Nutrition in Pandemic: Expecting a new life is indeed one of the warmest and delightful news to any of us. But the initiation of this decade with pandemic has left us in shock and conceiving has become a little more risky phase for any woman in the world. Though, in a world that is already dealing with pollution and pathogens, we humans have somehow ‘immunity’. But the new lives who step into the world from the sterile environment of the mother’s womb are in greater danger if not proper care and precautions are taken. This complex situation has made us more helpless and vulnerable, especially for those rural people who are already at a high risk of maternal deaths, miscarriage, child death, etc.
In this situation, the only measures we can take for the mother and the newborn or children is to provide protection in all terms and make them accustomed to a healthy diet. In this article, we will be focusing on infant health, breastfeeding, child health, and maternal health.
From the early years of life, proper nutrition and guard is necessary to combat pathogens and toxins, thus breastfeeding is the very first and crucial step towards your newborn family member. Colostrum, the first yellowish milk secreted, should be fed within the first one hour of birth. It is a dense thick liquid of essential vitamins, immunoglobulins, proteins, and carbs.
But many mothers might step back and won’t feed their baby in the fear of contamination. But there’s no supporting evidence of infection in infants through milk.
WHO says in their article “ Breastfeeding & COVID19” that “ Based on available evidence, WHO recommendation on the initiation and continued breastfeeding of infants and young children also apply to mothers suspected/confirmed COVID19”
In case the mother is suspected/found covid positive, some preventive measures can be taken like:
- The mother should express the breast milk even staying in separation and continue the supply of milk
- The caregiver should be healthy and feed the infant with the milk in a hygienic way.
- A breast pump can be provided and after usage, it should be disinfected properly.
- In case, the mother feels to feed in skin-to-skin contact, she should wear a mask and sanitize properly.
And exclusive breastfeeding should be continued for 6 months and no other prelacteal feeds should be given.
To meet the excess nutritional needs for sustainable growth and development, weaning must be introduced after 6 months along with breastfeeding. A feeding strategy by UNICEF can be introduced like the following:
|AGE OF INFANT||TIMES TO FEED A DAY||TYPE OF FOOD|
|6 to 8 months||2 to 3 times||Liquid consistency food where vegetables, cereals, pulses, meat, and fish are made a paste.Eg: mashed roti/rice/biscuit with sweetened undiluted milk, with thick dal, khichri cooked in ghee with some vegetables like carrots, beans, etc.|
|9 to 11 months||3 to 4 times||Puree consistent food where 4 food groups are provided properly.eg: any cereal porridge with milk, mashed boiled potatoes/seasonal fruits.|
|12 to 24 months||3 to 4 times||Ready to have family meals and solid foods can be introduced in this stage. Eg: rice, dal, yogurt, vegetables, fruits, bread, etc.|
- Faulty marketing of unhealthy processed food and lack of nutritious food is making the children vulnerable to chronic health problems like obesity, overweight, etc. which channelizes a way for pathogens to invade our body more easily.
- Nutrients like vitamin C, D, selenium, iron, calcium should be included in the proper amount to meet the daily requirements.
- Awareness among parents, avoiding sugar and salt-rich foods, avoiding junk and packaged foods, provision of fresh and safe foods will help them towards their growth and defense.
While a section of people is overeating, another unprivileged section is thriving without food and becoming the prey of malnutrition. Early detection of malnutrition or any form of deficiencies can solve the problem and reduce the risk of covid19. If the deficiency is detected on a large scale, nutrition programs like poshan Abhiyan in India, anemia control program, etc. can be implemented by national and international agencies.
Pregnancy is one of the most beautiful phenomena and it requires a lot of care, precautions, and healthy habits to develop a full-fledged life within oneself and giving birth with a lot of life risks and the extreme labor pain of motherhood. And when the situation is a pandemic, the mother and her caregivers should become more aware in terms of balanced nutrition supply, supporting mentally and physically.
In this challenging situation, maternal care should comprise proper nutritional care and counseling, antenatal care, intrapartum care, and family care and support.
COVID-19 and Pregnancy:
There are occasional cases for covid19 pneumonia in pregnancy and the recovery was milder and rapid. Though studies show that, women are more prone to the infection in their last trimester. Also, there are reports of preterm births in covid positive patients but needs more supportive context for it. Covid not only increases the health-related issues but the incidence of anxiety, depression, domestic violence, etc. also surges up day by day.
Transmission and effect on Fetus:
The Probability of vertical transmission(from mother to fetus) is suggested in recent researches, though the ratio of affected conceives and the importance of neonate is still to be examined. Fortunately, no cases have been recorded of transmission of covid through vaginal secretion and breastmilk or cases of miscarriage, or an indication of medical termination of pregnancy.
