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Fulltext Knowledge, attitudes and practice of preconception care among women attending maternal health clinic in Kelantan

Kasim R, Draman N, Abdul Kadir A, Muhamad R

Education in Medicine Journal, 2016;8(4):57-68.
MyJurnal

Introduction: Pregnancy is common among women in the reproductive age and is associated with several risks. Preconception care has thus been introduced to promote health before conception and to improve pregnancy-related outcomes. The aim of this study was to determine the level of knowledge, attitudes and practices regarding preconception care among women attending antenatal care appointments. Methodology: This was a cross-sectional study conducted from April to December 2012 at Klinik Kesihatan Bachok. A self-administered questionnaire was administered to 135 respondents from 18 to 45 years of age. The questionnaire consisted of four domains, assessing socio-demographic data and knowledge, attitudes and practice of preconception care. Results: The mean (SD) knowledge, attitude and practice scores were 11.37 (3.94), 15.39 (2.12) and 10.13 (2.30), respectively. In total, 98.5% of the respondents had good attitudes, 45.2% had good practices, and 51.9% had good knowledge of preconception care. Conclusion: Women in Bachok have fair knowledge of and good attitude towards preconception care. However, they have poor preconception care practices.

Matched MeSH terms: Pregnancy Outcome
Fulltext A retrospective review of 25 cases of lethal fetal anomalies

Dalia, F.A., Hamizah, I., Zalina, N., Yong, S.L., Mokhtar, A.

International Medical Journal Malaysia, 2016;15(1):19-23.
MyJurnal

Introduction: To review the gestational age at diagnosis, method of diagnosis, pregnancy outcome and
maternal complications of prenatally diagnosed lethal foetal anomalies. Methods: Retrospective review of 25
women who had aborted or delivered foetuses with lethal anomalies in a tertiary hospital in 2011 based on
patient medical records. Results: There were a total of 10,088 deliveries, in which 25 (0.24%) women were
found to have conceived foetuses with lethal anomalies. All of them were diagnosed by prenatal ultrasound
and only 7 (28.0%) had both prenatal ultrasound and genetic study done. The women’s mean age was 29.9
years old. The mean gestational age at diagnosis of lethal foetal anomalies was 25.5 weeks (SD=12.5) and
mean gestational age at termination of pregnancy (TOP) or delivery was 28.5 weeks (SD=12.5). Seven (28%)
women had early counseling and TOP at the gestation of < 22 weeks. Beyond 22 weeks of gestation, eight
(32%) women had TOP and ten (40%) women had spontaneous delivery. Twenty (80%) women delivered or
aborted vaginally, three (12%) women with assisted breech delivery and two (8%) women with abdominal
delivery which were performed due to transverse foetal lie in labour and a failed induction, leading to
emergency hysterotomy complicated by hysterectomy due to intraoperative finding of ruptured uterus.
Overall, the associated post-partum adverse events included post-partum haemorrhage (12%), retained
placenta (12%), blood transfusion (8%), uterine rupture (4%) and endometritis (4%). Mean duration of hospital
stay was 6.6 days (SD 3.7 days). Conclusion: Late diagnosis of lethal foetal anomalies leads to various
maternal morbidities, in this case series , which could have been prevented if they were diagnosed and
terminated at early trimester. A new direction is needed in our local practice.

Matched MeSH terms: Pregnancy Outcome
Advanced maternal age and adverse pregnancy outcomes in Muar, Johor, Malaysia

Herny Erdawati Mohd Rashed, S Maria Awaluddin, Noor Ani Ahmad, Nurul Huda Md Supar, Zubidah Md Lani, Fauziah Aziz, et al.

Sains Malaysiana, 2016;45:1537-1542.

Various factors may contribute to adverse pregnancy outcomes; either maternal or foetal outcomes. This study aimed was
to determine the association between advanced maternal age and adverse pregnancy outcomes. This is a cross sectional
study. Data were collected from the birth records from January 1st 2012 until December 31st 2012 in Muar District.
Descriptive and multiple logistic regression analyses were done and the results were presented as adjusted odds ratio
(aOR) with p-value <0.05. The proportion of birth in Muar district, Johor was 14.8% among mothers aged 35 years
and older and 85.2% among mothers aged 20 to 34 years. Advanced maternal age was associated with pregnancyinduced
hypertension (aOR: 5.00; 95%CI: 1.95-12.65), gestational diabetes mellitus (aOR: 2.32; 95%CI: 1.35-4.00)
and Caesarean section (aOR: 2.21; 95%CI: 1.53-3.19). Anaemia was negatively associated with advanced maternal
age (aOR: 0.50; 95%CI: 0.32-0.78). No significant association was found between advanced maternal age and adverse
foetal outcomes. In view of the findings, special attention should be paid to the antenatal mothers aged 35 years and
older, even to those without any pre-existing medical problems.

