Abstract
Background: Up-to-date dietary data are required to understand the diverse nutritional challenges of pregnant women living in low-middle income countries (LMIC). To that end, dietary data were collected from 1st trimester pregnant women in rural areas of Guatemala, India, Pakistan, and Democratic Republic of the Congo (DRC) participating in a maternal lipid-based nutrient supplement (LNS) Randomized Controlled Trial to examine dietary diversity (DD), usual group energy and nutrient intakes, and prevalence of inadequate dietary intakes. Methods: Two 24-h dietary recalls were conducted in ~240 pregnant women/site (total n = 966) prior to 12-week gestation. Adequate DD was assessed, i.e., ≥5 major food groups consumed within the past 24 h. Median, Q1, Q3 intakes (without LNS) of energy, macronutrients, 12 micronutrients, and phytate were examined. The “at risk” prevalence of inadequate intakes were based on international guidelines for pregnant women. Results: Dietary patterns varied widely among sites, with adequate DD reported: 20% (Pakistan), 25% (DRC), 50% (Guatemala), and 70% (India). Significantly higher intakes of most key nutrients were observed in participants with adequate DD. More than 80% of women in all sites had inadequate intakes of folate, vitamin B12, and choline, and >80% of women in India and DRC also had inadequate intakes of calcium, thiamine, riboflavin, and vitamin B6. Conclusions: Our data highlight the likely need for micronutrient supplementation in pregnancy, specifically multi-micronutrient interventions, and support the value of increasing DD as part of sustainable long-term nutrition programs for women of reproductive age in these poor rural settings in LMIC.
Highlights
Poor maternal nutrition during pregnancy has multiple long-term adverse effects on mother and offspring health, including maternal anemia, postpartum complications, and increased neonatal morbidity and mortality [1]
Repeat 24-h dietary recalls were conducted by a trained site nutritionist among pregnant women during their 1st trimester at each of the participating WF sites in Democratic Republic of the Congo (DRC), Guatemala, India, and Pakistan from 2012 to 2017, as described earlier [13,15]
DRC, Guatemala, India, and Pakistan support a rationale for multi-micronutrient interventions in in these populations, as well asstrategies for strategies to enhance dietary diversity, to improve the adequacy these populations, as well as for to enhance dietary diversity, bothboth to improve the adequacy of nutrient intakes
Summary
Poor maternal nutrition during pregnancy has multiple long-term adverse effects on mother and offspring health, including maternal anemia, postpartum complications, and increased neonatal morbidity and mortality [1]. Women of reproductive age (WRA) living in under-resourced environments in low-and middle-income countries (LMIC) are at high risk of inadequate nutriture, especially of critical micronutrients [2], leaving them and their offspring ill-prepared for the increased nutritional demands of pregnancy and fetal growth. Together with sufficient intakes of key micronutrients, a balanced and adequate supply of macronutrients, and energy, is required for the physiological demands of the growing fetus [1]. Up-to-date dietary data are required to understand the diverse nutritional challenges of pregnant women living in low-middle income countries (LMIC). Dietary data were collected from 1st trimester pregnant women in rural areas of Guatemala, India, Pakistan, and Democratic Republic of the Congo (DRC) participating in a maternal lipid-based nutrient supplement (LNS) Randomized Controlled Trial to examine dietary diversity (DD), usual group energy and nutrient intakes, and prevalence of inadequate dietary intakes. The “at risk” prevalence of inadequate intakes were based on international guidelines for pregnant women
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