Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 14 , ISSUE 6 ( November-December, 2022 ) > List of Articles


Implementing International Federation of Gynecology and Obstetrics Nutrition Checklist for Pregnant Women: Opportunities and Challenges in Low- and Middle-income Countries

Hema Divakar, Richa Mishra, Gubbi Venkatasubbaiah Divakar, Sheetal Joshi, Bhagyashri Kulkarni, Poorni Narayanan, Rita Singh

Keywords : International Federation of Gynecology and Obstetrics nutrition checklist, Nutrition status, Pregnant women, Triple burden of malnutrition

Citation Information : Divakar H, Mishra R, Divakar GV, Joshi S, Kulkarni B, Narayanan P, Singh R. Implementing International Federation of Gynecology and Obstetrics Nutrition Checklist for Pregnant Women: Opportunities and Challenges in Low- and Middle-income Countries. J South Asian Feder Obs Gynae 2022; 14 (6):704-709.

DOI: 10.5005/jp-journals-10006-2151

License: CC BY-NC 4.0

Published Online: 31-01-2023

Copyright Statement:  Copyright © 2022; The Author(s).


Background: The triple burden of malnutrition (TBM) presents a significant threat to the health of mothers and their future generations, particularly in low- and middle-income countries. Though having adequate macro- and micronutrients and maintaining a healthy weight are essential for all, pregnant women require special attention. However, their nutrition status and dietary requirements are not focused upon during their clinical visits. Methods: International Federation of Gynecology and Obstetrics (FIGO) nutrition checklist was administered to 714 women for the first time in selected private healthcare facilities in 3 states of India. A descriptive analysis of data was done to assess their nutrition status and dietary pattern. Logistic regression was done to evaluate any significant association of their dietary and supplementary intake with the hemoglobin (Hb) levels. The feedback on FIGO checklist administration from 50 healthcare providers (HCPs) was also collected using a survey questionnaire. Result: The analysis of FIGO checklist data has shown that a significant proportion (48%) of women are overweight or obese and 33% are with low Hb. The increased Hb levels were significantly associated with supplement intake. However, the associations observed between any other dietary intake and Hb levels were insignificant. Healthcare providers considered the checklist as an important tool to encourage nutrition-related dialogues with women and recommended its use during clinical visits. Conclusion: The FIGO checklist holds promising potential as a nutrition intervention to curb the increasing burden of malnutrition by keeping health, nutrition status, and weight management in check. However, the challenges associated with its administration should be addressed to have a greater impact.

