Nutrition Section, United Nations Children's Fund, New Delhi, India.
Institute of Economic Growth, New Delhi, India.
Int J Gynaecol Obstet. 2021 Dec;155(3):357-379. doi: 10.1002/ijgo.13939.
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.
本文回答了有关妊娠严重消瘦筛查和管理的研究问题，探讨了在印度可能有效的方法，以及在大规模实施这些方法方面还需要做些什么。对过去十年南亚国家的研究进行了桌面审查，收集了关于六组策略的证据，如单独的均衡能量补充（BEP）以及与营养教育等其他干预措施相结合。审查了南亚国家的政策和准则，以了解正在使用的方法。创建了一个涵盖世界卫生组织和其他组织涵盖的公共卫生维度的十点网格，以便与政策制定者和实施者进行讨论，并审查了来自卫生部和家庭福利部的政府文件。有 18 项研究入选，涵盖孟加拉国、印度、尼泊尔和巴基斯坦。BEP 持续时间更长、孕前开始补充以及更好的孕前体重指数（BMI）均对出生体重有积极影响。多种微量营养素补充对改善 BMI 更好的孕妇的妊娠期体重增加更为有效。行为改变沟通和营养教育对饮食实践（如更高的饮食多样性）显示出积极的结果。在南亚国家中，斯里兰卡和尼泊尔是仅有的两个在国家准则中纳入孕产妇消瘦管理的国家。印度至少有九种孕妇补充食品和三种全餐的变化形式，可以进行修改以满足那些严重消瘦的孕妇的额外营养需求。在国家营养行动计划下，几乎涵盖了全球推荐的所有孕产妇营养干预措施，但仍存在难以接触、识别和管理孕产妇严重消瘦病例的挑战。本文提供了通过现有公共卫生计划、基础设施和人力资源来解决孕产妇严重消瘦问题的四项行动。
