| BackgroundThe postpartum period, or puerperium, starts about an hour after the delivery of the placenta and includes the following six weeks. According to traditional Chinese custom, this period is referred to as "doing the month" or "sitting month" Puerperium is a very special stage in a woman’s lifetime. Inadequate maternal nutrition can not only compensate for the consumption of large quantities during pregnancy and childbirth, and detrimental to their own health recovery, but also affect the quality of milk, the baby’s growth.Therefore, it is of great significance to apply appropriate dietary nutrition in promotion of women’s physical recovery and lactation in puerperium.There are special behavior against women in the postpartum period. For example, eat plenty of foods of animal, do not eat fruits, vegetables, beans etc, which are considered "cool" food. Besides, women should not wash hair, not take a bath, not brush teeth, not touch cold water, pay attention to resting and tonic. While there are no "sitting month" in Western countries. Many studies have shown that some bad habits of traditional "sitting month" have a negative impact on the health status of women. In our previous cross-sectional survey results showed some women in Guangzhou area still insisted on the traditional custom of "sitting month". There are irrational eating behavior in puerperium Women, such as intake too much of eggs, meat and poultry and other animal food, the number of women in the puerperium who never intake of soy and soy products, nuts, crustacean food accounted for a higher proportion. On the other hand, there are some of the traditional "confinement" rest activity behavior, such as never go out, never sun, never wash your hair, do not do post-natal exercise, and some women stay in bed too long. Therefore, it is of significance to targeted to carry out the puerperium nutrition and health care intervention according to the preliminary cross-sectional survey study which found the problem of the puerperium diet, activity behavior.In this study, combination of convenience sampling and a prospective cohort study of the epidemiology was applied for puerperal women in Yuexiu urban and Baiyun suburb for nutrition education intervention. Through evaluating the effect, we expore a more efficient method of nutrition education to improve the quality of women’s lives.Objects533pregnant women (in the third trimester, age from18-35) were randomly selected from women who attended a local maternal health clinic in Yuexiu urban and Baiyun suburb as the subjects of follow-up study. The subjects were divided into two groups. Nutrition education was given in one group, another group as control group. A total of483people completed the entire survey, while a total of467met the requirement. Intervention group included225women (urban intervention group=116, the suburb intervention group=109), control group included242women (urban control group=124, the suburb control group=118). Method1.Intervention methods:Individual guidance,distribution of education materials were applied for the intervention group objects in the third trimester of pregnancy, hospital delivery period and2weeks after postpartum. The control group still accepted routine health service which was the same with the intervention group. The method of nutrition education included:balanced diet, puerperium reasonable diet, the importance of intake of fruits and vegetables, how to do post-natal exercises, health problems which should be noted in puerperium. The two groups of subjects were visited from the third trimester to42day after delivery. The data were collected through questionnaires which included puerperium diet, behavior, nutrition, health status to evaluate intervention results.2.Survey methodology:Using the survey method to investigate the basic situation, postpartum diet status, dietary intake status, status of the puerperium rest and sanitary behavior, the puerperium nutrition and health knowledge status, postpartum health and disease status.3.Dietary survey method:24h dietary recall method (the third trimester to review two days24h diet) combined with the dietary record method (delivery during the first three days and the delivery after two weeks) to survey diet. T he investigator accurately recorded the types, the number of food intake,and the cooking methods.4. Data collection and analysis:EpiData3.1was used to establish a databa se, Pottinger dietary software to analyze dietary component, SPSS13.0to anayl ze data. The main statistical methods included descriptive analysis, chi-square tes t (n≥40and T≥5), corrected chi-square test(n≥40, but there are1≤T<5), Fisher exact probability method (n<40ort<1), analysis of covariance, t-test (homogeneity of variance), as well as the calibration t-test (heterogeneity of variance), multiple li near stepwise regression analysis, Binary Logistic regression analysis.Results1. Before nutrition and health education, the knowing rates of nutrition and health knowledge of the subjects were low, and there were no significant differences between the intervention group and the control group. After the subjects of the intervention group educated, their levels of nutrition and health knowledge were increased significantly compared with the control objects as well as that before nutrition and health education (P<0.05). The urban intervention objects knew "the calcium of the best food" rose to68.1%from57.8%knew "chicken is more nutritious than chicken soup" rose from33.6%to55.2%, knew "vitamin C rich foods increased from71.6%to91.9%, knew "colostrum should be fed the children" rose from70.7%to97.4%..The suburb objects were more significant The suburb intervention objects knew" the calcium of the best food" rose to72.5%from24.8%before nutrition and health education, knew "chicken is more nutritious than chicken soup" from24.1%to73.4%, knew"parturient can choose to eat vegetables" increased from40.4%to87.2%, known "parturient can choose to eat fruit" from36.1%to85.3%,Known "parturient can wash hair," rose from42.2%to89.0%.The score before intervention as covariate Analysis of covariance was applied to analyze the score after invention. The results showed after intervention, the score of intervention objects were significantly higher than that of the control object.2. In the third trimester of pregnancy, both of the urban and the suburb, the intervention group and control group objects, the