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Preconception Nutrition refers to physical and psychological interventions for a woman and a couple before conception happens. The goal is to reduce actions and environmental patterns that lead to poor maternal and child health outcomes and improve their well-being. It is essential to take care of nutrition throughout one's life, from infancy to childhood, and adolescence. #Preconception Nutrition is a part of the continuous process with special focus on period before pregnancy to help prepare a woman's body in a better way for pregnancy as it can significantly enhance pregnancy and child health outcomes. How #PreconceptionNutrition is a continuous process? #Gametes refer to the reproductive cells of an organism. Female gametes are called ova, aka eggs, which are formed in the foetal stage and remain dormant until puberty. These ova are immature eggs, in which one of the eggs fully mature during the 1st ten days of the menstrual cycle and becomes a mature egg. This mature egg flows in to the fallopian tube. The mature egg contains food and mitochondria, in addition to DNA. Male gametes are called sperms. Since the storage of food can hinder their fast movement, the sperms contain only the required DNA and ‘energy stores’ to swim for up to 5 days. During fertilization, sperm and matured egg fuse together and form a zygote in the fallopian tube. The zygote, then gets transferred to the uterus. There, zygote develops into an embryo. The formation of an embryo, does not take any energy from the mother’s body, as it entirely takes food from mature egg. Thus, a woman’s health plays a pivotal role in the development of healthy baby. Preconception period: The preconception period refers to the 3 months before conception. It is calculated until the egg goes through its maturity, and becomes embryo. In this crucial phase, a mother’s diet directly impacts an infant’s brain, organs and tissues Smoking and drinking during this phase and pregnancy leads to health problems during pregnancy and also increases the chances of preterm birth, infant mortality and birth defects The nutritional remedies are particularly important for women who are in their reproductive age range, in the period of 2 years before their pregnancy and also in the gap between two pregnancies. What makes preconception care important? Preconception period serves an opportunity to provide remedial measures and prepare woman’s body for conception Embryo develops as a foetus based on the nutritional status of the mother Nutritional diet along with folic acid and multivitamin supplements during this period, avoid critical defects in the child Underweight in this period leads to low brain development, preterm birth and Small for gestational age (SGA) babies. Overweight in this period can cause #Preeclampsia (high blood pressure disorder during pregnancy), Gestation Diabetes Mellitus (#GDM) and caesarean section Positive impacts of preconception care: Decrease in Maternal and Infant Mortality rates Prevention in the incidence of unintended pregnancies Instances of #stillbirth, #pretermbirth, and low birth weight(#LBW) are minimized Less Occurrence of birth defects and #NeonatalInfection Reduction in the prevalence of underweight and stunted children Reduction the risk for type 2 diabetes and cardiovascular disorders in children at adulthood Factors that cause nutrition risks in preconception: Maternal age Micronutrient deficiencies Malnutrition Maternal age: Maternal age can severely affect in 2 ways, such as underage pregnancy and overage pregnancy Adolescent Pregnancy: Adolescent pregnancy carries higher risks of #eclampsia and postpartum infections 50% higher likelihood of stillbirths and preterm births Advanced Maternal Age: Reduced quality of eggs, as the egg count in a female baby is at 1 million at the time of birth and it becomes 30,000 at puberty due to natural processes and reaches 25,000 by 37 years of age Increased risk of foetal death by 44% during the perinatal period (between 20th-28th week of pregnancy to 2-4 weeks after childbirth) and preterm birth by 29% Increases the risk of #DownSyndrome in the child Micronutrient deficiencies: Iron deficiency Anaemia is a condition where the body lacks enough iron to produce haemoglobin and is linked with an increased risk of foetal growth retardation (#FGR). Severe anaemia leads to more severity in FGR as per Mid pregnancy studies published in the Journal of Nutritional Disorders and Therapy Folate deficiency Anaemia is the lack of folate (also known as vitamin B9) in the body and it is associated with neural tube defects such as #anencephaly where the brain is not fully developed), #spinabifida (where the spinal cord is not fully formed) Multivitamin Deficiency is the lack of essential vitamins and minerals in the body and can lead to a variety of health problems including anaemia, weakened immune system, poor bone health, and impaired cognitive function Malnutrition: Malnutrition refers to both undernutrition and overnutrition. Acute malnutrition is a decrease in nutritional levels for a short period. If malnutrition, continues to exist after a short period, it leads to Chronic malnutrition. 