Malnutrition is a significant problem in pregnant women, especially in developing countries. Before pregnancy, women need nutritious and safe diets to establish sufficient reserves for pregnancy. During pregnancy and breastfeeding, energy and nutrient needs increase. Meeting them is critical for women’s health and that of their child – in the womb and throughout early childhood.

But in many parts of the world, the nutritional status of women is unacceptably poor. Far too many women – especially adolescents and those who are nutritionally at risk – are not receiving the nutrition services they need to be healthy and give their babies the best chance to survive, grow and develop. This leads to malnutrition and its subsequent effects in girl children. These girls, who are already anaemic and malnourished, get married and become pregnant. The need for nutrition doubles during pregnancy, but even then, she does not get her due share. This leads to complications during pregnancy and delivery. Maternal morbidity and mortality is not going down due to these factors.

Potential Causes of Malnutrition

Morning sickness is a common symptom experienced during the first trimester of pregnancy. Pregnant women often experience nausea and vomiting, particularly in the morning, leading to a decrease in appetite. This can result in a reduction in caloric intake as well as essential nutrients. While morning sickness typically subsides in the second trimester, it may persist in some cases. Additionally, pregnant women may experience cravings for foods that may not necessarily provide adequate nutritional value.
Lack of awareness regarding nutrition is not limited to economically disadvantaged women. There is a general lack of understanding within the society about nutritional and caloric value of available food. Despite the abundance of food options, pregnant women often consume inadequately balanced diets, which can result in malnutrition.
There is a lack of understanding within society about the nutritional and caloric value of available foods. Sometimes certain health problems also do not allow ingestion of proper nutrition. Such cases need proper diagnosis and treatment.

Need for Healthy Nutrition in Pregnancy

During pregnancy, there is an increased need for calories to support the growth and development of the baby. In the first trimester, an additional 150 calories per day is recommended. By the 4th month, this requirement rises to an extra 300 calories per day. Along with calories, the need for other essential nutrients also increases. It is important to adjust one’s diet accordingly as these caloric needs continue to rise throughout pregnancy.

Health Risks for the Baby

The growth of the baby begins from the very first month of pregnancy. Sometimes, women may not realize they are pregnant early on and thus may not adjust their nutrition accordingly. This can potentially lead to developmental defects in the new born. One crucial nutrient during the first trimester is folic acid, which is essential for preventing neural tube defects. Failure to include folic acid in the diet or take it as a supplement can increase the risk of such defects. Also, malnutrition during pregnancy can result in various other complications including stillbirth, premature birth, brain damage, prenatal mortality, and underdevelopment of organs and limbs.
In the long term, maternal malnutrition during pregnancy can increase the risk of various health conditions for the baby, including type 2 diabetes, heart disease, osteoporosis, obesity, breast cancer, chronic kidney failure, and susceptibility to infectious diseases. If a child’s developmental milestones are delayed due to maternal malnutrition, it can lead to poor academic performance in school. Specific nutrient deficiencies can also have serious consequences; for example, vitamin D deficiency can lead to rickets, while calcium deficiency can result in poor foetal skeletal development.

Health Risks for the Mother

One of the most common risks is anaemia. Pregnant mothers with haemoglobin levels less than 7 gm% are always at risk of maternal morbidity and mortality during or after delivery. Zinc and magnesium deficiency can cause preeclampsia and preterm birth. Vitamin K deficiency can lead to excessive bleeding during childbirth. Inadequate iodine intake can lead to miscarriage. In the long term, it can lower immunity and lead to infections. It can also cause severe anaemia and weakness.

What Can Be Done?

Ideally, pregnant women should receive adequate nutrition, sufficient rest, and regular check-ups. However, ensuring a nutritious diet for pregnant women in developing countries is often challenging. There is a crucial need to raise awareness among the general public and pregnant women about the importance of good nutrition and the variety of easily accessible food items that can prevent malnutrition during pregnancy. Ideally, nutritious diets should be made available for pregnant women at the nearest “Anganwadi Centers”. If we aspire for a healthy nation, ensuring the health of women is imperative.

WHO Recommendations on Antenatal Care:

• A minimum of eight contacts are recommended to reduce perinatal mortality and improve women’s experience of care.
• Counselling about healthy eating and keeping physically active during pregnancy.
• Daily oral iron and folic acid supplementation with 30 mg to 60 mg of elemental iron and 400 µg (0.4 mg) folic acid for pregnant women to prevent maternal anaemia, puerperal sepsis, low birth weight, and preterm birth.
• Tetanus toxoid vaccination is recommended for all pregnant women, depending on previous tetanus vaccination exposure, to prevent neonatal mortality from tetanus.
• One ultrasound scan before 24 weeks’ gestation (early ultrasound) is recommended for pregnant women to estimate gestational age, improve detection of fetal anomalies and multiple pregnancies, reduce induction of labour for post-term pregnancy, and improve a woman’s pregnancy experience.
• Health-care providers should ask all pregnant women about their use of alcohol and other substances (past and present) as early as possible in the pregnancy and at every antenatal visit.

Role of Public Health Delivery System in Preventing Malnutrition