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Preventing malnutrition in pregnant and breastfeeding women.

Women have distinct nutritional requirements throughout their life – especially before and during pregnancy and while breastfeeding, when nutritional vulnerability is greatest. Ensuring women have nutritious diets and adequate services and care is fundamental for the survival and well-being of mothers and their children.

Before pregnancy, women need nutritious and safe diets to establish sufficient reserves for pregnancy. During pregnancy and breastfeeding, energy and nutrient needs increase. Meeting them is critical for women’s health and that of their child – in the womb and throughout early childhood. 

But in many parts of the world, the nutritional status of women is unacceptably poor. Far too many women – especially adolescents and those who are nutritionally at-risk – are not receiving the nutrition services they need to be healthy and give their babies the best chance to survive, grow and develop.

Women’s diets in many countries contain limited fruits, vegetables, dairy, fish and meat. 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. They can also lead to stillbirth, low birthweight, wasting and developmental delays for children. UNICEF estimates that low birthweight affects more than 20 million newborns every year.

Poor nutrition during breastfeeding makes it more challenging for mothers to replenish their nutrient stores and meet their additional dietary needs.   

Worldwide, women’s diets are influenced by various factors, especially food access and affordability, gender inequality and social and cultural norms that may constrain women’s ability to make decisions about their nutrition and care.

UNICEF’s response

Improving women’s diets, access to nutrition services, and nutrition and care practices – before and during pregnancy and while breastfeeding – is critical to preventing malnutrition in all its forms. This is particularly true for the most vulnerable mothers and babies.

Nutrition before pregnancy

UNICEF supports programmes that make nutritious foods more accessible and affordable, and uses behaviour change communication to promote nutritious diets and shift social norms and practices. We also support large-scale food fortification programmes – such as salt iodization and the fortification of wheat flour, rice, and cooking oil with vitamins and nutrients – to improve the quality of women’s diets.

Nutrition during pregnancy

UNICEF promotes healthy eating, micronutrient supplementation (iron and folic acid or multiple micronutrients, and calcium), deworming prophylaxis, weight gain monitoring, physical activity, and rest to improve the nutrition of pregnant women. We also help provide nutritional counselling and support during pregnancy, in line with global recommendations.

Nutrition while breastfeeding

UNICEF promotes healthy eating, micronutrient supplementation (either iron and folic acid, or multiple micronutrients), deworming prophylaxis, physical activity, and rest to improve the nutrition of breastfeeding women. We also help provide nutritional counselling and support for breastfeeding mothers during postnatal care visits.

Nutrition of adolescent mothers

UNICEF supports programmes that provide specialized support and nutritional care to pregnant adolescent girls, breastfeeding adolescent mothers and other nutritionally at-risk pregnant and breastfeeding women. This includes supporting counselling services, micronutrient supplementation and the use of balanced energy-protein supplements where appropriate.

Innovations for maternal nutrition

UNICEF tests innovations for improving women’s nutrition during pregnancy and breastfeeding. As part of this work, we aim to shape markets to help increase access to low-cost, high-quality micronutrient supplements for women, and drive product innovation for nutrition. This also includes exploring innovative ways to deliver nutrition services to women and low-cost, field-friendly methods to assess micronutrient deficiencies in women. 

Resources

By Dennis Anderson-Villaluz, MBA, RD, LDN, FAND, nutrition advisor, and Julia Quam, MSPH, RDN, ORISE health policy fellow, of the Office of Disease Prevention and Health Promotion

Good nutrition before, during, and after pregnancy is essential for a healthy mom and baby. The Dietary Guidelines for Americans, 2020-2025 dedicates a chapter to women who are pregnant and breastfeeding. Health professionals can use this guidance to better understand unique nutritional needs and develop strategies to support healthy dietary patterns during pregnancy.

Diet Quality During Pregnancy

Women who are pregnant tend to have slightly higher diet quality compared to their peers who are not pregnant or breastfeeding; however, intake is still not optimal. Most women who are pregnant do not consume enough fruits, vegetables, dairy, and seafood, while consuming too much added sugars, saturated fat, and sodium. They also consume too many refined grains and not enough whole grains.

Special Considerations for Women Who Are Pregnant

Women who are pregnant would benefit by making some of the same nutrition changes recommended for all adults. Other special nutrition considerations include:

• Healthy weight gain:Health professionals can encourage women to achieve a healthy weight before becoming pregnant and follow gestational weight gain guidelines during pregnancy.
• Increased energy needs: Women with a healthy pre-pregnancy weight need about 340 - 450 extra calories per day from nutrient-dense choices during the second and third trimester. Needs may be different for women with a pre-pregnancy weight that is overweight or obese.
• Seafood: Health professionals should recommend at least eight and up to 12 ounces of a variety of seafood per week from choices lower in methylmercury. Intake during pregnancy is associated with improved cognitive development in young children.
• Folic acid/folate: The United States (U.S.) Preventative Services Task Force recommends all women who are planning or capable of pregnancy take a daily supplement containing 400 to 800 mcg of folic acid to help prevent neural tube defects beginning at least one month before conception. Women should also consume plenty of folate from foods like dark-green vegetables and beans, peas, and lentils during pregnancy.
• Iron: Iron is key for fetal development. Heme iron, which is found in animal source foods is more readily absorbed than non-heme iron found in plant sources, but vitamin C can enhance non-heme iron absorption. Food sources lists for iron are available at DietaryGuidelines.gov.
• Iodine: Iodine is important for the baby’s neurocognitive development during pregnancy. Women who do not regularly consume dairy products, eggs, seafood, or use iodized table salt may not get enough. Encourage women to use iodized salt in place of any salt they’re already using.
• Choline: Most women don’t get enough choline during pregnancy. Meeting recommendations for the dairy and protein food groups (including meat, eggs, and some seafood—as well as beans, peas, and lentils) can help meet needs.
• Supplements: Most health professionals recommend a daily prenatal vitamin and mineral supplement in addition to consuming a healthy dietary pattern. This may be especially important to meet folic acid, iron, iodine, and vitamin D needs.
• Alcohol: Women who are or who may be pregnant should not drink alcohol.
• Caffeine: FDA recommends women who are pregnant or trying to become pregnant talk to their healthcare provider about their caffeine consumption.
• Food safety: FoodSafety.gov provides guidance on ways to reduce foodborne illness since women who are pregnant and their unborn children are more susceptible.

Resources for Supporting Women Who Are Pregnant

Women who are pregnant have diverse calorie and nutrient needs, but there are a variety of resources that can help make supporting them easier.

• The DRI Calculator for Healthcare Professionals Tool helps calculate daily calorie and nutrient needs.
• The National Institutes of Health dietary supplement fact sheets provide information about supplements and food sources of key nutrients.
• DietaryGuidlines.gov has resources for professionals, including a handout for pregnancy and breastfeeding.
• For information about supporting moms during breastfeeding, see Nutrition During Breastfeeding: How Health Professionals Can Support Healthy Moms and Babies.