
Pregnancy is no doubt a roller coaster ride where a woman's body goes through innumerable changes and thus her needs also expands. One of the most important requirements during pregnancy that doubles is for iron. Women have long been associated with lack of iron in their entire life cycle and during the gestational phase this has often commonly been diagnosed with pregnancy anaemia.
Let’s dive deeper to understand what exactly physiologically happens – During the antenatal period the amount of blood in our body increases by 20 – 30 % resulting in lower number of red blood cells and reduced oxygen flow. When the body needs more iron than it has been available we become anemic.
The most common categories of anemia found during pregnancy in women are –Iron Deficiency, B12 Deficiency & Folate Deficiency Anemia.
The cumulative risk of these kinds of anemia during the prenatal phase can lead to increased maternal morbidity, premature birth, low weight birth babies, infection, poor healing and postpartum depression. Some of the most common etiology associated with anemia are dizziness, pale skin, shortness of breath, rapid heartbeat, headaches, trouble falling asleep, lack of concentration.
The Escalating Figures
Several research & studies have shown that in India anemia has been widespread and persistently at a higher rate in women for decades this is an underlying cause of maternal malnutrition. 50 % of Indians are anemic and out of which women are worst affected as it has grappled in almost all geographical pockets of our country. In India according to National Family Health Survey 54% of women in rural and 46% women in urban areas are anemics during pregnancy. According to ICMR Data The relative prevalence of mild, moderate, and severe anemia are 13%, 57% and 12% respectively in India. Initiative to combat anemia in India has been undertaken with the joint and collaborative efforts by the Government of India & World Health Organization. The launch of programs such as Anemia Mukt Bharat, Poshan Abhiyan to eliminate anemia & nutritional deficiencies among women and children in our country but the targets for these programs have been estimated to achieve by 2030 and the primary focus is only on maternal nutrition.
The Ministry of Health, Government of India has now recommended intake of 100 mg of elemental iron with 500 mg of folic acid in the second half of pregnancy for a period of at least 100 days. Women who receive daily antenatal iron supplementation are less likely to have iron deficiency anemia at term. But the question is why the Government has been unable to take actionable steps prior to conceiving and also in the initial phase of conception?
To address anemia during the antenatal period we need to take into account other factors that can enhance a mother’s health is not just nutrition centric. Of course nutrition is key but a multidimensional approach is equally important.
“Prevention is Better than Cure”
Let’s talk about how we can eradicate anemia during pregnancy by taking steps at both individual & community level in near future. The question is how as citizens of India we can make a difference and amp up the progress rates. Some of the important steps we can chart a path forward are –
Access to Proper Nutrition & Advocacy – Good Nutrition plays a vital role in reducing maternal morbidity & anemia. We should advocate for women in our society regarding nutrient dense foods, how eating seasonally can help balance their hormonal health, local foods which are dense and have not travelled far and cultural and traditional foods should be incorporated in their diet.
Counseling Session with Health Care Providers – Regular check ups and visits with a health provider is important to be updated and well informed about our health parameters. Health care provider’s can be the first point of contact for educating about nutrition, supplementation and health related goals.
Awareness and education about Supplementation – Supplement is essential in bridging the gap between food. Education on targeted supplements for women such as Iron, Folic Acid, Multi vitamins should be important as these are required long before a women are planning for pregnancy. A platform or medium to empower women in our society should be established to educate on supplements as this is one area which is highly neglected.
Early initiation of Educating Women in Schools, Colleges, Universities & their Work Settings – Organizing seminars, webinar, educative sessions can help women at an early stage of life and during their youth to understand the requirements of certain foods into their diet, what nutrients are key for a women’s health and how it can enhance their overall health during their childbearing ages.
Creating Support Groups Pan India – Maternal Support groups can be of great help as it can encourage women to women empowerment by sharing their stories or experience or by educating each other. A mass of women can be reached through creating such online support groups. There can also be implementation of maternal cafes to reach out to rural women population who are in their youth, child bearing ages, pregnant mother’s as a medium of educating & enlightening them.
Here are some quick tips to Increase Haemoglobin levels during maternal period -
Heme means "Iron" and Globin means "Protein". Haemoglobin is a protein in our red blood cells that carries oxygen to our body's organs and tissues.
Food Related Practices & Frequency –
During Pregnancy Women should divide meals into smaller portions according to trimester wise to avoid long gaps in meals as eating in every 2 to 3 hours helps maintain blood sugar levels and if we have too long gaps iron absorption will be poor in the body.
1st Trimester – At least 3 Full Meals in a day should be consumed
2nd Trimester – Eating 3 full meals is recommended with at least 1 nutritious snack a day
3rd Trimester – Eating 3 Full Meals with 2 Nutritious snack a day must be consumed
Incorporate Diversified Food Groups -
Promoting pregnant woman to consume at least 1 food item from 5 food groups –
Protein
Fresh Fruits & Vegetables
Dark or Green Leafy Greens
Pulses, Lentils & Grains
Dairy Products
Include soaked, sprouted and cooked pulses, lentils, beans, & legumes as they contain live enzymes and are rich in oxygen which increases the uptake of haemoglobin. To name a few Kidney beans, Mung beans, Cow Peas, Soy beans, Chickpeas contain adequate amount of Iron content and should be included during main meals in the antenatal period.
Incorporate a plenty of seasonal & local citrus fruits such as oranges, mosambi, mangoes, amla especially during midday morning snack into your meals. Add once alternate day’s mango or amla murrabba as these are an excellent sources of vitamin C which helps in the absorption of iron levels. Figs, Dates, Pumpkin Seeds, Raisins are also an excellent sources of Iron .
Iron rich Vegetables such as Beets, Broccoli are also excellent addition in a would be mother’s diet as it increases the haemoglobin levels.
Adding seasonal and locally available leafy greens are essential in main meals as they are a good source of folate & iron which is needed to combat anemia & also the overall development of the fetus. Use of wild and uncultivated vegetables brings diversity with leafy greens such as ambadi, takla leaves, moringa leaves, karela, bhindi, palak, methi leaves into the plate & palate.
Eating good quality and adequate amounts of protein in each meal is important as it increases iron
absorption .For vegetarian and vegan woman the protein sources are lentils, beans, paneer, tofu,
tempeh, nut butters. For non -vegetarian mothers’ adding organ meats and animal products such as eggs , mutton, chicken, beef, liver, goat brain into their meals in moderation as it is beneficial and are rich sources of vitamin b12 and is responsible for the production of healthy red blood cells.
Double fortified dairy products like milk, butter or ghee can be added during pregnancy to increase iron levels in the body.
Micronutrient Supplementation -
IFA: Daily iron and folic acid tablet supplementation
- During pregnancy, woman should consume 1 tablet daily with water or lemon water, before sleeping at night from 2nd trimester onwards till the birth of the child. Consuming IFA with lemon water can be effective in the absorption of iron as it contains Vitamin C.
- Consuming IFA supplementation is advisable post meals to avoid complications.
- Avoid consuming IFA tea and/or milk, as they decrease the absorption of iron in the body.
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