Maternal undernutrition in India is a public health concern with about 18.7 per cent of women being underweight and 57 per cent in the reproductive age suffering from anaemia. Poor maternal nutrition before and during pregnancy affects foetal growth, leading to long-term developmental and metabolic risks. This not only harms the mother’s health, increasing risks during pregnancy and childbirth, but also perpetuates an intergenerational cycle of malnutrition and stunting.
“Women often carry nutritional deficits into pregnancy and those deficits are then passed on to the child. Practically, under-nutrition and lack of key micronutrients (iron, folate, B12, vitamin D, iodine) make pregnancy riskier, leading to more infections, preterm births and low birth-weight babies. This is a kind of hidden hunger, where you may be getting enough calories but not enough vitamins and minerals. This can blunt a child’s cognitive and physical potential. Poor foetal nutrition impacts the child’s metabolism, raising their risk of diabetes and heart disease later in life,” says Dr Ambrish Mithal, chairman, Endocrinology, Max Healthcare. Excerpts:
What’s a doable diet for mothers?
First, aim for a varied plate every day, which must include green leafy vegetables, at least one good source of protein such as milk, eggs, fish, meat or pulses, fruit and a small portion of whole grains or millets. Second, register early for antenatal care, take the iron-folic acid tablets and calcium as advised, and get deworming where indicated. Third, watch what you eat. For example, eat vitamin-C rich foods with iron-rich meals for better absorption of iron. Add a squeeze of lemon with spinach. Nutrition is often decided at the household level and involvement of the family can make a difference.
What are missteps that lead to more than recommended weight gain?
Gestational weight gain is a Goldilocks problem. Too little and the baby is at risk of growth restriction; too much and the mother and baby face delivery complications and long-term metabolic risk. Low gain often reflects during the initial phase of pregnancy when the woman may be underweight, have a high physical workload, poor appetite or illness. Excess gain usually reflects pre-pregnancy weight gain, ‘eating for two’ myths, and diets high in refined carbs, sugar and unhealthy fats.
The common nutrition mistakes I see are too much focus on calories rather than quality — large amounts of energy-dense junk food rather than nutrient-dense meals — ignoring portion sizes, and failing to tailor advice to the woman’s body weight. Weight goals should be discussed at the first visit, and monitored monthly.
What about anaemia? While there have been programmes to supplement iron, anaemia has not decreased to the extent expected.
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That’s because the solution does not come down to a single pill. Many women start pregnancy with a low haemoglobin and adherence to iron and folic acid tablets is erratic because of minor gastrointestinal side-effects, supply gaps, or poor understanding. Anaemia prevalence in pregnancy in India is over 50 per cent, with iron deficiency being the common cause. To make a difference, we must realise that anaemia is not just a pregnancy problem. Screening and treating girls and women of reproductive age much before conception are crucial.
We should also broaden the diagnostic lens beyond iron — check B12/folate if indicated or screen for haemoglobinopathies (inherited blood disorders that affect the haemoglobin) in high-prevalence areas. At the time of delivery, hospitals should be prepared to manage moderate-to-severe anaemia with timely iron infusion or transfusion when indicated.
(This feature is part of a collaborative awareness campaign between The Indian Express and Global Health Strategies)
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