Maternal Nutrition

Dr Tahmeed Ahmed
Senior Director
Nutrition & Clinical Services Division
Professor, Public Health Nutrition
James P. Grant School of Public Health
BRAC University

Targeting Nutrition Interventions to the First 1000 Days

Higher
mortality
rate

Impaired
mental
development

Baby
Low Birth
Weight

Untimely / inadequate
weaning
Frequent
infections
Inadequate
food, health
& care

Foetal
Malnutrition
Child
Stunted

Malnourished

Reduced
mental
capacity

ADULTS

Pregnancy
Low Weight
Gain

Adolescent
Stunted

Higher
maternal
mortality

Reduced
mental
capacity

Llanos, Alvear, Uauy 2004

 13% of households are headed by a woman

The median age at first marriage among women age
25-49 is 15.8 y
31% of adolescents age 15-19 start childbearing
27% of women are not educated
45%of women were employed with the highest
percentages employed in raising of poultry/cattle
(41%), semi-skilled services (14%), and factory (8%)
By 47 yr, 55% women are in menopause

Total fertility rate has declined in Bangladesh

7
6
5
4
3
2
1
0
1975 1989 1991 1994 1997 2000 2004 2007 2011 2014

BDHS and other sources

Number of antenatal care visits is important, but is poor in Bangladesh

BDHS Report Draft 2014

Evidence Highlights Importance of Nutritional

Status in Women Before and During Pregnancy
Short maternal stature may lead to obstructed labour and
maternal and fetal or neonatal death
Maternal stunting and low Body Mass Index increases the risk of
fetal growth restriction (small for gestational age)
Maternal obesity leads to gestational diabetes, pre-eclampsia,
haemorrhage and higher risk of neonatal and infant death

Undernourishment (BMI<18.5) still high in Bangladesh

BDHS 2014

Improving Nutrition of Women:

Seeking a Balance between Underweight and Overweight
BMI <18.5

BMI >=23

BMI >=25

52

39
24
19

7
3

1996

2000

2004

2007

2011

2014

Undernourishment (BMI<18.5) common among

poor women
BMI <18.5

BMI 25

Lowest

32.2

8.4

Second

24.9

13.3

Middle

19.0

20.2

Fourth

12.3

27.1

Highest

7.0

46.7

Total

19

24

BDHS 2014

Iron and Calcium Deficiencies Contribute to

Maternal Deaths
Anemia is a risk factor for maternal deaths, most likely due to
haemorrhage, the leading cause of maternal deaths (23% of total
deaths)
Calcium deficiency increases the risk of pre-eclampsia, currently the
second leading cause of maternal death (19% of total deaths)

Addressing these deficiencies could result in

substantial reduction of maternal deaths
11

 Womens nutrient needs increase during pregnancy and

Lactation
Some of the increased nutrient requirements protect
maternal health while others affect birth outcome and
infant health
If the requirements are not met, the consequences can be
serious for women and their infants

Weight gain recommendations for pregnancy

Increased nutritional needs during

pregnancy and lactation

Increased nutritional needs during

pregnancy and lactation

Increased nutritional needs during

pregnancy and lactation

Desired weight gain during pregnancy in

Bangladesh
In Bangladesh, recommended weight gain during
pregnancy is 9 kg

The standard set for the 3rd trimester is >4 kg

Desired weight gain during pregnancy in

Bangladesh

Ahmed T et al. Report of NNP Baseline Survey 2004

The 5 or more food groups out of 10 are

likely to meet MN needs of women

The weight gain is distributed for various

purposes
Baby: 7.5 pounds
Placenta: 1.5 pounds
Amniotic fluid: 2 pounds
Uterine enlargement: 2 pounds
Maternal breast tissue: 2 pounds
Maternal blood volume: 4 pounds
Fluids in maternal tissue: 4 pounds
Maternal fat stores: 7 pounds

Packages of Nutrition Interventions

Optimal maternal nutrition during pregnancy

Maternal multiple micronutrient supplements to all

Calcium supplementation to mothers at-risk of low intake
Maternal balanced energy protein supplements as needed
Universal salt iodisation

Infant and young child feeding

Promotion of early, exclusive breastfeeding for 6 months; continued breastfeeding
until 24 months
Appropriate complementary feeding education in food secure populations and
additional complementary food supplements in food insecure populations

Micronutrient supplementation in children at risk

Vitamin A supplementation between 6-59 months age
Preventive zinc supplements between 12-59 months of age

Management of acute malnutrition

Supplementary feeding for moderate acute malnutrition
Management of severe acute malnutrition
21

Nutrition-sensitive interventions crucial to

control stunting
Interventions or programmes that address the underlying determinants of fetal
and child nutrition and development food security; adequate caregiving
resources at the maternal, household and community levels; and access to health
services and a safe and hygienic environmentand incorporate specific nutrition
goals and actions
Nutrition-sensitive programmes can serve as delivery platforms for nutritionspecific interventions, potentially increasing their scale, coverage and
effectiveness

Examples
:

Agriculture and food security

Social safety nets

Early child development

Maternal mental health

Womens empowerment

Child protection

Schooling

Water, sanitation and hygiene

Health and family planning services

Ruel M, The Lancet Nutrition Series 2013

Maternal Nutrition during Pregnancy And

Lactation