Annals of African Medicine

: 2013  |  Volume : 12  |  Issue : 1  |  Page : 29--33

Using the effects of maternal nutritional indicators (hemoglobin and total protein) on baby's birth weight outcome to forecast a paradigm shift toward increased levels of non-communicable diseases in children

Baba Usman Ahmadu1, Nyandaiti Yakubu2, Haruna Yusuph2, Marshall Alfred1, Buba Bazza1, Abdullahi Suleiman Lamurde1,  
1 Department of Pediatrics, Federal Medical Center, Yola, Adamawa State, Nigeria
2 Department of Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria

Correspondence Address:
Baba Usman Ahmadu
Department of Pediatrics, Federal Medical Center Yola, P.M.B 2017, Yola, Adamawa State


Background: Maternal malnutrition can lead to low birth weight in babies, which puts them at risk of developing non-communicable diseases later in life. Evidence from developed countries has shown that low birth weight is associated with a predisposition to higher rates of non-communicable diseases later in life. However, information on this is lacking in developing countries. Thus, this work studied the effects of maternal nutritional indicators (hemoglobin and total protein) on birth weight outcome of babies to forecast a paradigm shift toward increased levels of non-communicable diseases in children. Materials and Methods: Mother-baby pairs were enrolled in this study using systematic random sampling. Maternal haemogblobin and total proteins were measured using micro-hematocrit and biuret methods, and birth weights of their babies were estimated using the bassinet weighing scale. Results: Of the 168 (100%) babies that participated in this study, 122 (72.6%) were delivered at term and 142 (84.5%) had normal birth weights. Mean comparison of baby�SQ�s birth weight and maternal hemoglobin was not significant ( P = 0.483), that for maternal total protein was also not significant ( P = 0.411). Even though positive correlation coefficients were observed between birth weight of babies, maternal hemoglobin and total proteins, these were however not significant. Conclusion: Maternal nutrition did not contribute significantly to low birth weight in our babies. Therefore, association between maternal nutrition and low birth weight to predict future development of non-communicable diseases in our study group is highly unlikely. However, we recommend further work.

How to cite this article:
Ahmadu BU, Yakubu N, Yusuph H, Alfred M, Bazza B, Lamurde AS. Using the effects of maternal nutritional indicators (hemoglobin and total protein) on baby's birth weight outcome to forecast a paradigm shift toward increased levels of non-communicable diseases in children.Ann Afr Med 2013;12:29-33

How to cite this URL:
Ahmadu BU, Yakubu N, Yusuph H, Alfred M, Bazza B, Lamurde AS. Using the effects of maternal nutritional indicators (hemoglobin and total protein) on baby's birth weight outcome to forecast a paradigm shift toward increased levels of non-communicable diseases in children. Ann Afr Med [serial online] 2013 [cited 2023 Nov 28 ];12:29-33
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Adequate nutrition in mothers is one of the most crucial components that determine the health status of children from birth to adult age. This is due to the fact that maternal malnutrition has been linked with variable foetal birth weight outcome. [1] Babies born with low birth weights have higher risk of morbidity and lower than average productivity as adults. [2] Mothers who were malnourished as children enter their reproductive years with inadequate nutritional stores, a predictor of low birth weight in babies, which has been associated with increased morbidities. [3] Some researchers think that fetal nutritional deprivation is a strong stimulus for developing non-communicable diseases such as heart diseases, diabetes, structural defects of the hippocampus, defects in immune function and development of depression in later life. [4],[5],[6] With regard to this, adequate girl child nutrition would have a significant effect not only on her growth, but also on her subsequent children. Low birth weight in babies is usually used as a marker for nutritional deprivation of their mothers. [1],[7] In addition, malnourished mothers with short inter-pregnancy intervals enter each pregnancy with depleted nutritional stores, thereby perpetuating the cycle of mother-baby malnutrition. [8]

Maternal hemoglobin and total protein have been adjudged as good indicators of nutrition. [9] Studies in the past used physical parameters to indicate adequacy of maternal nutrition or otherwise, but this physical indices may not be as effective as laboratory markers above. Extensive literature search on effects of maternal nutrition and baby's birth weight outcome revealed that most of the studies were carried out in developed countries. [1] Therefore; there is paucity of knowledge with regard to this in developing countries most especially in Borno state, North-Eastern Nigeria. Thus, the major objectives of this study were twofold: 1) To provide scientific data on the contributory role of maternal hemoglobin and total proteins on birth weight of babies. 2) To provide information that would have public health relevance as it relates to the overall wellbeing of babies in the future in our environment.

 Material and Methods

Study site

The study was carried out at the University of Maiduguri Teaching Hospital (UMTH), Nigeria. The UMTH is a tertiary center located in North-Eastern Nigeria and serves as a referral site for the six North-Eastern States of Nigeria and neighboring countries of Chad, Cameroon and Niger Republics.

