Screening and management options for severe thinness during pregnancy in India

Abstract

This paper answers research questions on screening and management of severe thinness in pregnancy, approaches that may potentially work in India, and what more is needed for implementing these approaches at scale. A desk review of studies in the last decade in South Asian countries was carried out collating evidence on six sets of strategies like balanced energy supplementation (BEP) alone and in combination with other interventions like nutrition education. Policies and guidelines from South Asian countries were reviewed to understand the approaches being used. A 10‐point grid covering public health dimensions covered by World Health Organization and others was created for discussion with policymakers and implementers, and review of government documents sourced from Ministry of Health and Family Welfare. Eighteen studies were shortlisted covering Bangladesh, India, Nepal, and Pakistan. BEP for longer duration, preconception initiation of supplementation, and better pre‐supplementation body mass index (BMI) positively influenced birthweight. Multiple micronutrient supplementation was more effective in improving gestational weight gain among women with better pre‐supplementation BMI. Behavior change communication and nutrition education showed positive outcomes on dietary practices like higher dietary diversity. Among South Asian countries, Sri Lanka and Nepal are the only two countries to have management of maternal thinness in their country guidelines. India has at least nine variations of supplementary foods and three variations of full meals for pregnant women, which can be modified to meet additional nutritional needs of those severely thin. Under the National Nutrition Mission, almost all of the globally recommended maternal nutrition interventions are covered, but the challenge of reaching, identifying, and managing cases of maternal severe thinness persists. This paper provides four actions for addressing maternal severe thinness through available public health programs, infrastructure, and human resources.

Mid-upper arm circumference and neck circumference to screen for overweight-obesity in young adults in South India

“…Mid-upper arm circumference is a feasible option as it does not require any calculation with exponentials and the tape is simple, portable and inexpensive [ 17 ]. While it has been incorporated into maternal nutrition assessment screening algorithms, there is a scope for its expansion to adult malnutrition screening with due consideration of ethnic variation [ 8 , 18 ]. It has been more often used to screen for undernutrition and MUAC cut-offs in the range of ≤23.5 to ≤25.0 cm have been proposed to screen underweight adults [ 17 ].…”

Impact of pregnancy on long‐term health: Advances in postpregnancy care—An opportunity to improve long‐term maternal health

“…Suboptimal nutrition and obesity are conditions that affect all women globally, spanning from high-to low-and middle-income countries. [7][8][9] The postpregnancy period presents a unique opportunity to improve maternal long-term health. Pregnancy complications can be reviewed and management plans devised to arrange follow-up to ensure that women can avail of early identification of chronic diseases such as glucose intolerance and type 2 diabetes, and cardiovascular diseases such as hypertension, ischaemic heart disease, and stroke.…”

“…It is estimated that one‐third of the world's population suffers from malnutrition, whether it be thinness or obesity or micronutrient deficiencies. Suboptimal nutrition and obesity are conditions that affect all women globally, spanning from high‐ to low‐ and middle‐income countries 7–9 …”

Integrating nutrition and mental health screening, risk identification and management in prenatal health programs in India

“…Detailed description of the services and practical feasibility of layering the nutrition services in the routine maternal and child health care settings are published elsewhere. [54][55][56] For the aforementioned reasons, the maternal nutrition consortium in collaboration with a prime mental health research institute in India have been striving towards integrating mental health services into the existing algorithms. The consortium has recently produced integrated algorithms for facility and community wherein mental health services are to be provided by non-specialist lay health and community workers (Auxiliary Nurse Midwives (ANMs), Accredited Social Health Activists (ASHAs), Anganwadi Workers (AWWs), Nurses, and Medical Doctors)…”

“…A maternal nutrition consortium with several academic, government, development, and research partners developed and tested a five‐action algorithm for the Ministry of Health and Family Welfare, aiming to strengthen nutrition services for pregnant women in routine prenatal care facilities. Detailed description of the services and practical feasibility of layering the nutrition services in the routine maternal and child health care settings are published elsewhere 54–56 …”