Economic and social factors and the quality of nutrition of pregnant women

Introduction

The manner of nutrition of future mothers has a significant influence on the proper course of the pregnancy and the newborn’s measurements at birth [1–5]. Intrauterine malnutrition, which is the cause of low birth weight, may create favourable conditions for the development of future metabolic abnormalities by disrupting the development of blood vessels, pancreas -cells, insulin resistance, impairment of muscle development, abnormal functions of the liver, kidneys and other organs [6]. The level of education and the social-and-economical status, connected with the amount of income, are part of the factors which decide in a significant way on the manner of a person’s nutrition [7–10]. Research concerning the influence of these factors on the nutrition of pregnant women was conducted mainly in developing countries, whereas there are relatively few reports on the subject originating from developed countries [11–16].

Aim of the research

The aim of the research was to assess the manner of nutrition of pregnant women depending on the level of their education and financial resources required to buy the necessary food.

Material and methods

The research was conducted within the years 2011–2012, in gynaecological and obstetric examination rooms and outpatient clinics in the Świętokrzyskie Voivodeship. Seven hundred and four pregnant women participated in the research, and 677 women were qualified for further analysis; 12.4% of them were in their first, 25.4% in their second and 62.2% in their third trimester of pregnancy. Information about social variables and consumption of selected products and beverages, and intake of folic acid and other vitamin and/or mineral supplements was obtained using an anonymous questionnaire. The questions in the questionnaire concerned the number of consumed portions in individual groups of products. The size of a portion was defined according to the principles presented in the literature [17]. Among the examined women, 21.0% received primary education (primary or basic vocational), 37.7% received secondary education and 41.3% received higher education (Bachelor’s or Master’s degree). In order to assess the possession of sufficient financial resources to purchase the necessary food, the women answered the following question: Do you always have enough money to buy the food that you need? (yes/no).



Statistical analysis



The non-parametric2 test was used in statistical analysis. A p < 0.05 was assumed as the level of significance. Only the products where statistically significant differences in consumption were observed, were presented in the tables. Isolation of the nutritional habits coexisting with corresponding categories of education and financial resources sufficient to buy the necessary food was done using correspondence analysis.

Results

Women with the lowest level of education consumed the least fruit, vegetables, legumes, milk and dairy products, saltwater fish and wholegrain foods; whereas the highest consumption of the aforementioned products was found among women with higher education (Table 1). The level of education of the examined did not influence the consumption of products which were the source of animal protein, that is meat, fish and eggs; and that of sweets and cereal products in general. Pregnant women with higher education ate more regularly and drank sweetened soft drinks significantly less often than other women (Table 2); whereas no significant differences were found in the consumption of alcohol beverages depending on education. 16.5% of all examined women admitted to having drunk alcohol while pregnant.

94.3% of women with higher education, and 80.3% of those with primary education, took folic acid during pregnancy; moreover, in the second group, it was more often only after the twelfth week of pregnancy that folic acid was taken (Table 2). Less frequent use of other vitamin and/or mineral supplements, including those which provided n-3 polyunsaturated fatty acids, was also connected to a lower level of education.

Among the women in the research, 15.4% (n = 104) declared a lack of sufficient financial resources to buy the necessary food. This factor was connected in a significant way to lower consumption of fruit, vegetables, products providing animal protein, milk and dairy products, saltwater fish, wholegrain products (Table 3) and vitamin and/or mineral supplements (Table 4). Whereas no differences were found in the consumption of leguminous vegetables, general grain products, as well as sweets and alcohol. Only sweetened soft drinks were consumed more often by women who did not have enough financial resources (Table 3).

Correspondence analysis showed that there was a connection between a higher level of education, and at the same time having enough financial resources to buy food, and intake of folic acid and other vitamin and/or mineral supplements, as well as the highest consumption of wholegrain products, saltwater fish, fruit, products being the source of animal protein, milk and dairy products, and not consuming sweetened soft drinks (Figure 1). The point standing for the lowest level of education was located in the chart very close to the point standing for the lack of sufficient financial resources to buy the necessary food. The lowest consumption of the following products was connected to these points: milk and dairy products, vegetables, fruit, products being the source of animal protein, saltwater fish, wholegrain products, lack of intake of folic acid and other vitamin and/or mineral supplements and the highest consumption of sweetened soft drinks.

