Nutrition of women before and during pregnancy and when breastfeeding is critical in determining the health and survival of the mother and of her unborn baby.
Undernourished pregnant women have higher reproductive risks. They are more likely to experience obstructed labour, or to die during or after childbirth. Poor nutrition in pregnancy also results in babies growing poorly in the womb and being born underweight and susceptible to diseases. These mothers also invariably produce low quality breast milk.
Maternal malnutrition has inter-generational consequences because it is cyclical. Poor nutrition in pregnancy is linked to undernourishment in-utero which results in low birth weight, pre-maturity, and low nutrient stores in infants. These babies end up stunted and, in turn, give birth to low birth weight babies. Optimal maternal nutrition is therefore vital to break this inter-generational cycle.
In Kenya, women’s nutritional needs during pregnancy has not received much attention. This has exposed a gap in efforts to improve maternal and child health.
Our study at the Kenya Medical Research Institute looked at micronutrient deficiencies among pregnant women in Nairobi. The study found that close to 20% of women had anaemia and just over a third had iron deficiency.
Nearly a third of women had zinc deficiency. About 21% of the women had a combination of two to three deficiencies. The most common - in two thirds of the women - was the combination of iron and zinc deficiencies. Studies show that women with zinc deficiency are more likely to develop anaemia during pregnancy. Anaemia contributes to 20% of all maternal deaths, poor pregnancy outcomes and impaired physical and cognitive development in children.
A continental problem
Micronutrient deficiencies are common across sub-Saharan Africa.
About 2 billion people – or more than 30% of the world’s population – are anaemic due to iron deficiency. In developing countries, this translates into every second pregnant woman. About 40% of preschool children are anaemic. In resource-poor areas, anaemia is exacerbated by infectious diseases such as malaria, HIV/AIDS, hookworm infestation, schistosomiasis (snail fever) and other infections like tuberculosis.
The continent also has the highest prevalence of vitamin A deficiency globally with about 48% of children between the ages of six months and five years affected. Vitamin A can be found in foods such as sweet potatoes, carrots and dark leafy green vegetables. But food insecurity and problems of bio-availability have resulted in vitamin A deficiency. This often leads to preventable childhood blindness.
Vitamin D deficiency is also extremely common despite the fact that Africa has a great deal of sunlight. This results in bone pain and muscle weakness. Insufficient vitamin D affects almost half of the world’s population.
From the study, more than half of the women had vitamin D deficiency while only 1% had vitamin A deficiency.
Lacking the essential micronutrients
Being undernourished in the womb increases the risk of death in the early months and years of a child’s life. While a baby’s weight at birth is a strong indicator of maternal and newborn health and nutrition, about 13% of infants in sub-Saharan Africa are born with low birth weight.
Those who survive tend to have increased risk of disease. They are likely to remain undernourished, with reduced muscle strength and cognitive abilities throughout their lives. As adults, they suffer a higher incidence of diabetes and heart disease.
It’s crucial that pregnant women get adequate micronutrients. If it is not addressed, there will be little progress made in promoting maternal and child health in Kenya.
Changing the cycle
Women in Nairobi have some access to resources and are likely to attend antenatal care. It is therefore possible that the micronutrient deficiency burden may be higher in rural areas where the health system infrastructure and capacity is limited.
What is clear is that there is an urgent need to address the issue of micronutrient deficiencies in pregnancy. We suggest the scaling-up of proven interventions that promote healthy pregnancies and improved pregnancy outcomes. This includes enhanced nutrition education and services in antenatal care.
These efforts should be complemented by other supporting interventions such as reduction of malaria infection; reduction of hookworm infection; birth spacing; decreased workload or rest during pregnancy.
Efforts geared at addressing maternal nutrition must be broad enough to encompass the pre-conception period, the pregnancy and after pregnancy – including the period of breastfeeding – to ensure safer and more optimal birth outcomes.