Association of Protein, Zinc, and Vitamin A Maternal Intake With Preterm Birth, but Not With the Dietary Inflammatory...

Preterm birth is defined as any birth that occurs before 37 weeks of gestational age. National Basic Health Research 2018 shows that 29.5% of births are preterm in Indonesia. Preterm delivery is associated with various risk factors and etiologies, such as malnutrition, inflammations, infections, pathological uterine distention, stress, and environmental toxins. Maternal diet plays a significant role in regulating chronic inflammation. This study aims to investigate the relationship between the dietary inflammatory index (DII) and preterm birth, as well as measure the nutritional intake of pregnant women.

This study included 365 pregnant women who showed signs of parturition at Cipto Mangunkusumo General Hospital between June 2021 and July 2022. They were divided into two groups: preterm and term birth. Dietary information was collected using a food frequency questionnaire. Nutrisurvey v2007 was used to convert the data into precise nutritional intake using an Indonesian food database. The DII was calculated based on 26 food parameters, and the participants were divided into tertiles by their DII. The lowest tertile represented the most anti-inflammatory DII, while the highest represented the most proinflammatory DII.

Preterm births were significantly associated with socioeconomic status (odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.29-0.66, p=0.007), fewer antenatal visits (OR = 3.10, 95% CI = 1.79-5.37, p < 0.001), inadequate intake of micronutrient supplements (OR = 0.44, 95% CI = 0.19-0.96, p=0.035), vaginal bleeding (OR = 2.56, 95% CI = 1.13-5.79, p=0.020), maternal energy intake (p < 0.001), vitamin B₁₂ (p=0.031), and amino acids (p=0.036). Multivariate analysis showed that fewer antenatal visits (adjusted OR [aOR] = 2.23, 95% CI = 1.34-3.78, p=0.001), vaginal bleeding (aOR = 3.76, 95% CI = 1.51-9.33, p=0.004), contributed to preterm birth. Lower energy (p=0.009) and protein (p=0.015) intake were significantly associated with birth outcomes. Higher zinc (p=0.041) and vitamin A (p=0.006) intake significantly reduced the risk of preterm birth. The DII was not significantly correlated with preterm birth.

Lower antenatal visits, vaginal bleeding, higher energy, higher protein, lower zinc, and lower vitamin A intake were significantly associated with preterm birth. The DII was not significantly correlated with preterm birth.