Next, the frequency of consumption of all products and supplements by the 104 women who declared lack of sufficient financial resources to buy the necessary food was analysed in relation to their level of education. It should be stressed that significantly fewer pregnant women with higher education were found in this group than among all the examined women, that is 20.2%; and more of them were found with primary education – 40.4% (p = 0.0003). The 2 test showed that the differentiating influence of education proved to be statistically significant in the case of saltwater fish and wholegrain products consumption (Table 5). The differences in consumption of the remaining products did not, in truth, pass the level of significance, however, the percentage of women with primary education declaring the lowest category of consumption of many of the products (that is less than one portion a day) was much higher in comparison to the percentage of participants with higher education and was respectively: 38.1% vs. 26.8% in the case of milk and dairy products; 38.1% vs. 4.8% in the case of fruit and 47.6% vs. 19.0% in the case of vegetables. This fact indicates a clear tendency of less frequent consumption of the aforementioned products by pregnant women with poorer education. The differences in supplement intake by women not having enough financial resources in relation to the level of their education also did not turn out to be statistically significant. It should however be stressed that 67% of women in the group with higher education took them, 61% in that with secondary education and only 38% in that with primary education, whereby none of the women with primary education took supplements containing n-3 polyunsaturated fatty acids.

Discussion

Analysis of the influence of social factors on the birth weight of newborns in the Polish population showed that a mother’s low level of education significantly heightens the risk of low birth weight in their children [18]. Results of the research conducted in the Świętokrzyskie Voivodeship show that the existence of this kind of relationship may, to a great degree, be due to an insufficient quality of the diet of pregnant women. Both the level of education and lack of sufficient financial resources to buy the necessary food lower in a significant way the consumption by the examined women of vitamin and/or mineral supplements and products such as fruit, vegetables, milk and dairy products, saltwater fish, wholegrain products, and in the case of a financial deficit, also of products being a source of animal protein. The social and economic factors under consideration did not influence only the consumption of products such as sweets and alcohol; whereas the consumption of sweetened soft drinks was higher in the group of women with a lower level of education and declaring financial deficits. The study of literature done by Skagerstróm et al. [19] shows that drinking alcohol by pregnant women was most related with its consumption before the pregnancy and exposure to violence. Some of the research showed that high income and/or a high social status favour drinking alcohol. Research concerning the influence of education or unemployment on drinking during pregnancy were the least coherent.

Results of other authors’ research confirm that pregnant women with a lower education and having lower income had a worse diet in terms of quality [11–16, 20]. Especially, insufficient consumption of vegetables [11] and fish [12] was found. Previous research in the Świętokrzyskie Voivodeship also showed that after taking into consideration the intake of supplements during pregnancy, as well as consumption of saltwater fish in accordance with recommendations, the risk of n-3 polyunsaturated fatty acids’ deficiency occurred in a significantly lower percentage of women with higher education (44.6%) than in women with secondary education (61.4%) or primary education (71.1%) [15].

It is mostly the limited financial capabilities for a free choice of food that decide about the errors in nutrition made by people with a low social and economic status. Less wealthy people to a greater degree satisfy their nutritional needs with cheaper food, one with lower nutrient content, but with more energy value [10, 21, 22]. Low energy value of products such as vegetables, fruit and fish is connected with a higher cost of a food-ration; also the cost of wholegrain products is usually higher than that of white-flour products. Admittedly, the definition of having insufficient financial resources is subjective in this research and does not have to precisely reflect the actual income, however the percentage of women who declared a difficult financial situation (15.4%) seems to be similar to the results of sociological research. It was lower than the percentage of people living below the relative poverty threshold, which is 26.2% in the Świętokrzyskie Voivodeship, and only slightly higher than the percentage of people living below the statutory poverty line (11.9%) [23]. Research on determinants of nutritional behaviour shows that, in general, with growth of education there is not only growth of income but also a higher level of knowledge about the available products and the possibilities of their use, and greater expectations towards the purchased products, which in a significant way influences the rationalisation of the diet [24]. Lack of sufficient income may also be a strong stimulus of stress for pregnant women. Fowles et al. [16] proved that psychosocial stress in pregnant women with low income had a significant and direct influence on worse nutritional habits and a direct and indirect one on the quality of their diet.

Conclusions

The diet of pregnant women, worse in terms of quality and characterised by low consumption of fruit, vegetables, milk and dairy products, saltwater fish and wholegrain products as well as more frequent consumption of sweetened soft drinks was connected with both insufficient financial resources to buy the necessary food and a low level of education. The social and economic factors under consideration did not, however, differentiate the consumption of sweets and alcohol among the examined women.

Women with higher education, even in the case of having low income, chose products more consistent with the principles of proper nutrition, which confirms the positive influence of awareness and greater knowledge on their nutrition.

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Address for correspondence:



Edyta Suliga MD, PhD, Prof. UJK

Faculty of Health Sciences

of the Jan Kochanowski University

Al. IX Wieków Kielc 19, 25-317 Kielce, Poland

Phone: +48 41 349 69 35

E-mail: edyta.suliga@ujk.edu.pl