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. 3 Major Issues in Maternal Nutrition  Inadequate weight and height  Micronutrient deficiencies

4. 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. 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. 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. 7 Chronic Energy Deficiency in Women 15-49 Years Old ACC/SCN, 1992 Percent Women BMI<18.5 kg/m 2

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

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

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

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

12. 12 Causes of Dietary Iron Deficiency  Low dietary iron intake  Low iron bioavailability  Non-heme iron  Inhibitors

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

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

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

16. 16 Severity of Anemia in Pregnant Women Stoltzfus, 1997 Percent

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

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

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

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

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

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

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

24. 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. 25 Iodine Deficiency in Women UNICEF/95-0065 Shadid Goiter

26. 26 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 UNICEF/C-79-39

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

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

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

30. Maternal Nutrition Interventions HAI photo

31. 31 Major Interventions in Maternal Nutrition  Improve weight and height  Improve micronutrient status

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

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

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

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

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

37. 37 Optimal Behaviors to 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. 38 Optimal Behaviors to Improve Women’s Nutrition UNICEF/C-88-15/Goodsmith Lactation: Increase food intake Take a high dose vitamin A at delivery Reduce workload

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

40. 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. 41 Optimal Behaviors to 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. 42 THANKS !