|Maternal Diet, Breast-Feeding Capacity, and Lactational Infertility (UNU/WHO, 1983, 107 pages)|
|8. Criteria for the assessment at the community level of the effectiveness of public-health measures relating to maternal and child nutrition|
8.9. To safeguard the nutritional health of women during their reproductive age, it is important to consider pre-pregnant status as well as that during pregnancy and lactation. The most meaningful measurements are weight-for-height and thigh circumference. The various skinfold measurements, such as triceps, biceps, subscapular, and pert-umbilical, may also be of value, although whether these provide clinically relevant information, not given by weight-for-height alone, is open to question and needs to be clarified. In countries where kwashiorkor is the major form of protein-energy malnutrition, the measurement of plasma albumin is important, as is blood haemoglobin where there is anaemia.
During pregnancy the most relevant anthropometric measurement is the amount of weight gained during its course. For the United Kingdom the recommended amount is 12.5 kg (12), and it would be considered undesirable if the mean increment for a population fell below 10 kg. This is a level of performance rarely achieved by poor women in the developing world. Research is desperatly needed in which anthropometric change is quantitatively related, both to the health and well-being of the mother, as well as to the success of the pregnancy and the subsequent growth and development of the baby. This work is necessary for the definition of health targets relevant to health planning in the Third World.
The biochemical measurements listed in the previous paragraph can be of even greater importance during pregnancy. For example, protein deficiency may compound the fall in albumin concentration that normally accompanies pregnancy because of haemodilution. Plasma amino-acid patterns can also be informative, but this is a subject for research; such measurements could not be recommended for public health programmes at the present time.
Babies' birth-weight, height, and head circumference relative to gestational age at birth are crucial parameters. Birth-weights in poor economic circumstances in the developing world are much lower than in Europe and North America, but this cannot be solely attributable to dietary deficiency since infections like malaria can profoundly affect birth-weigh/(13). The proportion of children born with a weight below 2.5 kg is a particularly relevant statistic because neonatal and infant mortality rise sharply below this point. In research programmes, placental weight is also an important measurement.
Assessment of maternal nutritional status during lactation is more difficult. Weight is normally lost during lactation at a rate of 570 g/month (14), but, as described in section 3.2, considerable metabolic adaptations occur and excessive weight loss is not observed unless food intake is exceptionally low. An important measurement is the baby's milk intake, although there is a wide normal range, and at an individual level only values below 500 ml/24 hr between one and five months of age can definitely be considered inadequate: however, a population mean volume of 650 ml would be considered low. As with bodyweight, it is apparent that considerable metabolic adaptation protects milk supply against the worst effects of dietary deficiency. For lactating women it is likely that assessments of overall health and well-being plus her capacity for an active life are likely to be the most revealing.