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  • Title: Energy requirements of pregnancy in The Gambia.
    Author: Lawrence M, Lawrence F, Coward WA, Cole TJ, Whitehead RG.
    Journal: Lancet; 1987 Nov 07; 2(8567):1072-6. PubMed ID: 2889977.
    Abstract:
    At most times of the year adjustments in maternal energy expenditure and energy balance in rural Gambian women can provide sufficient energy to sustain reasonable rates of fetal growth without an increase in food intake, although this study suggests that the overall level of energy intake has been substantially underestimated in the past. At certain times of year, however, pre-harvest food shortages and the energy demands of subsistence farming did substantially reduce maternal fat stores and fetal growth. Dietary supplementation, already known to increase birthweight, also had measurable effects on the mothers' physiology, resulting in increased energy expenditure on basal metabolism and improving maternal fat deposition. These findings suggest that the precise energy cost of pregnancy varies as a function of the additional energy intake consumed at this crucial period. Data were obtained on 52 pregnancies (2 women were followed consecutively through 2 pregnancies) in 50 women subsistence farmers from the villages of Keneba, Kantonkunda, and Manduar, Gambia, in an attempt to answer questions about the mechanisms by which rural Gambian women could achieve energy balance on a low food intake (about 6.25 MG/day during pregnancy) and the fate of the supplementary energy intake not contributing to improvements in fetal growth. It was possible to obtain measurements in 40 women before conception. The 29 women living in the village of Keneba received supplementary food throughout, consisting of energy-dense biscuits and a vitamin-enriched tea drink. All subjects received routine antenatal and general medical care. There were no significant differences between unsupplemented women and supplemented women. Energy expenditure on basal metabolism rate (BMR) and on various activities was measured by the Douglas bag method. Fat deposition was estimated from measurements of total body water. Changes in activity pattern were assessed in 32 women (16 unsupplemented, 16 supplemented) by an activity-diary technique on 1 day per fortnight. For this report, data were analyzed by within-subject multiple linear regression analysis. There were large differences between the theoretical changes in BMR and those actually measured. BMR was lower than before conception at 10-20 weeks gestation, the drop being significantly greater in unsupplemented than supplemented women. Thereafter, BMR rose progressively until term but to a point considerably below the predicted value. The rise in BMR during the 2nd half of pregnancy was almost certainly associated with the increasing metabolic rate of the fetus and products of conception. The cause of the early fall is less clear but changes in maternal metabolism dominate the early stages of pregnancy. The major difference between rural Gambian women and well-nourished European women was in the rate of weight gain during the 3rd trimester of pregnancy, which, in Gambian women, was about half that for the European group. Supplemented Gambian women gained slightly but not significantly more weight at each stage of pregnancy than their unsupplemented counterparts. Body fat content changed little during pregnancy in unsupplemented women; supplemented women gained a total of about 2 kg overall. For activities which required movement of the heavier body and for which work rate was unchanged, expenditure increased as would be expected. There were no differences between supplemented and unsupplemented women in total energy expenditure. The women in this community do become less active and thereby achieve a substantial saving in total energy expenditure during pregnancy. These findings confirm those of an earlier study conducted in Keneba.
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