRed Precipitation
with Station (CHIRPS) 0.05˚ resolution daily data. (A) As an example, CHIRPS data
for the study area are shown for January 20, 2013 and (B) values within a 0.25˚ radius from the
participant centroid are identified; (C) the mean value within the buffer for each day over the study period is shown. This process was completed for each participant using her home GPS
coordinates to calculate rainfall for each day of her pregnancy.
S1 Table. Predictors of missing antenatal care (ANC) attendance, VHEMBE study, South Africa, 2012–2013. Data are presented as mean (SD) or geometric mean (×/geometric SD) for continuous measures, and n (%) for categorical measures.
S2 Table. Unadjusted, complete-case comparison of truncated Fourier series models for seasonality of antenatal care attendance, maternal dietary intake, and infant birth size, VHEMBE study, South Africa, 2012–2013. Data are likelihood ratio test statistics comparing generalized linear models regressed on Fourier terms for date of birth. Four models were compared for each outcome: (1) intercept only (Null model); (2) including the first order Fourier pair (unimodal); (3) including the first and second order Fourier pairs (bimodal); and (4) including the first through third order Fourier pairs (trimodal). Likelihood ratio tests were used to compare nested models.
S3 Table. Relationship between daily rainfall during each trimester of pregnancy and antenatal care (ANC) attendance, VHEMBE study, South Africa, 2012–2013. Data are odds ratios (OR) and 95% confidence intervals (CI) from logistic regression models of binary antenatal care (ANC) attendance outcomes regressed on average daily rainfall (continuous mm/ day) for each trimester. Inverse probability of censoring weights were applied to all models to account for missing outcomes data. Adjusted models include maternal parity, HIV status, education, marital status, and pregnancy desire; father’s supportiveness of the pregnancy; and household income and distance to a main road.
S1 Table. Predictors of missing antenatal care (ANC) attendance, VHEMBE study, South Africa, 2012–2013. Data are presented as mean (SD) or geometric mean (×/geometric SD) for continuous measures, and n (%) for categorical measures.
S2 Table. Unadjusted, complete-case comparison of truncated Fourier series models for seasonality of antenatal care attendance, maternal dietary intake, and infant birth size, VHEMBE study, South Africa, 2012–2013. Data are likelihood ratio test statistics comparing generalized linear models regressed on Fourier terms for date of birth. Four models were compared for each outcome: (1) intercept only (Null model); (2) including the first order Fourier pair (unimodal); (3) including the first and second order Fourier pairs (bimodal); and (4) including the first through third order Fourier pairs (trimodal). Likelihood ratio tests were used to compare nested models.
S3 Table. Relationship between daily rainfall during each trimester of pregnancy and antenatal care (ANC) attendance, VHEMBE study, South Africa, 2012–2013. Data are odds ratios (OR) and 95% confidence intervals (CI) from logistic regression models of binary antenatal care (ANC) attendance outcomes regressed on average daily rainfall (continuous mm/ day) for each trimester. Inverse probability of censoring weights were applied to all models to account for missing outcomes data. Adjusted models include maternal parity, HIV status, education, marital status, and pregnancy desire; father’s supportiveness of the pregnancy; and household income and distance to a main road.
Keywords
Women's health, South Africa (SA), Seasonal variation, Prenatal care, Nutritional health, Maternal nutrition, Infant, Head circumference, Food composition, Fetus growth, Fat intake, Dietary intake, Carbohydrate intake, Body height, Birth weight, Venda health examination of mothers, babies and their environment (VHEMBE)
Sustainable Development Goals
Citation
Fahey CA, Chevrier J, Crause M, Obida M,
Bornman R, Eskenazi B (2019) Seasonality of
antenatal care attendance, maternal dietary intake,
and fetal growth in the VHEMBE birth cohort,
South Africa. PLoS ONE 14(9): e0222888. https://DOI.org/10.1371/journal.pone.0222888.