On 2 November 2017, Otilia Perichart-Perera joined the Maternal Health Task Force (MHTF) for a panel discussion about noncommunicable diseases and maternal health. Later, she sat down with the MHTF’s Sarah Hodin to talk more about the issues she raised during the dialogue.
SH: Please start by telling me a bit about you and your work.
OPP: My background is in nutrition, health promotion and food sciences. I’ve been working as a researcher at the Instituto Nacional de Perinatología in Mexico City, focusing on nutrition in high risk pregnancies. I’ve conducted studies evaluating nutrition interventions to prevent and treat pre-eclampsia, gestational diabetes and obesity in pregnancy. Currently I’m interested in maternal nutritional status and how that affects the fetus. Both undernutrition and overnutrition during pregnancy are not only dangerous for women but can also have a long-lasting impact on their children.
SH: Your paper, “Metabolic markers during pregnancy and their association with maternal and newborn weight status,” that was published in the new MHTF-PLOS Collection examined obesity in pregnancy in Mexico. What was the impetus for the study?
OPP: Three-quarters of women of reproductive age in Mexico are considered to be overweight or obese. This is a major problem because obesity in pregnancy is associated with many poor maternal and newborn health outcomes including gestational diabetes, pre-eclampsia, intrauterine growth restriction, miscarriage and hemorrhage.
SH: What did you find?
OPP: The markers we studied were all related to nutrient transport and metabolism, including energy substrates, hormones that affect metabolism of nutrients and proteins that participate in cell signaling. We found that women who began pregnancy with excessive weight had higher concentrations of many of these markers, even if they did not develop gestational diabetes. This may indicate an increased risk of nutrient-related complications in the fetus. We also found that excessive maternal weight gain at the end of pregnancy was associated with insulin resistance, an indicator of altered glucose metabolism. Our findings exemplify that screening for gestational diabetes is not enough. We need to offer more comprehensive prenatal care that incorporates other tests.
SH: We spoke earlier about how the maternal health and NCD communities tend to work in silos. Do you think the same applies to the fields of nutrition and maternal health?
OPP: I don’t think that nutrition is generally included in maternal health services in Mexico. Often nutrition is not positioned as a priority during prenatal care, for instance. Part of the problem is the limited number of health professionals who are nutrition-oriented. Nutrition is not a focus in Mexico’s health system—it’s not emphasized in medical education and training programs. Also, prenatal visits tend to be short and clinically-oriented, so there’s not enough time to discuss healthy pregnancy behaviors including nutrition.
SH: What would you like to see happen to better integrate nutrition into maternal health services?
OPP: We need quick, easy educational messages based on behavioral change as opposed to highly prescriptive dietary guidelines. We also need to move away from the curative, diagnostic perspective on health towards a model of clinical care centered on early prevention. Nutrition interventions should aim to empower women to make lifestyle changes for themselves and their babies.
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Browse resources related to nutrition and maternal health.
Watch the video of the panel discussion about NCDs and maternal health featuring Otilia Perichart-Perera.
Explore other open access papers from the MHTF-PLOS Collection on NCDs and maternal health.