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Maternal Nutrition and Fetal Growth Rate



Maternal nutrition is the foundation for the evolution of a child and its growth. 70% of the brain development is intrauterine. Poor diet during maternity leads to Fetal Growth Restriction(#FGR). FGR is the leading cause of Stunting (low height for age). FGR baby refers to reduced growth of the foetus in the womb. Often, FGR leads to Small for Gestational Age (#SGA) babies. SGA refers to birthweight below the 10th percentile for gestational age.


Research published in the National Library of Medicine states, “There is no definitive management for FGR except for correction of maternal factors and timely delivery.”


Poor maternal diet during preconception, pregnancy and birth leads to maternal undernutrition and poor weight gain. Adequate weight gain during pregnancy is essential for supporting a healthy pregnancy and optimal outcomes for the child. In India, Low Birth Weight(#LBW) is a key medical challenge. Low Birth Weight refers to a birthweight less than 2.5 Kg.


Every year, 8 million infant deaths occur due to Low birthweight, worldwide.


The Main Reasons behind #LowBirthWeight:

  • Poor health status of the mother

  • Inadequate weight gain during pregnancy

  • Maternal Short Stature

Outcomes of Maternal Poor Health Status and Diet:

  • Abortion i.e., loss of the infant, mostly in 1st trimester

  • Stillbirths i.e., loss of a baby before birth but after the 20th week of pregnancy

  • Preterm labour and birth i.e., labour and birth before 37 weeks of pregnancy

  • Delayed postpartum recovery, i.e., inability to gain strength for long periods after delivery

  • Risk of mortality from postpartum haemorrhage i.e., mortality due to loss of blood

  • Higher chances of mortality and morbidity from preeclampsia/eclampsia i.e., death from high blood pressure conditions which could cause convulsions in the brain

  • The impaired reproductive and productive capability of women i.e., poor maternal health leading to infertility, irregular menstrual cycles etc.,


Reciprocating effects of undernourished mothers:

Undernourished mothers give birth to:

  • Preterm babies

  • Small for Gestational Age Babies

  • Low Birth Weight babies


They suffer with:

  • Physical growth

  • Less immunity

  • Risk of death

  • Low cognition

  • Low understanding in school

  • Adulthood poor productivity


A Stunted baby:

  • has a short physical build

  • has low mental health

  • is vulnerable to health issues in adulthood


A stunted baby girl grows into a stunted adolescent. The stunted adolescent linearly grows into a short-statured woman. Globally, 6 million SGA births are associated with maternal short stature every year. Stunted pregnant adolescents are more susceptible to health risks, low-birthweight and stunted babies.


Low circulation of Pregnancy-associated Plasma protein-A(PAPP-A), in early pregnancy, increases the risk of FGR. Fetal Growth Restriction is a critical cause of newborn mortality, which mainly occurs due to maternal undernutrition.


Reasons to prevent FGR:

  • It gives rise to full-term babies who are SGA

  • It is the major cause of stunting

  • Out of 44 million newborn deaths, 11 million occur due to FGR

  • Half a million deaths per year globally, occur due to FGR, making it a major cause of newborn deaths

Why timely interventions are necessary to control FGR?

  • It causes stunting

  • Treatment is expensive

  • The treatments do not contain proven positive impacts

Timing of FGR:

Understanding the timing of Foetal Growth Restriction can assist in taking preventive measures during the critical periods of fetal growth to reduce its occurrence.


  • Fetal Growth Restriction becomes noticeable by the 8th week of pregnancy

  • Peak velocity of foetal weight occurs at around 30 weeks of pregnancy

  • #WastedIntraUterineGrowthRestriction (Wasted IUGR) is caused due to growth retardation in the third trimester of pregnancy, “Wasting” refers to having a low weight for the corresponding height


These timings indicate that FGR and IUGR are caused by issues that arise during pre-conception or the early stages of pregnancy.


There are many favourable policies for Women's health in India, still, women's health is not optimal. One major development is that “The maternal mortality ratio has gone down from 130 per one lakh live births in 2014-2016 to 113 per one lakh in 2016-18.”


  • 26.8% of the women marry before the required age of 18

  • The percentage of pregnancy in teenagers is 8%

  • 42% of the adolescent girls in the age range of 15 to 19 years are underweight

  • 54% of the 42% of adolescent girls in the age range of 15 to 19 are also anaemic

  • Anaemia is common in 50% of pregnant women

  • Being Underweight is a common issue with 22.9% of women going into pregnancy underweight

  • There is only a 7% average weight gain during pregnancy with one in five babies born with a low birth weight

  • 21% of the women in the reproductive age range are overweight with BMI >25

  • There is a significant gap from the recommendation of 360 days of IFA, as only 30% of pregnant women consume IFA tablets for 100 or more days

  • Still, 20% of pregnant women are not delivering in healthcare institutions


Recommended Interventions for maternal nutrition WHO and MoHFW:

