EVALUATION OF THE NUTRITIONAL STATUS OF PREGNANT WOMEN IN RELATION TO ALCOHOL CONSUMPTION DURING PREGNANCY, AND PREGNANCY OUTCOME IN NIGERIA

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Pregnancy is a critical period that demands optimal nutritional status to ensure the health and well-being of both the mother and the developing fetus. Adequate nutrition during pregnancy is crucial for proper fetal growth, development, and overall pregnancy outcome. The maternal diet not only provides essential nutrients to the fetus but also influences the mother's health and her ability to carry the pregnancy to term without complications. In this context, the nutritional status of pregnant women is a significant determinant of pregnancy outcomes, including birth weight, gestational age, and the risk of congenital anomalies.

Throughout history it had been found that the incidence of miscarriages, still births, neonatal deaths, malformations and low birth weight (LBW) all increased in infants conceived during famine. Maternal nutritional status is therefore an important predictor of infant birth weight. LBW is a major factor in infant deaths and long-term health problems such as developmental disabilities and learning disorders. Fortunately, both pre-pregnancy nutritional status and weight gain during pregnancy (which both affect birth weight) are factors that can be modified to improve pregnancy outcome. Of the weight gained during pregnancy less than half comprises of the fetus, amniotic fluid and the placenta.

It has been found that maternal size predicts placenta size. In turn, placental size determines the amount of nutrition given to the fetus. Exchange of gasses and removal of waste products also take place through the placenta. The rest of the weight gained consists of maternal reproductive tissues, fluid, blood and stores. The increase of blood volume serves to meet the needs of oxygen and nutrient transport to the fetus and maternal tissues. Uterine muscle growth takes place to facilitate delivery, and breast tissue growth for optimal lactation. The stores accumulated consist mostly of fat, which acts as an energy reserve during pregnancy and thereafter. After pregnancy, the fat stores are used for lactation and energy for the mother since the newborn’s demands on her make it difficult to take in adequate nutrition. Therefore, a good pre-pregnancy nutritional status and adequate weight gain during pregnancy is essential for the proper development and growth of the fetus, and to accommodate the mother’s needs.

Maternal malnutrition leads to decreased expansion of blood volume, which causes poor placental perfusion. This impairs the development of the placenta, which is the pipeline for nutrients from the mother to the fetus. These changes may be more important in the etiology of fetal growth restriction (FGR) than the decreased nutrient availability due to the mother’s lacking diet. Epidemiological studies conducted mostly in the United Kingdom (U.K.) indicate that maternal malnutrition may predispose the offspring to chronic lifestyle diseases, such as hypertension, Diabetes mellitus (DM), ischaemic heart disease and hypercholesterolemia. Barker et al. (2017), using past databases such as national birth registers, neonatal and infant mortality rates, have documented associations between these figures and more present day rates of mortality from ischaemic heart disease, stroke and chronic bronchitis. These studies suggested possible relations between early influences during pregnancy and later diseases, which could be explained by “programming”: an early stimulus or insult, operating during a sensitive or critical period, results in long-term changes in the structure or function of specific organs. The “insult” in question was poor maternal health and physique, which is in turn related to malnutrition and/or disease

Barker et al., (2017) found that the death rate from ischaemic heart disease fell with increasing birth weight, suggesting that maternal factors (which determine birth weight) are related to the later risk of ischaemic heart disease. There are various risk factors for ischaemic heart disease, such as hypertension, high plasma levels of clotting factors such as fibrinogen and factor VII, android fat distribution and DM, which were all investigated individually. Individuals with lower birth weight were more likely as adults to have increased blood pressure or hypertension. The possible mechanism behind this association is thought to be a rise in the pressure in the fetal circulation in order to maintain placental perfusion (an inverse relationship was found between lower birth weight and higher placental weight), which is maintained after birth.

Alcohol consumption during pregnancy is another critical factor that can negatively impact pregnancy outcomes. Despite widespread awareness of the dangers of alcohol use during pregnancy, it remains a significant public health issue in many parts of the world, including Nigeria. Alcohol consumption during pregnancy has been associated with various adverse outcomes, such as fetal alcohol syndrome (FAS), preterm birth, low birth weight, and developmental disorders. The teratogenic effects of alcohol are well-documented, with even low to moderate alcohol consumption during pregnancy potentially leading to detrimental effects on the developing fetus.

