- Title
- Women's reproductive health and nutrition
- Creator
- Gresham, Ellie
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2016
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- The importance of maternal nutrition on adverse perinatal outcomes has been clearly demonstrated in animal studies, however the evidence in human populations is more variable. Although the effect size of dietary interventions may be small it is incredibly important at a population level. Worldwide there is an increasing prevalence of adverse perinatal outcomes such as gestational hypertension, gestational diabetes, preterm birth and low birth weight. There is a need to optimise maternal dietary intake to reduce the burden of adverse perinatal outcomes and improve long term quality of life, whilst reducing morbidity, mortality and health care costs. The primary purpose of this thesis is to examine the role of maternal diet (preconception and pregnancy) in the prevention of adverse reproductive outcomes that may occur during pregnancy, birth, or thereafter focusing on the dietary predictors. Three important research methods were undertaken to meet the aims of this thesis: 1. A systematic review and meta-analysis of randomised controlled trials. ; 2. A reliability and agreement study using data linkage. ; and 3. A population-based observational study using longitudinal data. A brief overview of each study is provided below. A large and comprehensive systematic review and meta-analysis provided evidence that dietary intervention during pregnancy is effective in reducing blood pressure (both systolic and diastolic), increasing birth weight and length, and reducing the incidence of preterm birth, and low birth weight. Food and fortified food products and dietary interventions conducted in low-income countries and among underweight or nutritionally at-risk populations showed the most promising effects. This research demonstrates the need for additional high-quality randomised controlled trials that test different dietary interventions to identify maternal diet intakes that optimize maternal, neonatal and infant outcomes among different populations. Women from the 1973-78 cohort of the Australian Study on Women’s Health provided the sampling frame for the remaining analyses contained within this thesis. An agreement study compared women’s self-reported gestational hypertension, gestational diabetes, preterm birth and low birth weight in the Australian Longitudinal Study on Women’s Health, against the Perinatal Data Collection (N=1,914 women; N=3,811 children). This determined the accuracy of the self-reported data which are important for future research on the reproductive health of women in the Australian cohort. The study demonstrated that women accurately self-report perinatal outcomes (≥87 % agreement), meaning the data can be used with a high degree of confidence. Reporting perinatal outcomes per child offers a higher degree of accuracy than reporting by mother at ‘ever’ or ‘first-report’. Analysis of data from the 1973-78 cohort of the Australian Longitudinal Study on Women’s Health was then conducted to determine whether diet quality before or during pregnancy predicted adverse perinatal outcomes for the mother or child. This study focused on 1,907 women with biologically plausible dietary intakes. Women were classified as preconception or pregnant when completing the Dietary Questionnaire for Epidemiological Studies, a validated 74-item food frequency questionnaire. Diet quality was calculated using the Australian Recommended Food Score modified for pregnancy. Associations between pre-pregnancy and pregnancy diet quality scores and subsequent pregnancy outcomes were assessed. Findings from this analysis indicate that high diet quality scores are associated with a lower risk of a woman developing gestational hypertension or delivering a low birth weight child. In conclusion, the study findings presented in this thesis provide evidence that elements of maternal diet (preconception and pregnancy) influence the development of adverse reproductive outcomes that may occur during pregnancy, at birth, or thereafter. However, a gap remains in the literature for more high-quality randomised controlled trials to elicit the exact link between diet and maternal-child health, even if by meta-analysis.
- Subject
- nutrition; pregnancy; adverse reproductive outcomes; diet quality; systematic review; meta-analysis; agreement
- Identifier
- http://hdl.handle.net/1959.13/1313184
- Identifier
- uon:22536
- Rights
- Copyright 2016 Ellie Gresham
- Language
- eng
- Full Text
- Hits: 3419
- Visitors: 3581
- Downloads: 362
| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Abstract | 560 KB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Thesis | 16 MB | Adobe Acrobat PDF | View Details Download |