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Revolutionizing Our Approach to Maternal Health
New Study Underway to Assess the Impact of Pre-conception Nutritional Supplementation
CHORI senior scientists Janet King, PhD, Deborah Dean, MD, MPH, and their colleagues Andrew Hall, PhD, Tu Ngu, MD, PhD, and Henri Dirren, PhD, have received funding from the Thrasher Research Fund and the Nestle Foundation to study for the first time whether or not providing increased nutrition to women prior to conception can impact fetal health and improve birth weight. In combination with the Vietnamese VAC program, which can be translated as vegetables, aquaculture (or fish), and caged animals (chicken and pork), and supported by the Vietnamese government, the new study has the potential to revolutionize maternal and newborn health in Vietnam.
”It's a wonderful opportunity to really have an impact on maternal health.”
"If we are able to show that providing even just a small intake of animal source foods has a positive impact on pregnancy outcomes, the Vietnamese government will then make sure that all pregnant women have access to animal source foods every day," says Dr. King.

Depending on how maternal health is defined, as many as a third of the world's population of expecting mothers are micronutrient deficient. In Southeast Asia in particular, researchers estimate that 25 percent of newborns suffer from the malnutrition of their mothers. The result is lower birth weights, greater susceptibility to infection, and significantly increased morbidity and mortality. While researchers have understood the impact that malnutrition can have on the health of the newborn for decades, nutritional interventions have failed to show significant positive results.

"In my opinion there are two principles at work that can explain the lackluster success of these interventions," says Dr. King, an international expert in maternal nutrition, and zinc deficiency, in particular. "One is that you cannot live on vitamins and minerals alone. We need energy, we need protein, we need food."

No matter how much supplementation you provide in the form of vitamins and minerals or fortified foods, says Dr. King, you can't make up for an incomplete diet. No amount of vitamins can do enough to augment the consumption of only rice and a few vegetables, often a staple diet in rural communities.

"The second principle is that a key factor influencing the course of pregnancy is the nutritional state of the mother at conception," Dr. King says. "We don't have a lot of human data to support this, but we have a huge amount of animal data."
"Everyone knows before you breed an animal you want to make sure that animal is well nourished. This is the backbone of animal husbandry throughout the world, and the basis of our food supply. Somehow, however, this knowledge hasn't been translated to people."
Instead, maternal nutrition interventions have always focused on providing nutritional boosts in the form of supplements and vitamins only when a woman has already conceived. The new study addresses both these principles by focusing on newly married women who have not yet conceived, and by providing not a pill, but a food snack.

Vietnamese Women at Market
"Vietnam is one of the only countries in the world that has been actively working to make sure they maintain an agricultural infrastructure to provide a varied food source for their people, through their VAC program," explains Dr. King. "The communist government provides land to farmers in rural areas for them to produce VAC foods, and consequently, they have maintained animal source foods sufficient to supply the entire population of Vietnam."

The problem, however, has been the distribution of those foods. The rural farmers are so poverty-stricken that they must sell all their meats, and forgo such consumption themselves.
In addition, because of cultural issues, any meat consumed at home generally goes to men. Thus while there is an adequate supply through the VAC program, the nutrition found in animal source foods iron, zinc, vitamin A and vitamin B12 doesn't get to those who need it most pregnant women and their children.

"What we are doing is developing 10 different food snacks that come from eggs, pork and chicken, that we provide on a daily basis to both potential but not yet pregnant women, as well as already pregnant women," says Dr. King. "It's a study I have wanted to be able to do my entire career to provide nutritional supplementation to women pre-conception."

It's also a study that utilizes a fundamental part of the Vietnamese government's existing agricultural and food policies, which means that translating the potential positive results into clinical practice making sure women and children get meat proteins every day will not only be supported by the government, but will be inherently implementable.

"We can have as many policies and World Health Organization recommendations we want, but if you really want to have an impact, you have to find a way that works for the individual cultures and governments to get the nutrition to those who need it most," says Dr. King.

With the help of the Thrasher and Nestle Foundations, Dr. King is helping make that happen. The three-year grant began November 1, 2010, and its results will hopefully provide not only a foundation for increasing maternal health in Vietnam, but also a framework for how to combat maternal malnutrition and low birth weights on a global scale.


Tuesday, May 17, 2011 8:19 AM

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