The intersection of alcohol consumption and poor nutritional status during pregnancy presents a compounded risk to both maternal and fetal health. Pregnant women who consume alcohol may also have inadequate nutritional intake, further exacerbating the risk of adverse pregnancy outcomes. Alcohol can interfere with the absorption and metabolism of essential nutrients, leading to deficiencies that can affect fetal growth and development. For instance, alcohol consumption is known to impair the absorption of folic acid, a critical nutrient for neural tube development, increasing the risk of neural tube defects in the fetus.

In Nigeria, alcohol consumption among women of reproductive age is influenced by various socio-cultural factors, including traditional beliefs, social norms, and economic conditions. In some communities, alcohol consumption is culturally accepted and even encouraged during social gatherings and ceremonies. However, the implications of alcohol consumption during pregnancy are not fully understood or acknowledged in many of these communities. This lack of awareness, coupled with poor access to prenatal care, contributes to the persistence of alcohol use during pregnancy and its associated risks. The evaluation of the nutritional status of pregnant women in relation to alcohol consumption during pregnancy is essential to understanding the extent to which these factors contribute to adverse pregnancy outcomes in Nigeria. Hence the need for this study.

1.2 Statement of the Problem

The health and well-being of pregnant women are critical to ensuring positive pregnancy outcomes and the long-term health of their children. In Nigeria, the nutritional status of pregnant women remains a significant public health challenge, particularly in regions characterized by poverty, food insecurity, and limited access to healthcare services. Poor nutrition during pregnancy is known to contribute to a range of adverse outcomes, including low birth weight, preterm birth, and increased neonatal mortality. Compounding this issue is the widespread consumption of alcohol among pregnant women, which poses additional risks to both maternal and fetal health.

Alcohol consumption during pregnancy has been shown to interfere with the absorption and metabolism of essential nutrients, leading to deficiencies that can have severe consequences for fetal development. For instance, alcohol impairs the absorption of folic acid, increasing the risk of neural tube defects in the fetus. Furthermore, alcohol can exacerbate the effects of existing nutritional deficiencies, potentially leading to compounded adverse outcomes such as fetal alcohol syndrome (FAS), low birth weight, and developmental delays. Despite these risks, many pregnant women in Nigeria continue to consume alcohol, often due to a lack of awareness about its potential harms or due to socio-cultural norms that encourage alcohol use.

The nutritional status of pregnant women in Nigeria is further compromised by socio-economic factors that limit access to adequate and diverse diets. Malnutrition among pregnant women in Nigeria is characterized by deficiencies in micronutrients such as iron, calcium, and vitamins, which are essential for fetal growth and development. When combined with alcohol consumption, these deficiencies can result in a higher likelihood of complications during pregnancy and childbirth, including stillbirth, preeclampsia, and maternal anemia.

Despite the global recognition of the dangers associated with alcohol consumption during pregnancy, there is a lack of comprehensive data on the prevalence of this behavior among pregnant women in Nigeria. Moreover, the interaction between poor nutritional status and alcohol consumption during pregnancy has not been adequately explored in the Nigerian context. This gap in knowledge is particularly concerning given the high prevalence of malnutrition and the cultural acceptance of alcohol consumption in certain Nigerian communities. It is on this backdrop that this study seeks to evaluate the Nutritional Status of Pregnant Women in Relation to Alcohol Consumption During Pregnancy, and Pregnancy Outcome in Nigeria

1.3 Objectives of the study

The primary objective of this study is to critically assess Maternal Dietary Intake During Pregnancy in Nigeria. Specific objectives of this study are to:

1. To determine the prevalence of alcohol consumption among pregnant women in different regions of Nigeria

2. To evaluate the relationship between alcohol consumption, nutritional status, and pregnancy outcomes among pregnant women in Nigeria

3. To examine how alcohol consumption influences dietary intake and nutritional status among pregnant women in Nigeria

4. To investigate the relationship between alcohol consumption during pregnancy and various pregnancy outcomes among pregnant women in Nigeria

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

1. 1. 1. What is the level of prevalence of alcohol consumption among pregnant women in different regions of Nigeria?

