Nutritional Guide for Pregnant and Lactating Women by the Bill & Melinda Gates Foundation

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A report of an Expert Consultation held at the Bill & Melinda Gates Foundation: Framework and Specifications for the Nutritional Composition of a Food Supplement for Pregnant and Lactating Women (PLW) in Undernourished and Low-Income Settings

Maternal undernutrition continues to threaten maternal and child health – particularly in low income and food insecure environments. Despite recent progress, over 30 million babies are still born too small— putting them at an increased risk of infant mortality, childhood stunting and poor cognitive function later in life. Approximately six million of these births are associated with maternal short stature in pregnancy. Low maternal BMI and poor weight gain during pregnancy are other factors that lead to fetal growth restriction. While the importance of the first 1,000 days is widely known, there has been little attention given to a woman’s nutritional status during and following pregnancy. To address this, the Bill & Melinda Gates Foundation convened a group of experts to explore how to best meet the nutritional requirements of vulnerable women during pregnancy and lactation.

The consultation set out to capture considerations and consensus for ready-to-use food supplements for pregnant and lactating women who are undernourished and/or at risk of undernutrition in low and middle-income countries. In their report, the expert group assess the daily minimum and maximum macro- and micronutrient consumption amounts for this target demographic—drawing upon recommendations from the US Institute of Medicine, the Food and Agriculture Organization and the World Health Organization (WHO). The group considered the types of foods that can best deliver these nutrients, and consideration of different formats including spreads, biscuits, bars, extruded snacks and instant drink powders. Lastly, they assessed the roles that the public and private sectors could play to create access to and demand for nutritional food supplements during and after pregnancy. The group concluded that both sectors will have an important role to play in moving these products from concept to market, and ultimately getting them to the women who need them most.

Dr. Klaus Kraemer, Sight and Life’s Managing Director, was part of the expert panel to advance these pressing topics surrounding women’s nutrition. He emphasizes, “This important and timely document provides a blueprint to develop nutritious foods for women of reproductive age in countries with the highest nutritional needs.”

The new » WHO antenatal care guidelines—released shortly after the consultation—filled a gap in guidance for supplementation during pregnancy. The new guidelines include a context-specific recommendation for balanced-energy protein supplementation for pregnant women in undernourished populations. This offers an exciting opportunity to develop an affordable, nutritious food supplement for pregnant women that could also be considered for use by postpartum women to support lactation.

Now we must put the consultation’s recommendations into action. The group has outlined a series of next steps, including the development and testing of prototypes in different geographies and contexts. The potential for delivering a nutritious food supplement to undernourished populations is significant, and can help drive progress towards achieving the World Health Assembly’s global nutrition targets on anemia and low birth weight.