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Brief Reports Indian Pediatrics 2002; 39:365-368 |
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Zinc and Magnesium Nutriture Amongst Pregnant Mothers of Urban Slum Communities in Delhi: A Pilot Study |
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Zinc and magnesium are known to be limiting in the diets of the socio-economically weaker sections of the population(1,2). Mild/moderate zinc deficiency is associated with eclampsia, uterine dystocia, prolonged labor, premature delivery and rupture of membranes, increased lacerations and placental abruption(3,4). A number of recent epidemiological findings have implicated magnesium as being an essential element for fetal well being(5,6). Trials have documented that oral supplementation of magnesium in physiological amounts during pregnancy reduces pregnancy hypertension, miscarriage, premature birth and fetal growth retard-ation(6,7). Limited data is available on the nutriture of zinc and magnesium amongst pregnant mothers from India; hence, the present study was conducted to assess the status of these elements amongst pregnant mothers from urban slum communities of Delhi, India. Subjects and Methods The present study was conducted amongst pregnant mothers belonging to three urban slum communities of Delhi. A total of 829 pregnant mothers (more than 12 weeks of gestational age) attending the antenatal clinic, Rural Health Training Center, Najafgarh, New Delhi were included. All consecutive pregnant mothers attending the clinic for the first time were enrolled in the study. Consent of the pregnant mothers to participate in the study was taken. All the biochemical estimations to be undertaken were explained to them. Each pregnant mother was inquired about her age, gestational age, socio-economic status and other demographic parameters by utilizing a pretested semi-structured questionnaire. A subset of 109 pregnant mothers was selected randomly utilizing random tables out of the 829 enlisted women to assess their dietary intake. The dietary intake of the individual subjects was assessed using the 24 hours dietary recall method(8). The intake of energy, protien, zinc and magnesium in the subjects was calculated by using the Nutritive Value of Indian Foods by Indian Council of Medical Research(9). Another subset of 90 pregnant mothers was randomly selected utilizing random tables out of the 829 enlisted subjects to assess zinc and magnesium status. Blood from antecubital vein was drawn from the subjects and collected in previously labeled polypropylene tubes. Blood was transported in ice packs to the central laboratory for separation of serum. The samples were centrifuged at 3500 rpm at 4ºC for 30 minutes for the collection of serum. Serum zinc and magnesium was determined by the standard atomic absorption spectro-photometry method(10). Results Out of a total of 829 pregnant mothers enrolled for the study, 54% (n = 448) of them were in gestational age 12 to < 28 weeks and 46% (n = 381) in 28 weeks and more. The pregnant mothers were of the age group 17-40 years. More that 54% of them belonged to the age group 20-25 years. The dietary intake data revealed that the mean daily intake of calories and protein was 1500 Kcal and 46.4 g, respectively. Nutrient intake of the pregnant mothers was significantly lower than their recommended dietary allowance. A total of 31.2 and 6.4 per cent of the study population was consuming less than the minimum of RDA for zinc (5-15 mg) and magnesium (200-300 mg) respectively (Table I)(9). Fifty-six and five per cent of the pregnant mothers had deficient zinc (serum level less than 60 mcg/dl) and magnesium (serum level less than 1500 mcg/dl) nutriture, respectively (Table II)(11). On comparison of pregnant mothers of different gestational age, it was also found that with increase in gestational age the serum zinc levels decreased. This change in the levels was found to be statistically significant (p = 0.045). The mean serum zinc level was 64.5 and 56.3 mcg/dl amongst the pregnant mothers of the second and third trimester, respectively.
Discussion In the present study, 55.5% and 4.6% of pregnant mothers had deficiency of zinc and magnesium, respectively as revealed by serum level. Low intake of zinc by the study subjects may be a contributing factor for low serum zinc levels among the pregnant mothers. A similar finding has been reported from an earlier study(12). A decline in serum levels of zinc and magnesium was observed with increase in gestational age. Similar results have been documented in studies conducted in developed countries(13). This may be due to altered binding affinity of zinc proteins and increased transfer of zinc from the mother to the fetus(12,14). Hemo-dilution during preg-nancy is another contributing factor for the lowered concentration of these trace elements. There are limited studies on maternal serum zinc and magnesium levels from the country. However, studies conducted in the developed nations have documented that the zinc concentrations in the plasma of pregnant women of the Indian origin was significantly lower than that of white pregnant women in Natal, South Africa, and was apparently related to lower dietary intake(15). Studies have also documented that 82% of the pregnant women worldwide are likely to have an inadequate intake of zinc(16). The limitation of the present study was that the pregnant mothers without clinical signs and symptoms of any pathological conditions and morbidity were included in the study. The results of the present study indicate a need of longitudinal studies with larger sample size need to be undertaken in different parts of the country to assess the magnitude of element deficiencies amongst pregnant mothers. Contributors: UK coordinated the study and drafted the paper; he will act as the guarantor of the manu-script. PP and PS participated in data collection, data analysis and co-ordinating. CS helped in coordinating the study and recruitment of subjects. Funding: None. Competing interests: None stated.
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