By Risikat Ramoni
The first room, the neonatal ward, in the Paediatric section of the Mother and Child Centre at Isolo General Hospital in Lagos State, Nigeria, has a lot of children. Some are premature and are in an incubator; some have low birth weight and are on oxygen; others have jaundice and are on a phototherapy machine.
Some of these children, especially those with low birth weight and those born prematurely, probably would not have been there if the mother had adequate nutrition and necessary micronutrient supplements during pregnancy, said Dr Francis Ohanyido, a consultant public health physician.
He insisted multiple micronutrient supplements, also known as prenatal supplements, reduce the incidence of stillbirth and low birth weight.
According to a 2022 Programming Guidance by the United Nations Children’s Fund (UNICEF) on the prevention of malnutrition in women before and during pregnancy and while breastfeeding, only 38 per cent of women receive iron, folic acid (IFA) tablets during their pregnancy.
It also stated that only 59 per cent of pregnant women attend four antenatal care (ANC) visits.
The UNICEF PG further stated each year, 20 million babies suffer from low birthweight (LBW), an early marker of poor maternal and fetal nutrition.
At least eight ANC contacts are one of the World Health Organisation (WHO)’s 2016 recommendations on antenatal care for positive pregnancy experience.
Highlighting the dangers of improper maternal nutrition, UNICEF, in an article, explained women’s diets in many countries contain limited fruits, vegetables, dairy, fish and meat.
“Lack of adequate nutrition can lead to critical health risks to the infant, such as low birth weight, pre-term delivery, stillbirth and being born small for gestational age,” it stated.
“During pregnancy, poor diets lacking in key nutrients – like iodine, iron, folate, calcium and zinc – can cause anaemia, pre-eclampsia, haemorrhage and death in mothers.”
Also, an article on human nutrition and metabolism published by Science Direct underscored the impact of malnutrition.
“Globally, around 13 per cent of women were estimated to be undernourished. Malnutrition was responsible for nearly 3.5 million maternal and child deaths,” it noted.
“The risk of adverse birth outcomes such as prematurity, small for gestational age, neural tube defect, intrauterine growth restriction and low birth weight increased with malnutrition.”
The 2021 article stated, “The World Health Assembly endorsed a comprehensive implementation plan on maternal nutrition for 2025. This major reduction in the burden of undernutrition can be made through programmatic health and cost-effective nutritional interventions and policies.”
It added that this would contribute to achieving the Sustainable Development Goals (SDGs) of ending all forms of malnutrition and ensuring healthy lives and well-being for all ages.
Investigations revealed that when women attend antenatal clinics in government-owned health facilities in Lagos State, some receive micronutrients, while others do not.
The general hospitals, for instance, give women at every antenatal care (ANC) visit some iron tablets, vitamin C and folic acid. The medication would not be enough to last the pregnant woman until her next appointment. Whereas the primary healthcare facilities where women attend ANC do not give any medication; rather, they refer women to the pharmacy to buy them.
Poor nutrition consequences are also serious for the mother, and they can lead to anaemia, increased risk of haemorrhage, eclampsia, sepsis and other complications during delivery, and even maternal mortality, according to UNICEF.
What are micro and macronutrients?
Pregnant women have a greater need for all nutrients, macro and micro, to allow the rapid growth and development of their unborn child – and they are more susceptible to the harmful consequences of poor diets and nutrient deficiencies, a medical expert, Dr Francis Ohanyido, explained.
Several major classes of nutrients fall into two groups: macronutrients and micronutrients.
Macronutrients are carbohydrates, fats, and proteins that provide energy, whereas Micronutrients are minerals and vitamins (and are needed in small quantities).
The expert noted micronutrient supplements as critical for mothers and that many vitamins and minerals, including iron and Vitamin A, are important for good health during pregnancy and breastfeeding.
He pointed out that pregnant women in low- and middle-income countries (LMICs) are at increased risk of being deficient in multiple critically important micronutrients.
Multiple micronutrients supplements (MMS)
MMS contains 15 essential vitamins and minerals for pregnant and nursing women and meets micronutrient requirements that poor diets cannot meet.
According to the United Nations International Multiple Micronutrient Antenatal Preparation Multiple Micronutrient Supplementation (UNIMMAP MMS), the 15 components of MMS are Vitamins: A, C, D, E, B1 (thiamine), B2 (riboflavin), B3 (niacin), B6, B12, folic acid. Others are; Minerals: iron, zinc, iodine, copper, and selenium.
“Every woman who attends antenatal clinic should be given multiple micronutrient supplements (MMS) at the hospital regardless of whether it is a primary or secondary or tertiary health facility,” Ohanyido, the Country Director of Vitamin Angels, suggested.
Beyond supplements, Dr Ohanyido further explained, “The more colourful our food is, the better because we are more likely to get more nutrition from the various options. We should avoid eating only white food. Our food should be cooked with fortified salt as well.”
He added pregnant women should eat orange-coloured potatoes as they contain a lot of vitamin A.
Research outcome
Research published by eight authors from the Department of Nutrition and Dietetics, Imo State University and the Department of Pediatrics, Nnamdi Azikiwe University 2017, discovered that deficiencies in micronutrients are prevalent and may occur among women of childbearing age.
A study was conducted on 222 mother-child pairs from two health centres in Umuna, Orlu Local Government Area, Imo State, to assess the impact of micronutrient supplementation during pregnancy on the birth weight of infants.
The result showed that 59.5% of the mothers were between 26-35 years. Married women were 98.2%, 54.1% were traders, 66.7% had secondary education, 76.1% had less than three children and 85.1% earned between ₦5,000-₦20,000 monthly.
About 89% attended the antenatal visits, 61.7% started micronutrient supplementation in the second trimester, and none had prenatal supplementation. Folic acid (98.2%), Vitamin C (94.6%) and vitamin B complex (83.8%) were the supplements taken once daily by the mothers, while ferrous sulphate (83.8%) and multivitamin (82%) were taken three times daily.
Less than half (23.9%) of the mothers gave birth to macrosomic (over 4.0kg) babies, while 9.0% gave birth to low-weight (less than 2.5kg) babies. The result also showed that the mothers were not taking Omega 3, Zinc, Vitamin A and Calcium supplements. There was a significant difference between supplement intake and birth weight.
The authors, Amadi Joy, Iwuoha Stephanie and six others, concluded that MMS in pregnant women might help improve infants’ birth weight.
The experts suggested nutrition education on the importance of micronutrient supplementation before and during pregnancy for women of childbearing age.
Meanwhile, Dr Ohanyido called on the federal and state government to ensure MMS is incorporated into health facilities for pregnant women and children to reduce maternal mortality and childhood-related illnesses associated with lack of nutrition.
Beyond pregnancy
After birth, micronutrient deficiencies can lifelong impact a child’s physical, mental, and emotional development.
Poor nutrition in the first 1,000 days can cause irreversible damage to a child’s growing brain, affecting their ability to do well in school. It can also set the stage for future issues such as obesity, diabetes, and other chronic diseases, leading to a lifetime of health problems.
A Healthy Mothers Healthy Babies Consortium report highlighted, “Children in Nigeria are not spared from the high incidence and prevalence of deficiencies of multiple micronutrients, especially during the period of complementary feeding when breastfeeding alone can no longer sustain their nutritional needs. They are often fed with poor and inadequate complementary foods.”
