Maternal health and birth outcomes in a South African birth cohort study

Autoři: Heather J. Zar aff001;  Jennifer A. Pellowski aff002;  Sophie Cohen aff001;  Whitney Barnett aff001;  Aneesa Vanker aff001;  Nastassja Koen aff003;  Dan J. Stein aff003
Působiště autorů: Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa aff001;  Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, United States of America aff002;  Department of Psychiatry and Mental Health and SA-MRC Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa aff003
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222399



Maternal physical and mental health during pregnancy are key determinants of birth outcomes. There are relatively few prospective data that integrate physical and mental maternal health measures with birth outcomes in low- and middle-income country settings. We aimed to investigate maternal health during pregnancy and the impact on birth outcomes in an African birth cohort study, the Drakenstein Child Health Study.


Pregnant women attending 2 public health clinics, Mbekweni (serving a predominantly black African population) and TC Newman (predominantly mixed ancestry) in a poor peri-urban area of South Africa were enrolled in their second trimester and followed through childbirth. All births occurred at a single public hospital. Maternal sociodemographic, physical and psychosocial characteristics were comprehensively assessed. Multivariable linear regression models were used to explore associations between maternal health and birth outcomes.


Over 3 years, 1137 women (median age 25.8 years; 21% HIV-infected) gave birth to 1143 live babies. Most pregnancies were uncomplicated but gestational diabetes (1%), anaemia (22%) or pre-eclampsia (2%) occurred in a minority. Most households (87%) had a monthly income of less than USD 350; only 27% of moms were employed and food insecurity was common (37%). Most babies (80%) were born by vaginal delivery at full term; 17% were preterm, predominantly late preterm. Only 74 (7%) of babies required hospitalisation immediately after birth and only 2 babies were HIV-infected. Food insecurity, socioeconomic status, pregnancy-associated hypertension, pre-eclampsia, gestational diabetes and mixed ancestry were associated with lower infant gestational age while maternal BMI at enrolment was associated with higher infant gestational age. Primigravida or alcohol use during pregnancy were negatively associated with infant birth weight and head circumference. Maternal BMI at enrolment was positively associated with birth weight and gestational diabetes was positively associated with birth weight and head circumference for gestational age. Smoking during pregnancy was associated with lower infant birth weight.


Several modifiable risk factors including food insecurity, smoking, and alcohol consumption during pregnancy were identified as associated with negative birth outcomes, all of which are amenable to public health interventions. Interventions to address key exposures influencing birth outcomes are needed to improve maternal and child health in low-middle income country settings.

Klíčová slova:

Birth – Birth weight – Hypertensive disorders in pregnancy – Infants – Labor and delivery – Mental health and psychiatry – Pregnancy


1. Upton M. Effects of parental smoking on the respiratory health of adults. Thorax. 2004; 59: 274–6. doi: 10.1136/thx.2003.018424 15047943

2. Skorge TD, Eagan TM, Eide GE, Gulsvik A, Bakke PS. The adult incidence of asthma and respiratory symptoms by passive smoking in uterus or in childhood. Am J Respir Crit Care Med. 2005; 172: 61–66. doi: 10.1164/rccm.200409-1158OC 15805186

3. Narang I, Bush A. Early origins of chronic obstructive pulmonary disease. Semin Fetal Neonatal Med. 2012; 17: 112–8. doi: 10.1016/j.siny.2012.01.002 22265926

4. Dahlen HG, Barnett B, Kohlhoff J, Drum ME, Munoz AM, Thornton C. Obstetric and psychological risk factors for Austrailian-born and non-Austrailian born women and associated pregnancy and birth outcomes: a population based cohort study. BMC Pregnancy Childb. 2015; 15: 292.