Matched MeSH terms: Pregnancy Outcome
Fulltext Exploring the determinant of pre-pregnancy care services usage among reproductive ages women in Kedah, Malaysia

Rozaimah Abu Talib, Idayu Badilla Idris, Rosnah Sutan, Norizan Ahmad, Norehan Abu Bakar, Sharifah Hildah Shahab

Int J Public Health Res, 2016;6(2):719-726.
MyJurnal

Introduction In Malaysia although mortality rate among women of reproductive ages has
reduced over the years, the reduction has been stagnant for the past ten years.
In order to achieve the 5th Millennium Development Goal, several measures
need to be taken including a proper implementation of pre-pregnancy
services in this country. This study explores the awareness, intention and
usage of pre-pregnancy care (PPC) services and its determinant among
women of reproductive ages in Kedah, Malaysia.

Methods This is a qualitative study, which consisted of a focus group discussion
(FGD) among women in the ages of 18 to 45 years old from all ethnic groups
who attended four government clinics in the state of Kedah. The mothers
were chosen through purposive sampling from twelve districts that were
selected through a multistage random sampling. A semi-structured
questionnaire was utilized during the FGD. The results from the FGD were
recorded verbatim and thematic analysis was finalized once saturation of
information from respondents was achieved.

Results These are two themes was identified, namely personal reasons and reasons of
service and there are several subthemes under two main themes. Under the
Personal reason themes, the subthemes including awareness and intention to
used the services, knowledge, perception, social support and history of
medical illness. While under pre-pregnancy care services themes, the
subthemes including the promotion of the services, the communication
relationship with the health staff, the waiting time and also the accessibility
of the service.

Conclusions As a conclusion, there is still part of society who was unaware of prepregnancy
services and its importance in reducing maternal mortality rate as
well as producing good pregnancy outcome. Information and knowledge on
pre-pregnancy care services should be disseminated among community
members through various means including roadshows and pre wedding
workshops.

Matched MeSH terms: Pregnancy Outcome
Impact of maternal marital status on birth outcomes among young Malaysian women: a prospective cohort study

Mohd Zain N, Low WY, Othman S

Asia Pac J Public Health, 2015 Apr;27(3):335-47.
PMID: 25005933 DOI: 10.1177/1010539514537678

This study evaluated the impact of maternal marital status on birth outcomes among young Malaysian women and investigated other risk factors influencing the birth outcomes. Pregnant women with and without marital ties at the point of pregnancy diagnosis were invited to participate in this study. Participants were interviewed using a structured questionnaire at pregnancy diagnosis and shortly after childbirth. From a total of 229 unmarried and 213 married women who participated, marital status was significantly associated with preterm birth (odds ratio [OR], 1.66; 95% confidence interval [CI], 1.05-2.61) and low birth weight (OR, 3.61; 95% CI, 1.98-6.57). Other factors significantly associated with birth outcomes was prenatal care (OR, 4.92; 95% CI, 1.43-16.95), "use of drugs" (OR, 10.39; 95% CI, 1.14-94.76), age (OR, 1.12; 95% CI, 1.07-1.16), and number of prenatal visits (OR, 1.03; 95% CI, 1.00-1.07). Promoting access to prenatal care and social support programs for unmarried mothers may be important to reduce adverse pregnancy outcomes.

Matched MeSH terms: Pregnancy Outcome/epidemiology*
Pregnancy outcomes with a primary complaint of perception of reduced fetal movements

Nor Azlin MI, Maisarah AS, Rahana AR, Shafiee MN, Aqmar Suraya S, Abdul Karim AK, et al.