      2. What is the relationship between alcohol consumption, nutritional status, and pregnancy outcomes among pregnant women in Nigeria?

      3. How does alcohol consumption influence dietary intake and nutritional status among pregnant women in Nigeria?

      4. What is the relationship between alcohol consumption during pregnancy and various pregnancy outcomes among pregnant women in Nigeria?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: There is no significant relationship between alcohol consumption, nutritional status, and pregnancy outcomes among pregnant women in Nigeria.

Ha: There is a significant relationship between alcohol consumption, nutritional status, and pregnancy outcomes among pregnant women in Nigeria.

1.6 Significance of the study

Grasping the connection between nutritional status, alcohol consumption, and pregnancy outcomes is vital for enhancing the well-being of both mothers and infants. In Nigeria, where a wide range of socio-economic and cultural factors shape health behaviours, this study seeks to offer a thorough understanding of how these variables interact and affect pregnancy outcomes. This study holds great importance in multiple areas, such as public health, healthcare practice, and policy-making.

Pregnant women will benefit greatly from gaining access to improved health advice and support. Enhancing knowledge about the dangers linked to alcohol consumption and nutritional deficiencies can result in more favourable outcomes for both mothers and infants during pregnancies.

Enhanced knowledge and evidence-based recommendations will empower physicians, midwives, and nutritionists to deliver more effective care and support to pregnant women. Public health officials will utilise the study's findings to create and execute focused health interventions and educational campaigns to tackle the identified issues.

The study's findings will provide valuable evidence for policy makers to develop and implement policies that effectively tackle nutritional deficiencies and alcohol consumption during pregnancy. Implementing effective policies involves enacting more stringent regulations on the availability of alcohol and implementing specialised nutrition programs for expectant mothers.

Organisations dedicated to improving maternal and child health will find value in the study's data, which can help them strengthen their programs and advocacy efforts. The data covers important areas such as nutritional support and preventing alcohol consumption.

This study will contribute valuable information to the existing body of research by offering detailed insights into the correlation between nutritional status, alcohol consumption, and pregnancy outcomes in Nigeria. This can inspire additional research and scholarly discussions on related subjects. The study will provide valuable data to the academic community, supporting further research and knowledge in the field of maternal and child health.

1.7 Scope of the study

Broadly, this study focus is to critically evaluate the nutritional status of pregnant women in relation to alcohol consumption during pregnancy, and pregnancy outcome in Nigeria. Empirically the study will explore the prevalence of alcohol consumption among pregnant women in different regions of Nigeria, the relationship between alcohol consumption, nutritional status, and pregnancy outcomes among pregnant women in Nigeria, how alcohol consumption influences dietary intake and nutritional status among pregnant women in Nigeria and the relationship between alcohol consumption during pregnancy and various pregnancy outcomes among pregnant women in Nigeria.

Geographically, the study will be carried out in Ikeja, Lagos state.

1.8 Limitations of the study

During the examination, the researchers carefully examined the inherent limitations that are present in all human behaviours. One of the main challenges we faced was the lack of extensive scholarly research on the subject. A notable factor that contributed to the issue was the limited data available regarding evaluation of the nutritional status of pregnant women in relation to alcohol consumption during pregnancy, and pregnancy outcome in Nigeria. Given the task at hand, it was quite demanding to find the required materials, books, or information and organise the data, requiring a significant investment of time and effort.

In addition, the study's findings may be constrained by the small number of participants and the limited scope of the research, which mainly revolves around Ikeja, Lagos state. Therefore, the findings of the study have limited practical implications, highlighting the need for further research.

In addition, the individual experienced significant constraints due to financial constraints. As a student with limited financial resources, they had to carefully navigate these constraints throughout their study. The exorbitant transportation fees at the research site proved to be a significant hindrance in meeting the financial obligations tied to travel expenses.

Furthermore, the person had a packed schedule due to their scholarly obligations, including attending lectures and participating in a range of educational pursuits.

1.9 Definition of terms

Maternal nutrition: Maternal nutrition refers to the nutritional needs of women during the antenatal and postnatal periods and to the period before conception.

Anemia: Anemia refers to low levels of healthy red blood cells. Symptoms include feeling very tired, weak and short of breath

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