average daily intake of food were no significant difference in the third trimester.In the hospital delivery during the first3days, intake of milk, vegetables, fruit in urban intervention group objects were higher than the control subjects. There are significant differences between the two groups in vegetable intake (P<0.05). The average daily intake of meat, poultry and aquatic products of the control subjects were up to396.39g, more than lactating women diet pagoda recommended intake- 300g per day, which was also significantly higher than the intervention subjects (P<0.05). Subjects were insufficient intake of most of the energy and nutrients. Urban subjects lacked of calcium, Vitamin C, riboflavin, retinol equivalent intake (accounting for below50%of the RNI or AI). The lack of calcium intake was more serious for suburb subjects (only25.09%of the AI). Compared with intervention and control subjects in urban, the intake of vitamin C, calcium of intervention subjects were significantly higher than that of the control subjects.The dietary survey results of two weeks after delivery reflected the entire puerperium diet. Compared with the third trimester of pregnancy, the intake of eggs, meat, poultry and aquatic products increased. Average daily intake of eggs in suburb was195.63±137.75g,which was5times the third trimester of pregnancy, milk, fruits and vegetables decreased, and fruit intake is only1/6of the third trimester of pregnancy. But there were always low legume intake in both pregnancy and puerperium. The average daily intake of Vinegar was51.84±106.97g, the intakes of which of intervention objects was significantly higher than the control subjects (P<0.05). In addition, the proportion of the intake of cereals and meat, poultry and aquatic in the lactating women diet pagoda recommended amount range of the intervention group subjects was higher than that of the control subjects, so the intervention group was more reasonable in the diet structure. The intake of calcium was deficiency during the puerperium. The urban was589.56±249.33mg (accounted for49.13%of the AI), suburb was381.02±212.74mg(accounted for31.75%of the AI). The proportion of energy and protein intake in the intervention group which accounted for RNI90%～110%was higher, it was more reasonable in energy and protein intake of the intervention group, which showed that intervention achieved some success.Although increased the intake of fruits and vegetables was an important part of intervention, compared with the intervention group and control group, the intake of vegetables, fruits, milk had no significant differences, so were calcium, vitamin C and other nutrients, which did not meet the expected effect of intervention.3. The incidence rate that subjects in the intervention group do postpartum gymnastics (χ2=5.679、P<0.05) and outdoor activities (χ2=4.923, P<0.05) were significantly higher than the control subjects in suburb. Nutrition education played a role in the behavior change in puerperium.4. The shortest sleep time of subjects in puerperium was only4h.The average daily sleep time was8.64±1.60h.51.3%of women slept less than eight hours. Average time in bed was11.58±2.90h per day. The sleep time and the time in bed of the suburb subjects in the intervention group was significantly lower than the control group.5. Puerperal illness were mainly bloody lochia extend, anemia, breast disease, low back pain and constipation (incidence were81.6%、43.2%、26.3%、24.2%、16.7%). Both of time of lochia duration (t=3.799, P<0.001=and the duration of bloody lochia (t=2.719, P<0.01) in the intervention group were significantly shorter than that in the control group in urban (P<0.05). Binary Logistic regression analysis showed that the intake of meat, poultry and aquatic products and milk was to reduce the prevalence of duration of bloody lochia, not often do postpartum gymnastics was to increase the bloody lochia duration.6. After delivery, weight of women was obvious increased compared with before pregnancy. The rates of overweight increased from7.9%to16.6%. Weight loss for urban subjects was5.58kg,2.49kg for suburb. The weight loss of urban subjects was significantly higher than the suburb (P<0.01).Multiple linear regression analysis showed that the urban, short time in bed, regular diet, intake of more fiber can promote puerperium weight loss.Conclusion1. Guangzhou subjects had some knowledge of nutrition and health knowledge, but still not comprehensive enough. After intervention, nutrition knowing rate of intervention subjects was higher than that of before intervention and of control subjects(P<0.05).To strengthen the knowledge of nutrition will help guide the correct beliefs and health behavior.2. In the first three days diet, in the hospital delivery, intervention subject intake of milk, vegetables, fruit were higher than control subjects. The daily average intake of meat, poultry and aquatic products of the control group objects exceed lactating mothers diet pagoda recommended intake. And in the puerperium, the proportion of the intake of cereals and meat, poultry and aquatic in the diet pagoda recommended amount range of the intervention subjects was higher than that of the control subjects, so were the energy and protein. Therefore the diet structure of the intervention subjects was more reasonable. Intervention has achieved a certain effectThe diet structure was still unreasonable. Meat, poultry and aquatic food intake was still too much as well as the protein. And our intervention to intake more vegetables, milk does not meet the expected effect.3. The behavior of rest and health activities, the majority of puerperal women can not ensure adequate sleep time. The rate of doing postpartum exercises was lower.So it is important to intervene to do postpartum exercises, as well as to ensure adequate sleep time in later intervention. There are still many healthy problems, such as anemia, the duration of bloody lochia, breast disease, low back pain. The next step should strengthen post-natal visits system for monitoring and evaluation to guide women to spend the puerperium more healthy.4. Although our intervention had made some achievements, but there are still not perfect enough. In the next step, we should improve the intervention methods and expand range of subjects in order to better guide women’s health through the puerperium. |
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