While proven maternal nutrition interventions exist, the capacity to support scale-up is limited, and – in high-burden contexts –delivery systems are often weak.
Antenatal care (ANC) is an important platform for integrated delivery of essential health and nutrition services for pregnant women and strengthening ANC services offers an opportunity to improve maternal nutrition and reduce maternal mortality in low- and middle-income countries.
Healthcare workers should be equipped to identify potential nutritional risks for the pregnancy, deliver nutrition counseling, address the social and behavioral challenges faced by women and adolescent girls, and improve the uptake of proven maternal nutrition interventions.
Today, we have evidence-based, cost-effective solutions available and ready to scale to improve maternal nutrition.
Guidance on Maternal Nutrition Interventions
The World Health Organization has provided comprehensive, evidence-based guidance on the practice, organization, and delivery of ANC to facilitate a positive pregnancy experience, with 14 of the 49 recommendations in the WHO’s ANC guidelines being related to nutrition. This guidance was updated in 2020 regarding MMS and Vitamin D supplementation, and in 2021 regarding zinc supplementation.
UNICEF also published guidance in support of UNICEF’s vision for maternal nutrition programming as outlined in the UNICEF Nutrition Strategy 2020–2030. This guidance is complemented by a program brief that describes a set of approaches to strengthen maternal nutrition counseling
The following interventions – when integrated within a well-functioning health system and effectively supervised and managed – can significantly improve maternal health and survival and ensure healthy birth outcomes.
Interventions
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Counseling about healthy eating and keeping physically active during pregnancy is recommended for pregnant women to stay healthy and prevent excessive weight gain during pregnancy. Specifically, in undernourished populations, nutrition education on increasing daily energy and protein intake is recommended for pregnant women to reduce the risk of low birth-weight newborns.
Effective, at-scale social and behavior change communication (SBCC) campaigns – grounded in the local context – can be used at the population, facility, and individual level to strengthen nutrition counseling and improve the uptake of and compliance with all maternal nutrition interventions.
The UNICEF technical programme brief on Counselling to improve maternal nutrition aims to improve the coverage and quality of nutrition counseling before and during pregnancy and while breastfeeding.
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Daily oral iron and folic acid supplementation with 30 mg to 60 mg of elemental iron and 400 g (0.4 mg) of folic acid are recommended by WHO for pregnant women to prevent maternal anemia, puerperal sepsis, low birth weight, and preterm birth.
Intermittent oral iron and folic acid supplementation with 120 mg of elemental iron and 2800 µg (2.8 mg) of folic acid once a week are recommended by WHO for pregnant women to improve maternal and neonatal outcomes only if daily iron is not acceptable due to side effects, and in populations with an anemia prevalence among pregnant women of less than 20%.
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The United Nations International Multiple Micronutrient Antenatal Preparation of Multiple Micronutrient Supplements (UNIMMAP MMS) is an antenatal supplement that is recommended by WHO for pregnant women within the context of routine ANC programs, supported by implementation research.
MMS is proven to improve maternal nutrition status and has additional benefits over IFA in reducing the risk of adverse birth outcomes such as preterm birth, stillbirth, low birth weight, and small for gestational age. Find out more here.
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In undernourished populations, balanced energy and protein dietary supplementation is recommended by WHO for pregnant women to reduce the risk of stillbirths and small-for-gestational-age neonates.
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In populations with low dietary calcium intake, daily calcium supplementation (1.5–2.0 g oral elemental calcium) is recommended by WHO for pregnant women to reduce the risk of pre-eclampsia.
Vitamin A supplementation is only recommended by WHO for pregnant women in areas where vitamin A deficiency is a severe public health problem, to prevent night blindness.
Greater investment in scaling up prenatal nutrition interventions will not only improve maternal wellbeing and birth outcomes but will also lead to better educational and productivity outcomes later in the life of these babies.
Potential Human Capital Gains of Scaling Prenatal Nutrition Interventions
The societal impact of scaling up prenatal nutrition interventions is dramatic. Tackling anemia alone could lead to increased productivity of up to 17 percent in these populations.[1]
Scaling up prenatal nutrition interventions could lead to significant human capital gains in schooling and lifetime incomes in low- and middle-income countries, with the greatest benefits for countries with high burdens of adverse outcomes.[2]
Increasing coverage with MMS supplementation to 90% of pregnant women in 132 low- and middle-income countries would lead to an increase of 5 million school years and cumulative lifetime income gains by approximately $18 billion for each birth cohort.
For calcium supplementation, the expected impact would be 4 million additional school years and also an estimated $18 billion lifetime cumulative income gain per birth cohort.
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- Horton S, Ross J. The economics of iron deficiency. Food policy. 2003 Feb 1;28(1):51-75.
- Perumal N, Blakstad MM, Fink G, Lambiris M, Bliznashka L, Danaei G, Sudfeld CR. Impact of scaling up prenatal nutrition interventions on human capital outcomes in low-and middle-income countries: a modeling analysis. The American journal of clinical nutrition. 2021 Nov;114(5):1708-18.