Document Type : Original Article


1 Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non‑communicable Disease

2 Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non‑communicable Disease Department of Biostatistics, School of Health,

3 Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non‑communicable Disease Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran


Objective: This study was conducted to investigate the relationship between the intake of
different food groups by pregnant mothers and neonatal low birth weight and premature
births. Materials and Methods: In this cohort, the target population was 225 pregnant women,
randomly selected from different geographical areas of the city of Isfahan, Iran (from April to
September, 2012). The main variables in the study were weight and gestational age of the
neonates and the type and amount of different food groups used by the mothers. All nutritional
variables were compared according to different groups of infants (normal, premature, and low
birth weight). In the multivariate analysis, multiple linear and logistic regression models were
used to identify those different food frequency questionnaire (FFQ) variables independently
associated with the newborn’s weight and gestational age, adjusted by maternal consumption
of calcium supplementation, folic acid, and omega‑3, during pregnancy. Results: A total
of 214 (47.7% boys) infants with complete information were included. They had a mean
gestational age of 38.72 ± 1.2 weeks. The mean birth weight was 3.11 ± 0.384 kg. The
percentages of premature and low birth weight (LBW) infants were 7 and 5%, respectively. At
multiple logistic regression controlling for potentially confounding factors that were significantly
associated with prematurity and LBW at univariate analysis (maternal consumption of calcium
supplementation, folic acid, and omega‑3, during pregnancy), type of nutritional groups
containing dairy products, proteins, fish, and shrimp group, as well as fruits and vegetables,
had a significant positive association with increasing the gestational age (P < 0.05). The group
that consumed proteins, fish, and shrimp, as well as fruits and vegetables had a significant
positive association with the newborn’s weight (P < 0.05). Conclusion: This study indicated
the importance of proper nutrition on reducing the rates of LBW and premature births.
Comprehensive educational programs at
individual and public levels are warranted in
this regard.


