Malnutrition fuelling bleeding after childbirth

Uganda faces significant nutrition challenges, with high levels of malnutrition among women of reproductive age. According to the Uganda Demographic and Health Survey (2016), approximately 20 percent of women aged 15-49 years have a body mass index (BMI) below 18.5, indicating chronic energy deficiency.

Additionally, micronutrient deficiencies, particularly iron and vitamin D, are prevalent among Ugandan women.

Poor nutrition can contribute to PPH in several ways:

1. Weakened uterine muscles: Malnutrition can lead to weakened uterine muscles, making them less effective at contracting and reducing blood flow during delivery foods like, including foods rich in iron, protein, and omega-3 fatty acids to strengthen uterine muscles. Iron-rich foods like spinach, beans, and lean meats help maintain healthy uterine tissue. Protein-rich foods like chicken, fish, and tofu support muscle growth and repair. Omega-3 fatty acids in fatty fish, flaxseeds, and walnuts reduce inflammation and promote uterine health.

Additionally, foods high in vitamin C like citrus fruits and berries support collagen production, while magnesium-rich foods like dark leafy greens, nuts, and seeds help relax and tone uterine muscles. Whole grains like brown rice, quinoa, and whole wheat bread provide fiber, iron, and B vitamins, further supporting uterine muscle strength.

A balanced diet incorporating these foods can help strengthen uterine muscles, reducing the risk of postpartum haemorrhage and other complications.

2. Impaired blood clotting: Inadequate nutrient intake can disrupt blood clotting mechanisms, increasing the risk of excessive bleeding, lack of essential nutrients and minerals such as  vitamin K-rich leafy greens like spinach and kale, omega-3 fatty acid-rich fatty fish like salmon, and iron-rich red meat and beans to support blood clotting. Zinc-rich oysters and beef, vitamin C-rich citrus fruits and berries, and calcium-rich dairy products and leafy greens also play a crucial role. Additionally, whole grains and legumes high in fiber help promote blood vessel health.

 These foods work together to provide essential nutrients for clot formation, reduce inflammation, support platelet function, and promote blood vessel health, ultimately supporting blood clotting and reducing the risk of excessive bleeding. A balanced diet incorporating these foods can help support haemostasis and overall cardiovascular health.

3. Reduced iron stores: Iron deficiency can lead to anaemia, exacerbating blood loss during delivery. Include iron-rich foods like red meat, poultry, fish, beans, lentils, and fortified cereals to boost iron stores. Vitamin C-rich foods like citrus fruits, berries, and bell peppers enhance iron absorption, while cooked spinach, beets, and Swiss chard provide easily absorbable iron. Nuts and seeds like pumpkin seeds, sesame seeds, and sunflower seeds are also good sources.

Additionally, consider cooking in cast-iron cookware and consuming organic, grass-fed beef to increase iron intake. Other iron-boosting foods include oysters, clams, and dark chocolate (70 percent cocoa or higher). Consuming these foods regularly can help maintain healthy iron stores, reducing the risk of anaemia and related complications.

4. Poor wound healing: Malnutrition impairs wound healing, increasing the risk of infection and prolonged bleeding, leading to delayed recovery, infection, and chronic wounds. Inadequate protein intake, for instance, limits collagen synthesis, while insufficient vitamin C and zinc hinder collagen cross-linking and immune function.

Deficiencies in omega-3 fatty acids and antioxidants exacerbate inflammation, causing oxidative stress.

Poor nutrition is often a result of limited access to nutritious food, particularly among rural and disadvantaged populations, insufficient understanding of proper nutrition during pregnancy and postpartum periods and traditional beliefs and practices that prioritise other family members’ nutritional needs over those of the pregnant or lactating mother.

To address the link between poor nutrition and PPH in Uganda, there is a need for nutrition education and targeted nutrition counselling for pregnant and postpartum women, investing in preconception care; the issue of getting pregnant by miracle and accident should stop among mothers in Uganda, offering nutrient-dense food supplements to vulnerable mothers and ensuring widespread access to iron and folic acid supplements.

Also, local communities should be engaged in promoting maternal nutrition and addressing food insecurity.

Way forward

Poor nutrition is a significant contributor to postpartum haemorrhage among Ugandan mothers. Addressing nutrition challenges through preconception care, nutrition education, supplementation, and community-based initiatives can help mitigate this risk.

By prioritising maternal nutrition through Nutrition Preconception care, Uganda can reduce PPH-related morbidity and mortality, promoting healthier mothers and babies.

Kamara Daniel- Nutritionist- Bwindi Community Hospital.

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