Previous studies have yielded conflicting results on the associations of maternal Fe intake with birth outcomes. This study aimed to investigate the associations between maternal Fe intake (total Fe from diet and supplements, dietary total Fe, haeme Fe, non-haeme Fe and Fe supplements use) and adverse birth outcomes in Shaanxi Province of Northwest China. In all, 7375 women were recruited using a stratified multistage random sampling method at 0-12 months (median 3; 10th-90th percentile 0-7) after delivery. Diets were collected by a validated FFQ and maternal characteristics were obtained via a standard questionnaire. The highest tertile of haeme Fe intake compared with the lowest tertile was negatively associated with low birth weight (LBW) (OR 0·68; 95 % CI 0·49, 0·94), small for gestational age (SGA) (OR 0·76; 95 % CI 0·62, 0·94) and birth defects (OR 0·55; 95 % CI 0·32, 0·89). Maternal haeme Fe intake was associated with a lower risk of intra-uterine growth retardation (IUGR) (medium tertile v. lowest tertile: OR 0·78; 95 % CI 0·61, 0·95; highest tertile v. lowest tertile: OR 0·76; 95 % CI 0·59, 0·93; P trend=0·045). The OR of LBW associated with Fe supplements use were as follows: during pregnancy: 0·72 (95 % CI 0·50, 0·95); in the second trimester: 0·67 (95 % CI 0·42, 0·98); in the third trimester: 0·47 (95 % CI 0·24, 0·93). We observed no associations of total Fe, dietary total Fe or non-haeme Fe intake with birth outcomes. The results suggest that maternal haeme Fe intake is associated with a reduced risk of LBW, SGA, IUGR and birth defects, and Fe supplements use during pregnancy reduces LBW risk.

ObjectivesTo report the situation of maternal micronutrient supplementation before and during pregnancy in Northwest China and to examine the rates of and factors related to the adherence to micronutrient supplementation among pregnant women in this region, where dietary micronutrient intake is commonly insufficient.DesignA large-scale population-based cross-sectional survey.SettingTwenty counties and ten districts of Shaanxi Province.ParticipantsA sample of 30 027 women were selected using a stratified multistage random sampling method. A total of 28 678 women were chosen for the final analysis after excluding those who did not provide clear information about nutritional supplementation before and during pregnancy.Main outcome measuresMaternal adherence to micronutrient supplementation (high and low) were the outcomes. They were determined by the start time and duration of use according to Chinese guidelines (for folic acid (FA) supplements) and WHO recommendations (for iron, calcium and multiple-micronutrient (MMN) supplements).ResultsIn total, 83.9% of women took at least one kind of micronutrient supplement before or during pregnancy. FA (67.6%) and calcium (57.5%) were the primarily used micronutrient supplements; few participants used MMN (14.0%) or iron (5.4%). Adherence to supplementation of all micronutrients was low (7.4% for FA, 0.6% for iron, 11.7% for calcium and 2.7% for MMN). Higher educational levels, higher income levels, urban residence and better antenatal care (including pregnancy consultation and a higher frequency of antenatal visits) were associated with high adherence to micronutrient supplementation.ConclusionMaternal micronutrient supplementation before and during pregnancy in Northwest China was way below standards recommended by the Chinese guidelines or WHO. Targeted health education and future nutritional guidelines are suggested to improve this situation, especially in pregnant women with disadvantaged sociodemographic conditions.

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Objective: To explore the relationship between parity and macrosomia and provide the necessary reference for the maternal and children health service. Method: A cross-sectional epidemiological survey with the purpose to assess the birth outcomes was conducted in Shaanxi province, China. Results: The incidence of macrosomia in multiparas was higher than that in primiparas. Univariate analysis showed that maternal age < 25 years, peasant/housework, living in rural areas and female infants were the protective factors of macrosomia. The possibility of having a macrosomic infant also increased with gestational age, maternal education level, household wealth index, living in Central Shaanxi and gestational diabetes. The generalized linear mixed models represented the association between parity and macrosomia. After adjusting for statistically significant factors in univariate analysis from model 1 to model 3, the risk of being born macrosomia was 1.26 times higher for a multipara compared to that for a primipara. Conclusions: Present study indicated parity of two children was associated with increased risk for macrosomic births compared with parity of one child. Compared to primiparas, multiparas should far strengthen the prepregnancy education and the guidance during pregnancy to control pre-pregnancy body mass index and pregnancy weight, and keep the appropriate exercise and balanced diet.

To explore the effect of pregnancy-induced hypertension (PIH) on neonatal birth weight and provide the necessary reference value for the maternal and children health service. A cross-sectional study was carried out in Shaanxi Province of China in 2013. And a total of 28 045 singleton live infants and their mothers were recruited using a stratified, multistage, probability-proportional-to-size sampling method. Among the 28 045 women of childbearing age surveyed, multiple linear regression and quantile regression analysis all showed that the birth weight of newborns whose mothers had suffered from PIH during pregnancy was significantly lower than those whose mothers had not suffered from PIH during pregnancy from very low to higher birth weight percentiles (q=0-0.85), an average decrease of 137.45 g (β=-137.45, t=-5.77 and p<0.001). When birth weight was at q=0.90-1.00 percentiles, there was no birth weight difference between two groups. The present cross-sectional study indicated that PIH had an effect of on neonatal birth weight. When pregnant women with PIH are identified then the healthcare professional initiates a closer supervision of their pregnancy in order to ameliorate the status of BP and provide a good intrauterine environment for the fetus. In addition, the gynecologists should admonish the pregnant women that their health is related to the health of their fetus, then gravidas may be more engaged to alert their physician and accept early or preventative interventions. And the healthcare professional should ask and be alert to the issues of hypertension during pregnancy.