الفهرس 
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Abstract
Maternal nutrition and health is considered as the most important regulator of
human fetal growth. A healthy mother can produce a healthy child. If women are not
well nourished, they are more likely to give birth to weak babies resulting in a high
infant mortality rate. Pregnancy is the period of dynamic change for a mother
requiring a lot of care. During this period the fetus is nourished directly by the mother
through the placenta.
This study was conducted in department of Gynecology and obstetrics,
Alsabeen hospital and other MCH centers in Sana’a – Yemen, and in obstetrics and
gynecology department of Suez Canal University hospital in Ismailia – Egypt. The
studied group consisted of 130 pregnant women 100 were Yemeni (76.9%) and 30
(23.1%) were Egyptian pregnant women. The pregnant women were divided into
three groups, Para 1, 2, 3 and more for urban and rural areas.
The studied pregnant women their ages ranged between 16- 40 years, with the
mean age (26.92 ± 5.7). We observed that most of pregnant women 106 (81.5%)
were house wives. Almost forty four percent (44.6%) of mothers were illiterate,
(3.8%) received Primary education, (11.5%) received Elementary education, (26.1%)
received Secondary education and (13.8%) had a college education. On the basis of
family size 72.3% had more than 4 members, while 27.7 % had a family size less
than 4 members. Regarding family income, the majority of pregnant women had low
income (60.8%). Most of the pregnant women (66.2%) did not receive elements
supplementation during pregnancy, and (24.6%) 0f pregnant women were smoking
during pregnancy. About 48% of Yemeni pregnant women had history of chewing
qat, 62.5% of them, associated with reduced appetite during pregnancy.
The mean ±SD of anthropometric measurements ( height, weight, and body
mass index ) were (159.2 ± 3.7 CM, 58.1 ± 6.4 KG , 22.6 ± 3.2 kg/m2 ) and (162.8 ±
6.0 CM , 70.6 ± 14.0 KG, 26.8 ± 6.02, kg/m2 ) FOR Yemeni and Egyptian pregnant
women respectively. The difference is statistically significant.
The mean ±SD of hemoglobin and hematocrit were (11.1± 1.1, 34.4±2.6 -
10.4± 1.6, 32.7±3.5.0) for Yemeni and Egyptian pregnant women respectively, and
the differences between them was significant at p<0.05. While there were no
statistically significant differences between the two groups in the mean of RBC,
MCV and albumin levels.
Comparing the daily intake of Energy and nutrients to recommendation of the
committee on dietary reference intake, it was found that the percentage of daily
intake of the studied group for protein, zinc and copper is less than 75% of DRI, and
the percentage of deficiency is more than 25% of recommendation. While the
percentage of daily intake for Iron is less than 50% of DRI and the percentage of
deficiency is more than 65% of recommendation. The mean ±SD for Yemeni and
Egyptian pregnant women in relation to energy consumption were 2482 ± 182, 2660
± 414. There were statistically significant difference between them at (p<0.001). But,
there were no statistically significant difference between the two groups in
micronutrients (iron, zinc, copper, and selenium) intake.
In our study, the mean ±SD of biochemical analysis of cord blood of the
studied group` for Zinc, Iron, and Selenium for Yemeni and Egyptian pregnant
women were; (88.76 ± 27.33, 95.4 ± 31.2, 99.6 ± 30.8), (94.5 ± 25.33, 95.6 ± 30.6,
97.5 ± 31.2) respectively, and there is no significant difference between them. A
statistically significant at p<0.05 increase in cord blood serum copper of studied
Egyptians’ compared to Yemeni pregnant women was found.
The prevalence of anemia (Hemoglobin <11g/dl) among the subjects of the
study is (54.6%), and (26.9%), (27.7%) for urban rural and Egyptian pregnant women
respectively. The prevalence of anemia is high in multigravida (23%), and the
majority of anemic pregnant women 73.2% were categorized as mild anemia Hb (10
- <11 gldL), and 90.1% of anemic pregnant women have ( hematocrit value less than
36, MCV< 80fl and MCH below 27pg), and the mean daily dietary intake of iron
obtained by the mothers was significantly low, 8.5±2.93, (31.48% of intake of DRI)
and the deficiency is (68.5%) of DRI, and 81.7% of anemic pregnant women have no
elements supplementations during pregnancy. Also it was observed that the most
common manifestations were the dyspnea (50%), palpitation (47.7%), easily
fatigability (42.3%). This means that these women may be deficient in iron (red blood
cells are very small), and have iron deficiency anemia.
In our study, there were significant relationship between the prevalence of
anemia and Sociodemographic status, anemia prevalence was highest in those with
four and more family members (77.5%), and among those women who had low
(insufficient) family income and housewives (p<0.05) .
In our study chewing qat was seen in 48(48%) pregnant Yemeni females, and
there is a highly significant statistical association (p< 0.05) between chewing qat
during pregnancy and anemia. Chewing qat during pregnancy was associated with
reduced appetite in 62.5% of pregnant Yemeni females. This may contribute to the
increased prevalence of anemia among those chewing qat during pregnancy. Also qat
may interfere with iron absorption and or in hemoglobin synthesis.
In our study hematological parameters (hematocrit, hemoglobin), and plasma
albumin level were significantly (p < 0.05) lower in underweight pregnant women
(BMI<18.5), when compared to overweight and women with normal BMI, and the
neonatal anthropometric measurements (birth weight, birth length, head and mid- arm
circumferences) were significantly (p < 0.05) lower in underweight women with BMI
(< 18.5) when compared to obese and women with normal BMI. Pregnant women
with hemoglobin more than 11 g/dl, which is considered as normal level gave birth to
neonates with normal weight, while pregnant women with lower hemoglobin level (<
11 g/dl), who were considered as anemic gave birth to low birth weight babies. The
difference was statistically significant, (p < 0.05).
There were no statistically significant differences between serum iron and
copper levels of cord blood and mothers with normal and low birth weight infants ( P
> 0.05), while there were statistically significant differences between serum zinc and
selenium levels of cord blood and mothers with low birth weight infants (p < 0.05).
But the cord serum selenium and zinc levels in both groups were in a suggested
normal range.
from the results of our study we concluded that inadequate dietary intake of
macro and micronutrients during pregnancy leads to deficiency of these nutrients.
Factors affecting are low family income, increased family size, bad habits as well as
lack of nutritional awareness. Pregnant women participated in this study (Yemeni and
Egyptian pregnant women) had a low dietary intake for most nutrients especially for
nutrients crucial during pregnancy such as iron, zinc, copper and selenium.
In spite of better education and high monthly income of some of pregnant
women, nutrition intake was lower than RDA. This might have been due to poor
knowledge and ignorance about nutrition and health by these women. Therefore,
apart from supplementary nutrition to pregnant women of poor socioeconomic status,
emphasis should be given towards nutrition and health education adopting multi-
media approach.
It is concluded from the findings of this study that pregnant women need to
increase their intake of food rich in iron, zinc, copper, protein and energy. There is a
need for nutrient supplements to all pregnant women to ensure optimum growth and
better nutrient transfer to the offspring. These interventions can be integrated with the
existing health care programs to reach all beneficiaries.
Prevalence and severity of multiple macro and micronutrient deficiency during
pregnancy and their effect on the health of both pregnant and the growing fetus
showed be the most important issue for researches and decision makers in developed
countries.
This study suggests that nutritional status of pregnant women may influence
birth weight of their neonates. Adequate nutrient intake is important for pregnancy
outcome. BMI, hemoglobin and energy intake of pregnant women could be
considered as predictor factors for birth weight of neonates.