When is Malnutrition most prevalent during pregnancy?

Introduction

A healthy mother makes a healthy child in society. Maternal (during pregnancy) and child malnutrition are the leading causes of health loss in India. Low birth weight (LBW) children of women affected by malnutrition often exhibit insulin resistance, wasting and vulnerability to developing cardiometabolic disorders in adulthood. The disease burden due to malnutrition cannot be resolved merely with the help of uniform dietary recommendations. 

As per research, malnutrition during pregnancy in mothers is most likely to promote the self-developing high disease burden in India. Also, nowadays, rapid dietary shifts to high sugar, high salt and high saturated fats have created the need to address the interventions aiming to resolve the leading risk factors for health deterioration in India.

When is malnutrition most prevalent during pregnancy?

The peri-implantation period and rapid placental development (i.e., during the first trimester of gestation) is when malnutrition is most prevalent in pregnancy. During these periods of pregnancy in a woman, the placental and fetal growth are vulnerable or are at most risk of maternal nutrition status. 

A pregnant mother’s under-nutrition or over-nutrition could affect her fetal growth. 

This might result in Intrauterine growth restriction or IUGR. IUGR is a condition when a baby in a fetus does not grow as much as expected. 

So, to avoid such cases, it is necessary to increase awareness about addressing malnutrition, which will contribute to proper fetal development and reduce the risk of chronic diseases in adults.

Why does malnutrition occur in pregnant mothers?

Malnutrition and other nutritional deficiencies occur in pregnant woman because of insufficient intake of iron, folate, and other micronutrients during their pregnancy, in their rapid growth phases. During pregnancy, a woman must get essential nutrients, brisk energy and proteins, and essential fatty acids (particularly omega-3 fatty acids). ​

During pregnancy, poor diets with lower essential nutrients like iodine, iron, calcium, folate and zinc could lead to anaemia, pre-eclampsia, bleeding and even the death of a pregnant mother. They could result in stillbirth, low birth weight, wasting and developmental delays for children.

In malnourished pregnant women, serum is also high, while glycine levels are not, leading to SAM deficiency. This might signify the importance of the availability of limited choline-rich foods like fish, meat, crustaceans and eggs, as, during pregnancy, choline deficiency might cause placental dysfunctions by promoting slow fetal growth as gestation continues.

What is Malnutrition?

Malnutrition is the term used to define deficiencies or excesses in nutrient consumption and imbalance of necessary nutrients. Malnutrition includes all the undernutrition, overweight, obesity, and diet-related noncommunicable diseases. Undernutrition occurs in four forms: wasting, stunting, underweight, and micronutrient deficiencies.

1) Wasting refers to low weight-for-height. It is when a person does not have sufficient quality and quantity of food and they have long-term illnesses. Wasting in children is connected with a vulnerability of death if not treated properly.

2) Stunting refers to a low height for age. It is the result of recurrent undernutrition, connected with poverty, poor maternal health and nutrition, frequent illness and inappropriate care in early life. Stunting prevents children from reaching their physical potential. 

3) Underweight refers to low weight-for-age. An underweight child might be stunted, wasted or both.

4) Micro-nutrient Deficiency results in many serious health problems. Insufficient iron, vitamin B12 and vitamin A could result in anaemia. 

Symptoms of Malnutrition in Pregnant Woman

A pregnant woman with malnutrition could feel several symptoms during her pregnancy, though she might not know it. 

• Constant and frequent hunger – A pregnant woman might feel hunger even after taking food. 
• Constipation – Constipation leads to infrequent bowel movements, causing hard and dry stool passage.
• Low weight – Failure to attain sufficient weight during pregnancy might be due to poor nutrition or an underlying medical condition. 
• Nausea and vomiting – Nausea is an uneasiness felt in a pregnant mother’s stomach, which could result in vomiting, thus forcibly emptying the stomach contents through their mouth.
• Headaches – Frequent headaches might disturb the pregnant woman, which might also disturb her unborn baby. 
• Low energy levels – Their ability to do regular work will decrease through decreasing their speed at work. 
• Tired/poor sleep quality – A pregnant woman’s sleep quality will be affected, as she might experience inadequate sleep irregularly. 
• Mental health problems – When the sleep cycle of a pregnant woman gets disturbed by a pregnant woman, then she might be affected by mental issues.

Diagnosis

Malnutrition in adults can be diagnosed depending on factors like duration and precipitating causes. Regular clinical history and the symptoms of malnutrition are often the simple, everyday ways to learn about malnutrition. Diagnostic and imaging studies have only a tiny role in evaluating malnutrition.

However, some tests could help a pregnant woman to identify her health status. They are:

• Blood tests for general monitoring.
• Prealbumin tests to know the level of the protein.
• Albumin tests to check if there is any liver or kidney disease.
• Tests for a few nutrients, like iron or vitamins.

The dietary diversity score (DDS) and the mid-upper arm circumference (MUAC) could be used to evaluate the nutritional status. 

• Dietary diversity score (DDS) – It is a test to indicate the food quality. Dietary diversity can boost health status. 
• Mid-upper arm circumference (MUAC) – A measurement done with the help of health workers determines if a person is acutely malnourished.

Treatment 

If a doctor diagnoses malnutrition in a pregnant woman, they (the doctor) will prepare a treatment plan for her. A malnourished woman might need to meet a doctor and other healthcare professionals. Treatment will vary based on the intense malnutrition and several other complications. The processes may include:

• Screening and monitoring.
• Preparing a dietary plan considering supplements.
• Treating some symptoms like Nausea.
• Treating any infections present at that time.
• Diagnosing other mouth or swallowing problems
• In severe cases, a doctor may monitor nutrients intravenously (via an IV).

Then, her (pregnant mother) healthcare team will monitor her to ensure she gets enough nutrition as needed.

Prevention 

Pregnant women are advised to consume a wide range of nutrients from various food types to prevent malnutrition.

• Start to include many vegetables and greens in your food. 
• Avoid consuming large amounts of high salt, high sugar and high-fat foods.
• People with chronic illnesses may need extra care to ensure they get the nutrients they need.
• A malnourished woman who gets the signs of malnutrition or undernutrition must see a doctor for a diagnosis and treatment.

Conclusion 

Malnutrition in pregnant women is strict because of an improper diet, which could be under-nutrition (too few nutrients) or over-nutrition (too many nutrients). However, malnutrition is not because of poor diet choices in all cases. Sometimes, a malnourished pregnant woman could be poverty-struck to get even a bit of food, or she might have a digestive disorder that prevents their body from properly absorbing nutrients. 

In such a condition, the community, especially her friends and relatives, can help her treat malnutrition to improve her health. Apart from that, it is a pregnant woman’s responsibility to properly consume sufficient amounts of nutrients to strengthen her and her baby’s health.

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