For several years, Iron and Folic Acid (IFA) were the primary nutritional supplements given to pregnant women. This approach was highly effective, significantly reducing serious birth defects and common iron deficiencies in mothers. Doctors widely supported its use, recognising its importance in saving lives and improving pregnancy outcomes.
However, as the understanding of maternal health advanced, it became clear that relying solely on IFA is no longer sufficient for a truly healthy pregnancy. The modern view of prenatal care demands a more comprehensive nutritional strategy.
The broader nutritional imperative
A pregnant body requires a comprehensive array of nutrients, not just a select few. While iron is crucial for preventing anaemia and supporting increased blood volume, and folic acid is vital for the baby’s early brain and spinal development, many other vitamins and minerals are also essential. These include Vitamin D, Vitamin B12, Zinc, Iodine, and critically, Calcium. Each of these plays a vital role in proper foetal formation and maintaining maternal health.
The need for broader nutritional support is evident given the widespread prevalence of nutrient deficiencies among women, even before pregnancy. For instance, almost 6 out of 10 teenage girls in India have low iron (anaemia) (NFHS-5), and 3 out of 4 Indian women do not consume enough dietary iron. Beyond iron, other nutrient shortages are also common. A recent study found that almost half of women had low Vitamin B12 levels. Vitamin D deficiency is another significant concern: a 2023 study showed that 76 per cent of the Indian population had low Vitamin D, with 75 per cent being women.
The role of calcium and vitamin D
Calcium is profoundly important for helping the baby’s bones grow properly. The developing foetus places substantial demands on maternal calcium reserves for its rapidly forming skeletal structure. If dietary intake is insufficient, the mother’s own bone density can be compromised, increasing her risk of osteoporosis later in life. This “calcium drain” during pregnancy and lactation underscores the critical need for consistent and adequate intake.
Crucially, for calcium to be effectively utilised by the body, you also need sufficient Vitamin D. Vitamin D facilitates calcium absorption in the gut and plays a key role in bone mineralisation. Inadequate maternal levels of both calcium and Vitamin D during pregnancy can lead to serious health issues for the mother, such as gestational diabetes and preeclampsia, and for the baby, including poor growth and low birth weight.
Even the distribution of basic IFA and Calcium supplements faces challenges. A study from 2018-2021 in Northeast India revealed that only about 8 out of 10 pregnant women (79.36 per cent) received a full course of IFA, slightly below the national average (88.13 per cent). For calcium, the coverage was even lower: only about 6 out of 10 women (61.26 per cent) in the Northeast received full courses, compared to the national average of about 7 out of 10 (69.86 per cent). This demonstrates that even established supplements do not consistently reach all pregnant women, let alone the broader spectrum of nutrients required.
When these other essential nutrients are not present, the effects can be subtle initially but become very significant. They can impact foetal growth, influence the child’s long-term health, and contribute to maternal complications during pregnancy. While IFA has been effective for common deficiencies, it does not cover all the nutritional needs for optimal maternal and foetal health.
Towards a comprehensive approach
Therefore, healthcare providers must adopt a more comprehensive approach to prenatal nutrition. This involves:
- Complete nutritional assessment: Moving beyond just checking for low iron to also identify other common nutrient deficiencies, particularly Vitamin D and Calcium.
- Enhanced dietary guidance: Providing guidance on consuming a diverse range of healthy foods, including fruits, vegetables, whole grains, and lean proteins, with an emphasis on calcium-rich sources.
- Integrating supplementation in diet: Recommending prenatal supplements that offer a wider array of essential nutrients, tailored to individual needs, ensuring adequate Vitamin D and Calcium.
- Patient awareness: Helping expectant parents understand the critical role of each nutrient in pregnancy and foetal development.
As scientific knowledge advances, medical practices must also evolve. While IFA remains a vital component of prenatal care, it serves as a foundational step, not the complete solution. By providing more comprehensive nutrition, healthcare providers can help ensure every pregnancy begins strong, building a healthier future for mothers and children for generations to come.
Reference Links:
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9339897/
- https://www.mohfw.gov.in/?q=en/pressrelease/indias-fight-against-anemia#:~:text=Nourish per cent2C per cent20Prevent per cent2C per cent20Protect,-Posted per cent20On: per cent2018&text=by per cent20PIB per cent20Delhi-,Key per cent20Takeaways:,Abhiyaan per cent20and per cent20School per cent20Health per cent20Program.