The health and well-being of pregnant women has a major influence on the health of their babies and an adequate intake of nutrients during pregnancy is vital for the health of the mother and the optimal development of the foetus. Mothers who are malnourished have a higher risk of delivering babies with poor birth outcomes such as being premature, underweight, short (stunted) and wasted.
These are some of the findings from the Nutritional status of Expectant Mothers and their newborn infants (NuEMI) study conducted by a research team in the Department of Nutrition and Dietetics  at the University of the Free State (UFS) Faculty of Health Sciences.
Prof Corinna Walsh  of the Department of Nutrition and Dietetics and an NRF C-rated researcher is leading the research team. She also serves as Chairperson of the Nutrition Society of South Africa (NSSA) .
The aim of the study
According to Prof Walsh, malnutrition in mothers may include undernutrition, micronutrient deficiency and/or overweight and obesity. Says Prof Walsh: “Babies born with poor birth outcomes are at risk of lifelong impairments in physical, neurological and educational areas, increasing the economic burden faced by families, communities and healthcare systems in resource-poor settings.” The NuEMI study aimed to determine the nutritional status of pregnant women attending the antenatal clinic at Pelonomi Regional Hospital as well as those visiting antenatal clinics in the rural Southern Free State during 2018 and 2019.
During the first phase of the study, questionnaires on socio-demographic background and household information; reported health and lifestyle; pregnancy history, social support and stress; household food security; and dietary intake were completed for 682 pregnant women at Pelonomi and 100 pregnant women at clinics in the Southern Free State. Blood and urine samples were also collected and mothers were weighed and measured.
During the second phase of the study, the same mothers were invited to provide the information on their babies’ Road to Health Booklets after they were born (gestational age, method of delivery, HIV exposure and weight, length and head circumference at birth); 331 mothers returned with their babies (N=347) in the second phase.
Studies that have used the NuEMI database
The data collected in the NuEMI study has been used in a large number of studies, including those of two doctoral students and a postdoctoral fellow in the Department of Nutrition and Dietetics. Prof Walsh says very little has been published on the iodine and iron status of pregnant women in South Africa and especially in the Free State. As part of the blood tests that were done, Dr Jennifer Ngounda assessed the iodine and iron status of the cohort of women included in the NuEMI study, including associations with sociodemographic, diet and health factors in urban and rural participants.
In another study, Dr Marizeth Jordaan , developed a nutrition screening tool to predict birth outcomes of the NuEMI cohort of pregnant women at Pelonomi Hospital. Based on the variables identified as independent predictors of overall birth outcomes, she developed an eight-item nutrition-related screening tool to detect those pregnant women who are at risk of poor birth outcomes. The screening tool can assist nursing staff to identify high-risk pregnancies and to refer at an early stage, when nutrition intervention can still positively impact on birth outcomes.
Adequate intake of the nutrient choline and optimal diet quality play a critical role in normal development of the foetus and the short- and long-term health of the offspring. Dr Liska Robb  developed a risk assessment profile and diet quality index for inadequate choline intake in the pregnant women included in the study. Dietary intake (including intake of the nutrient choline) was assessed using a Quantitative Food Frequency Questionnaire and factors that could affect choline intake in this population were identified. In addition, a diet quality index, with a focus on choline-rich foods, was developed for use in pregnant women in South Africa.
The NuEMI research team looks forward to translating the findings of the study into other tools and resources that may benefit pregnant women and their children in the Free State and beyond. Furthermore, we trust that this study will serve as a strong foundation for a larger multidisciplinary birth cohort study that is planned in the Faculty of Health Sciences.