Maternal Nutrition Issues and Interventions MCH in Developing Countries HServ/GH 544 January 27, 2011

1. Maternal Nutrition Issues and Interventions • MCH in Developing Countries • HServ/GH 544 • January 27, 2011

2. Maternal Nutrition Issues UNICEF/C-79-15/Goodsmith

3. Major Issuesin Maternal Nutrition • Inadequate weight and height • Micronutrient deficiencies

4. 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

5. 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

6. Maternal Malnutrition:A Life-Cycle Issue (3) • Throughout life • Food insecurity • Inadequate diets • Recurrent infections • Frequent parasites • Poor health care • Heavy workloads • Gender inequities

7. Chronic Energy Deficiencyin Women 15-49 Years Old Percent Women BMI<18.5 kg/m2 ACC/SCN, 1992

8. Consequences of Maternal Chronic Energy Deficiency • Infections • Obstructed labor • Maternal mortality • Low birth weight • Neonatal and infant mortality

9. Intrauterine Growth Restriction (IUGR): causes Kramer, 1989

10. Iron Deficiency • Most common form of malnutrition • Most common cause of anemia • Other causes of anemia: • Parasitic infection • Malaria

11. Dietary Iron RequirementsThroughout the Life Cycle Required iron intake (mg Fe/1000 kcal) Pregnancy Age (years) Stoltzfus, 1997

12. Causes of DietaryIron Deficiency • Low dietary iron intake • Low iron bioavailability • Non-heme iron • Inhibitors

13. Parasitic Infection • Causes blood loss • Increases iron loss

14. Malaria • Destroys red blood cells • Leads to severe anemia • Increases risk in pregnancy

15. Prevalence of Anemiain Women 15-49 years old Percent ACC/SCN, 1992

16. Severity of Anemiain Pregnant Women Percent Stoltzfus, 1997

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

18. Severe Anemia andMaternal Mortality (Malaysia) Maternal deaths / 1000 live births • < 65 > 65 Pregnancy hemoglobin concentration (g/L) Llewellyn-Jones, 1985

19. Consequences of Anemiaon Women’s Productivity UNICEF/91-029 J /Schytte

20. Maternal Vitamin A Deficiency: Causes • Inadequate intake • Recurrent infections • Reproductive cycles UNICEF/C-16-8/Isaac

21. Consequences of Vitamin A Deficiency in Pregnancy (1) • Increased risk of: • Nightblindness • Maternal mortality (??) • Miscarriage • Stillbirth • Low birth weight

22. Consequences of Vitamin A Deficiency in Pregnancy (2) • Increased risk of: • Reduced transfer of vitamin A to fetus • HIV vertical transmission

23. Consequences of MaternalVitamin A Deficiency on Lactation Low vitamin A concentration in breastmilk UNICEFC-92-18/Sprague

24. 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

25. Iodine Deficiency in Women • Goiter UNICEF/95-0065 Shadid

26. Consequences of Iodine Deficiency on Intelligence • 3% cretins • 10% severely mentally impaired • 87% mildly mentally impaired UNICEF/C-79-39

27. Who is at risk for iodine deficiency? Mercer photo

28. Consequences of Maternal Zinc Deficiency • Rupture of membranes • Prolonged labor • Preterm delivery • Low birth weight • Maternal and infant mortality

29. Consequences of Maternal Folic Acid Deficiency • Maternal anemia • Neural tube defects • Low birth weight

30. Maternal Nutrition Interventions HAI photo

31. Major Interventionsin Maternal Nutrition • Improve weight and height • Improve micronutrient status

32. Improving Maternal Weight • Increase caloric intake • Reduce energy expenditure • Reduce caloric depletion (e.g., infections)

33. Improving Maternal Height • Increase birth weight • Enhance infant growth • Improve adolescent growth

34. Optimal Behaviorsto Improve Women’s Nutrition Early Infancy: Exclusive breastfeeding to about six months of age UNICEF/C-79-10

35. Optimal Behaviorsto Improve Women’s Nutrition Late Infancy and Childhood:Appropriate complementary feeding from about six months UNICEF/C-55-3F/Watson

36. Optimal Behaviorsto Improve Women’s Nutrition • Late Infancy and Childhood:Continue frequent on-demand breastfeeding to 24 months and beyond UNICEF/C-56-7/Murray-Lee

37. Optimal Behaviorsto Improve Women’s Nutrition • Pregnancy: • Increase food intake • Take iron+folic acid supplements daily • Reduce workload • Management of malaria, other parasites UNICEF/C-55-10/Watson

38. Optimal Behaviorsto Improve Women’s Nutrition • Lactation: • Increase food intake • Take a high dose • vitamin A at delivery • Reduce workload UNICEF/C-88-15/Goodsmith

39. Optimal Behaviorsto Improve Women’s Nutrition • Delay first pregnancy • Increase birth intervals UNICEF90-070/Lemoyne

40. 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

41. 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

42. THANKS!