Abstract
Optimal nutrition in both mothers and infants from conception to the first 2 years of
life or the first 1000 days is crucial for growth, health and cognitive development. Thailand
has made considerable progress in maternal and child nutrition, but currently facing the
double burden of malnutrition, i.e., coexistence of both under and over nutrition.
Objectives: This study aimed to improve a tool used in assessing gestational weight gain
(GWG) which is appropriate for pre-pregnancy nutritional status (Body Mass Index, BMI),
develop a new tool for assessing physical activities during pregnancy and lactation, develop
practical recommendations on dietary advice during pregnancy and lactation, develop a
food product using resistant starch for management of overnutrition and finally, to examine
the current nutrition services in maternal and child health program. Key findings: (1) GWG
data of mothers who delivered normal birth weight infants at Siriraj Hospital were obtained
from hospital records. Recommended GWG tables and charts were developed according to
pre-pregnancy BMI, i.e., underweight, normal weight, overweight or obese. (2) A physical
activity questionnaire for pregnancy and lactating women (PAQ-PL) was developed based on
the common physical activities among Thai population. The validity of the PAQ-PL against
the accelerometer was acceptable. This PAQ-PL can be used to monitor GWG and control
post-partum weight retention. (3) Optifood program, which utilized the linear programming
method, was used to create food based dietary recommendations (FBDG) for pregnant and
lactating women. The development was based on dietary consumption data (quantity,
frequency, and food items) of Thai pregnant and lactating women as well as women of
reproductive age. The developed FBDG contained recommended food groups, quantity, and
frequency which aimed to meet the recommended energy, protein, and vitamin and
minerals intake. This FBDG should be tested for acceptability and practicality prior to
implementation. (4) RS milk-based beverage, containing 30 grams of RS, was developed and
tested for acceptability and side-effects. The developed RS beverage was well accepted
among women of reproductive age and the side-effects were rare. The total daily energy intake decreased; however, further study on health impacts is needed. (5) Exclusive breast
feeding (EBF) practice during the first 6 months of age among middle income and working
outside the home mothers was evaluated using the questionnaire, then compared with the
data from the stable isotope technique. Only 31% at 3 months and 61% at 6 months of the
EBF practice data from the questionnaire were consistent with the actual practice. (6) The
current nutrition services in maternal and child health program were based on the policy
and indicators established by the Ministry of Public Health. The services were implemented
through the Regional Health Promotion Center (HPC), which acted as the advisory and
technical support group and monitored policy implementation according to the indicators.
The constraints in the real practices were the lacks of sufficient personnel compared to the
workload and inadequate nutrition knowledge. There was an urgent attention on capacity
building for the health personnel, especially those who work at the local level and
community health volunteers. Recommendation: This study suggests the importance of the
action research that integrates the developed recommendations and tools in the maternal
and child health care services and modify them to be appropriate for the implementation at
all service levels, and suggests the importance of the intensive capacity building on nutrition
aspect for public health personnel.