J Obstet Gynaecol, 2015 Jan;35(1):13-5.
PMID: 24987985 DOI: 10.3109/01443615.2014.930108

Reduced fetal movement is a worrisome common complaint, not only for mothers but also for the attending medical personnel. The aim of this study was to analyse the pregnancy outcomes of women who presented primarily with reduced fetal movements (RFM). A retrospective study was performed based on patients' perception alone. Obstetric, past medical history, current presentation and outcomes of pregnancy were analysed. A total of 230 case notes were reviewed, with the majority being primigravidae. Less than half (48.7%) of the women had spontaneous labour, 45.7% had induction and 5.6% had elective caesarean section. There were no maternal complications in 97.4% (n = 224) of them. About 0.9% (n = 2) and 1.7% (n = 4) had primary postpartum haemorrhage and extended perineal tear, respectively. Although there was no major neonatal mortality and morbidity, until a randomised trial with a significant sample is conducted in the management of RFM, careful selections for elective delivery or conservative management would prevent untoward complications.

Matched MeSH terms: Pregnancy Outcome*
When Pregnancy Goes SOUTH: Keeping Birth Gentle

Lim R

Midwifery Today Int Midwife, 2015.
PMID: 26309925
Matched MeSH terms: Pregnancy Outcome/epidemiology*
The impact of endometrioma on IVF/ICSI outcomes: a systematic review and meta-analysis

Hamdan M, Dunselman G, Li TC, Cheong Y

Hum. Reprod. Update, 2015 Nov-Dec;21(6):809-25.
PMID: 26168799 DOI: 10.1093/humupd/dmv035

Endometriosis is a disease known to be detrimental to fertility. Women with endometriosis, and the presence of endometrioma, may require artificial reproductive techniques (ART) to achieve a pregnancy. The specific impact of endometrioma alone and the impact of surgical intervention for endometrioma on the reproductive outcome of women undergoing IVF/ICSI are areas that require further clarification. The objectives of this review were as follows: (i) to determine the impact of endometrioma on IVF/ICSI outcomes, (ii) to determine the impact of surgery for endometrioma on IVF/ICSI outcome and (iii) to determine the effect of different surgical techniques on IVF/ICSI outcomes.

Matched MeSH terms: Pregnancy Outcome
Determining optimal gestational weight gain in a multiethnic Asian population

Ee TX, Allen JC, Malhotra R, Koh H, Østbye T, Tan TC

J Obstet Gynaecol Res, 2014 Apr;40(4):1002-8.
PMID: 24611987 DOI: 10.1111/jog.12307

To define the optimal gestational weight gain (GWG) for the multiethnic Singaporean population.

Matched MeSH terms: Pregnancy Outcome
Weighing the evidence of low glycemic index dietary intervention for the management of gestational diabetes mellitus: an Asian perspective

Mohd Yusof BN, Firouzi S, Mohd Shariff Z, Mustafa N, Mohamed Ismail NA, Kamaruddin NA

Int J Food Sci Nutr, 2014 Mar;65(2):144-50.
PMID: 24517860 DOI: 10.3109/09637486.2013.845652

This review aims to evaluate the effectiveness of low glycemic index (GI) dietary intervention for the treatment of gestational diabetes mellitus (GDM), specifically from the Asian perspective. A systematic review of the literature using multiple databases without time restriction was conducted. Three studies were retrieved based upon a priori inclusion criteria. While there was a trend towards improvement, no significant differences were observed in overall glycemic control and pregnancy outcomes in GDM women. However, a tendency for lower birth weight and birth centile if the intervention began earlier was noted. Low GI diets were well accepted and had identical macro-micronutrient compositions as the control diets. However, due to genetic, environment and especially food pattern discrepancies between Western countries and Asians, these results may not be contributed to Asian context. Clearly, there are limited studies focusing on the effect of low GI dietary intervention in women with GDM, particularly in Asia.

Matched MeSH terms: Pregnancy Outcome*
Fulltext Talcum powder or aqueous gel to aid external cephalic version: a randomised controlled trial

Vallikkannu N, Nadzratulaiman WN, Omar SZ, Si Lay K, Tan PC

BMC Pregnancy Childbirth, 2014 Jan 28;14:49.
PMID: 24468078 DOI: 10.1186/1471-2393-14-49

