|Anthro assessement in pregnamcy|
|Anthro assessement in pregnamcy||Pushpa Acharya||26.10.98|
|Re: anthro assessement in pregnamcy||Andy Seal||26.10.98|
|Re2: anthro assessement in pregnancy||Saskia van der Kam||07.12.98|
|anthro assessement in pregnancy||Penelope Nestel||05.01.99|
|Re: Re2: anthro assessement in pregnancy||Monika Bloessner||06.01.99|
Date: Mon, 26 Oct 1998 09:34:27 +0000
From: "Pushpa Acharya"<acharyapatun.org>
Subject: Ngonut: anthro assessement in pregnamcy
Can anybody provide me information on indicators for assessing PEM on pregnant and lactating women? Appreciate any suggestion.
Pushpa Acharya, World Food Programme, Iraq
Date: Mon, 26 Oct 1998 16:15:54 +0000
From: Andy Seal <A.Sealatich.ucl.ac.uk>
Subject: Re: Ngonut: anthro assessement in pregnamcy
You could try this publication. Hope its useful.
Maternal anthropometry and pregnancy outcomes. A WHO Collaborative Study.
Bull-World-Health-Organ. 1995; 73 Suppl: 1-98
Andrew Seal PhD, Researcher in Public Health Nutrition
Centre for International Child Health Institute of Child Health
30 Guilford Street, London, WC1N 1EH
tel. +44 (0)171 242 9789 ext. 2468, fax +44 (0)171 404 2062
Subject: Re2: anthro assessement in pregnancy
Author: Saskia VD KAM at MSF-Amsterdam
Date: 13-11-98 15:16
Checking my E-mail after a few weeks of absence I found your inquiry and,
surprisingly, there was hardly any reaction on this.
This reflects the feeling of several staff members of Médecins Sans
Frontières on the subject of nutritional supplementation of pregnant and
Often we include pregnant and lactating women in our supplementation
programmes because they belong to the classic vulnerable groups. However,
we did not see much impact of these supplementations in the projects. This
has several reasons: lack of proper admission criteria, lack of monitoring
of the admitted individuals, and lack of criteria to assess the impact of
the supplementation programme. Additionally the objectives of the
supplementation programmes are not clear.
Last year a student of the LSHTM choose this as the subject for her thesis:
Md. Mija Ververs: Nutrition intervention for pregnant and lactating women
in relief situations: the assessment of need and impact. November 1997.
In this document the author gives an excellent overview about the different
indicators which could be used in supplementation programmes for pregnant
and lactating women.
She concludes that Mid Upper Arm Circumference (MUAC) can identify
pregnant women at risk of Low Birth Weight, Intra Uterine Growth
Retardation and foetal or infant mortality. MUAC is simple to use and is
fairly stable over the pregnancy period so it can be used throughout the
entire pregnancy period as a tool for screening and identification of
beneficiaries. However, because of the small or late change in MUAC after
an intervention, the MUAC is not suitable for evaluation of the impact of
the supplementation programme. Weight gain during pregnancy is a good
indicator for measuring impact of the supplementation programme.
Cut-off points for screening are between 21 and 23 cm. A MUAC of 23 cm is
associated with a weight below 45kg, a cut of for risk on IUGR.
Also suggestions are given for cut-off points for screening; unfortunately
Iraq had not been mentioned:
21 cm: India,Nepal, Guatemala
22 cm: China,Indonesia, Myanmar,Sri Lanka
22,5 cm: Bangladesh, Guatemala
23 cm: The Gambia, Thailand, Vietnam, Malawi
23,5 cm: Brazil
Other indicators like Weight-for-gestational age, weight gain and BMI are
valid to identify people at risk, but they don't have particular
advantages above MUAC, more over several variables are not easily
identified in emergencies: pre-pregnancy weight, subsequent weighings, age
of the women. teenage pregnant girls deserve a different approach: the are
besides being prganant still growing themselves. As groth of tissues
related to preganancy has preference above the normal growth of a teenager,
these teanger are at risk for their own develpemnt and later preganancies.
Therefore height which could be used for selection and monitoring and
impact for teenage pregnant girls.
The author also examined the impact of a nutrition interventions.
Various researchers suggest that there is a direct relationship between
maternal dietary intake and birthweight only when maternal stores are low
or depleted. (low pre-pregnancy weight or gestational undernutrition)
The relationships between supplementation and birth weight are twofold: 1.
supplementation shows a significant increase in maternal weight;
additionally maternal weight has a significant relation with birthweight.