  • For an undernourished population, providing knowledge on Energy and protein diet is very important as it avoids LBW, SGA and stillbirth

  • Health advice on Physical exercise

  • Iron-Folic Acid supplements must be taken every day

  • Calcium supplements play a huge role in bone health

  • Consumption of Vitamin A supplements is advised only if there is a severe Vitamin A deficiency in the country

  • Iodized salt consumption is recommended to avoid thyroid problems

  • Supplements that are not recommended are, high protein supplements, Vitamin D, Vitamin B6, Vitamin C and Vitamin E

  • Recently, WHO has stated that multiple micronutrients with Iron and Folate must be prescribed only after thorough research

  • Deworming is also recommended

These are the World Health Organisation(WHO) and the Ministry of Health and Welfare of Women(MoHFW) recommendations.


Recommended Nutritional diet during pregnancy:



Five groups of food such as

  1. Milk and milk products

  2. Yellow/orange fruits and vegetables that have pulp

  3. Eggs and flesh products

  4. Pulses and beans and

  5. Green leafy vegetables

are recommended along with rice/ or roti for every meal. Also, the Intake of milk and milk products must be increased in vegetarian households.


Every trimester meal plan:

1st trimester: 2 Healthy meals with five food groups - every day

2nd trimester: 3 Healthy meals with five food groups - every day

3rd trimester: 3 Healthy meals with five food groups and 2 nutritious snacks- every day


Recommended protein-rich foods for undernourished women include Pulses, Lentils, Beans, Peanut butter, Soya, Yoghurt, Chicken, Organ meat, Milk etc.,


The government of India's recommended diet chart for North Indian women is given below: https://wcd.nic.in/sites/default/files/Diet%20Chart%20For%20North%20India.pdf


The government of India's recommended diet chart for South Indian women is given below:


Recommended IFA during pregnancy:

  • 60 mg of elemental Iron

  • 500 mcg of Folic acid

This helps to prevent maternal anaemia, sepsis, LBW and preterm birth. The above quantity is prescribed for 180 days from the second trimester and another 180 days post-childbirth.


Minor side effects of IFA supplementation:

  • IFA tablets should be consumed daily with water or lime juice, more preferably at bedtime

  • It should not be consumed with tea/coffee/milk

  • It should not be consumed with Calcium supplements

  • It might cause vomiting, nausea or constipation

  • The best way is to drink a lot of water and fluids, fibre-rich foods and Vitamin C-rich fresh food

Recommended Calcium Supplementation:


Recommended Calcium Supplementation is at 500 mg of Calcium twice a day which aids in the reduction of Pre-eclampsia, Eclampsia and Preterm Birth. This prescribed quantity also be followed for 180 days from the second trimester and another 180 days post-childbirth.

  • Calcium tablets should be taken preferably after morning meal and evening meal/dinner

  • It should not be taken on an empty stomach or with an IFA tablet


Additional Vitamin A supplementation is advised only if there is a severe Vitamin A deficiency across the country or society.


Iodized Salt consumption:

  • Eliminates abortion and still-birth

  • Increases child health outcomes

  • Reduces Brain damage, Congenital defects, speech and hearing impairment, intellectual disability and mental retardation

Deworming:


A single dose of 400 mg Albendazole tablet is recommended during 2nd trimester of pregnancy to remove parasites, worms and improve digestion.


Pregnancy weight gain:



All the nutritional requirements increase during pregnancy as pregnancy has a lot of physical requirements. Therefore, a nutritional diet along with these supplements should be consumed to improve

  • Health and development of the foetus

  • Health and growth of maternal tissues that help foetal development

  • Pregnancy weight gain must be checked on every ANC visit

  • The recommended weight gain by ICMR is 1.5 - 2 Kg per month from 2nd trimester

  • The total recommended weight gain is 10-12 Kg

  • High-risk weight gain is less than 1 Kg in one month and above 3 Kg in one month


The required pregnancy weight gain is nowadays calculated from weight before conception.


Points to be noted:


Due to maternal nutritional interventions:
In Mothers, criticalities such as pre-eclampsia, eclampsia, anaemia, micronutrient deficiencies and maternal mortality are prevented
In Children, complications such as preterm birth, LBW and Small for Gestational Age babies are prevented

Consuming a nutrient-dense diet containing an abundance of vitamins, minerals, and micronutrients is vital for optimal maternal and fetal health

According to the Indian Council of Medical Research (ICMR), pregnant women in India need an additional 300-500 Kcal/day, depending on their body weight and activity level

Due to government initiatives, 89% of pregnant women received tetanus toxoid injection which is a safe and effective vaccine that has been used for many years to prevent tetanus infections

The government of India has implemented several programs to address Maternal and Child malnutrition, such as the Integrated Child Development Services (ICDS) and the National Health Mission (NHM). These programs provide nutritional supplements, health services, and education to pregnant women and children in India





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