Role of diet in reducing maternal mortality (2)
Energy needs increase by an average of 300kcal throughout pregnancy. This should be properly adjusted for taking into cognisance factors such as pre-pregnancy weight, activity level and the trimester of pregnancy.
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The pregnant woman will need 10kcal more during the first trimester, 90kcal more during the second trimester and 200kcal more during the third trimester.
Consuming energy foods below the recommendations increase the incidence of the complications that lead to maternal mortality. Snacking on a glass of fruit juice and 2 thin slices of bread will supply the additional energy needed daily.
Protein requirement is increased by 15g/day, thus bringing the average requirement to 65g/day in the pregnant woman. This increase is needed for rapid growth of the foetus, the enlargement of the uterus, mammary glands and placenta, increase in maternal circulating blood volume, transfer of amino acids from the mother to the foetus, among others.
Taking about 9½ matchbox sizes of meat or fish daily will supply the amount of protein needed throughout pregnancy. If protein requirement is not met during pregnancy, there is increased risk of maternal death at delivery.
Other nutrients increase in requirement during pregnancy. Calcium and folic acid requirements are more than doubled during pregnancy. When mothers go through pregnancy without adequate amounts, it endangers their life and that of the unborn baby.
Nausea and vomiting characteristic of early pregnancy can be due to nervous disturbances, placental protein intoxication or due to derangement in carbohydrate metabolism.
It leads to nutrient loss and malnutrition. Small frequent meals and fairly dry foods are more tolerated. Liquids may best be taken between meals and not with meals. This also relieves heartburns.
Constipation is due to the pressure of the enlarging uterus on the lower portion of the intestine among other causes. Increased fluid intake and naturally laxative foods such as whole grains, fruits, vegetables, that are rich in fibre has proven to be very useful.
Oedema and leg cramps are a commonplace. Oedema may be caused by the pressure of enlarging uterus on veins returning fluid from the legs. This does not require any sodium restrictions or other dietary changes.
Leg cramps is thought to be relieved by magnesium; nuts, soybeans and cocoa are rich sources of magnesium.
Beliefs, avoidances, cravings, aversions and pica should be managed very well to ensure adequate nutrition during pregnancy.
Breastfeeding days
Deciding to breastfeed your baby exclusively for six months as recommended by the WHO can help improve the health status of the mother so much so as to prevent deaths soon after delivery.
Breastfeeding soon after giving birth increases levels of a hormone called oxytocin in the mother. This makes her uterus contract more quickly and reduces bleeding.
Breastfeeding helps stabilise maternal endometriosis and reduces the risk of post-partum haemorrhage (thus bleeding after delivery). Post-partum haemorrhage is a leading cause of maternal deaths.
As fat accumulated during pregnancy is used to produce milk, breastfeeding can help mothers lose weight. Maintaining a healthy weight improves health status. Breastfeeding mothers have less risk of breast and ovarian cancer, and endometrial cancer, and less risk of osteoporosis.
Mothers who breastfeed longer than eight months have better bone re-mineralisation. Breastfeeding diabetic mothers require less insulin for blood sugar control. This ensures better control of diabetes and reduces incidence of complications.
Also, breastfeeding has beneficial effects on insulin levels for mothers with polycystic ovary syndrome.
I want to believe that exclusive breastfeeding is an option that most mothers and potential mothers are considering now. The overall nutrition of the girl who becomes a woman tomorrow and a mother the next moment is very important and thus contributes to better pregnancy outcomes.
In all our efforts to reduce maternal mortality, let us not forget to teach mothers and prospective mothers how to eat well so they can stay with us after child birth.