A flowchart adapted by Lancet summarises covid management in pregnant women can be seen in the “Guidance for the management of pregnant women in COVID19 pandemic” by ICMR
Nutrition in Pregnancy:
- Healthy dietary practices with the required amount of energy, protein, fat, and micronutrients can meet the excess need during pregnancy. Deficiency not only risks pregnancy and labor but also makes us more vulnerable to pathogens.
- Provision of all the food groups with variety should be added to the diet.
Below is the reference of the recommended dietary intake of some nutrients by ICMR.
Supplementation Guidelines by WHO:
|IRON AND FOLIC ACID SUPPLEMENTS||30mg to 60mg of elementary iron oral dose and 0.4mg folic acid recommended to deal with gestational anemia, LBW, etc.||Required for blood production Deficiency causes anemia and complicated delivery|
|CALCIUM SUPPLEMENTS||Low deficiency population in calcium should take 1.5 to 2.0g oral elemental calcium||To meet the high demands during lactationFetal Skeletal mineralizationTo ensure mineral reservoir as the fetus utilises mothers bone density in calcium deficiency.|
|VITAMIN A SUPPLEMENTS||Recommended to pregnant women in vitamin A deficient population.||To prevent night-blindness associated with malnutrition|
|ZINC SUPPLEMENTS||Supplementation for pregnant women only in the context of rigorous research||Deficiency causes fetal mortality, reduced uterine growth rate, fetal malformations.|
|MULTIPLE MICRONUTRIENT SUPPLEMENTS||Recommended to improve maternal and perinatal outcomes||Necessary for maintaining the optimal status of the body.|
|VITAMIN B6 SUPPLEMENTS||Not recommended to improve maternal and perinatal outcomes.||It is said to reduce nausea|
|VITAMIN E & C SUPPLEMENTS||Not recommended to improve maternal and perinatal outcomes.||Acts as antioxidantsVitamin E has a great role in infertility and childbirthVit C deficiency might result in premature rupture of fetal membranes and neonatal deaths.|
|VITAMIN D SUPPLEMENTS||Not recommended to improve maternal and perinatal outcomes.||The crucial vitamin is related to calcium absorption.It is important for immune and nervous system functions.|
|RESTRICTING CAFFEINE INTAKE||Lowering daily caffeine intake to reduce the risk of pregnancy and LBW|
|DIETARY INTERVENTIONS||Counseling about healthy eating and physical eating to prevent weight gainNutrition education on daily energy and protein intakeA Balanced diet and protein dietary supplementation to reduce the risk of stillbirths etc.High protein intake is not recommended in the undernourished population.||To aware people about the outcomes of deficiencies in motherhoodTo clear myths related to foodEnsuring food safetyAwareness regarding pregnancy vaccination doses and diagnosis.|
- Hydration is another important part of maintaining homeostasis during pregnancy. The amniotic fluid which helps the fetus keep floating is made up of the body’s stored water. Also, water keeps the gut metabolism smooth and prevents any form of urinary infections in this period.
- It is generally recommended to drink 6-7 glasses of water in addition to other fluid intakes like milk, stews, soups, etc.
- similarly, in lactating mothers, plenty of water is mandatory for adequate milk production. 2-3 litres of water and additional beverages like milk, buttermilk are suggested to meet the needs.
- Also, in addition to combat COVID, hydration is a key point. Lack of water in the body thickens respiratory secretions which becomes hard to clear and forms blockage or may also lead to pneumonia. Even if someone is not able to take a large amount of water, small sips after every 15mins. Can be recommended.
Exercises and rests in Pregnancy
According to the United States Department of Health and Human Services, physical activity guidelines, a healthy expecting mother or a nursing mother can do at least 150mins/week of moderate activity like brisk walking. But exercise in contradiction in high-risk pregnancy.
Sleep is the recovery time for our body as it repairs damaged cells and rejuvenates the body. 8hrs of sleep and 2hrs of rest per day is suggested. Heavy strenous activity should be avoided. Lying on the left side might enhance the blood supply to the fetus.
Other points to remember
- Vaccination during pregnancy.
- Proper dosage of supplements to avoid any further complications.
- Family support and care.
- To take all covid preventing measures while visiting clinics.
- Seek medical help in times of need.
- Small or frequent meals should be encouraged than missing out on meals.
It is a hard time for all of us, and it becomes more challenging for the next generation to cope up with. But we believe our champs are brave and are born to fight. What else we need is to take care of them, provide adequate nutrients to them from their days in the embryo and build them into a strong healthy individuals for the next years.