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Despite rapid economic growth and exponential medical advancement, India continues to have a high prevalence of adverse birth outcomes such as low birth weight (LBW). Worldwide, the prevalence of low birth weight babies is 15.5 percent, with 95 percent of these occurring in low- and middle-income countries. The 2019-20 National Family Health Survey (Nfs-5) data revealed that in India, the proportion of LBW births was 17.29 percent, with 6 percent having very low birth weight (<1500 g). Facility-based health services have seen steady growth. For example, institutional delivery and uptake of antenatal services have increased, with 88.6 percent of pregnant women availing institutional deliveries and 70 percent having an antenatal care (ANC) checkup in the first trimester in 2019-2021. However, the coverage remains higher in urban areas than in rural areas. Furthermore, despite these improvements, the prevalence of LBW has not significantly declined since the NFHS 4 survey of 2014-2015.
Factors such as lower socioeconomic status, limited education, teenage pregnancies, and poor access to antenatal care significantly increase the odds of LBW
LBW babies are at a high risk of developing hypothermia and hypoglycemia initially and are more prone to long-term neurological and language impairments. They are also at a higher risk of early death. Additionally, LBW heightens the risk of chronic diseases, including cardiovascular disorders, diabetes, and dyslipidemia in adulthood, often with early onset.
It is well documented that pregnant women from a disadvantaged social background are at high risk of having LBW babies. Factors such as lower socioeconomic status, limited education, teenage pregnancies, and poor access to antenatal care significantly increase the odds of LBW. Abuse of any substanceincluding alcohol, cigarettes or drugs, increases the possibility of preterm (before 37 weeks) and LBW births. Besides, these can precipitate other health issues in the infant, including respiratory difficulties, feeding issues, and developmental delays. Other risk factors for LBW include multiple pregnancies, obstetric complications, trauma, pre-eclampsia or eclampsia, infections, chronic disorders like hypertension and diabetes, as well as the nutritional status of the mother. In the fetus, intrauterine growth restriction (IUGR), infections, and certain placental abnormalities also contribute to LBW.
The foetus depends completely on the mother for crucial nutrients. Good maternal nutrition is therefore a critical component of prenatal care. The foetus requires various nutrients like proteins, carbohydrates, fats, vitamins and minerals for organ development, skeletal growth, and normal physiological functioning. Inadequate intake of these nutrients may result in developmental delays, restriction of perinatal outcomes, and LBW. Maternal nutritional deficiencies continue to affect the child’s growth and development even after the baby’s birth. Several studies have linked chronic disorders such as obesity and diabetes, as well as poor cognitive development, to mothers’ poor nutritional status during pregnancy. These findings emphasise the significance of consuming a balanced diet, with adequate macro and micronutrients during pregnancy and its role in shaping the newborn’s long-term health.
Macronutrients such as carbohydrates, proteins, and fats provide energy and are needed for foetal growth and development. Micronutrients such as iron, calcium, vitamin B12 and folate are required for the formation of red blood cells, bone growth, and the prevention of congenital malformations. Vitamin D promotes calcium absorption; vitamin C promotes tissue repair and boosts immunity; vitamin A is needed for vision and cell growth; vitamin E for cell protection, and B-complex vitamins for metabolism and brain development. A deficiency in any of these essential nutrients can lead to adverse outcomes for the infant.
Maternal nutritional deficiencies continue to affect the child’s growth and development even after the baby’s birth. Several studies have linked chronic disorders such as obesity and diabetes, as well as poor cognitive development, to mothers’ poor nutritional status during pregnancy.
Maternal mental health during the prenatal period significantly impacts the child’s development. Positive maternal mental health promotes mother-child bonding, secure attachment, and healthy social-emotional development of the child. Maternal mental health disorders during pregnancy adversely affect the infant’s emotional, cognitive, and behavioural development. Maternal anxiety, stress, and depression increase the levels of cortisol in the body. This passes through the placental barrier and reaches the foetus, affecting foetal brain development and stress response. Long-term exposure to high levels of these stress hormones can cause abnormal foetal brain development, adversely affecting regions controlling emotions, attention, and memory. As a result, offspring of pregnant women with mental health issues are more likely to grow up with behavioural and cognitive issues and psychiatric illnesses. Research shows that infants exposed to maternal depression during the antenatal and postnatal periods may experience higher levels of insecure attachment, emotional problems, and poor social skills. Additionally, depression may hamper the mother’s capacity to provide sensitive and responsive care to her child.
Various strategies have been adopted to reduce adverse birth outcomes across the globe. The United Nations’ (UN) third Sustainable Development Goal (SDG-3) aims to improve maternal and neonatal health and combat mortality by increasing the proportions of deliveries by skilled health workers. To address the issue of LBW births in India, the central and state governments have focused on strengthening their respective health programmes. Some programmatic initiatives place greater emphasis on improving the quality of ANC services and reducing out-of-pocket costs for mothers, such as the Janani shishu suraksha karyakram and the Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition programme (Rmnceh+n). Others focus on providing supplementary nutrition services for pregnant mothers, coupled with monitoring of maternal weight, as seen in the Integrated Child Development Services (ICDS) Scheme and Poshan abhiyaan.
Research shows that infants exposed to maternal depression during the antenatal and postnatal periods may experience higher levels of insecure attachment, emotional problems, and poor social skills.
The psycho-social health of women during pregnancy has not received adequate attention as a risk factor causing adverse pregnancy outcomes. While post-partum depression is now increasingly recognised—especially within the medical community— ante-natal depression, anxiety and stress, and their impact on birth outcomes, remain largely overlooked. For optimal child development, it is crucial to prioritise maternal mental well-being through appropriate support and treatment and the provision of a nurturing environment both for the mother and the child. This highlights the need to look beyond hospital-based approaches to address improvements in reproductive health outcomes. Early identification and support at the individual, family and community levels are essential for alleviating maternal stress. The impact of maternal stress on early child growth and development can be minimised through interventions that promote a nurturing environment, and by exposure to stress management techniquesas well as other social support mechanisms.
Addressing maternal stress and nutrition is vital for improving birth outcomes, infant survival rates, and can play a critical role in promoting healthy fetal development. This involves providing access to a balanced diet, addressing nutrient deficiencies, and implementing effective stress management strategies. A holistic approach that supports maternal well-being, both physical and emotional, is a prerequisite for a healthy and positive pregnancy.
Seema Puri is a former Professor from the Department of Food and Nutrition at the Institute of Home Economics, University of Delhi.
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