2. supplementation shows significant increase in birthweight
In non-famine situations there is no significant direct relationship
between supplementation and birthweight;
Aditinoally in non-famine situations the impact of a supplementation
programme is modest. Threshold values are mentioned of an foodavailability
of 6.3 - 7.3 MJ/d (1500 - 1740 kcal/d). These thresholds are a result of
epidemiological studies; the individual variation is great.
For lactating women there is no good anthropometric indicator developed to
identify women at risk of poor lactational performance, or to select women
who might benefit from a supplementation programme.
Again MUAC has the greatest potential to identify women at risk of a poor
Weight losses during lactation is an indicator for prediction of the
benefit from a supplementation programme (not more then 600-7000
grams/month) BMI, which has no particular advantage above MUAC can be used
: 20.3 post partum, reduced by 0,3 monthly resulting in 18.5 after six
months. It is clear that research is needed to come to conclusive answers.
The milk volume is less subject to change due to nutritional changes of the
mother than the composition of the milk, which is, in itself, important
enough. The infant hardly benefit of a energy supplement; but the mother
does, what might be reflected in an reduced weight loss or increased
physical activity (work) of the mother.
MUAC is the best screening and identification tool for pregnant and
lactating women, weight gain (or loss) is the best indicator to monitor
progress in individuals and the project s a whole.
It seems that supplementation of pregnant women is particularly effective
when given during times of food shortage. (seasonal fluctuations, drought,
war, floods) and when it is timely given, from the first trimester in
order to give time to increae body weight etc as a reaction on the
supplement. Supplementation of the lactating mother benefits the child in
terms of a better composition of hte milk. The supplement benefits the
mother in terms of energy supplement. However, the greatest impact for
lactation performance could be expected from a timely supplement given
during pregnancy: the end of the 1rst trimester and the 2nd trimester are
crucial in terms of growth in the breast and uterus tissue, blood volume
and accumulation of fat.
The author purposes an intervention model:
*If food security is an problem:
Include in an supplementation programme all pregnant and lactating women
regardless anthropometry and stage of pregnancy.
*If food security is not a problem:
Include for pregnancy:
MUAC 21-23 cm and/or weight gain < 1,5 kg/month in 2&3 trimester
Include for lactation:
MUAC 21-23 cm and/or BMI 20.3 at birth with decrease of 0,3/month to 18.5
at six months and mother with malnourished infants who are breastfed.
*If food security is a moderate problem:
Pregnancy: all anthropometric indicators of the non problematic food
security plus all pregnant teenagers
Lactation: all anthropometric indicators of the non problematic food
security plus individual cases like mothers of twins, teenage mothers,
mothers of LBW babies, lactating mothers with malnourished children under
Saskia van der Kam, Médecins Sans Frontières Holland
(also on behalf of Md Msc Mija Tesse Ververs)
Date: Tue, 05 Jan 1999 18:03:27 +0000
From: Penelope Nestel <pnestelaterols.com>
Subject: Re: Re2: anthro assessement in pregnancy
To add to Saskia's comments you may find the following refs helpful:
Gueri M, Jutsum P, Sorhaindo B. Anthropometric assessment of nutrition
status in pregnnat women: a reference table of weight-for-height by week
of pregnancy. AJCN. 1982:35;609-11.
Krasovec K, Anderson MA. Metranla nutrition and pregnancy outcomes:
abthropometric assessment. PAHO Scientific Publication No 529. 1991.
I have seen a preprint draft of a WHO monograph called Maternal
anthropometry and pregnancy outcomes: A WHO collaborative project meta
analysis by A. Kelly et al, but do not know if the final has been
Date: Wed, 6 Jan 1999 14:00:01 +0100
From: David Morley <Davidatmorleydc.demon.co.uk>
Dear Penelope Nestel, In response to your e-mail query over PEM in pregnant
and lactating. TALC has an accurate 'insertion tape' printed on non stretch
plasticised paper. On the back of this we have printed under 24cm
significant and real concern under 20cm. Delighted to send you a sample if
you will let me have an address. DAvid Morley.
From: Monika Bloessner bloessnermatwho.ch
Date: Wed, 6 Jan 1999 08:46:05 +0100
Subject: Re: Re2: anthro assessement in pregnancy
The supplement to Volume 71, 1995, of the Bulletin of the World Health Organization Maternal anthropometry and pregnancy outcomes: A WHO collaborative study. is available from the WHO Distribution and Sales office (E-mail address: publicationsatwho.ch).
Furthermore there is a summary paper A WHO Collaborative Study of Maternal Anthropometry and Pregnancy Outcomes. Int J Gynaecol Obstet. 1996 Jun;53(3):219-33.
I hope this information will be useful.
Nutrition for Health and Development