Addressing the gaps in nutritional care before and during pregnancy

Abstract

The present paper outlines current issues in the nutritional care of women during pregnancy and potential resources to address them. Globally, overnutrition, undernutrition and nutritional imbalances are widespread among women of reproductive age; increasing the risk of pregnancy complications and non-communicable diseases in both mothers and their children. Most women do not meet dietary guidelines for pregnancy. The World Health Organisation (WHO) recommends nutrition and weight counselling during pregnancy for all women. However, clinical practices focusing on nutrition vary and there is no consensus on which outcomes are most important for pregnancy nutrition interventions, with little consideration for the ‘patient voice’. The International Federation of Gynaecology and Obstetrics (FIGO) nutrition checklist is a clinical practice tool that is available for healthcare professionals that will address this issue. The pregnancy nutrition core outcome set will also support advancement of antenatal nutrition by identifying the most critical nutrition-related outcomes from the perspective of healthcare professionals, researchers and women with experience of pregnancy. While poor nutrition can result in adverse outcomes across women of all weight categories, those with obesity may require specialist care to reduce their risk. Obesity is a chronic, progressive, relapsing disease that has high individual variability in its prognosis. The use of obesity staging systems, which consider mental, physical and functional health, can stratify individuals into risk categories and aid in treatment prioritisation in pregnancy. As the prevalence of obesity continues to rise, an obesity staging approach may support clinicians, especially those in limited resource settings.

Trends in Gliosis in Obesity, and the Role of Antioxidants as a Therapeutic Alternative

“…In some cases, this trigger increases or reductions in CNS metabolism, which leads to higher susceptibility to type 2 diabetes or metabolic syndrome [ 25 ]. This fact is verified in adults with high rates of intra-abdominal adiposity and who are prone to developing metabolic diseases and energy imbalances, and their medical history shows that they usually come from mothers who suffered a high degree of malnutrition during pregnancy [ 26 ]. Obesity derived from malnutrition during gestational development has been related to alterations in brain metabolism, mainly in the nuclei of the hypothalamus, related to metabolism and food intake, encircling the prevention of gliosis in pregnant women.…”

UsingFIGONutrition Checklist counselling in pregnancy: A review to support healthcare professionals

“…19 It is known that dietary counselling before and during pregnancy improves maternal nutrition knowledge, dietary intakes, and clinical outcomes like anemia, gestational weight gain, birth weight, with reduced risk of perinatal complications. [20][21][22][23][24] Dietary counselling during lactation is also of value to support achievement of increased nutrient requirements during this time. 25 A woman's engagement with health-related material may differ depending on their pregnancy history or intention to conceive.…”

“…International organizations such as the World Health Organization (WHO) and FIGO recommend that all women receive nutrition and weight counselling during pregnancy 19 . It is known that dietary counselling before and during pregnancy improves maternal nutrition knowledge, dietary intakes, and clinical outcomes like anemia, gestational weight gain, birth weight, with reduced risk of perinatal complications 20–24 . Dietary counselling during lactation is also of value to support achievement of increased nutrient requirements during this time 25 …”

Evaluating implementation of the FIGO Nutrition Checklist for preconception and pregnancy within the Bukhali trial in Soweto, South Africa

“…This is based on guidelines recommending access to a dietitian in the case of obesity, 7 since evidence suggests that support delivered by dietitians may be more effective compared with that delivered by nondietitians (including community health workers and healthcare professionals) 8 . Despite this, dietary counselling led by a dietitian is not the norm for preconception or antenatal care in South Africa, and even in high‐income countries clinical practices vary between healthcare professionals, partly due to a lack of standardized resources and training 9 …”