Maternal Nutrition Issues and Interventions

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• Maternal Nutrition Issues and
  Interventions
• MCH in Developing Countries
• HServ/Epi 544
• January 15, 2009

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Maternal Nutrition Issues
UNICEF/C-79-15/Goodsmith
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Major Issuesin Maternal Nutrition

• Inadequate weight and height
• Micronutrient deficiencies

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Maternal MalnutritionA 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 MalnutritionA 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 MalnutritionA 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
Percent Women BMIlt18.5 kg/m2
ACC/SCN, 1992
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Consequences of Maternal Chronic Energy
Deficiency

• Infections
• Obstructed labor
• Maternal mortality
• Low birth weight
• Neonatal and infant mortality

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Intrauterine Growth Retardation causes
Kramer, 1989
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Iron Deficiency

• Most common form of malnutrition
• Most common cause of anemia
• Other causes of anemia
• Parasitic infection
• Malaria

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Dietary Iron RequirementsThroughout the Life
Cycle
Required iron intake (mg Fe/1000 kcal)
Pregnancy
Age (years)
Stoltzfus, 1997
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Causes of DietaryIron Deficiency

• Low dietary iron intake
• Low iron bioavailability
• Non-heme iron
• Inhibitors

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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
Percent
ACC/SCN, 1992
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Severity of Anemiain Pregnant Women
Percent
Stoltzfus, 1997
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Consequencesof Maternal Anemia

• Maternal deaths
• Reduced transfer of iron to fetus
• Low birth weight
• Neonatal mortality
• Reduced physical capacity, energy
• Impaired cognition

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Severe Anemia andMaternal Mortality (Malaysia)
Maternal deaths / 1000 live births
lt 65
gt 65
Pregnancy hemoglobin concentration (g/L)
Llewellyn-Jones, 1985
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Consequences of Anemiaon Womens Productivity
UNICEF/91-029 J /Schytte
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Maternal Vitamin A Deficiency Causes

• Inadequate intake
• Recurrent infections
• Reproductive cycles

UNICEF/C-16-8/Isaac
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Consequences of Vitamin A Deficiency in
Pregnancy (1)

• Increased risk of
• Nightblindness
• Maternal mortality
• Miscarriage
• Stillbirth
• Low birth weight

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Consequences of Vitamin A Deficiency in
Pregnancy (2)

• Increased risk of
• Reduced transfer of vitamin A to fetus
• HIV vertical transmission

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Consequences of MaternalVitamin A Deficiency on
Lactation
Low vitamin A concentration in breastmilk
UNICEFC-92-18/Sprague
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Iodine Deficiency in Women
UNICEF/95-0065 Shadid

• Goiter

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Consequences of Iodine
Deficiency on Intelligence

• 3 cretins
• 10 severely mentally impaired
• 87 mildly mentally impaired

UNICEF/C-79-39
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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

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Maternal Nutrition Interventions
Mercer photo
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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

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Optimal Behaviorsto Improve Womens Nutrition
Early Infancy Exclusive breastfeeding
to about six months of age
UNICEF/C-79-10
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Optimal Behaviorsto Improve Womens Nutrition
Late Infancy and Childhood
Appropriate complementary feeding from about six
months
UNICEF/C-55-3F/Watson
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Optimal Behaviorsto Improve Womens Nutrition

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

UNICEF/C-56-7/Murray-Lee
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Optimal Behaviorsto Improve Womens Nutrition

• Pregnancy
• Increase food intake
• Take ironfolic acid supplements daily
• Reduce workload
• Management of malaria, other parasites

UNICEF/C-55-10/Watson
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Optimal Behaviorsto Improve Womens Nutrition

• Lactation
• Increase food intake
• Take a high dose
• vitamin A at delivery
• Reduce workload

UNICEF/C-88-15/Goodsmith
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Optimal Behaviorsto Improve Womens Nutrition

• Delay first pregnancy
• Increase birth intervals

UNICEF90-070/Lemoyne
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Parasite Control to Improve Womens
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 Womens 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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THANKS !