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  1. Gopalan C. The changing nutrition scenario. Indian J Med Res 2013;138(3):392–397. PMID: 24135189.
  2. Kumar P, Chauhan S, Patel R, et al. Prevalence and factors associated with triple burden of malnutrition among mother–child pairs in India: A study based on National Family Health Survey 2015–16. BMC Public Health 2021;21(1):391. DOI: 10.1186/s12889-021-10411-w.
  3. Bharati S, Pal M, Sen S, et al. Malnutrition and anaemia among adult women in India. J Biosoc Sci 2019;51(5):658–668. DOI: 10.1017/S002193201800041X.
  4. Mathur P, Pillai R. Overnutrition: Current scenario and combat strategies. Indian J Med Res 2019;149(6):695–705. DOI: 10.4103/ijmr.IJMR_1703_18.
  5. Popkin BM. Global changes in diet and activity patterns as drivers of the nutrition transition. Nestle Nutr Workshop Ser Pediatr Program 2009;63:1–10. DOI: 10.1159/000209967.
  6. Kumar M, Mohanty P. Does maternal overnutrition carry child undernutrition in India? PLoS One 2022;17(6):e0265788. DOI: 10.1371/journal.pone.0265788.
  7. Bassett MN, Romaguera D, Giménez MA, et al. Prevalence and determinants of the dual burden of malnutrition at the household level in Puna and Quebrada of Humahuaca, Jujuy, Argentina. Nutr Hosp 2014;29(2):322–330. DOI: 10.3305/nh.2014.29.2.7075.
  8. Goldberg GR. Nutrition in pregnancy: The facts and fallacies. Nurs Stand 2003;17(19):39–42. DOI: 10.7748/ns.17.19.39.s57.
  9. Hanson MA, Bardsley A, De-Regil LM, et al. The International Federation of Gynecology and Obstetrics (FIGO) recommendations on adolescent, preconception, and maternal nutrition: “Think Nutrition First”. Int J Gynaecol Obstet 2015;131(Suppl. 4):S213-53. DOI: 10.1016/S0020-7292(15)30034-5.
  10. Narayan J, John D, Ramadas N. Malnutrition in India: Status and government initiatives. J Public Health Policy 2019;40(1):126–141. DOI: 10.1057/s41271-018-0149-5.
  11. von Haaren P, Klonner S. Lessons learned? Intended and unintended effects of India's second-generation maternal cash transfer scheme. Health Econ 2021;30(10):2468–2486. DOI: 10.1002/hec.4390.
  12. Rai RK, Singh PK. Janani Suraksha Yojana: The conditional cash transfer scheme to reduce maternal mortality in India – a need for reassessment. WHO South East Asia J Public Health 2012;1(4):362–368. DOI: 10.4103/2224-3151.207038.
  13. Caut C, Leach M, Steel A. Dietary guideline adherence during preconception and pregnancy: A systematic review. Matern Child Nutr 2020;16(2):e12916. DOI: 10.1111/mcn.12916.
  14. Grenier LN, Atkinson SA, Mottola MF, et al. Be healthy in pregnancy: Exploring factors that impact pregnant women's nutrition and exercise behaviours. Matern Child Nutr 2021;17(1):e13068. DOI: 10.1111/mcn.13068.
  15. Lee A, Newton M, Radcliffe J, et al. Pregnancy nutrition knowledge and experiences of pregnant women and antenatal care clinicians: A mixed methods approach. Women Birth 2018;31(4):269–277. DOI: 10.1016/j.wombi.2017.10.010.
  16. Killeen SL, Callaghan SL, Jacob CM, et al. “It only takes two minutes to ask”: A qualitative study with women on using the FIGO Nutrition Checklist in pregnancy. Int J Gynaecol Obstet 2020;151(Suppl. 1): 45–50. DOI: 10.1002/ijgo.13322.
  17. Killeen SL, Callaghan SL, Jacob CM, et al. Examining the use of the FIGO Nutrition Checklist in routine antenatal practice: Multistakeholder feedback to implementation. Int J Gynaecol Obstet 2020;151(Suppl. 1):51–56. DOI: 10.1002/ijgo.13323.
  18. Doku DT, Neupane S. Double burden of malnutrition: Increasing overweight and obesity and stall underweight trends among Ghanaian women. BMC Public Health 2015;15:670. DOI: 10.1186/s12889-015-2033-6.
  19. Papathakis PC, Singh LN, Manary MJ. How maternal malnutrition affects linear growth and development in the offspring. Mol Cell Endocrinol 2016;435:40–47. DOI: 10.1016/j.mce.2016.01.024.
  20. Knight–Agarwal CR, Cubbage R, Sesleja R, et al. The nutrition-related information seeking behaviours and attitudes of pregnant women with a high BMI: A qualitative study. Women Birth 2020;33(3):294–299. DOI: 10.1016/j.wombi.2019.03.005.
  21. Bookari K, Yeatman H, Williamson M. Informing nutrition care in the antenatal Period: pregnant women's experiences and need for support. Biomed Res Int 2017;2017:4856527. DOI: 10.1155/ 2017/4856527.
  22. Lobo S, Lucas CJ, Herbert JS, et al. Nutrition information in pregnancy: Where do women seek advice and has this changed over time? Nutr Diet 2020;77(3):382–391. DOI: 10.1111/1747-0080.12589.
  23. Tsoi KY, Chan RSM, Li LS, et al. Evaluation of dietary pattern in early pregnancy using the FIGO Nutrition Checklist compared to a food frequency questionnaire. Int J Gynaecol Obstet 2020;151(Suppl. 1): 37–44. DOI: 10.1002/ijgo.13324.
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