5. Myers B, Koen N, Donald K, Nhapi R, Workman L, Barnett W, et al. Effect of hazardous alcohol use during pregnancy on growth outcomes at birth: findings from a South African cohort study. Alcohol Clin Exp Res. 2018; 42: 369–377. doi: 10.1111/acer.13566 29197115

6. Vanker A, Barnett W, Brittain K, Gie RP, Koen N, Myers B, et al. Antenatal and early life tobacco smoke exposure in an African birth cohort study. Int J Tuberc Lung Dis. 2016; 20: 729–737. doi: 10.5588/ijtld.15.0697 27155174

7. Harville E, Rabito F. Housing conditions and birth outcomes: The National Child Development Study. Environ Res. 2018; 161: 151–157.

8. Nnam N, Improving maternal nutrition for better pregnancy outcomes. P Nutr Soc. 2015; 74: 454–459.

9. Lartey A. Maternal and child nutrition in sub-Saharan Africa: challenges and interventions. P Nutr Soc. 2008; 67: 105–8.

10. Dolatian M, Sharifi M, Mahmoodi Z. Relationship of socioeconomic status, psychosocial factors, and food insecurity with preterm labor: a longitudinal study. Int J Reprod Biomed (Yazd). 2018; 16: 563–570.

11. Borders AE, Grobman WA, Amsden LB, Holl JL. Chronic stress and low birth weight neonates in a low-income population of women. Obstet Gynecol. 2007; 109: 331–338. doi: 10.1097/01.AOG.0000250535.97920.b5 17267833

12. Vogel JP, Lee ACC, Souza JP. Maternal morbidity and preterm birth in 22 low- and middle-income countries: a secondary analysis of the WHO Global Survey dataset. BMC Pregnancy Childb. 2014; 14: 56.

13. Myer L, Stein DJ, Grimsrud A, Seedat S, Williams DR. Social determinants of psychological distress in a nationally-representative sample of South African adults. Soc Sci Med. 2008; 66: 1828–1840. doi: 10.1016/j.socscimed.2008.01.025 18299167

14. Tucker CM, Berrien K, Menard MK, Herring AH, Daniels J, Rowley DL, et al. Predicting preterm birth among participants of North Carolina's Pregnancy Medical Home Program. Matern Child Health J. 2015; 19: 2438–2452. doi: 10.1007/s10995-015-1763-5 26112751

15. Dewing S, Tomlinson M, le Roux IM, Chopra M, Tsai AC. Food insecurity and its association with co-occurring postnatal depression, hazardous drinking, and suicidality among women in peri-urban South Africa. J Affect Disord. 2013; 150: 460–5. doi: 10.1016/j.jad.2013.04.040 23707034

16. Yamamoto S, Premji S. The role of body, mind, and environment in preterm birth: mind the gap. J Midwifery Womens Health. 2017; 62: 696–705. doi: 10.1111/jmwh.12658 29135075

17. Smid MC, Stringer EM, Stringer JS. A worldwide epidemic: the problem and challeges of preterm birth in low- and middle-income countries. Am J Perinatol. 2016; 33: 276–89. doi: 10.1055/s-0035-1571199 26841086

18. Zar HJ, Barnett W, Myer L, Stein DJ, Nicol MP. Investigating the early-life determinants of illness in Africa: the Drakenstein Child Health Study. Thorax. 2015; 70: 592–4. doi: 10.1136/thoraxjnl-2014-206242 25228292

19. Stein DJ, Koen N, Donald K, Adnams C, Koopowitz S, Lund C, et al. Investigating the psychosocial determinants of child health in Africa: The Drakenstein Child Health Stuyd. J Neurosci Methods. 2015; 252: 27–35. doi: 10.1016/j.jneumeth.2015.03.016 25797842

20. Donald K, Hoogenhout M, du Plooy CP, Wedderburn CJ, Nhapi R, Barnett W, et al. Drakenstein Child Health Study (DCHS): investigating determinants of early child development and cognition. BMJ Paediatr Open. 2018; 2: e000282. doi: 10.1136/bmjpo-2018-000282 29942867

21. Bickel D, Nord M, Price C, Hamilton W, Cook J. United States Department of Agriculture (USDA) Guide to Measuring Household Food Security. 2000.

