CHAPTER 19

REVIEW OF MATERNAL NUTRITION AND MALNUTRITION

MATERNAL NUTRITION AND MALNUTRITION

Introduction

Good nutrition before and after pregnancy and adequate weight gain during pregnancy are important preventive measures for tackling problems such as LBW and prematurity.

Nutrition Needs Before Conception

Nutrition Needs During Pregnancy

• Nutrition needs increase during the second and third trimesters as the uterine placental fetal unit develops, the maternal breast develops, and maternal blood volume and metabolic needs get increased.
• Weight gain recommendations for pregnancy should be based on women’s pre-pregnancy BMI. Pre-pregnant BMI classifications and weight gain recommendations for women with single fetuses are as follows .

Weight gain recommendation in pregnancy

• The reasons for inadequate or excessive weight gain can include inadequate or excessive dietary intake, measurement or recording errors and differences in the weight of clothing or the time of the day.
• Pregnant women (as well as women who are breastfeeding and young children) should avoid eating fish high in mercury (shark, swordfish, king mackerel, tilefish).
• The artificial sweeteners aspartame (Nutra Sweet, Equal), acesulfame potassium (Sunett), and sucralose (Splenda) are approved by the US food and drug administration (FDA) for use in pregnancy.

Special Nutritional Risks in Pregnancy

Recommended weight gain goals for pregnant adolescent are not different from those of adult women. BMI is calculated for adult women, rather than by using the adolescent BMI growth charts.

Weight gain in case of twins

There is not enough information available to make firm recommendations about optimal weight gain for women with more than two fetuses.

BUILDING PARTNERSHIP WITH WOMEN FOLLOWING RMC PROTOCOL

• Respect and Dignity: Quality of Care

• 10 Steps Mother Baby Friendly Hospital Initiative

Mother baby friendly hospital initiative:

1. Respectful and dignified maternity care.
2. Offer all treatments needed for the care of mothers and babies in order to avoid death and disability of mothers and newborns i.e., Emergency Obstetric and Newborn Care.
3. Effective communication with the community about availability of quality maternal and newborn care.
4. Ensure appropriate documentation of levels of care.
5. Protocol establishment and reinforcement.
6. Nurture friendly and well-motivated health care professionals.
7. Family-centered maternity care with feedback system.
8. Functional referral network (inter and intra health facility communication).
9. Adhere to baby-friendly hospital initiative.
10. Commitment to ongoing certification by Mother Baby Friendly Hospital Initiative

• Respectful Care and Program Implementation
• To provide country stakeholders with a flexible process to guide, design, implement and monitor efforts to strengthen RMC and eliminate mistreatment.
• Explosion of interest and evidence.
• Strong body of research, analysis and various programming approaches.

• Fathers’ Engagement In Maternity Care

The father’s beliefs and feelings about the ideal mother and father and his cultural expectation of appropriate behavior during pregnancy affect his response to his partner’s need for him.

May (1982) described three phases characterizing the developmental tasks experienced by the expectant father

May (1982) described three phases characterizing the developmental tasks experienced by the expectant father .

phases of developmental tasks

• Father’s Engagement in Maternity Care

Father’s engagement in maternity care can be done as follows:

• Accepting the Pregnancy
• Identifying with the Father Role
• Reordering Personal Relationships
• Preparing for Childbirth