BACKGROUND: External cephalic version (ECV) is offered to reduce the number of Caesarean delivery indicated by breech presentation which occurs in 3-4% of term pregnancies. ECV is commonly performed aided by the application of aqueous gel or talcum powder to the maternal abdomen. We sought to compare gel with powder during ECV on achieving successful version and increasing tolerability.
METHOD: We enrolled 95 women (≥ 36 weeks gestation) on their attendance for planned ECV. All participants received terbutaline tocolysis. Regional anaesthesia was not used. ECV was performed in the standard fashion after the application of the allocated aid. If the first round (maximum of 2 attempts) of ECV failed, crossover to the opposing aid was permitted.
RESULTS: 48 women were randomised to powder and 47 to gel. Self-reported procedure related median [interquartile range] pain scores (using a 10-point visual numerical rating scale VNRS; low score more pain) were 6 [5-9] vs. 8 [7-9] P = 0.03 in favor of gel. ECV was successful in 21/48 (43.8%) vs. 26/47 (55.3%) RR 0.6 95% CI 0.3-1.4 P = 0.3 for powder and gel arms respectively. Crossover to the opposing aid and a second round of ECV was performed in 13/27 (48.1%) following initial failure with powder and 4/21 (19%) after failure with gel (RR 3.9 95% CI 1.0-15 P = 0.07). ECV success rate was 5/13 (38.5%) vs. 1/4 (25%) P = 0.99 after crossover use of gel or powder respectively. Operators reported higher satisfaction score with the use of gel (high score, greater satisfaction) VNRS scores 6 [4.25-8] vs 8 [7-9] P = 0.01.
CONCLUSION: Women find gel use to be associated with less pain. The ECV success rate is not significantly different.
TRIAL REGISTRATION: The trial is registered with ISRCTN (identifier ISRCTN87231556).

Matched MeSH terms: Pregnancy Outcome
Fulltext Factors associated with placenta praevia in primigravidas and its pregnancy outcome

Nur Azurah AG, Wan Zainol Z, Lim PS, Shafiee MN, Kampan N, Mohsin WS, et al.

ScientificWorldJournal, 2014;2014:270120.
PMID: 25478587 DOI: 10.1155/2014/270120

To examine the factors associated with placenta praevia in primigravidas and also compare the pregnancy outcomes between primigravidas and nonprimigravidas.

Matched MeSH terms: Pregnancy Outcome*
A case series of α-thalassemia intermedia due to compound heterozygosity for Hb Adana [HBA2: c179G>A (or HBA1); p.Gly60Asp] with other α-thalassemias in Malay families

Alauddin H, Jaapar NA, Azma RZ, Ithnin A, Razak NF, Loh CK, et al.

Hemoglobin, 2014;38(4):277-81.
PMID: 24829075 DOI: 10.3109/03630269.2014.916720

Hb Adana [HBA2: c179G>A (or HBA1); p.Gly60Asp] is a rare hemoglobin (Hb) variant due to a mutation at codon 59 of the α2- or α1-globin gene resulting in a glycine to aspartic acid substitution. Two siblings with a unique coinheritance of Hb Adana and Hb Constant Spring (Hb CS, α142, Term→Gln, TAA>CAA; HBA2: c.427 T>C) (α(codon 59)α/α(CS)α), were compared phenotypically with another two siblings carrying the Hb Adana mutation and a 3.7 kb deletion (α(codon 59)α/-α(3.7)). Although they all had α-thalassemia intermedia (α-TI), the former were clinically more severe than the latter. The first pair of siblings presented at a much younger age than the second pair and showed lower Hb levels and significant extramedullay hemopoiesis. Another case of a hydropic fetus as a result of Hb H/Hb Adana is also described. Their clinical phenotypes and hematological parameters are all presented for comparison.

Matched MeSH terms: Pregnancy Outcome
Fulltext Successful external cephalic version: factors predicting vaginal birth

Lim PS, Ng BK, Ali A, Shafiee MN, Kampan NC, Mohamed Ismail NA, et al.

ScientificWorldJournal, 2014;2014:860107.
PMID: 24587759 DOI: 10.1155/2014/860107

To determine the maternal and fetal outcomes of successful external cephalic version (ECV) as well as factors predicting vaginal birth.

Matched MeSH terms: Pregnancy Outcome
Fulltext Corticosterone-induced oxidative stress alters epididymal sperm fertility in rats

Abd-Aziz, N.A.A., Chatterjee, A., Chatterjee, R., Durairajanayagam, D.