Study population

Mother-baby pairs who formed our study population were selected at the labor ward of the UMTH. Mothers who met the following inclusion criteria were eligible for participation in this study: (i) had an uncomplicated singleton birth at ≥36 weeks gestation (based on Naegale's rule, or Eregie estimate for gestational age or Obstetric ultrasound scan), (ii) mother had no known underlying chronic ill-health. Mothers who smoke cigarette and drink alcoholic beverages or coffee were excluded from this study.

Study design

The study was a hospital-based randomized descriptive study of mother-baby pairs. Mother-baby pairs were enrolled using the systematic random sampling method, where the first of every three mother-baby pair was picked at the labor ward. Where the first mother did not fulfil the inclusion criteria the immediate next mother that qualified was selected.

Ethical issues

Ethical approval was obtained from the Medical Research and Ethics Committee of UMTH. Linguistics interpreters of informed consent form in local languages mainly (Kanuri and Babur) were sought due to low literacy rate in Maiduguri. [10] Parents had unlimited liberty to deny consent without any consequences while confidentiality was maintained.

Sample size and collection of specimens

Minimum sample size was obtained from a formula that computes 10% non-communicable disease prevalence for Nigeria, at 95 confidence interval and alpha levels of 0.05. [11],[12] However, 20% of the calculated minimum sample was added to maximize power. Therefore, the sample size for this study was one hundred and sixty-eight mother-baby pairs.

On enrolment, study proforma were administered to the mothers to collect information on their bio-data, pregnancy history and antenatal care history. Three milliliters of venous blood were obtained from mothers on admission using sterile disposable five milliliters syringe under aseptic technique. Of the three milliliters of maternal venous blood drawn, one milliliter was placed in ethylenediaminetetracetic acid (EDTA) bottle. This blood was used to measure maternal hemoglobin in grams per deciliter using the micro-hematocrit method. [13] Maternal hemoglobin ≤10 grams per deciliter was considered low, while values >10 grams per deciliter were acceptable in current study, similar to values reported for other resource poor countries. [14] The remaining two milliliters of maternal venous blood were placed in sterile plain bottles and sera were separated after centrifuging the blood samples at 5000 revolutions per minute (rpm) for five minutes. Sera obtained were used for estimating maternal total protein in grams per liter. [15] Maternal total proteins between (64-83) grams per liter were considered to be within normal range. [15] All sera collected were pooled in a refrigerator at −20°C until the time of maternal total protein estimation.

The weight of babies at birth was determined using the basinet weighing scale, which has a sensitivity of 50 grams. Babies weighing >3.99 kg were classified as macrosomia, those weighing 2.5-3.99 kg as normal and those between 1.5 and <2.5 kg were termed low birth weight. In addition babies weighing 1.0 - <1.5 kg were tagged very low birth weight and those <1.0 (kg) as extremely low birth weight. [16]

Data analysis

Appropriate statistical methods were used to analyzed the data obtained from this study using SPSS statistical software version 16, Illinois, Chicago USA. A P value <0.05 was considered significant. Tables were used appropriately for illustrations.


One hundred and sixty-eight mother-baby pairs were enrolled in this study. Majority of babies 122 (72.6%) were term and the ratio of male to female babies is 1.02:1 [Table 1]. One hundred and forty two (84.5%) babies in present study had normal birth weights [Table 2].{Table 1}{Table 2}

[Table 3] revealed birth weights of babies according to their mean maternal (hemoglobin and total protein). Comparing birth weights of babies with mean maternal (hemoglobin and total protein was not significant. Overall mean maternal hemoglobin (SD) was 10.95 (1.02), 95% CI (10.79-11.10) grams/deciliters, and that for maternal total protein was 73.34 (19.85), 95% CI (70.32-76.36) grams/liters.{Table 3}

[Table 4] shows positive correlation coefficients of birth weights of babies, maternal hemoglobin and maternal total protein. These correlation coefficients were not significant.{Table 4}


Most of the babies in present study were delivered at term and had normal birth weights. The birth weights of babies in current study were observed to be directly proportional to maternal nutritional indicators (Hemoglobin and Total protein), however, these were not significant. This corroborates a recent study that negates maternal nutrition and birth weights outcome of babies. [1] Epidemiological study which has indicated genetic factors accounting for vast majority of birth weight variances in babies could be used to explain above observation. [17] Because investigators had established evidence linking birth weights of babies to gene coding for insulin-like growth factors, there is now growing support for other candidate genes in doing similar functions. [17] Contemporary studies abroad, however, indicated that nearly one-third of mothers who deliver babies with low birth weights suffer from eating disorders. [18] Confounders like maternal smoking possibly would have caused this since it was not addressed in that study. It has been argued by several researchers in the past that confounders such as smoking could cause low birth weights in babies and not necessarily maternal malnutrition. [1]

