Maternal and Child Nutrition Observatory - Dec 7, 2020 - 4 Min read
Prenatal care and nutritional status
Updated: Jan 26
In Mexico, prenatal care is considered to be a set of actions through a series of visits by the pregnant woman to the health institution and the respective medical consultation; its objective is to monitor the evolution of the pregnancy, detect risks early (e.g. gestational diabetes, malnutrition, vitamin and micronutrient deficiency, etc.), prevent complications and prepare the patient for childbirth, motherhood and parenting; involving the family. This care should include nutritional assessment and care (1).
The low-risk pregnant woman should receive at least five prenatal consultations, as established in the Mexican Official Standard NOM-007-SSA2-2016 should be: The first consultation between 6 - 8 weeks; the second between 10 - 13 weeks; the third between 16 - 18 weeks; the fourth at 22 weeks; the fifth at 28 weeks; the sixth at 32 weeks; the seventh at 36 weeks and the eighth between 38 and 41 weeks of gestation. Throughout this care, valuable information related to nutrition and feeding will be provided: about risk factors, healthy lifestyles, nutritional aspects that reduce risks, and exclusive breastfeeding (2).
Among the actions exercised by health professionals, related to food and nutrition, during these consultations to all women, are (2):
- Measurement, recording and interpretation of weight and height.
- Screening for gestational diabetes between the 24th and 28th week of pregnancy (women at higher risk can be screened earlier).
- Promotion of exclusive breastfeeding.
- And the promotion of the importance of nutritional surveillance of growth and development in the different stages of their newborn's childhood.
| BMI range (kg/m²) | Interpretation |
|---|---|
| Less than 18.5 | Low weight |
| 18.5 a 24.9 | Normal |
| 25 a 29.9 | Overweight |
| 30 a 34.9 | Mild obesity |
| 35 a 39.9 | Moderate obesity |
| More than 40 | Morbid obesity |
According to the Official Mexican Standard for the care of women during pregnancy, childbirth and puerperium, and of newborns (2):
- The BMI is not validated in adolescent pubescent girls or in women with height less than 1.50 m (150 cm) and should not be used in these cases.
- Un IMC bajo (<18.5) sugiere desnutrición, un IMC alto (25 a <30) indica sobrepeso y un IMC muy alto (30 o más) permite diagnosticar obesidad. Estos valores son indicativos y ameritan estudios más detallados.
Importance of weight gain assessment
Being overweight or underweight can have negative consequences.
The importance of assessing weight gain during pregnancy is that gestational weight gain is one of the few modifiable risk factors for adverse perinatal outcomes, and its abnormalities have the potential to influence short- and long-term maternal and offspring health (3).
| The Desired Weight Gain, Throughout Pregnancy, is: | |
|---|---|
| Women with normal BMI | 11.35 to 15.89 Kg |
| Women with low BMI | 12.5 to 18.0 Kg |
| Women with very high BMI | 4.00 to 9.0 Kg |
| Women with high BMI | 6.81 to 11.35 Kg |
According to NOM-007-SSA2-2016, it should be considered that (2):
- In adolescents, the upper limit of desirable gain is recommended.
- En mujeres pequeñas (<1.50 m) se recomienda el límite inferior de la ganancia deseable.
Consequences of inadequate weight gain:
- On the one hand, it has been observed that babies born to women with inadequate weight gain have: increased probability of infant death up to one year after birth; increased risk of not initiating breastfeeding and increased risk of preterm delivery (3).
- On the other hand, it has been proven that excessive gestational weight gain is associated with complications for mothers and their babies in both the short and long term.
- Maternal complications include hypertensive disorders of pregnancy and increased rates of cesarean delivery. In addition, women who begin pregnancy with a higher BMI have a higher risk of excessive weight gain, as well as postpartum weight retention (4), with attendant consequences.
- Complications in their offspring include: short term causes fetal macrosomia (4), large for gestational age infants, low Apgar scores at five minutes, seizures, hypoglycemia, polycythemia and meconium aspiration syndrome. In the long term it causes an increased risk of childhood overweight or obesity (3, 4). In addition, it is now suggested that nutrition in utero may predispose to chronic diseases such as diabetes, hypertension and other metabolic diseases in later life (3).
References:
- Secretary of Health. Prenatal control with patient-centered care. Guía de evidencias y Recomendaciones: Guía de Práctica Clínica. Mexico: CENETEC; 2017. pp. 7, 8.
- Norma Oficial Mexicana NOM-007-SSA2-2016 [online]. For the care of women during pregnancy, childbirth and puerperium, and of the newborn. Diario Oficial de la Federación. 08 Mar 2016 [accessed: 09 Sep 2020]. Available at: https://www.dof.gob.mx/
- Kominiarek MA, Peaceman AM. Gestational weight gain. Am J Obstet Gynecol. 2017;217(6):642-651. doi:10.1016/j.ajog.2017.05.040
- McDowell M, Cain MA, Brumley J. Excessive Gestational Weight Gain. J Midwifery Womens Health. 2019;64(1):46-54. doi: 10.1111/jmwh.12927.
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