ASM Science Journal, 2014;8(2):117-124.
MyJurnal

Elevated glucocorticoid levels during stressed conditions have been demonstrated to impair reproductive function in rats. In our previous study investigating the dose-related effects of corticosterone (CORT) on the fertilising capacity of epididymal sperm in surgically-manipulated rats, we found that 25 mg/kg/day of CORT given subcutaneously for seven consecutive days significantly decreased the number of implantation sites and increased intrauterine embryonic loss compared to controls. Based on these findings, the current study aims to elucidate the possible mechanisms of action of CORT-induced stress on impaired sperm fertility in rats. Results of the present study showed that compared to controls, 25 mg/kg/day of CORT given subcutaneously for 7 consecutive days significantly increased the level of plasma malondialdehyde (MDA) with corresponding attenuated levels of superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT) activities. Plasma adrenocorticotropin (ACTH) and testosterone levels were also found to be decreased in CORTtreated rats. These findings suggest that CORT-induced oxidative stress and exert an inhibitory effect at the hypothalamic-pituitary-gonadal (HPG) axis, as evidenced by increased lipid peroxidation, reduced enzymatic antioxidant activities, and decreased testosterone production. These subsequently result in decreased fertilising capacity of epididymal sperm leading to poor pregnancy outcomes.

Matched MeSH terms: Pregnancy Outcome
Feasibility of successful pregnancies in women with spinal injury

Nor Azlin MI, Abd Rahman R, Abdul Karim AK, Sulaiman AS, Mahdy ZA

J Obstet Gynaecol, 2013 Aug;33(6):631-2.
PMID: 23919870 DOI: 10.3109/01443615.2013.807781
Matched MeSH terms: Pregnancy Outcome
Homeostatic indices of insulin resistance among gestational diabetics in anticipating pregnancy complications

Ismail NA, Kasim MM, Noor Aizuddin A, Umar NA

Gynecol Endocrinol, 2013 Jul;29(7):691-4.
PMID: 23772780 DOI: 10.3109/09513590.2013.797398

OBJECTIVE: This was to determine HOMA-IR score as well as to assess its association in fetal and maternal outcomes among pregnant women with diabetes risks.
METHODS: A prospective cohort study of pregnant women with diabetes risks was done. GDM was diagnosed using modified glucose tolerance test. Serum insulin was taken and measured by an electrochemiluminescence immunoassay method. Plasma glucose was measured by enzymatic reference method with hexokinase. HOMA-IR score was calculated for each patient. Maternal and fetal outcomes were analyzed.
RESULTS: From 279 women recruited, 22.6% had GDM with higher HOMA-IR score (4.07 ± 2.44 versus 2.08 ± 1.12; p = 0.001) and fasting insulin (16.76 ± 8.63 µIU/L versus 10.15 ± 5.07 µIU/L; p = 0.001). Area under ROC curve for HOMA-IR score was 0.79 (95% confidence interval, 0.74-0.84) with optimum cut-off value of 2.92 (sensitivity = 63.5%; specificity = 89.8%), higher than recommended by IDF (2.38). This point showed significant association with neonatal hypoglycemia (p = 0.02) and Cesarean section (p = 0.04) in GDM mothers.
CONCLUSIONS: HOMA-IR score and insulin resistance levels were higher in GDM women in our population. With the cut-off HOMA-IR value of 2.92, neonatal hypoglycemia and Cesarean section were significant complications in GDM mothers. This can be used in anticipation of maternal and fetal morbidities.

Matched MeSH terms: Pregnancy Outcome/epidemiology
Effect of melatonin supplementation on pregnancy outcome in Wistar-Kyoto and Sprague-Dawley rats