1. Underweight- increases likelihood of preterm birth by 32% 2. Overweight - increases occurrence of #pre-eclampsia and #GDM by 2.17 and 3.67 times, respectively Read more about our AI Technology MAAP (Malnutrition Assessment and Action Plan) Nutritional goals for women in the preconception period: Obtaining an optimum weight Assessing anaemic conditions through blood tests and taking appropriate treatments Consumption of folate and micronutrients Standard level of physical activity Withdrawing from alcohol and tobacco consumption Nutritional interventions to be focused during the preconception period: Every day consumption of minimum 400 micrograms (mcg) of folic acid to avoid neural tube defects Counselling on nutrition and information about lifestyle modifications Nutritional status assessment to find whether the required quantities of vitamins and minerals are present in the body Nutritional diet rich in micronutrients Test for Diabetes and its treatments if found Treatments for any other health issues Physical activities to improve fertility Iodised salt consumption to avoid thyroid problems and improve the brain development of the foetus Treatments for any specific health condition present during preconception period Recommended interventions for Nutritional status: Assessment of weight to verify whether the BMI is Ideal or not Tests for anaemia deficiencies Nutritional value and adequacy of diet Recommended interventions for Underweight and Anaemia: Counselling on nutrient-rich and well-balanced diet Consumption of iron rich foods such as whole grains, dates, spinach and fruits and folic acid-rich foods such as beetroot, banana, green beans, fortified cereals and nuts. Provision of foods with wholesome nutrients Supplementation of #Iron-FolicAcid (IFA) for anaemic women as per recommendation Supplementation of micro-nutrients such as vitamins and minerals Contact our team of experts to know more about supplementation In essence A female child is born with all the eggs required for reproduction in her adulthood, which is a primary cause for intergenerational health cycles. The poor health of woman leads to poor health in her children and subsequent generations. The preconception measures should be implemented for every woman of reproductive age before 2 years of conception and in between pregnancies. Sufficient nutrition before Pregnancy and early Pregnancy (i.e., less than 12 weeks of pregnancy) is necessary to augment essential periods of foetal development. Health interventions has to be combined with sexual and reproductive health services including family planning to improve healthy spacing in between pregnancies and also with comprehensive women empowerment practices targeted on overall improvement of women.

Why are “the first 1000 days” so significant? The critical Window of Opportunity for ensuring a Child’s optimal physical and mental development is “#1000days”, starting from Conception to 2 years of age. These “1000 days” are a crucial period for Maternal and Infant services and it must be attended to with utmost care. This period is a provision to create a good impact and to enable every child to lead a hale and healthy life. Almost 50% of morbidity occurs during the “first 1000 days”, particularly among children under the age of 5. Also, in general, this period of “1000 days” is the phase of high susceptibility to malnutrition and infections, which further leads to stunted growth. Undernutrition during this phase can cause long-lasting physical and mental damage. Growth defects profile: Maternal undernutrition and infant undernutrition lead to FGR, stunting, wasting and undernutrition among children. #FoetalGrowthRestriction (FGR) refers to a condition that limits the growth of the foetus in the womb #Stunting refers to non-attainment of the required height for age #Wasting refers to a deficiency in weight for corresponding height Actions that are taken after 2 years post-birth are futile, as these conditions become irrevocable. In support of this statement, Cerebral atrophy is prevalent on the scans of the undernourished children. #CerebralAtrophy is the degeneration in the volume of the brain due to the loss of brain cells. It has severe effects on body awareness, balance, motor coordination, hearing and speech. Growth potential of a baby at the time of its birth is almost the same in a developed country when compared to that of a developing or underdeveloped country. However, the gap in potential growth widens after the 24 months post-birth of any baby. Due to this fact, interventions or rectifying measures must be done within this decisive “1000 days” itself, else it becomes too late, too little and too expensive. When does stunting occur and why it has to be prevented? #Stunting in the foetus is evident by 8 weeks, which leads to low birthweight children. The rapid increase of height in the Foetus happens around the 20th week, while the rapid gain of weight in the foetus happens around the 30th week. And the detailed “growth in inches” can be assessed through common ultrasound scans. After these specified periods, both the weight and height does not change so rapidly. Why growth faltering must be prevented? Growth faltering with a height deficit of 2 cm in an infant at the time of birth can successively lead to a 4 cm height deficit in 6 months, 6 cm height deficit in 12 months, 9 cm deficit in 24 months and 10 cm deficit in 36 months of age. The deficit increases mainly due to improper breastfeeding practices. As per the National Family Health Survey (NHFS-5), among children below 5 years, 35.5% are stunted (low height for that age), 32.1% are underweight (low weight for that age) and 19.3% are wasted (underweight for that height) This is a huge challenge for a developing country like India. As per a publication in Lancet (a globally acclaimed medical journal), child deaths can be prevented to a certain extent i.e., up to ~20% with known preventive interventions (13% through Breastfeeding and 6 % through Complementary feeding practices) 7% through Insecticide-treated bed nets and 5% through Zinc supplements. Successful interventions: The three best and most