Bihar: What, when, and how much we eat is an important roadmap of our health. This becomes more important during pregnancy when the health of a pregnant woman and that of her growing baby inside the womb are at stake. Nutrition at this stage has a generational impact. In India, 26.8 per cent of women (20-24 years) marry before 18 years and 8 per cent of girls get pregnant when they are adolescents. Leading to this, 22.9 per cent of women in India enter pregnancy as underweight (Body Mass Index<18.5). An average weight gain in pregnancy is about 7 kg only. Around 58 per cent of pregnant women are anaemic in India. (Data source: NFHS-4 2015-16, SRS 2016 & 2017, SRS 2016-18, CNNS 2016)
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Intergenerational Effects Of Maternal Nutrition
Maternal nutrition is the foundation stone for a child’s growth and development. It is critical for a woman’s health and well-being across life stages. Fetal Growth Restriction (FGR) is one of the leading risks of stunting (low height for age) worldwide. The FGR contributes to one-quarter of newborn deaths globally. Fetal stunting is evident in 8 weeks of pregnancy. Also, 70 per cent of brain develops inside the mother’s womb. If nutrition is not adequate, this physical and mental growth will be hampered.
Stunted growth in girls leads to short stature and poor nutritional status in adult life. Short maternal stature is a risk factor for small weight age babies. Poor maternal nutritional status at conception leads to inadequate gestational weight gain due to poor dietary intake. Short maternal stature is also a risk factor for childhood stunting, increases with small for gestenational age babies and preterm birth. Some of these babies have poor cognitive development and impaired learning achievements in school. This may lead to poor productivity in adult life.
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The fetal origin of adult disease- it is now widely accepted that chronic diseases of adulthood are merely a result of lifestyle change and have a strong fetal life influence affecting the epigenetic. Diseases like coronary heart disease, diabetes mellitus and hypertension are the by-product of fetal life nutrition. Starvation in fetal life leads to a syndrome of insulin resistance. This is a fertile ground for development or aggravation of the same factors in adult life when there is relative prosperity.
Positive effects of preconception care are pivotal as the right start for pregnancy begins well before the conception itself. This is associated with a reduction in maternal and child mortality, prevent unintended pregnancies. It reduces stillbirth, preterm birth and low birth weight babies. There is a scope for preventing birth defects and neonatal infections.
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Impact of adequate nutrition
These are some critical impact of adequate nutrition of mother:
- Improvement in micronutrient status of a mother
- Reduction in low birth weight babies
- Reduction in maternal mortality rate (MMR) from post delivery bleeding
- Reduction in maternal anaemia, sepsis, low birth weight and premature babies
- Reduction in MMR from pre-eclampsia/eclampsia
- Reduction in abortion/stillbirth, brain damage & congenital defects
Interventions To Improve The Maternal Nutrition
Counselling on healthy eating including dietary diversity and physical activity. In undernourished populations, balanced energy and protein dietary supplements can be initiated. Folic acid supplementation (400 microgram) during peri-conception and first trimester stage is recommended. Iron and folic acid supplementation (60mg elemental iron) daily from the second trimester (180 days). Calcium supplementation (1gm) daily from the second trimester (180 days). Deworming (albendazole 400mg) in the second trimester. Use of double fortified (iron and iodine) salt and restrict caffeine intake.
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Food-acquired infections; pregnant women should be informed on how to reduce the risk of listeriosis by drinking only pasteurised milk, not eating ripened soft cheese such as Camembert, Brie and blue-veined cheese (there is no risk with hard cheeses, such as cheddar, or cottage cheese and processed cheese). The uncooked or undercooked, ready-prepared meal should not be taken.
Pregnant women should reduce the risk of salmonella infection by avoiding raw or partially cooked eggs or food that may contain them (such as mayonnaise). They should avoid raw or partially cooked meat, especially poultry.
Pregnant women should be informed of primary prevention measures to avoid toxoplasmosis infection, such as washing hands before handling food and thoroughly washing all fruits and vegetables, including ready-prepared salads; before eating, thoroughly cooking raw meats and ready-prepared chilled meals. They should be wearing gloves and thoroughly washing hands after handling soil and gardening, avoiding cat faeces in cat litter or in soil.
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Diet During pregnancy
In pregnancy, there is an additional energy requirement of 350 kcal and 23g protein. Three full meals and 2 nutritious snacks are recommended in the second and third trimester. Diet diversity indicates diet quality, associated with micronutrient adequacy. Minimum diet diversity is defined as the consumption of food items from at least 5 out of 10 defined food groups per day. Severely underweight pregnant women are advised to have one additional energy dense snack (350 kcal). Overweight/obese women are advised to take small meals throughout the day and replace two small meals with two nutritious low calorie (100-150 kcal) snacks, avoid fried, oily, and sweetened foods.
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Problems Leading To Poor Nutrition In Pregnancy
Many mothers face problems of nausea and vomiting, loss of appetite and unusual cravings. All of these may affect the nutrition of the mother. Most of these can be tackled with time and doctor’s prescription. Knowledge about the right food is essential for the mother and her family members. There may be a low intake of nutrient-dense foods (fruits and vegetables) and a high intake of added sugars and fats (fried foods, processed foods, desserts). There may be a more serious issue of lack of resources for adequate nutrition.
Overweight or obesity may pose challenges to the adequate nutrition of the woman. Medical history of bariatric surgery or other conditions that cause malabsorption. Substance misuse, worm infestation, chronic illness like tuberculosis may aggravate the nutritional deficiencies.
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Dr. Meena Sawant is the Secretary at Indian Society of Perinatology and Reproductive Biology (ISOPARB), Patna, Bihar.
Disclaimer: The opinions expressed within this article are the personal opinions of the author. The facts and opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.
NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.