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Maternal Nutrition Issues and Interventions
MCH in Developing CountriesHServ/GH 544
January 27, 2011
Maternal Nutrition
Issues
UN
ICE
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ood
smith
33
Major Issuesin Maternal Nutrition
Inadequate weight and height
Micronutrient deficiencies
44
Maternal Malnutrition:A Life-Cycle Issue (1)
Infancy and early childhood (0-24 months)– Suboptimal breastfeeding practices– Inadequate complementary foods – Infrequent feeding – Frequent infections
Childhood (2-9 years) – Poor diets – Poor health care– Poor education
55
Maternal Malnutrition:A Life-Cycle Issue (2)
Adolescence (10-19 years)– Increased nutritional demands– Greater iron needs – Early pregnancies
Pregnancy and lactation – Higher nutritional requirements– Increased micronutrient needs – Closely-spaced reproductive cycles
66
Maternal Malnutrition:A Life-Cycle Issue (3)
Throughout life– Food insecurity– Inadequate diets – Recurrent infections– Frequent parasites– Poor health care– Heavy workloads– Gender inequities
77
Chronic Energy Deficiencyin Women 15-49 Years Old
41.1 40.5
18.722.4
14.6
7.2
0
25
50
S Asia SE Asia China SS Africa C Amer. S. Amer.
ACC/SCN, 1992
Percent WomenBMI<18.5 kg/m2
88
Consequences of Maternal Chronic Energy Deficiency
Infections
Obstructed labor
Maternal mortality
Low birth weight
Neonatal and infant mortality
99
Intrauterine Growth Restriction (IUGR): causes
Low pre-pregnancy weight
Short stature
Low caloric intake
Maternal low birth-weight
Non nutritional factors
Kramer, 1989
1010
Iron Deficiency
Most common form of malnutrition
Most common cause of anemia
Other causes of anemia:
Parasitic infection
Malaria
1111
Dietary Iron RequirementsThroughout the Life Cycle
0
2
4
6
8
10
12
0 10 20 30 40 50 60 70
Men
Women
Required iron intake(mg Fe/1000 kcal)
Stoltzfus, 1997
Age (years)
Pregnancy
1212
Causes of DietaryIron Deficiency
Low dietary iron intake
Low iron bioavailability Non-heme iron
Inhibitors
1313
Parasitic Infection
Causes blood loss
Increases iron loss
1414
Malaria
Destroys red blood cells
Leads to severe anemia
Increases risk in pregnancy
1515
Prevalence of Anemiain Women 15-49 years old
ACC/SCN, 1992
Percent
1616
Severity of Anemiain Pregnant Women
0
50
100
Nepal China
Mild anemia (90<Hb<110 g/L)
Moderate to severe anemia (Hb<90 g/L)
Stoltzfus, 1997
Percent
1717
Consequencesof Maternal Anemia
Maternal deaths Reduced transfer of iron to fetus Low birth weight Neonatal mortality Reduced physical capacity, energy Impaired cognition
1818
Severe Anemia andMaternal Mortality (Malaysia)
15.5
3.5
0
10
20
Llewellyn-Jones, 1985
< 65 > 65 Pregnancy hemoglobin concentration (g/L)
Maternal deaths / 1000 live births
1919
Consequences of Anemiaon Women’s Productivity
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2020
Maternal Vitamin A Deficiency: Causes
• Inadequate intake
• Recurrent infections
• Reproductive cycles
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2121
Consequences of Vitamin A Deficiency in Pregnancy (1)
Increased risk of: Nightblindness Maternal mortality (??) Miscarriage Stillbirth Low birth weight
2222
Consequences of Vitamin A Deficiency in Pregnancy (2)
Increased risk of:
Reduced transfer of vitamin A to fetus
HIV vertical transmission
2323
Consequences of MaternalVitamin A Deficiency on Lactation
UN
ICE
FC
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18/
Spr
ague
Low vitamin A concentrationin breastmilk
2424
Effects of Vitamin A deficiency on children
Contributing factor in 2.2 million deaths each year from diarrhea and 1 million deaths from measles
Severe deficiency can also cause irreversible corneal damage, leading to partial or total blindness
Field trials indicate that VA supplementation of at-risk children can reduce deaths from diarrhea. Four studies showed deaths were reduced by 35-50 per cent.
VA can reduce by half the number of deaths due to measles
2525
Iodine Deficiency in Women
UN
ICE
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5-0
065
Sha
did
GoiterGoiter
2626
Consequences of Iodine Deficiency on Intelligence
3% cretins
10% severely mentally impaired
87% mildly mentally impaired
3% cretins
10% severely mentally impaired
87% mildly mentally impaired
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2727
Who is at risk for iodine deficiency?
Mer
cer
phot
oM
erce
r ph
oto
2828
Consequences of Maternal Zinc Deficiency
Rupture of membranes
Prolonged labor
Preterm delivery
Low birth weight
Maternal and infant mortality
2929
Consequences of Maternal Folic Acid Deficiency
Maternal anemia
Neural tube defects
Low birth weight
MaternalNutrition
Interventions
HA
I p
hoto
HA
I p
hoto
3131
Major Interventionsin Maternal Nutrition
Improve weight and height
Improve micronutrient status
3232
Improving Maternal Weight
Increase caloric intake
Reduce energy expenditure
Reduce caloric depletion (e.g., infections)
3333
Improving Maternal Height
Increase birth weight
Enhance infant growth
Improve adolescent growth
3434
Optimal Behaviorsto Improve Women’s Nutrition
Early Infancy: Exclusive breastfeeding to about six months of age
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Optimal Behaviorsto Improve Women’s Nutrition
Late Infancy and Childhood: Appropriate complementaryfeeding fromabout six months
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3636
Optimal Behaviorsto Improve Women’s Nutrition
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Late Infancy and Childhood: Continue frequent on-demand breastfeeding to 24 months and beyond
3737
Optimal Behaviorsto Improve Women’s Nutrition
Pregnancy:• Increase food intake• Take iron+folic acid supplements daily• Reduce workload• Management of malaria, other parasites
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Optimal Behaviorsto Improve Women’s Nutrition
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Lactation:• Increase food intake• Take a high dose
vitamin A at delivery• Reduce workload
3939
Optimal Behaviorsto Improve Women’s Nutrition
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ICE
F90
-070
/Lem
oyne
• Delay
first
pregnancy
• Increase
birth
intervals
4040
Parasite Control to Improve Women’s Micronutrient Status
Reduce parasite transmission:
Improve hygiene, footwear
Increase access to effective care
Bednets, malaria management especially during pregnancy
4141
Optimal Behaviorsto Improve Women’s Nutrition
At all times:• Increase food intake if underweight• Diversify the diet• Use iodized salt• Control parasites, including malaria• Take micronutrient supplements if needed
4242
THANKSTHANKS !!
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