Singh HJ, Saleh HI, Gupalo S, Omar E

Sheng Li Xue Bao, 2013 Apr 25;65(2):149-57.
PMID: 23598870

Although melatonin supplementation is known to influence numerous physiological functions, little is however known of its effects on pregnancy outcome. This study investigated the effects of melatonin supplementation on pregnancy outcome in Wistar-Kyoto (WKY) and Sprague-Dawley (SD) rats aged 12-13 weeks. Upon confirmation of proestrus, each female rat was housed overnight with a male of the same strain. On the next morning, following confirmation of mating (vaginal smear), WKY female rats were isolated into individual metabolic cages and given 0, 25, 50 or 100 mg/kg per day of melatonin in drinking water from day 1 of pregnancy to day 21 postpartum. SD females were given 0 or 100 mg/kg per day of melatonin. Maternal weight, duration of pregnancy, litter size, birth weight and body weight of pups up to day 42, and pup mortality were recorded. Data were analyzed using ANOVA for repeated measures. Compared to controls, maternal weight gain during pregnancy was significantly lower in melatonin-supplemented dams (P < 0.01). Litter size was significantly smaller in melatonin-supplemented dams (P < 0.01). Mean birth weight of pups was significantly lower only in pups of dams given 100 mg/kg per day of melatonin (P < 0.001). Mean body weight of pups of dams given melatonin was significantly lower than controls (P < 0.01). Pup mortalities were 9.5% and 21.6% in WKY dams given 25 and 100 mg/kg per day of melatonin respectively, and all pup deaths occurred after day 21 of weaning. The results suggest that melatonin supplementation during antenatal and postpartum period appears to adversely affect litter size, pup growth and mortality in WKY and SD rats. The precise mechanism causing the death is not clear.

Matched MeSH terms: Pregnancy Outcome*
Fulltext Differential outcomes in an extended family with constitutional t(11;22)(q23.3;q11.2)

Kee SK, See VH, Chia P, Tan WC, Tien SL, Lim ST

J Pediatr Genet, 2013 Mar;2(1):37-41.
PMID: 27625838 DOI: 10.3233/PGE-13046

The t(11;22) rearrangement is the most common recurrent familial reciprocal translocation in man. Heterozygote carriers are phenotypically normal but are at risk of subfertility in the male, miscarriages, and producing chromosomally unbalanced offspring. The unbalanced progeny usually results from an extra der(22) chromosome resulting from a 3:1 malsegregation. We present here a family with t(11;22). Of six siblings, three were found to be carriers following prenatal diagnosis of the proband fetus. Neither of the two married carrier siblings have a live born child. In keeping with the prevailing knowledge of the pregnancy outcomes of heterozygote carriers, between the siblings they had recurrent miscarriages, a fetus with a +der(22) chromosome, and other subfertility issues resulting in multiple failed in vitro fertilization cycles with preimplantation genetic diagnosis. However, unlike the siblings, their extended family comprising their heterozygote translocation mother, married aunts and an uncle had normal fertility and a lack of a history of miscarriages or an abnormal child. The differing outcomes may be related to the male partners having additional semen anomalies which may further exacerbate problems associated with the t(11;22). Because the t(11;22) rearrangement tends to run in families, it is recommended that chromosome studies are offered to family members of an affected relative as an option, and provide them with appropriate genetic counseling so that they will have the necessary information with regard to their risk for subfertility, miscarriages, and production of viable unbalanced offspring. Follow-up prenatal diagnosis should also be offered to affected expectant family members, especially after preimplantation genetic diagnosis.

Matched MeSH terms: Pregnancy Outcome
Fulltext Association between maternal food group intake and birth size

LOY S, MARHAZLINA M, HAMID JAN J

Sains Malaysiana, 2013;42(11):1633-1640.

Maternal nutrition is one of the dominant factors in determining fetal growth and subsequent developmental health for both mother and child. This study aimed to explore the association between maternal consumption of food groups and birth size among singleton, termed newborns. One hundred and eight healthy pregnant women in their third trimester, aged 19 to 40 years who visited the Obstetrics and Gynecology Clinic of Hospital Universiti Sains Malaysia completed an interviewed-administered, validated semi-quantitative food frequency questionnaire. The maternal socio-demographic, medical and obstetric histories and anthropometry measurements were recorded accordingly. The pregnancy outcomes, birth weight, birth length and head circumference were obtained from the medical records. The data were analyzed using multiple linear regression by controlling for possible confounders. Among all food groups, fruits intake was associated with higher birth weight (p=0.018). None of the food intake showed evident association with respect to birth length while only fruits intake was associated positively with head circumference (p=0.019). In contrast, confectioneries and condiments were associated with lower birth weight (p=0.013 and p=0.001, respectively). Also, condiments appeared to associate inversely with ponderal index (p=0.015). These findings suggest the potential beneficial effects of micronutrient rich food but detrimental effects of high sugar and sodium food on fetal growth. Such an effect may have long term health consequences to the lives of children.

Matched MeSH terms: Pregnancy Outcome

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