Maternal nutrition: Micronutrient supplements to the rescue

By Doris Obinna

Maternal nutrition is a key regulator of fetal growthas the mother provides the macro and micronutrients that both the fetus andplacenta require to grow. Therefore, maintaining good nutrition and a healthydiet during pregnancy is critical for the health of the mother and unborn child.

According to United Nations Children’s Fund (UNICEF),women have distinct nutritional requirements throughout their life;especially before and during pregnancy and while breastfeeding, whennutritional vulnerability is greatest. Ensuring women have nutritious diets andadequate services and care is fundamental for the survival and well-being ofmothers and their children.

Before pregnancy,women need nutritious and safe diets to establish sufficient reserves forpregnancy. During pregnancy and breastfeeding, energy and nutrient needsincrease. Meeting them is critical for women’s health and that of their childin the womb and throughout early childhood.

A Public HealthNutritionist and State Coordinator, Lagos, Alive & Thrive Nigeria, Olawumi Ajayi, said, one in five maternaldeaths and nearly half of all child deaths under age five are caused bymalnutrition.

Shesaid women need nutritious, safe, affordable, and sustainable diets along withessential nutrition services and positive nutrition practices for their ownsurvival, health and well-being as well as that of their children. “Protectingwomen’s nutrition is especially important during pregnancy and breastfeeding,when nutrient requirements increase and vulnerability is greatest.”

Ajayi,who spoke on Multiple Micronutrients Supplement (MMS) at a one day mediaroundtable organized by a non-governmental organisation FHI 360Alive&Thrive in collaboration with the Lagos State Ministry of Health,said, physiologically, pregnancy, is a period when women have increasednutritional needs.

According to her, sensitisation on the importance of multiplemicronutrient supplementation for pregnant women is very crucial for maternalnutrition.

She reiteratedthat poor nutrition during pregnancy has serious adverse effects on birth andmaternal health outcomes, as well as the long-term development of the child.

“Malnourishedmothers are also likely to suffer from conditions such as anaemia, whichincrease the risk of preterm birth, post partum haemorrhage, the leading causeof maternal death.

“Childrenborn to malnourished women are more likely to be born too small, too soon, orstillborn. Children of malnourished mothers who survive infancy are more likelyto experience physical and cognitive setbacks that can keep them from reachingtheir full potential as adults.”

Publichealth problem

Ajayiexplained that the high prevalence of anaemia in women of reproductive age andpregnant women in Nigeria is widely recognized as an important public healthproblem because of its negative consequences for pregnancy outcome and itsimpact on maternal mortality

She said: “Over the past five decades, iron and folic acid (IFA) supplementationhas become a core component of antenatal care for pregnant women in Nigeria toaddress anaemia. While iron and folic acid are critical nutrients, they are notthe only nutrients that pregnant women may need to support their health and thehealth of their child.

“Other vitamins and minerals; collectively referred toas micronutrients, including vitamins A, B₁, B₂, B₃, B₆, B₉ (folic acid), B₁₂, C, D, E, and the minerals iron, zinc, iodine,copper, and selenium are essential for a healthy pregnancy and foetaldevelopment. Dailyintake of these micronutrients during pregnancy increases by as much as up to50 per cent.”

Maternalnutrition

Ajayidisclosed that across the world, women’s diets are often poor in quality andlack nutrients; deficiencies in essential vitamins and minerals e.g., folate,iodine, iron and zinc are rampant. “These nutritional deficiencies underminewomen’s health and threaten the survival and development of their children.”

Shestressed that maternal nutrition is critical to ensuring that women havehealthy pregnancies and that children grow into healthy adults, yet evidenceshowed that women in low-resource settings find it difficult to meet theirdaily dietary requirements leading to high proportion of women of reproductiveage (WRA) with low minimum dietary diversity (MDD) across the nation.

Citingthe Minimum Nigeria Demographic and Health Survey (NDHS 2018), she said,dietary diversity is a proxy for micronutrient intake and the proportion of WRAthat met it.

“TheNational Food Consumption and Micronutrient Survey (NFCMS 2021) showed asignificant decline as about a third of non-pregnant and non lactating (28.2 percent) and pregnant (28.8 per cent) pregnant women achieved minimum dietarydiversity, while the MDD score for WRA is 3.6 per cent out of the maximum of 10signifying poor dietary diversity.

Nutritionalneeds during pregnancy

“Whena woman is pregnant, there is an increase in nutritional needs; to meet thephysiological conditions, sustain fetal growth and development, protect thehealth of the mother during pregnancy and prepare her for breastfeeding.

“Also,both macro and micronutrients requirements during pregnancy differ for nonpregnant women. Increase in calories intake is 340Klcal/day and 452Kcal/day inthe second and third trimester respectively.”

Importance of nutrition

According to WHO, thereproductive period is a critical time for establishing risks of chronicdiseases in offspring later in life. “Nutrition plays a vital role during thisdevelopmental period, and because it is a determinant of lifetime risk ofdisease, it is potentially a modifiable risk factor.”

WHO provides guidelines forantenatal care, comprehensive guidelines detailing nutritional needs of womenthroughout reproduction from preconception through pregnancy and lactation arelacking.

WHO recommendation

“Counseling about healthy eatingand keeping physically active during pregnancy is recommended for pregnantwomen to stay healthy and to prevent excessive weight gain during pregnancy.

“In undernourishedpopulations, nutrition education on increasing daily energy and protein intakeis recommended for pregnant women to reduce the risk of low birth weightneonates.

“A healthy dietduring pregnancy contains adequate energy, protein, vitamins and minerals,obtained through the consumption of a variety of foods, including green andorange vegetables, meat, fish, beans, nuts, pasteurized dairy products andfruit.”