|Year : 2014 | Volume
| Issue : 1 | Page : 34-38
Effect of cooking posture on birth weight
Yugantara R Kadam, Pragati V Chavan, Randheer V Dhoble, Alka D Gore
Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Sangli, Maharashtra, India
|Date of Web Publication||15-Mar-2014|
Yugantara R Kadam
Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Sangli, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Low birth weight is still prevalent and has a multifactorial causation. Indian women in the reproductive age group, usually engage themselves and spend considerable time in cooking. Cooking, when done in a standing position may affect birth weight adversely. Aim and Objective: The goal of this study was to study the postnatal mothers and their newborns to assess the effect of cooking posture on birth weight. Materials and Methods: Study type-cross-sectional study setting: Hospital based. Sample size: 499, study subject: Mothers and their newborns. Inclusion criteria: Those mothers, who are using liquid petroleum gas for cooking, attended ANC Clinic from the first trimester with minimum three antenatal visits, non-anemic at the end of the second trimester, full term and singleton delivery. Exclusion criteria: Those mothers with a history of toxemias of pregnancy, diabetes, tuberculosis etc., delivered pre-term and tobacco chewers. Study period: July 2011 to December 2011, study tools: (i) Questionnaire. (ii) Pediatric weighing machine. Statistical Analysis: Percentages, mean and standard deviation of birth weight, χ2 -test, ANOVA, Z-test. Results: Babies born to mothers cooking in a standing position were 101 g lighter than those born to mothers cooking in a sitting position. Observed difference was significant (z = 2.220, P = 0.027). Multivariate analysis shows significant association between cooking posture and birth weight (P = 0.034). There was a low degree but significant negative correlation between duration of cooking and birth weight in a standing position (r = −0.115, P = 0.045). Conclusion: Cooking posture affects birth weight adversely which is preventable as it is a modifiable risk factor.
Keywords: Birth weight, cooking posture, low birth weight
|How to cite this article:|
Kadam YR, Chavan PV, Dhoble RV, Gore AD. Effect of cooking posture on birth weight. Muller J Med Sci Res 2014;5:34-8
| Introduction|| |
Even now-a-days, the etiology for low birth weight (LBW) is complex and it has remained as a public health problem in many countries and different regions of the world.  Birth weight is an important indicator of a child's vulnerability to the risk of childhood illness and chances of survival. There is considerable evidence, mostly from developed countries, that intra uterine growth retardation (IUGR) is associated with an increased risk of coronary heart disease, stroke, diabetes and raised blood pressure.  The etiology of LBW is also complex; with demographic, nutritional, reproductive and socioeconomic factors, each potentially playing a role. These causes can be enlisted as maternal hemoglobin level, hard manual work during the antenatal period, maternal nutrition, economic condition, antenatal care, parents' education, tobacco use, maternal age and parity.  Occupational factors are also considered to increase the risk. 
Upright posture is a unique feature of human beings. Pregnant women usually remain in upright position for more than ½ of the day. In contrast, the majority of investigations on the physiological changes during pregnancy deal only with women in the recumbent position.  A number of epidemiological studies have studied the effect of prolonged standing at the job on birth weight and some of them observed a significant effect. ,,,,, Women in the reproductive age group are usually involved in cooking especially; Indian women spend considerable time in cooking in a standing position. However, household work especially cooking is not considered as employment and hence neglected as a potential risk factor for LBW. Many studies have been done on the effect of posture on birth weight, in domestic or occupational settings. None, but one study, was available on online search which has studied the effect of cooking posture on birth weight. Today, with increasing use of liquid petroleum gas (LPG), cooking is done in a standing position which may affect birth weight adversely. Hence, this study was conducted to assess postnatal mothers and their newborns attending the hospital for finding out the effect of cooking posture on birth weight.