22. Pellowski JA, Barnett W, Kuo C, Koen N, Zar HJ, Stein DJ. Investigating tangible and mental resources as predictors of perceived household food insecurity during pregnancy among women in a South African birth cohort study. Soc Sci Med. 2017; 187: 76–84. doi: 10.1016/j.socscimed.2017.06.022 28666232

23. Republic of South Africa Department of Health, South African Antiretroviral Treatment Guidelines. 2018.

24. Orley B. A user's guide to the self reporting questionnaire (SRQ). D.o.M. Health, Editor. 1994; World Health Organization: Geneva.

25. Brittain K, Myer L, Koen N, Koopowitz S, Donald K, Barnett W, et al. Risk factors for antenatal depression and associations with infant birth outcomes: results from a South African birth cohort study. Paediatr Perinat Epidemiol. 2015; 29: 505–514. doi: 10.1111/ppe.12216 26236987

26. Jewkes R. Intimate partner violence: causes and prevention. Lancet. 2002; 359: 1423–9. doi: 10.1016/S0140-6736(02)08357-5 11978358

27. WHO ASSIST Working Group. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST): development, reliability, and feasibility. Addiction. 2002; 97: 1183–94. doi: 10.1046/j.1360-0443.2002.00185.x 12199834

28. Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013; 13: 59. doi: 10.1186/1471-2431-13-59 23601190

29. Chawanpaiboon S, Vogel JP, Moller A-B, Lumbiganon P, Petzold M, Hogan D, et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health. 2019; 7: PE37–PE46.

30. Yaya S, Uthman OA, Adjwanou V, Bishwajit G. Exposure to tobacco use in pregnancy and its determinants among sub-Saharan Africa women: analysis of pooled cross-sectional surveys. J Matern Fetal Neonatal Med. forthcoming.

31. Cois A, Day C. Obesity trends and risk factors in the South African adult population. BMC Obesity. 2015; 2: 42. doi: 10.1186/s40608-015-0072-2 26617987

32. Koen N, Brittain K, Donald K, Barnett W, Koopowitz S, Mare K, et al. Psychological trauma and posttraumatic stress disorder: risk factors and associations with birth outcomes in the Drakenstein Child Health Study. Eur J Psychotraumatol. 2016; 7: 28720. doi: 10.3402/ejpt.v7.28720 26886489

33. Koen N, Brittain K, Donald K, Barnett W, Koopowitz S, Mare K, et al. Maternal posttraumatic stress disorder and infant developmental outcomes in a South African birth cohort study. Psychol Trauma. 2017; 9: 292–300. doi: 10.1037/tra0000234 28459271

34. Hannigan JH, Armant DR. Alcohol in pregnancy and neonatal outcome. Semin Neonatol. 2000; 5: 243–54. doi: 10.1053/siny.2000.0027 10956449

35. Donald KJ, Fouche JP, Roos A, Koen N, Howells FM, Riley EP, et al. Alcohol exposure in utero is associated with decreased gray matter volume in neonates. Metab Brain Dis. 2016; 31: 81–91. doi: 10.1007/s11011-015-9771-0 26616173

36. Gray D, Willemse L, Visagie A, Czovek D, Nduru P, Vanker A, et al. Determinants of early-life lung function in African infants. Thorax. 2017; 72: 445–450. doi: 10.1136/thoraxjnl-2015-207401 27856821

37. le Roux DM, Myer L, Nicol MP, Zar HJ. Incidence and severity of childhood pneumonia in the first year of life in a South African birth cohort: the Drakenstein Child Health Study. Lancet Glob Health. 2015; 3: e95–e103. doi: 10.1016/S2214-109X(14)70360-2 25617203

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2019 Číslo 11