Maternal Nutrition Issues and Interventions

MCH in Developing CountriesHServ/GH 544

January 27, 2011

Maternal Nutrition

Issues

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Major Issuesin Maternal Nutrition

Inadequate weight and height

Micronutrient deficiencies

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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

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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

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Maternal Malnutrition:A Life-Cycle Issue (3)

Throughout life– Food insecurity– Inadequate diets – Recurrent infections– Frequent parasites– Poor health care– Heavy workloads– Gender inequities

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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

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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

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Malaria

Destroys red blood cells

Leads to severe anemia

Increases risk in pregnancy

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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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Maternal Vitamin A Deficiency: Causes

• Inadequate intake

• Recurrent infections

• Reproductive cycles

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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

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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

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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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Who is at risk for iodine deficiency?

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Consequences of Maternal Zinc Deficiency

Rupture of membranes

Prolonged labor

Preterm delivery

Low birth weight

Maternal and infant mortality

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Consequences of Maternal Folic Acid Deficiency

Maternal anemia

Neural tube defects

Low birth weight

MaternalNutrition

Interventions

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Major Interventionsin Maternal Nutrition

Improve weight and height

Improve micronutrient status

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Improving Maternal Weight

Increase caloric intake

Reduce energy expenditure

Reduce caloric depletion (e.g., infections)

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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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Optimal Behaviorsto Improve Women’s Nutrition

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Late Infancy and Childhood: Continue frequent on-demand breastfeeding to 24 months and beyond

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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

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Optimal Behaviorsto Improve Women’s Nutrition

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• Delay

first

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• Increase

birth

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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

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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

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THANKSTHANKS !!