cost-effective Interventions to improve livelihood in “Critical 1000 days” are Maternal nutrition practices Breastfeeding practices Complementary Breastfeeding practices These recommended high-impact nutrition interventions are needed to be included in the services of medical colleges or any other dedicated platform. Know more about our Technology MAAP (Malnutrition Assessment and Action Plan) to prevent Malnutrition linked Stunting and Wasting Maternal nutritional interventions overview: Dietary practices during Pregnancy are very crucial for improving maternal nutrition. This involves Diet counselling including maternal diet diversity (to enhance nutrition by consumption of variety of food) Provision of iron, folic acid and calcium supplements with counselling (to improve essential micronutrients) Pregnancy weight gain monitoring (to assess the growth of the child) Child nutrition interventions overview: Breastfeeding ensures nutrition and bonding between a mother and her infant and strengthens the child’s immune system. It also prevents allergies, respiratory problems, obesity and #SIDS (sudden infant death syndrome). And so, it should be started immediately after infant birth. Exclusive breastfeeding refers to providing “only breastmilk” to the baby till the first six months of life, as it contains all the necessary nutrients for the child. Complementary breastfeeding refers to breastfeeding alongside the administration of solid foods, after 6 months. Timely introduction of breastfeeding, diet diversity of mother and child and age-appropriate feeding(frequency/quantity) are important. Consistent feeding even during illness is essential. Continued breastfeeding at least for 2 years is also important. 1. First intervention-Antenatal Nutrition: Antenatal nutritional intervention is essential for improving birth outcomes in pregnant women and classified into two categories, such as Macronutrient supplementation interventions and Micronutrient supplementation interventions. These two broad categories are facilitated in the following 3 ways. Providing balanced protein-energy content with diet diversity: Reduction of 32% in the risk of Low Birth weight (#LBW) babies Reduction of 34 % in Small for Gestational Age (#SGA) babies Reduction of 38 % in the risk of stillbirth babies These effects are more seen in undernourished women. Iron-Folic Acid (IFA) supplementation: Reduction of 19% in the risk of Low Birth weight (LBW) babies Reduction of 16 % in Small for Gestational Age (SGA) babies Supplementation with multiple micronutrients: Reduction of 12% in the risk of Low Birth weight (LBW) babies Reduction of 10 % in Small for Gestational Age (SGA) babies. 2. Second intervention – Breastfeeding: As per Lancet 2018 report, around 8,23,000 children under 5 years can be saved every year by breastfeeding. And as per Lancet 2016, the relevance of breastfeeding in the 21st century is it decreases development of diarrhoea and pneumonia in infants increases children's intelligence scores prevents maternal cancer deaths by 20,000 per year decreases the risk of ovarian and invasive breast cancer decreases the likelihood of adult chronic diseases such as obesity and diabetes plays significant role on birth spacing 3. Third intervention - Complementary feeding practices: Providing complementary feeding and offering nutritional counselling alone has resulted in a significant increase in weight and linear growth in children below 2 years. Providing appropriate complementary foods in children aged 6 - 24 months has resulted in an extra gain of 0.25kg(± 0.18) in weight and 0.54(±0.38) in height Education of the mother about complementary feeding has led to an positive outcome of extra weight gain of 0.30 kg(±0.26) and a gain of 0.49 cm(±0.50) height in children aged 6 - 24 months. Platforms for MICYN programmes: Some of the Platforms that contribute to improvement of Maternal Infant Young Child Feeding Nutrition (MICYN) programs are Health platforms Self-Help Group (SHG) platforms Child Development Services (CDS) platforms Medical College platforms Private sector platforms Medical college institutions being highly specialized care facilities and teaching points, have a critical role in providing #MICYN programs. They have different contact points for “1000-days” period. The “1000-days” window is further divided into two parts 270 days from conception until the discharge of the mother and baby after labour and 730 days from discharge until the baby reaches 2 years. Programs in the 1st 270 Days from conception: In Antenatal Care Outpatient Department (ANC OPD), the pregnant woman’s husband and other family members are provided counselling on the mother’s nutrition, Iron-Folic acid (IFA) and Calcium (Ca) supplementation and on preparation for breastfeeding. It is done during every ANC OPD visit, which happens at least for 4 times. Counselling on nutrition and breastfeeding is also provided at the prep room which is visited at the onset of labour. In the Labour room, the new mother is educated on Early initiation of breastfeeding, Kangaroo Mother Care (KMC) which is the practice of providing skin-to-skin contact for LBW and preterm babies and Exclusive Breastfeeding. In Prenatal Care (PNC Ward), until discharge, counselling is provided. Programs in the next 730 Days: Vaccination and counselling on breastfeeding in the immunization clinic, Counselling on complementary breastfeeding and continued breastfeeding in Paediatric OPD, with both the mother and father. These are the high-impact interventions along with the aspect of nutritional counselling. Summary: Thereby, the three main interventions for the critical #1000days are Maternal Nutrition, Breastfeeding and Complementary feeding. The MICYN practices must be delivered in efficient ways for the prevention of undernutrition. Doctors, Healthcare workers, Nurses and Counsellors need to be trained and oriented on these MICYN concepts. Nutrition is not the individual obligation of mothers. It is the collective obligation of the entire society to establish the maternal nutrition. Read more about our AI Technology MAAP (Malnutrition Assessment and Action Plan)

