Targeting Malnutrition: Isotopic Tools for Evaluating Nutrition Worldwide
Contributing to Safe Motherhood

Why is IAEA working in support of safe motherhood?

Nutritional challenges during pregnancy and lactation

Dietary energy requirements increase markedly during pregnancy and lactation. Normally, a pregnant woman or nursing mother either increases food energy intake or reduces physical activity, or both. But when resources are limited and the demands on women's labour are great, unmet energy needs result in low birth weight infants and reduced maternal work capacity and fat stores, which limits the success of breastfeeding.

Providing pregnant women with sufficient dietary energy can prevent these socially costly outcomes. But what is "sufficient" in a developing country setting has yet to be carefully defined. The International Dietary Energy Consultancy Group (IDECG) -a prestigious panel of experts from international organizations and universities -has advised that recommendations for energy intake during pregnancy be based on measurements of actual energy expenditure.

Pregnancy and lactation also increase maternal needs for vitamins, minerals and proteins. Some nutrients which are crucial to the health of a newborn are maintained at the expense of the mother's health. For others, the infant suffers more severe dietary deficiency than the mother.

For malnourished breast-feeding mothers, chronic reductions in dietary intake of some nutrients may lead to below normal concentrations of nutrients in the milk and/or depletion of maternal stores of key nutrients such as calcium, magnesium, zinc, folic acid, vitamin A and possibly proteins. Such reductions can have adverse physical effects and increase the mother's risk of degenerative diseases such as osteoporosis.

In recognition of the importance of adequate maternal nutritional stores to guarantee a healthy pregnancy outcome and safe motherhood, the United Nations Population Fund (UNFPA) recommended (1995) a variety of actions including:

Maternal diets and nutritional status: conventional indicators and isotope techniques

Until the advent of isotopic methods, it was impossible to accurately assess energy needs and nutrient stores in pregnant or lactating women. The 2H218O doubly-labeled water method is the only technique that can accurately determine energy needs of people in their own environments. The method is non-intrusive and non-invasive and employs stable isotopes that pose no risk to the woman or the unborn baby.

IAEA's support of safe motherhood

The IAEA has already helped in two important ways to improve the global information-base on maternal energy requirements. First, a report on the theoretical and practical aspects of the 2H218O method for measuring energy expenditure was published in collaboration with the IDECG. This report has been distributed to researchers in more than 40 countries and has served widely as a central reference for studies utilizing the 2H218O method.

Second, the IAEA has supported several multi-centre analyses of energy expenditure during pregnancy and lactation. Results have been used in a new evaluation of dietary energy requirements which is being conducted by the Food and Agricultural Organization (FAO), the World Health Organization (WHO), the United Nations University (UNU) and IDECG.

Future applications of isotopic techniques which would be appropriate for and beneficial to Member States include measurements of:

The information obtained will improve the basis for protecting nutritionally vulnerable women through appropriate nutrition intervention programmes including supplementation, fortification, dietary diversity and education.

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