Maternal Health Care and Her Nutrition: Indian Scenario: Nestle

Speaker: Prof. Alokendu Chatterjee, FRCOG. Formerly, Head OBGY Dept. NRS Medical College & Hospital, Kolkata Presented at: Nestlé Nutrition Institute, Kolkata

Summary

During the time of pregnancy, every woman essentially requires to follow a well-balanced diet. As sources of nutrients, the five major food groups include bread, cereals, fruits, vegetables, meat, fish, milk and dairy products. During pregnancy, women need to consume foods rich in folic acid, iron, riboflavin, potassium, zinc, fibre, calcium, iodine, vitamins and DHA; each in adequate quantities. The minimum Body Mass Index needs to be 18.5 and even during the lactation period, women need more energy and proteins. High rate of anaemia increases the risk of maternal death. A child’s nutritional welfare is directly proportional to the precautions that the mother undertakes.

Maternal Health Care is a rather wide term. It usually refers to health care of women during pregnancy and child birth. But it also encompasses health care dimensions of adolescents, preconception care, post natal care & family planning. 270 million (approx. 23% of population) women are in the child bearing age in India, as per 2011 census. Healthy pregnancy depends on pre pregnancy diet, related body composition and on nutrients consumed during pregnancy. Undernourished women with less than 22% fat rarely ovulate. Normal BMI during famine/starvation irregularly ovulates. Under weight or over weight may have an ovulatory infertility.

Basic fundamentals state that in pregnancy women need more food, a varied diet and micronutrient supplements. During lactation there are higher demands on maternal stores of energy, protein, and other nutrients. Counselling pregnant and lactating women to meet increased nutrient requirements through dietary, behavioural changes and other health practices is recommended. It is important to translate general requirements into individual, clinical recommendations.

Nutrients required during pregnancy are folic acid, iron, vitamin b6, b12, c, d, k, fibre, potassium, riboflavin, zinc and docosahexaenoic acid (DHA). DHA helps baby’s brain growth, vision, may reduce heart disease in mother. DHA is available in cooked coho salmon, blue crab, light tuna fish, cat fish, and fortified eggs (all non-veg). Strong evidence supports that folic acid prevents neural tube and may reduce risk of other birth defects. It also improves hematologic indices when receiving routine it. In an average non-pregnant adult 800 ug iron is lost/day, 500 ug iron lost/day during periods. 85% Indian pregnant population suffers from iron deficient anaemia. Women with low baseline calcium intake have the greatest effect. Average risk of preterm birth reduced in the calcium group. No overall effect on the risk of stillbirth or death before discharge.

The short term effects on foetal and infant health is increased risk of morbidity, infection, prematurity, possible birth defects, cretinism and possible damage to brain function. The long term effects on new born are that under-nutrition during pregnancy is associated with increased risk of CHD, type 2 Diabetes Mellitus, stroke and hypertension. A child’s nutritional wellbeing begins with her mom’s nutritional status. It is a continuous process which covers generations and cannot be adequately upgraded by adding few extra supplements for a few months during a current pregnancy.