According to Rebecca Milner, "If you check the health of a woman, you check the health of society." Globally, undernutrition is a major health concern that affects the overall health of pregnant women and adolescent girls. Indian mother is feeding her baby on her lap in a rural background. Credit: Abir Bhattacharya/ Shutterstock 1. Overview of #Undernutrition: Undernutrition refers to less-than-standard levels of macro and micronutrients that are stored in the body and consumed through the diet. #Macronutrients refer to nutrients that are required in large amounts for proper growth and functioning of the body. They play a major role in providing energy and maintaining the body’s structure. The major macronutrients are: · Carbohydrates · Proteins · Fats · Water · Fibre One of the most prevalent forms of undernutrition is the deficit of energy and protein. #Micronutrients refer to nutrients that are required in smaller amounts for proper growth and functioning of the body. They play a major role in secreting hormones and enzymes. The major micronutrients are: · Vitamins · Minerals There are 13 major vitamins required by the body, which are vitamins A, C, D, E, K and B vitamins such as thiamine, riboflavin, pantothenic acid, niacin, biotin, folate, B6 and B12. Calcium, phosphorus, iron and zinc are some of the main minerals required by our body. 2. Prevalence of undernutrition in pregnant women: One of the most prevalent forms of undernutrition is the deficit of energy and protein. Globally, 29.9% of women of reproductive age (15-49) are anemic due to iron deficiency, according to WHO reports. Pregnant women have a higher vulnerability to anemia due to the increased demand for iron required to support the growth of the placenta and fetus, as well as the increase in blood volume during pregnancy. The occurrence of anemia is higher among pregnant women, with the National Family Health Survey-5 (NFHS-5) conducted in 2019-21, reporting that the prevalence of anemia among pregnant women in urban areas is at 45.7% and in rural areas is at 54.3%. Undernutrition in pregnancy often leads to preterm birth, morbidity, other neonatal complications, and #maternal death. 3. Implications of undernutrition of Adolescent girls: Adolescent girls are also more likely to suffer from undernourishment due to major factors such as poverty, inaccessibility to healthy foods, and lack of knowledge of nutrition. Adolescent girls are more probable to give birth to low-weight babies, as their growth is still not complete, and their body utilizes the nutrition for both their individual growth and fetal growth. 4. Major effects of maternal undernutrition on the child: Pregnant women who are undernourished are more likely to give birth to low-weight and low-height babies. Undernourishment during pregnancy has serious consequences on the child, such as stunting, wasting and foetal growth restriction (FGR). · #Stunting refers to non-attainment of the required height for age · #Wasting refers to a deficiency in weight for corresponding height · #FoetalGrowthRestriction (#FGR) refers to a condition that causes a foetus to not reach its normal weight in the womb Reports of the NFHS-5 (2019-2021) in India reveal that 35.5% of children under the age of five years are stunted, 19.3% of children under the age of five years are wasted, while 32.1% of children under age five years are underweight. Over 85% of stunted children around the world are native to Africa and Asia. Contact us to know how we can help you track the nutrition and growth of your baby 5. Intergenerational cycle: Growth deficiencies in babies gradually result in stunted height and low weight during their teenage years and adulthood. A short-statured woman is more likely to give birth to a growth-restricted and stunted baby, perpetuating the cycle further. Furthermore, early pregnancy in teenage girls who are underweight and stunted often leads to childbirth complications, such as hindered labour, excessive bleeding, uterine infections, other infections such as flu and birth of Small for Gestational Age (SGA) babies. · Small for gestational age (#SGA) refers to a birth weight of less than 10% of gestational age. Around 6 billion Small Gestational Age (SGA) births, globally are associated with women of short stature. UNICEF’s recent findings reveal “Poor nutrition is passed down through generations: about half of children under 2 with stunting become stunted during pregnancy and the first six months of life”. Thus, #Undernutrition is a major health concern that affects women's health, particularly pregnant women and adolescent girls. The prevalence of undernutrition among women has a severe impact not only on their health but also on the health of their children. The impact of maternal undernutrition on society is significant, and preventive measures must be taken to improve the overall health and wellbeing of society. Thus, addressing maternal undernutrition is a vital step towards building a healthy society, as it not only impacts women's health but also the health of their children and future generations. Governments, civil society organizations, and other stakeholders must work together to implement comprehensive and sustainable