Reproduction and maternal nutrition in Madura, Indonesia.

Between late 1982 and late 1985 and early 1987 and late 1989 health workers collected anthropometric and caloric intake data on 1032 women living in a rural village on the island of Madura East Java Indonesia to determine the prevalence and severity of chronic energy deficiency and the effect reproduction had on their nutritional status. These women had 2013 single births. 41.3% of all women suffered from chronic energy deficiency defined as a body mass index (BMI) less than 18.5. Further 2.6% of all women had severe chronic energy deficiency. This indicated that these women had suffered malnutrition during childhood. 31.6% of the women weighed less than 41 kg before pregnancy. 80% of these women had chronic energy deficiency. Caloric intake during pregnancy averaged 1550 kcal/day. Pregnancy women ate a mean of 42 g of protein/day. Their physical activity level was low. Mean total weight gained during pregnancy was a low 6.6 kg. Pregnant women used fat reserves during pregnancy as indicated by lower upper aim circumferences and skinfold thicknesses (in 75% of cases) at the end of pregnancy compared to the first trimester. Women who weighted the least before pregnancy ( 18.5 BMI. Thus the tiniest women built up fat reserves during pregnancy at the expense of fetal growth. Postpartum women consumed just 200 kcal more during lactation than they did during pregnancy. Women who weighed less than 35 kg and had a low BMI at 4 weeks postpartum gained weight over the 12 months postpartum while those who weighed the most lost weight. These findings stress the need to put as much emphasis on maternal undernutrition as there is on malnutrition among preschoolers.