| Materials and Methods|| |
To find out the effect of cooking posture on the birth weight it was necessary to control the effect of confounders. For that purpose it was planned to use a birth cohort from a hospital setting so as to take care of confounding factors as well as to record the birth weight correctly, e.g., taking care of observer and instrumental error. A cross-sectional hospital based study was planned. Ethical clearance was obtained from the Institutional Ethics Committee. All the eligible mothers and their newborns admitted during the study period were included in the study. Data was collected during the period of July 2011 to December 2011. Study subjects were mothers who qualified the inclusion criteria and their newborns. An informed written consent was obtained from all the mothers who participated in the study. Those mothers were included who used LPG for cooking, who attended antenatal clinic from first trimester onwards (with minimum three antenatal visits), who were non-anemic at the end of the second trimester and who had a full term, singleton delivery. Mothers who had a history of pregnancy induced hypertension; diabetes mellitus, tuberculosis, urinary tract infection, pre-term delivery and tobacco chewing and/or mishri (burnt tobacco used to apply on teeth) use were excluded. Mothers not willing to participate in the study were also excluded. All antenatal mothers attending the obstetrics outpatient clinic were chosen and then selected as per inclusion criteria. For face to face interview, an appropriate questionnaire was developed after reviewing references and interacting with experts. The questionnaire was pre-tested by conducting a pilot study on 50 mothers and rectified necessary. Data of the pilot study was not included in the final study. Data was collected by one of the investigator, who was trained for it, especially for recording accurate birth weight. Each study subject was interviewed for collecting information on socio-demographic characteristics, parity, hours spent in cooking and posture while cooking. Birth weight of new born was recorded using digital pediatric weighing machine, within 48 h of delivery. Data was compiled using Microsoft Excel-10 and analyzed with the help of SPSS 18 (trial version). Percentages, mean and standard deviation (SD) of birth weight, χ2 -test, ANOVA, Z-test and multivariate analysis was used for analysis.
| Results|| |
In this study, 499 mothers and their newborns participated. Range of birth weight was 1-4.1 kg (mean ± SD, 2.719 kg ± 0.488). Out of the 499 new borne, 271 were male and 227 female. Males were heavier than females by 56 g. This difference was not significant, statistically [Table 1].
|Table 1: Association of some socio-demographic factors and mean birth weight|
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Maternal age varied between 17 years and 39 years (mean ± SD, 23.87 ± 3.340). Mothers were divided into four groups on the basis of age. Mean birth weight was highest in mothers above 30 years and lowest in the age group between 21 and 25 years. Observed difference was non-significant [Table 1].
Education wise, mean birth weight was less in babies born to illiterate mothers than those belonging to other educational groups. Mean birth weight of children was high in those mothers, who completed their PG and professional education. However, the difference was not significant [Table 1].
Majority of women (476, 95.39%) were house wives. There were only 23 women who were either in service or self-employed. They were either school teachers or office clark. Self-employment includes petty shop keepers. Birth weight was not much different in these two groups.
As per parity, mean birth weight was better in second para (2.783 kg) and lowest in multipara (2.639 kg). However the observed difference was not significant [Table 1].
Out of 499 women, 481 had breakfast regularly and the newborns born to them were heavier by 367 g than newborns born to mothers who skipped breakfast. The observed difference was statistically highly significant (z = 3.07, P = 0.002) [Table 2].
There were total 236 women not taking evening snacks and the babies born to them were lighter than those having. However, the observed difference was not significant [Table 2].
Babies born to mothers who cooked till last trimester (n = 222), were lighter by 80 g than babies born to mothers who were not involved in cooking till last trimester. However, observed difference was not significant (z = 1.874, P = 0.07) [Table 2]. Out of these 222 mothers, 88 cooked in a sitting posture while remaining 134 in standing posture. Babies born to mothers who cooked till last trimester in a standing position (mean birth weight ± SD, 2.665 ± 0.507 kg) were lighter by 26 g than those, who cooked in a sitting position (mean birth weight ± SD, 2.691 ± 0.450 kg).
Out of 499 mothers 318 (63.73%) cooked food in a standing position while 181 (36.27%) in a sitting position. Babies born to mothers cooking in a sitting position were heavier by 101 g than babies born to mothers cooking in a standing position. This difference in birth weight was significant (z = 2.220, P = 0.027) [Table 3].
To see dose - response relationship between duration of cooking in standing posture and birth weight, further analysis was done for women who cook in standing posture. When mean birth weight of babies was compared on the basis of duration of cooking of their mothers, it was observed that there is a decrease in mean birth weight as duration of cooking increases from "up to 2 h" to "2-3 h". But this trend was not observed in group of "3-4 h" and the observed difference was not significant [Table 3].