1. Szawajcer EM, Hiddink GJ, Koelen MA, Van Woerkum CM.
Nutrition awareness and Pregnancy: Implication for the life course
perspective. Eur Jobstet Gynecol Reprod Biol 2007;135:5864.
2. Hosseini MS, Nastaran J. Relationship between pregnancy outcome
and maternal BMI and wight gain. Int Congr Ser 2004;1271:380‑3.
3. Rasmussen MK. The “fetal origins” hypothesis: Challenges and
opportunities for maternal and child nutrition. Annual Rew Nut
4. Fagen C. Nutrition During pregnancy and Laction. In: Mahan KL,
Escott‑stumps, editors. Krause’s food nutrition and diet therapy.
11th ed. USA: W. B. Saunders; 2004. p. 168‑46.
5. Garmaroudi GR, Eftekhar H, Batebi A. Low birth weight frequency
and risk factors in Tehran. Payesh 2002;1:13‑8.
6. Wong JE, Parnell WR, Black KE, Skidmore PM. Reliability and relative
validity of a food frequency questionnaire to assess food group
intakes in New Zealand adolescents. Nutr J 2012;11:65.
7. Gilbert ES, Harmon JS. Manual of high risk pregnancy and delivery.
3rd ed. London: Saunders; 2003. p. 522‑5.
8. Wall PD, Pressman EK, Woods JR Jr. Preterm premature rapture
of the membrance and antioxydants: The free radical connection.
J Perinat Med 2002;30:447‑57.
9. Roozbahani N, Torkestani N, Gazerani N. Study of the relationship
between preterm labor and consuming fruit and vegetable before
and during pregnancy. J Arak Univ Med Scis 2004;7:13‑9.
10. Halliwell B. The antioxidant paradox. Lancet 2000;355:1179‑84.
11. Woods JR Jr. Reactive oxygen species and preterm premature
rupture of membranes‑a review. Placenta 2001;(Suppl A):S38‑44.
12. Eberherdt M. Reactive oxygen metabolits. 1st ed. USA: CRC Press;
2001.p. 272‑9.
13. Mercola J. Lack of vitamin C may trigger premature delivery. Optimal
wellness center/ [Last accessed on 2013].
14. Conlin PR, Chow D, Miller ER 3rd, Svetkey LP, Lin PH, Harsha DW,
et al. The effect of dietary patterns on blood pressure control in
hypertensive pations: Results from the dietary approaches to stop
hypertension (Dash) trial. Am J Hypertens 2000;13:949‑55.
15. Gilbert E, Harman J. Manual of high risk pregnancy and delivery.
2nd ed. St Louis: Mosby; 2003. p. 445‑62.
16. Villar J, Merialdi M, Gülmezoglu AM, Abalos E, Carroli G,
Kulier R, et al. Nutritional interventions during pregnancy for
the prevention of treatment of maternal morbidity and preterm
delivery: An overview of randomized controlled trials. J Nutr
17. Mangels R. Vegetaration diet during pregnancy. Human Society of
United State 2004. p. 1‑8. Available from:
[Last accessed on July10,2012]
18. Zhang C, Williams MA, King IB, Dashow EF, Sorensen TK,
Frederio IO, et al. Vitamin C and the risk of preeclampsia‑resaits
from dietary questionnaire and plasma assay. Epidemiology
19. Atkinson JO, Mahomed K, Williams SM, Woelk GB, Mudzamiris WN.
Dietary risk factors for preeclampsia among women attending
Harare Maternity Hospital, Zimbewe. Cont Afr J Med 1999;44:86‑92.
20. Olsen SF, Secher NJ. LOW consumption of seafood in early
pregnancy as a risk factor for preterm delivery: Prospective cohort
study. BMJ 2002;324:447.21. Jafarian M. Long life without disease with omega‑3. Miracle of the
new century. Row Publishers, 2004. p. 61 to 52.
22. Kohen Dara. Woman and mental Health. London: Rout Leadge;
23. Louis ST. Facts and comparisons. Philadelphia: Wolters Kluwer
Company CEO; 2001.
24. Merialdi M, Carroli G, Villar J, Abalos E, Gulmezoglu AM, Kulier R,
et al. Nutritional interventions during pregnancy for the prevention
or treatment of impaired fetal growth: An overview of randomized
controlled trials. J Nutr 2003;133:S1626‑31.
25. Burris HH, Mitchell A, Werler MM. Periconceptional Multivitamin Use
and Infant Birth Weight disparities. Ann Epidemiol 2010;20:233‑40.
26. Miller GD, Anderson JJ. The role of calcium in prevention of chronic
diseases. J Am Coll Nutr 1999;18:S371‑2.
27. Foruzani M. Nutrition during pregnancy. 1st ed. Tehran: Chehr
Publications; 2003.
28. Repke J, Villar J. Pregnancy induced hypertension and
low‑birth‑weight: The role of calcium. Am J Clin Nutr 1991;54:237‑41.
29. Enquobahrie DA, Williams MA, Butler CL, Frederick IO, Miller RS,
Luthy DA. Maternal plasma lipid concentrations in early pregnancy
and risk of preeclampsia. Am J Hypertens 2004;17:574‑81.
30. Winkler K, Wetzka B, Hoffmann MM, Friedrich I, Kinner M,
Baumstark MW, et al. Triglyceride‑rich lipoproteins are associated
with hypertension in preeclampsia. J Clin Endocrinol Metab
31. Khaliq F, Singhal U, Arshad Z, Hossain MM. Study of serum lipid
and lipoprotein in preeclampsia with special reference to parity.
Indian J Physiol Pharmacol 2000;44:192‑6.
32. Wiznitzer A, Mayer A, Novack V, Sheiner E, Gilutz H, Malhotra A,
et al. Association of lipid levels during gestation with preeclampsia
and gestational diabetes mellitus: A population based study. Am J
Obstet Gynecol 2009;201:482.el.
33. Baeten JM, Bukusi EA, Lambe M. Pregnancy complications and
outcomes among overweight and obese nulliparous women. Am
J Public Health 2001;91:436‑40.
34. Salvaggro A, Periti M, Quaglia G, Marzorati D. Iron and ferritin in
Italian Subyects Eur. J Epidemiol 1991;7:621‑7.
35. Foroozani M. Nutrition in pregnancy, Tehran: Chehreh Publications;
1381. p. 4,5,37,38.
36. Zlatnick FJ, Burmeister LF. Dietary in pregnancy: Effect on
anthropometric indices of the new born infant. Am J Obstet Gynecol
37. Kramer SM. The epidemiology of adverse pregnancy outcomes:
An overview. J Nutr 2003;133:1284‑42.
38. Langley Evans JL, Langley Evans CS. Relationship between maternal
nutrient intake in early and late pregnancy and infants weight and
proportions at birth. Prospective cohort study. J R Soc Promot
Health 2004;123:210‑6.
39. Khoushabi F, Saraswathi G. Association between maternal nutrition
status and birth weight of neonates in selected hospitals in Mysore
City, India. Pak J Nutr 2010;9:1124‑30.