Potential processes through which nutritional and non-nutritional factors can relate to infant state and behavior and mother-infant interactions were examined in 41 mother-infant pairs from semirural Egyptian households. All infants were breast-fed, and breast milk was the main source of their nutrient intake. Median birth weight was close to reference median; however, most infants showed growth faltering when they were 3-6 mo of age. Among the infant behavioral and state variables, only drowsiness (a proxy for activity and alertness) was significantly associated with the nutritional and non-nutritional factors examined. Among these factors, mothers' intakes of animal source foods and certain B vitamins were the strongest predictors of drowsiness. The nature of the association between maternal diet and drowsiness, examined by multiple regression analysis, showed clearly that inadequate diet of the mother was the major risk factor. Alertness of infants was further compromised when there were several children in the households. The small, less vocal and less alert infants received less vocalization from their mothers. In this environment, infants of undernourished mothers may not receive the extra care and stimulation needed and are at risk for subsequent developmental disabilities.
PIP: Each week physicians visited the households of 41 mother-infant pairs living in Kalama, Egypt, to examine infant behavior and caregiver-infant interactions from 3 to 6 months of age, as they relate to various factors, e.g., maternal nutrition and health and socioeconomic status. All the mothers breast fed their infants. Liquids which are inferior sources of energy and nutrients were the most customary food supplements during the first 6 months. Even though the median birth weight tended to equal that of the WHO international reference, most infants experienced faltering growth by 3 months. At 6 months, 75% were below the 25th percentile and 20% were in the 5th percentile. Growth faltering was linked with increased diarrhea (p .05). Even though the mothers' diets contained sufficient niacin, thiamin, folate, and vitamin C, the diets did not supply mothers enough riboflavin, vitamin B-6, vitamin A, calcium, and zinc. Breast milk did not have adequate amounts of vitamin B-6 and, perhaps, not even enough riboflavin and vitamin A. It did contain adequate amounts of calcium, however. Drowsiness was significantly related to maternal diet during lactation but not during pregnancy (especially energy intake from animal sources, p = .0001; energy intake from plant sources, p = .03); number of siblings (p = .009); crowding (p = .06); vocalization from mothers (p = .08); and low socioeconomic status (p = .07). Maternal diet was the best predictor of drowsiness followed by number of siblings. Without remediation in maternal nutrition, infants of undernourished mothers appeared not to receive appropriate care and stimulation, therefore placing them at risk of subsequent development disabilities. Intervention studies should be done to examine this main effect of maternal undernutrition and the importance of covarying environmental risk factors, e.g., crowding.