There was a low degree but significant negative correlation between duration of cooking and birth weight in a standing position (r = −0.115, P = 0.045).
Binary logistic regression analysis was performed by using Wald's backward method to find out best predicted factor for birth weight. Odds ratio for cooking posture was 4.502 (confidence interval: 0.443-0.968) and it was statistically significant. Having regular breakfast was also the best predictor of birth weight [Table 4].
| Discussion|| |
Birth weight is affected by multiple factors. Some factors are modifiable while others are non-modifiable. It is important to identify the modifiable factors so that they can be managed. Especially in India where proportion of LBW births is still high identifying and controlling modifiable factors will help.
The purpose of this study was to examine the effect of cooking posture on birth weight. Babies born to mothers who cooked in standing posture were 101 g lighter than those born to mothers cooking in a sitting posture. Schneider and Deckardt in their study mention that prolong standing during late pregnancy may imply risks for the fetus such as LBW, prematurity and an increase in stillbirths because of an "uterovascular syndrome." They also further mention that maternal standing possibility may be used as a physiological fetal stress test.  Another study states that pregnancy increases the variability in the pressor response to standing.  Moreover, birth weight was directly related to the magnitude and direction of the pressor response in late pregnancy.  One more study concludes that prolonged standing during late pregnancy may signal potential risk for the fetus such as LBW, prematurity and still births because of an "uterovascular syndrome."  There is one study which states that even during the first trimester cardiovascular changes occur with upright maternal position. 
As LBW has multifactorial causation, care of confounders and effect modifiers was taken at various levels of study. Inclusion and exclusion criteria for selection of study subject had taken care of few confounders, like high risk pregnancy, chronic diseases, addiction.
Effect of some cofounders was tested by using bi-variate analysis. In the bi-variate analysis sex of child, maternal age, education and parity were not significantly associated.
To have a normal birth weight extra allowances' of calories, proteins, vitamins and minerals are required during pregnancy. If mother consumes food at least 4 times a day it can meet extra demands of pregnancy. Furthermore maintaining blood glucose level in the mother is vital because glucose is the fetus's preferred fuel and because the fetus's blood glucose level is always lower than the mothers. That is why intake should be distributed throughout the day.  Therefore to assess dietary intake, mothers were asked about their diet frequency. All mothers had the two principal meals, i.e., lunch and dinner, but the difference in frequency of having breakfast and evening snacks was observed. Mean birth weight of newborns born to mothers consuming breakfast and evening snacks was more than those who skipped them. The observed difference was statistically significant in mothers who had breakfast whereas marginally significant in those who had their evening snacks. This observation highlights the importance of advice on having breakfast and evening snacks, which is simpler to advice as well as to follow.
Babies born to mothers cooking until last trimester were lighter, especially those who cook in a standing position. It was also observed that cooking in a standing position significantly affects birth weight adversely and dose response relationship was observed in duration between up to "2 h" and "2-3 h." A study mentions that prolonged standing (≥3 h/day) was significantly associated with reduced birth weight. , Similar findings were noted by a study done in Brazil.  A study about the relationship between physical activity at work and risk of fetal growth restriction found that standing or walking at work-up to 30 h a week were not significantly associated with IUGR. 
In multivariate analysis standing posture during cooking was the strong predictor of LBW along with breakfast. Finally, this relationship suggests "standing cooking posture" as an additional cause for unexplained cases of IUGR. Pompeii et al. have mentioned in their study named "obstetricians practices and recommendations for occupational activity during pregnancy" that only 26% of obstetricians in Texas advice to avoid standing more than 4 h a day at work. 
Low birth weight is an important public health problem in India and has multifactorial causation. Physical activity during pregnancy is detrimental to birth weight, especially the activity which requires standing posture. This study provides a baseline work on the possible role of standing posture in affecting birth weight adversely. Further research, particularly, a cohort study involving follow-up of antenatal mothers throughout their pregnancy to know their activity status with special reference to cooking in a standing position, may have to be taken up to substantiate role of standing posture in affecting birth weight.
| Conclusion|| |
Cooking in standing posture during pregnancy affects birth weight adversely. Mothers can be advised on the importance of right posture apart from advice on diet.
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[Table 1], [Table 2], [Table 3], [Table 4]