Maternal Nutrition during Pregnancy and Lactation BY PROFESSOR JIB ADINMA DEPARTMENT OF OBS/GYN NNAMDI AZIKIWE UNIVERSITY TEACHING HOSPITAL NNEWI, NIGERIA Presentation delivered on behalf of FrieslandCampina WAMCO Nigeria at the 48th scientific conference and AGM of the Society of Gynecology and Obstetrics of Nigeria (SOGON) Asaba 21 st Nov. 2014

INTRODUCTION  Nutritional demands are enormous during pregnancy and lactation. Tendency towards maternal malnutrition date to intrauterine life. Malnourished mothers give birth to low birth weight babies and are associated with high risk of obstetrics complications; pregnancies associated with micro nutrient deficiencies affect the fetuses shortly after conception. Health workers should recognize and counsel pregnant women on increased nutritional demands during pregnancy. 

Highlight of presentation Nutrient-demand during pregnancy and lactation. Meeting Nutrient Requirements during pregnancy and lactation. Interventions to improve maternal nutrition during pregnancy and lactation. Conclusion.

Nutrient-demand during pregnancy and lactation Pregnancy requires more food, a balanced diet and micronutrient supplement during pregnancy Energy demand is more marked during the 2 nd and 3rd trimester resulting in weight gain. Unmet energy demand result in low birth weight babies and sometimes still birth Among the nutrient requirement during pregnancy include protein, iron, iodine, vitamin A, folate, and other nutrients.

Nutrient demand during pregnancy and lactation contd….. Nutrient deficiencies may cause maternal complications and death, fetal, and newborn deaths, birth defect and decreased physical and mental potential of the child Breast feeding also places high demand on maternal energy stores To avoid dietary deficiency during pregnancy and lactation, mothers should improve their diet before, during, and between cycles of pregnancy and lactation and take supplement. Women without adequate amount of water and nutrient stand the risk of maternal depletion with its untoward consequences.

Meeting Nutrient Requirements during pregnancy and lactation. Energy and diversified diet consisting of fruit, vegetable and animal product are required to commence pregnancy without nutritional deficiency. Food sources are not enough to provide nutrient such as iron, folic acid and vitamin A in sufficient amount. They therefore need to be obtained through food supplement

Table 1: Recommendation of weight gain during pregnancy Pre-pregnancy Weight Category Recommended Total Gain in Kilogram BMI < – 18.0 BMI – 16.0 BMI > 26.0 – – 11.5

Table 2: Shows The Distribution By Micro Nutrient Supplementation of Iron/folate, Vitamin A and Iodine During Pregnancy and Lactation for Timing and Dosage Supplement Timing Dosage Vitamin A 2 During pregnancy: after the 1 st trimester During lactation(after delivery): as soon as possible but not later than 8weeks after delivery. 10,000IU daily or a maximum of 25,000IUweekly. Single dose of 200,000IU.

Table 2 cont… Iron/folate 3-4,b Prevention of anemia Anemia prevalence >40%; 6 months during pregnancy, through 3 months postpartum anemia≤ 40%: 6 months during pregnancy 60mg iron and 400µl folic acid daily 120mg iron and 800µl folic acid daily Iodine 5 Before conception or as early in pregnancy as possible in high risk areas where iodized salt is not available Single dose of 400 – 600mg (2 or 3 capsule)

INTERVENTIONS TO IMPROVE MATERNAL NUTRITION DURING PREGNANCY AND LACTATION: These Interventions also compliment dietary and micro nutrients supplementation: 1. Combat of malaria during pregnancy, in endemic areas. 2.Reduction of Hook worm infestation using appropriate anti- helminthics administered after the 1 st trimester of pregnancy. 3.Advocating for child birth spacing of three years or more to ensure replenishment of nutrients in between birth and lactation. 4.Ensuring adequate rest and reduction of work load and curtailing long working hours during pregnancy.

Contd….. 5Advocacy by health worker to households concerning increase dietary demands during pregnancy and the need for diversification of food and intake of micro-nutrient supplementation during pregnancy 6Mobilization of Community leaders by health workers to facilitate uptake of malaria and hookworm reduction interventions as well as improve intake of diversified foods and micro nutrient supplements.

Conclusion  Every maternal health worker should be mindful of the increased energy and nutritional demands of the pregnant and breastfeeding mother and have the necessary skill and competence to counsel mothers and indeed community appropriately  Food specialty companies should expend towards the production of micro nutrient fortified foods and food products specifically formulated to meet the nutritional demands of the pregnant and lactating mother.

Thank you