Contents - Previous - Next


Table 7a. Infant growth in weight (g) by mother's post-partum body mass index (BMI), at 4-7 weeks

Mother's BMI


< 17

17-18.4

18.5


n

Mean

SD

n

Mean

SD

n

Mean

SD

Birthweight <2800










Weight: at birth

17

2577

185

63

2419

217

106

2558

173

3 months

17

4866

532

63

5051

631

106

5235

677

6 months

17

6094

535

63

6285

759

106

6481

713

12 months

17

7699

568

63

7792

1104

106

7902

935

Weight gain 0-6 months


3579

452


3802

668


3928

676

6-12 months


1520

444


1505

617


1453

562

Birthweight 2800










Weight: at birth

27

2891

168

124

3105

226

369

3145

263

3 months

27

5186

772

124

5301

642

369

5515

716

6 months

27

6260

681

124

6560

704

369

6660

829

12 months

27

7540

831

124

8012

820

369

8082

936

Weight gain 0-6 months


3278

646


3426

732


3515

829

6-12 months


1240

500


1528

569


1415

516

Numbers at birth adapted to numbers at 3 months.


Table 7b. Statistical analysis

Test: < 2800, < 17 vs 17-18.4:

attained weight + weight gains

NS


< 17 vs 17:

attained weight + weight gains

NS


< 18.5 vs 18.5:

birth weight

t = -1.98

P = 0.049


weight at 3 months

t = -2.35

P = 0.020


weight at 6 months

t = -2.24

P = 0.026


weight at 12 months

NS



weight gains at 0-6 months/6-12 months

NS


2800, <17 vs 17-18.4:

birth weight

t = -2.68

P = 0.008


weight at 3 months/6 months

NS



weight at 12 months

t = -2.64

P = 0.009


weight gain at 0-6 months

NS



weight gain at 6-12 months

t = -2.38

P = 0.019

< 17 vs 17:

birth weight

t = -3.10

P = 0.002


weight at 3 months

t = -1.97

P = 0.050


weight at 6 months

t = -2.34

P = 0.020


weight at 12 months

t = -2.88

P = 0.004


weight gains at 0-6 months/6-12 months

NS


<18.5 vs 18.5:

birth weight

t = -2.76

P = 0.006


weight at 3 months

t = -3.56

P < 0.001


weight at 6 months

t = -2.48

P = 0.014


weight at 12 months

NS



weight gains at 0-6 months/6-12 months

NS


< 2800 vs 2800, BMI < 17:

birth weight

t = -7.37

P < 0.001


weight at 3, 6 and 12 months

NS



weight gains at 0-6 months/6-12 months

NS


BMI 17-18.4:

birth weight

t = -19.47

P < 0.001


weight at 3 months

t = -3.01

P = 0.004


weight at 6 months

t = -2.27

P = 0.024


weight at 12 months

NS



weight gains at 0-6 months/6-12 months

NS


BMI 18.5:

birth weight

t = -25.88

P < 0.001


weight at 3 months

t = -4.14

P < 0.001


weight at 6 months

t = -2.01

P = 0.046


weight at 12 months

NS



weight gain at 0-6 months

t = 4.98

P < 0.001


weight gain at 6-12 months

NS


As commonly observed in undernourished communities, Madurese women were able to produce about 700 g breast milk per day in the first year (Steenbergen et al., 1989). However, these women happen to have a 4-7 week postpartum BMI of 18.5. To assess lactation performance of CED women, infant growth can be used as a proxy for breast milk intake.

Although it is customary to force-feed infants from as early as the first week after birth, the semi-solid additional food (mashed rice and banana) did not influence milk production in the study population (Steenbergen et al., 1991). To adjust for birth weight, infant growth is presented in two categories with a birth weight of 2800 g as cut-off. The infant growth was obviously determined by birth weight (Table 7). The data also reveal the expected upward gradient in weight and weight gain in the first 6 months by increasing post-partum BMI of women in both birth weight categories but only attained weight was significantly lower in the group with a BMI <18.5. Hence, infants remained in their growth channel and there was no catch-up growth. At 12 months the differences by BMI categories disappeared, indicating that the heavier babies at birth started to falter in growth in the second half year of life.

Table 8. Maternal weight (kg) changes in the first year post partum by 4-7 week post-partum (BMI) categories, mean and SD


4-7 week post-partum BMI


< 16

16.0-16.9

17.0-18.4

18.5-22.4

22.5

Months

n

Mean

SD

n

Mean

SD

n

Mean

SD

n

Mean

SD

n

Mean

SD

Post partum
















1

16

35.2

3.1

52

37.5

2.2

230

40.7

2.7

512

44.9

3.6

52

54.8

5.4

3

16

35.7

3.0

52

38.0

2.7

230

40.9

3.0

512

44.7

3.8

52

54.6

5.4

6

11

36.5

4.3

39

38.3

3.1

210

40.9

3.3

502

44.2

4.0

43

54.

6.0

12

11

36.9

4.2

39

38.4

3.6

210

41.1

3.5

502

43.9

4.1

43

52.7

5.6

Change at 1-6

11

+1.3

2.3

39

+0.9

2.6

210

+0.1

2.2

502

-0.7

1.9

52

-0.7


2.6 at 1-12

11

+2.5

3.1

39

+0.8

3.3

210

+0.4

2.9

502

-0.9

2.3

43

-2.1

3.3

Weight changes between

< 16 vs 16-16.9: NS.
< 17 vs 17-18.4: t = -2.40 P = 0.018.
< 17 vs 17: t = -4.56 P <0.001.
< 18.5 vs 18.5: t = -6.57 P <0.001.

Interestingly, in the first 6 months the weight gains of infants with a birth weight <2800 g were consistently and significantly higher than those of the heavier ones at birth. It is tempting to attribute this difference to a substrate limitation to milk production, being insufficient for the bigger babies. One can at least conclude that infants, born to CED women, are not 'in the driving seat', in determining energy intake according to their needs.

The repercussion of lactation on the women is illustrated in Table 8. Contrary to the appreciable weight loss commonly observed among well-nourished lactating women (NAS, 1991), as a group Madurese women did not lose much weight in the first year post partum (0.2 kg, not shown in Table 8). Broken down by post-partum BMI categories at 4-7 weeks, the same pattern of weight changes can be observed as during pregnancy. The severe CED women gained weight (1.3 kg) in the first 6 months and 2.5 kg in the whole year. So did the moderate CED group but only in the first 6 months and to a lesser extent (0.9 kg). Mild CED women had only a slight weight increment of 0.4 kg over the 12 months. On the other hand, the non-CED group lost weight and the fatter women more so (2.1 kg) at BMI (22.5 and 0.9 kg at BMI 18.5-22.4 over the year. There was no difference between primiparae and multiparae. As for the weight changes over pregnancy, the differences in the first 6 months and over the whole period of infancy were highly significant at BMI cut-offs of 17.0 and 18.5 (P < 0.0001).

Trends over two consecutive reproduction cycles

There were 217 women who had given birth twice in the study period and from whom complete data were available on pre-pregnant weight and post-partum weight at 6 and 12 months for the consecutive reproduction cycles. Table 9 shows a remarkable similarity in weight trends by BMI categories as compared with the cross-sectional data. The most severe CED women gained weight while among non-CED weight did not change much.


Contents - Previous - Next