The role Nutrition in RMNCAH

Nutrition counseling is a cornerstone of pre-conception, antenatal, intrapartum and postpartum care for women and the newborns. A woman’s nutritional status not only influences her health, but also pregnancy outcomes and the health of her fetus and neonate. Healthcare providers need to be conversant of nutritional needs during pregnancy, as they differ significantly compared to non-pregnant populations. Furthermore, an individualized approach to nutritional counseling that considers a woman’s access to food, socioeconomic status, race-ethnicity and cultural food choices, and body mass index (BMI) is recommended. In addition, many of the recommendations are geared for uncomplicated pregnancies, so adjustments need to be made when complications, such as gestational diabetes, arise.

A nutritionist or dietitian can help facilitate dietary counseling and interventions. The key issues include maternal physiological adaptations as well as macronutrient and micronutrient requirements during pregnancy and lactation. Physiological changes during pregnancy alter the normal ranges of several laboratory values. Both total red blood cell mass and plasma volume increase, but plasma volume increases to a greater extent resulting in hemodilution and anemia during pregnancy. Caloric intake increases by approximately 300 kcal/day during pregnancy. This value is derived from an estimate of 80,000 kcal needed to support a full-term pregnancy and accounts not only for increased maternal and fetal metabolism but for fetal and placental growth. Recommended protein intake during pregnancy is 60g/day, which represents an increase from 46g/d in non-pregnant states. In other words, this increase reflects a change to 1.1g of protein/kg/day during pregnancy from 0.8g of protein/kg/day for non-pregnant states. Carbohydrates should comprise 45-64% of daily calories and this includes approximately 6-9 servings of whole grain daily. Total fat intake should comprise 20-35% of daily calories, similar to non-pregnant women. The recommendations for daily micronutrient intake for a pregnant woman are determined by the “Recommended Dietary Allowances” or RDA data. The critical difference compared to other multivitamins is the folic acid dose, which is necessary to support rapid cell growth, cell replication, cell division, and nucleotide synthesis for fetal and placental development.

Breastfeeding and breast milk are the global standard for infant feeding. Similar to pregnancy, energy and nutritional requirements also differ during lactation and breastfeeding. Women who breastfeed require approximately 500 additional kcal/day beyond what is recommended for non-pregnant women. Lactation is considered successful when the breast-fed infant is gaining an appropriate amount of weight. The recommended daily allowance for protein during lactation is an additional 25 g/day. Requirements of many micronutrients increase compared to pregnancy, with the exception of vitamins D and K, calcium, fluoride, magnesium, and phosphorus. As such, it is recommended that women to continue to take a prenatal vitamin daily while they are breastfeeding. Maternal factors such as stress, anxiety, and smoking can decrease milk production, but the quantitative and caloric value of breast milk does not change with dieting and exercise. Moreover, a woman’s weight, BMI, body fat percentage, and weight gain during pregnancy do not influence milk production. These all issues need attention both at policy, service delivery and community levels and this conference looks forward discuss best practices for advancing nutrition in RMNCAH.