Maternal nutrition contributed insignificantly to birth weights of babies of this study population. It, therefore, means that maternal nutrition has little or no impact on our subjects contracting some of the non-communicable diseases earlier stated in future. Similar observation was made in another study that was conducted abroad. [19] This would be anticipated as most foetuses of malnourished mothers have reduced placental ratio relative to birth weight ratios. [1] Suggesting that, foetuses adapt in malnourished environment in order to improve placental transfer of substrates. As a result, their birth weights are within normal range. Other workers, however, are of the view that poor maternal nutrition leads to reduced uterine arterial blood flow, which could yield lower birth weights in babies. [1] As such the tendencies to contract non-communicable diseases would increase in affected population. In contrast, other colleagues argued that only subjects with high placental to birth weight ratio stemming from maternal malnutrition stand the risk of acquiring some of these non-communicable diseases. [19] Chronic fetal stress response to poor maternal nutrition could reprogramme steroid and renin-angiotensin sensitivity in foetus. [1],[20] Fetal overexposure to these hormones may lead to some of these non-communicable diseases such as hypertension. [20],[21]

Unfortunately, we were not able to estimate the placental to birth weight ratio, which is an important factor in predicting possible future development of non-communicable diseases in children. This limitation may be a drawback on information regarding future development of non-communicable disease in our children. Therefore, there is the need to incorporate this aspect in future research.


Birth weight in our babies was not significantly associated to maternal nutrition, and majority of these subjects had normal birth weights. Based on this, the link between maternal nutrition and development of some non-communicable diseases by our subjects in the future may be rare.


1Stephenson T, Symonds ME. Maternal nutrition as a determinant of birth weight. Arch Dis Child Fetal Neonatal Ed 2002;86:4-6.
2Walker SP, Chang SM, Powell CA, Grantham-McGregor SM. Effects of early childhood psychosocial stimulation and nutritional supplementation on cognition and education in growth-stunted Jamaican children: Prospective cohort study. Lancet 2005;366:1804-7.
3Hinderaker SG, Olsen BE, Bergsjo PB, Gasheka P, Lie RT, Kvale G. Perinatal mortality in northern rural Tanzania. J Health Popul Nutr 2003;21:8-17.
4Armitage JA, Taylor PD, Poston L. Experimental models of developmental programming: Consequences of exposure to an energy rich diet during development. J Physiol 2005;565:3-8.
5Bellingham-Young DA, Adamson-Macedo EN. Foetal origins theory: Links with adult depression and general self-efficacy. Neuroendocrinol Lett 2003;24:412-6.
6Gomez-Pinilla F, Vaynman S. A "deficient environment" in prenatal life may compromise systems important for cognitive function by affecting BDNF in the hippocampus. Exp Neurol 2005;192:235-43.
7McDade TW. Life history, maintenance, and the early origins of immune function. Am J Hum Biol 2005;17:81-94.
8Cheryl AL, Stephenson KG, Kuppler KM, Williams JP. The effects of dieting on food and nutrient intake of lactating women. J Am Diet Assoc 2006;106:908-12.
9Kamar S, Chowdhury O, Murshed M, Hasan R. Effect of Gestational Age and Nutrition on Transplacental Transfer of Measles Antibody. Med Today 2010;22:1-5.
10Hamidu JL, Salami HA, Ekanem AU, Hamman L. Prevalence of protein-energy malnutrition in Maiduguri, Nigeria. Afr J Biomed Res 2003 6:123-7.
11Naing L, Winn T, Rusli BN. Practical Issues in Calculating the Sample Size for Prevalence Studies. Arch Orofac Sci 2006;1:9-14.
12World Health Organization. Country health system fact sheet Nigeria. Lagos. 2006.
13Barbara B. Performing a blood count. In: Maria K, Saskia V, Rob B, editors. Blood Cells A Practical Guide. 4 th ed. Australia: Blackwell; 2006. p. 31-7.
14Idowu OA, Mafiana CF, Sotiloye D. Anemia in pregnancy: A survey of pregnant women in Abeokuta. Afri Health Sci 2005;5:295-9.
15Tietz NW. Clinical Guide to Laboratory tests. 4 th ed. Philadelphia: WB Saunders Company; 2006. p. 518-9.
16Uche N. Assessment and care of the newborn. In: Azubuike JC, Nkanginieme KE, editors. Pediatrics and Child Health in a Tropical Region. 2 nd ed. Owerri: African Educational Services; 2007. p. 163-77.
17Johnston LB, Clark AJ, Savage MO. Genetic factors contributing to birth weight. Arch Dis Child Fetal Neonatal Ed 2002;86:2-3.
18Koubaa S, Hallstrom T, Lindholm C, Hirschberg AL. Pregnancy and Neonatal Outcomes in Women With Eating Disorders. Obstet Gynecol 2005;105:255-60.
19Barker DJ, Bagby SP, Hanson MA. Mechanism of disease: In utero programming in the pathogenesis of hypertension. Nat Clin Pract Nephrol 2006;2:700-7.
20Bogdarina IG, King PJ, Clark AJ. Characterization of the angiotensin (AT1b) receptor promoter and its regulation by glucocorticoids. J Mol Endocrinol 2009;43:73-80.
21Bertram C, Trowern AR, Copin N, Jackson AA, Whorwood CB. The maternal diet during pregnancy programs altered expression of the glucocorticoid receptor and type 2 11beta-hydroxysteroid dehydrogenase: Potential molecular mechanisms underlying the programming of hypertension in utero. Endocrinol 2001;142:2841-53.