Preconception nutrition refers to the nutrition status of an individual before pregnancy. It is recommended that at least six months prior to conception, men and women should focus on achieving optimum nutrition, increasing fitness and living a healthy lifestyle. This would ensure that the female body is ready for a successful pregnancy and that the male produces adequate and quality sperms. It also helps to improve fertility, hence increasing the chances of conception. Optimal nutrition before conception ensures that the unborn baby has a healthy environment to grow in and decreases the risk of deficiencies that may contribute to birth defects. A woman who is healthy at the time of conception is more likely to have a successful pregnancy. Good nutrition also has the potential to have long-term health impacts on both the mother and the yet-to-be-conceived child.
The level of uptake of preconception nutrition and care services is still low globally despite the growing body of evidence on the role it plays in birth outcomes. Uptake is even lower in developing countries where preconception risk factors for adverse outcomes are higher compared to developed nations. This has been associated with factors such as poverty, low knowledge, and inadequate access to preconception care services. Poor preconception nutrition has been proven to be one of the major contributing factors to adverse birth outcomes; a big concern in Kenya. The national prevalence for preterm births is 12%, low birth weight is 8% and stillbirth is 2.3%. Further, the child mortality rate is 52 per 1000 live births, the neonatal mortality rate is 20.9 per 1000 live births and the infant mortality rate is 39 per 1000 live birth.
Kenya has made significant efforts in improving maternal and child health. However, most of these efforts are focused on nutrition during pregnancy and lactation. The Ministry of Health through the National Guidelines for Maternal and Child Nutrition identifies the need for pre-conception nutrition, but it lacks comprehensive information on how this is to be accomplished. There is, therefore, need to update the guidelines to include a comprehensive guide on preconception nutrition that would ensure that women are aware of how nutrition and other factors influence their reproductive health and pregnancy outcomes.
Body Mass Index (BMI)
Kenya is undergoing a triple burden of malnutrition comprising overweight, underweight, and micronutrient deficiencies. These forms of malnutrition especially among women of reproductive age are associated with adverse pregnancy outcomes, and the consequences can spread across generations. Globally, 1.9 billion adults were overweight in 2016 while 650 million were obese. In Kenya, the prevalence of overweight and obesity among women and men is estimated to be 38.6% and 17.5%, respectively. Pre-pregnancy overweight is associated with risk of gestational diabetes, pre-eclampsia, prolonged labour, macrosomia, miscarriages and still births. Obesity in men and women has been associated with increased chances of infertility. Underweight is associated with increased risk for preterm births, giving birth to low-birth-weight babies and intrauterine growth retardation (IUD). Under-nutrition reduces the chances of a woman to survive childbirth and give birth to a healthy baby, translating to increased maternal and infant morbidity and mortality.
Kenya has made considerable progress towards preventing micronutrient deficiencies. However, these deficiencies are still a concern in Kenya, especially among women and children. About 28% of non-pregnant women in Kenya experience iron deficiency anemia while the prevalence of other types of nutritional anemia, such as folate and vitamin B12 deficiency is 31.5% and 47.7%, respectively, among non-pregnant adolescent girls aged 15-19 years. A woman will benefit from boosting her iron stores before becoming pregnant as this helps to prepare her body for the needs of the fetus. Low levels of haemoglobin and ferritin during the pre-conception period increase the risk of poor embryonic growth and giving birth to low-birth-weight babies. Adequate folic acid before conception has been proved to reduce the risk of Neural Tube Defects (NTD), such as Spina Bifida.
Smoking and alcohol consumption
Smoking and alcohol consumption are habits that are addictive and may become difficult to cease even when one gets pregnant. These habits before and during pregnancy have been associated with adverse pregnancy outcomes. Studies on factors influencing pregnancy outcomes show that the impact of maternal smoking include low birth weight, intrauterine growth restriction and pregnancy loss. Some studies associate preconception paternal smoking with neural tube defects, congenital heart diseases and limb abnormalities in the offspring. Smoking has also been associated with reduced fertility in both men and women.
Maternal alcohol consumption has been associated with a range of spectrum disorders that result in learning, behavioural and physical difficulties. There is also an association between maternal and paternal alcohol consumption with reduced fertility. The increase in infertility in women is due to ovulatory disorders while in men, alcohol affects fertility by altering sperm count, size, shape, and motility.
We recommend the following actions to support women and men in optimizing their nutrition status before conception:
Enhance assessment of nutrition status during preconception period: This should not be limited to anthropometric assessment of Body Mass Index (BMI) but should also include other assessment methods such as clinical assessments, biochemical measurements, dietary and body composition assessment. Contact points for assessment would include family planning visits, community outreaches for maternal health care, and immunization/young child clinic visits. This would help identify high risk groups, identify existing nutrition problems, and form a basis for evidence-based nutrition policies.
Promote access to micronutrient deficiencies prevention and control services: National nutrition programmes for preventing and control of micronutrient deficiencies in Kenya include iron and folic acid supplementation for pregnant women, salt iodization, mega dosing of vitamin A for children under five years, food fortification and disease prevention measures such as water, sanitation, and hygiene (WASH). While these are great strides in the fight against micronutrient deficiencies, the programmes are faced with challenges, including lack of coordination and monitoring, shortage of manpower, inadequate and irregular supplies and lack of education. There is therefore need to develop strategies that enhance implementation of these programmes to improve their effectiveness. This can be achieved by improving monitoring and evaluation and ensuring that the vulnerable populations have adequate access to the resources. It is especially crucial to ensure that all women of childbearing age have an adequate intake of folic acid and iron through diets and/or supplementation. The government could consider expanding the folic acid and iron supplementation programme to all women of reproductive age, since most pregnancies in Kenya are unplanned.
Promote awareness on preconception nutrition and its effects: Nutrition education and counselling contributes to improvement in nutrition knowledge, attitudes and practices that are necessary for developing a healthy lifestyle. Nutrition education should be conducted for individuals, communities, schools, in outreaches and at health facilities. The counselling should focus on the importance of adequate nutrition before pregnancy, the importance of iron and folic acid supplementation, maintaining normal nutrition status, healthy diets, and other risk factors for adverse pregnancy outcomes such as cigarette smoking and alcohol consumption.
Authors: Grace Waweru, Young Professional, Social Sector Department
Kevin Wafula, Young Professional, Trade and Foreign Policy Department