By Tom Brenna
An intergenerational cycle of undernutrition is perpetuated when an undernourished mother inevitably gives birth to an undernourished baby. A third of Indian women of reproductive age are undernourished, with a body mass index (BMI) of less than 18.5 kg/m2. According to a WHO report, India ranks number 1 in preterm births with 3.5 million babies born. Premature birth is the global leading cause of death in children under the age of 5 years. To prevent such deaths and complications that arise from a preterm birth, it is necessary to have a healthy pregnancy.
If we focus on the first 1000 days of life — from a woman’s pregnancy to the child’s second birthday — for nutrition, we are offered a unique window of opportunity to shape healthier and more prosperous futures. Mothers and Infants who get the right nutrition, including an optimal and balanced intake of nutritional fats during this important window of development, have stronger physical and cognitive development, are ten times more likely to overcome life-threatening childhood diseases, have healthier families of their own and be more productive adults.
The third trimester of pregnancy in particular is characterised by massive foetal growth and consequently, a high demand of nutrients by the foetus. The amount of particular nutritional lipids reaching the placenta strictly depends on maternal diet and metabolism. Hence, the maternal diet during gestation and lactation influences pregnancy, foetal, and neonatal health outcome.
India, like its other global counterparts, has an acute intertwined problem of an unhealthy balance of nutritional fats intake, and social status which hinders optimal foetal development and maternal health. Indian dishes are usually prepared with a high amount of vegetable fats such as sunflower and safflower oils. These oils are typically high in omega-6 fatty acids. In addition, many Indians eat very little food of animal original, which naturally provides a source of omega-3 fatty acids. In fact, in 2007, UN FAO statistics indicated that Indians had the lowest rate of meat consumption in the world.
In addition, most Indians have the ability to metabolise these fats far more efficiently than most other people in the world. Research indicates that the ratio of consumption of omega-6 to omega-3 fatty acids in Indians is 30:1 against an ideal of 3-5:1.
Whilst edible oils like sunflower, corn, and soya bean oil are rich in omega-6 fatty acids and beneficial to the human body in general, pregnant women must follow a balanced diet, where an ideal diet would consist of a balance between the consumption of omega-6 and omega-3 fatty acids. Omega-3 fatty acids contain docosahexaenoic cid (DHA) which has proven to be essential for brain development of the newborn. From the third trimester until the second year of age, exactly when the brain growth is the fastest, brain and retinal tissue are heavily enriched with DHA, making DHA critically important nutrient during pregnancy.
Lack of balance between omega-6 and omega-3 fatty acids has also been proven to cause premature births, low birth weights, and altered brain structure of the newborn, leading to possibly impaired cognitive function in infants and children. Achieving the right balance is directly associated with a healthy baby and this begins at the preconception stage. Insufficient or skewed amounts can lead to preterm births, low weight at child birth, and even maternal death.
Lactating mothers require a healthy combination of fatty acids for normal growth and development of the central nervous system, cardiovascular and immune functions of the child. The DHA status of newborns and breastfed infants depends on the maternal dietary intake, with short and long-term implications for neural function. Decrease in DHA leads to high risk of poor infant and child visual and neural development.
The Indian ability to metabolise omega-6 more efficiently may also cause maternal depression. In fact, about 50 percent of Indian women do report symptoms of depression during this critical period of time and, according to a systemic review, about a quarter of all Indian women are diagnosed with post-partum depression.
Pregnant women in India can become aware of their lipid status by utilising a minimally invasive tool which utilises a finger prick test. A drop of blood can assess one’s lipid profile and DHA status in red blood cells.
Global guidelines indicate that pregnant woman should consume between 200-300 mg of DHA per day, either through her diet or through supplements. From epidemiological studies, it’s known that Indian women do not consume these recommended intakes per day. Omega-3 DHA supplementation is therefore highly recommended for pregnant women in India. For vegetarians, there is a vegetarian source of DHA available.
Tom Brenna is a professor of pediatrics, human nutrition and chemistry in the Dell Medical School and the College of Natural Sciences at University of Texas at Austin.
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