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Adequate maternal weight gain

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Anonymous 1722

Normal user

11 Nov 2012, 14:56

Hi there,

Can anyone share information on using maternal weight gain as an admission/discharge criterion into maternal supplementary feeding programmes? I remember seeing a brilliant table on maternal weight gain for SFP, though can’t recall where I saw this... (?)

Thank you

Steve Kegoli

Nutrition manager

Normal user

14 Nov 2012, 17:18

pregnant
low weight gain of < 1.3 Kg per month and discharge if weight gain is = or greater than 1.3 Kg per month

lactating
Non intentional rapid weight loss of > 07kg per month in normal and low BMI clients and graduate when BMI = or > then 0.5 and weight loss is <0.5Kg per month for 2 consecutive months or BMI =or > 20 and steady weight gain observed for 2 consecutive months..
hope this ban be of help to you

Mija Ververs

Normal user

15 Nov 2012, 08:17

Thanks for this question. What is especially interesting is that you want to use maternal weight gain for admission or discharge.
It also worries me.
I think maternal weight gain for inclusion of a SFP is NOT the way to go. I explain:

If you want to include a pregnant women (PW) into a SFP , you need to realise first : what is your objective of doing this?

You want to prevent her becoming more malnourished?
You want to treat her for malnutrition?
You want to prevent having adverse birth outcomes (e.g. a low birth weight baby)?
Or adverse maternal outcomes?

Depending on what you want to gain from putting a PW in a SFP, your (anthropometric or nutritonal) criteria will pop up.

I have done a lot of research for MSF and in process of publishing this.
I can tell you that, in case you want to prevent low birth weight, pre-term etc there is insufficient and inconclusive data available on using maternal weight gain that demonstrates high risk for LBW etc. and there are NO clear cut-off values (certainly not universal values!). Whatever table you saw or our colleague that responded with 1.3 kg, I am not convinced you should use that.

I can assure you MUAC has proven to be a good indicator in PW that relates to, esp, risk of low birth weight (and there is a lot of peer reviewed journal articles that support this). This means, if your objective is to identify a PW that is malnourished and you want to reduce risk to LBW, use MUAC 22-23 cm (depending on the continent)

She and her fetus might benefit from a SFP.

Maternal weight gain to discharge: you can’t do that. You don’t know how much weight (that she gained during your SFP) was used for what. I explain: if she was very severely malnourished she needs to gain much more weight to build up her reserves, use for fetus AND for her own tissues that she lost during her malnutrition. If she was not too much malnourished before, perhaps she needs less maternal weight gain as she might not need it all.

Personally, I am of the opinion that in the ideal world EVERY PW is entitled to good nutrition, and if not obese, anyone should be included in a SFP regardless … with the condition that there is good emergency obstetric care.

Hopefully I helped you a bit. I am sure you never anticipated this lengthy answer.
Good luck, Mija

Publication on this hopefully soon to come.


Ranjith

Normal user

15 Nov 2012, 09:50

so, what is the recommendation for discharge based on this MSF research?

Anonymous 1722

Normal user

15 Nov 2012, 11:33

Thanks everyone for this useful information. We dont intend to use maternal weight gain for admission/discharge, as we are currently using MUAC. We selected MUAC based on the evidence available, however my own knowledge on the use of maternal weight gain is limited, and that is why I asked the question :)

Even though we are using MUAC, I would like to identify whether the supplementary food is having an impact. Each month we collect data on weight and MUAC, with other health data. I am wondering how we could potentially use the data to identify if the supplemntary food had an impact of weight gain while taking into consideration expected weight gain during pregnancy. We can use MUAC for this, though would like to identify other methods that could potentially contribute towards the findings.

If you have any ideas or suggestions, I warmly welcome all thoughts.

Mija Ververs

Normal user

15 Nov 2012, 12:53

You state: I would like to identify whether the supplementary food is having an impact on maternal weight gain


Here my answer:
A total weight gain of <7 kg for the whole pregnancy looks also a strong indicator for risk on lower birth weights (lower, which is NOT LOW birth weight) or peri-natal mortality for women that had initially normal weight . However, for underweight women this might need to be much higher (probably >10 kg) as they would need to compensate for their malnutrition on top of what is needed for pregnancy.
I have advised NGOs to use perhaps weight gain = 1.5 kg/month in 2nd and 3rd trimester as an indicator of risk on adverse effects, but not enough is known on this

Weight gain is possibly only an indicator of benefit in SFPs, not risks.

I question whether you should be looking at all whether the supplementary food is having an impact on maternal weight gain. I think you should look at much more important indicators such as impact on LBW, Maternal mortality, infant mortality, haemorrhage etc. Maternal weight gain is only an intermediate factor if you know what I mean. It should not be a goal in itself, reducing adverse birth and maternal outcomes are much more meaningful.

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