Anthropometric results in pregnancy and lactation.

To throw more light on the interrelationship between maternal nutrition during pregnancy lactation and the reproductive performance of mothers in the Machakos program a longitudinal study of anthropometric measurements of pregnant and lactating women was conducted over the period May 1 1978 to December 31 1980. The results are reported in this chapter. Male field workers taking part in the programs disease and demographic surveillance system were instructed to assist in identifying pregnancies. Mothers were invited to attend pregnancy meetings and defaulters were visited at home. Examinations by trained female field workers were scheduled in each trimester at 3-4 5-6 and 7-9 months; this included measurement of height weight upper arm circumference and triceps and subscapular skin fold thicknesses. Birth weight was measured within 48 hours of birth. All low-birth-weight infant-mother pairs were matched with a control group of normal-birth-weight infant mother pairs. Data were collected at 6-weekly intervals during the 1st year postpartum. During the period May 1 1978 to June 30 1980 a total of 2874 women were pregnant. The mean weight of nonpregnant nonlactating women in the study area was about 52 kilograms which is close to local reference weight. Calculated total weight gain during the pregnancy period was about 5.8 kilograms or 11% of pregravid weight. The weight gain observed between 3-8 months of pregnancy in the longitudinal sample is dangerously close to the malnutrition borderline mentioned by Bailey. Under such circumstances adequate fetal growth can only be safeguarded at the expense of maternal reserves. Although in general the maternal body can compensate for the low energy intake during pregnancy and low weight gain does not result in poor fetal growth the fact that low birth weight mothers were leaner than normal birth weight mothers indicates that there is a limit in maternal weight for height that can support adequate fetal growth. Considering stature as a measure of maternal nutritional health during childhood the lower height of low birth weight mothers supports the view that it will take generations for a population to achieve optimal reproduction performance. The observation that weight for height during pregnancy was not negatively associated with parity is important suggesting that recovery takes place during lactation since 1 of the main reasons for stopping breastfeeding is a new pregnancy. Mothers lose 2.4 and 2.6 kilograms in weight to subsidize milk production. On average rural Kamba women in the sample had their 1st child when they were 19.6 years old. Only changes in weight and subscapular skin fold are significant.