title: Adequately diversified dietary intake and iron and folic acid supplementation during pregnancy is associated with reduced occurrence of symptoms suggestive of pre-eclampsia or eclampsia in Indian women.
abstract: OBJECTIVE
  Pre-eclampsia or Eclampsia (PE or E) accounts for 25% of cases of maternal mortality worldwide. There is some evidence of a link to dietary factors, but few studies have explored this association in developing countries, where the majority of the burden falls. We examined the association between adequately diversified dietary intake, iron and folic acid supplementation during pregnancy and symptoms suggestive of PE or E in Indian women.
  
  
  METHODS
  Cross-sectional data from India's third National Family Health Survey (NFHS-3, 2005-06) was used for this study. Self-reported symptoms suggestive of PE or E during pregnancy were obtained from 39,657 women aged 15-49 years who had had a live birth in the five years preceding the survey. Multivariable logistic regression analysis was used to estimate the association between adequately diversified dietary intake, iron and folic acid supplementation during pregnancy and symptoms suggestive of PE or E after adjusting for maternal, health and lifestyle factors, and socio-demographic characteristics of the mother.
  
  
  RESULTS
  In their most recent pregnancy, 1.2% (n=456) of the study sample experienced symptoms suggestive of PE or E. Mothers who consumed an adequately diversified diet were 34% less likely (OR: 0.66; 95% CI: 0.51-0.87) to report PE or E symptoms than mothers with inadequately diversified dietary intake. The likelihood of reporting PE or E symptoms was also 36% lower (OR: 0.64; 95% CI: 0.47-0.88) among those mothers who consumed iron and folic acid supplementation for at least 90 days during their last pregnancy. As a sensitivity analysis, we stratified our models sequentially by education, wealth, antenatal care visits, birth interval, and parity. Our results remained largely unchanged: both adequately diversified dietary intake and iron and folic acid supplementation during pregnancy were associated with a reduced occurrence of PE or E symptoms.
  
  
  CONCLUSIONS
  Having a adequately diversified dietary intake and iron and folic acid supplementation in pregnancy was associated with a reduced occurrence of symptoms suggestive of PE or E in Indian women.
authors.affiliation: South Asia Network for Chronic Disease, Public Health Foundation of India, Gurgaon, Haryana, 122022, India.
authors.forename: Sutapa
authors.initials: S
authors.lastname: Agrawal
authors.affiliation: Department of Sociology, Oxford University, Oxford, United Kingdom.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Fledderjohann
authors.affiliation: South Asia Network for Chronic Disease, Public Health Foundation of India, Gurgaon, Haryana, 122022, India; Department of Sociology, Oxford University, Oxford, United Kingdom.
authors.forename: Sukumar
authors.initials: S
authors.lastname: Vellakkal
authors.affiliation: South Asia Network for Chronic Disease, Public Health Foundation of India, Gurgaon, Haryana, 122022, India; Department of Sociology, Oxford University, Oxford, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Stuckler
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D019587:Dietary Supplements / Q000706:statistics & numerical data*; D004461:Eclampsia / Q000453:epidemiology* / Q000517:prevention & control; D005247:Feeding Behavior; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage*; D006801:Humans; D007194:India / Q000453:epidemiology; D007501:Iron / Q000008:administration & dosage*; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D011225:Pre-Eclampsia / Q000453:epidemiology* / Q000517:prevention & control; D011247:Pregnancy
chemical_list: D005492:Folic Acid; D007501:Iron