Stunting

Protecting Future Generations,Preventing Stunting in the Womb

Indonesia is the fourth mostpopulous country in the world and also has strategic geographic location, withabundant natural resources. The development of Indonesia’s human resources (HR)is a part of the process and goal in Indonesia’s national development. Theyoung generation as the nation’s successor must be healthy, intelligent,creative, and productive. If children are born healthy, grow well and aresupported by quality education, they will become a generation that supports thesuccess of national development. Conversely, if children are born and grow upin a situation of chronic malnutrition, they will experience stunting. Decreasingmalnutrition is a challenge for many countries, mainly developing countries. InIndonesia, malnutrition remains a significant problem among children under fiveyears old.

Stunting is a condition offailure to thrive in children under the age of five due to chronic malnutritionand recurrent infections, especially in the first 1.000 days of life period,calculated from the foetus until the child is 23 months old. Stunting alsoinhibits cognitive development, which will affect children's intelligencelevels and future productivity. Stunting and malnutrition is one of the primarycauses of mortality in children less than five years of age. Stunting and othernutritional problems are estimated to reduce gross domestic product (GDP) byaround 3% per year.

From Indonesian NutritionalStatus Survey (SSGI) 2022 data, it can be seen that from 2021 to 2022,Indonesia experienced a decrease in stunting rates by 2,8%. The 2016 GlobalNutrition Report noted that the prevalence of stunting in Indonesia was ranked108 out of 132 countries. In the Southeast Asia Region, the prevalence ofstunting in Indonesia is the second highest after Cambodia. Stunting preventionneeds to focus on addressing the direct and indirect causes of nutritionproblems. Direct causes include inadequate nutrient intake and infectiousdiseases.

Nutritional status likemicronutrients during pregnancy can have a significant impact on maternal andneonatal health outcomes. Micronutrients play a critical role in cellular andhumoral immune responses, cellular signalling and function, reproductive health,learning and cognitive functions. This body cannot synthesize micronutrients,so they can be obtained from supplement.

Several important micronutrientsfor pregnant women and their functions are as follows.

5-MTHF (Active Folate)

Folate is a water-soluble vitaminB and folate deficiency results in the accumulation of homocysteine, which canincrease the risk of adverse outcomes including preeclampsia and foetalanomalies. Supplementation with folate during preconception and early pregnancyis critical and can prevent 40-80% of neural tube defects such as spina bifida.Because the neural tube develops in the first four weeks of pregnancy, theprotective effects of folate supplements are diminished after pregnancy isestablished (3). (6S)-5-MTHF supplementation during pregnancy is preferred overfolic acid for its ability to bypass the block in folic acid metabolism linkedto enzymatic polymorphism. The use of (6S)-5-MTHF can overcome the concernsabout the risk for deleterious effects of Unmetabolized Folic Acid (UMFA)related to the use of a supraphysiological dose of folic acid.

Iodine

Iodine Is an essential nutrientfor regulating growth, development and metabolism via the biosynthesis ofthyroid hormones including thyroxine (T4) and triiodothyronine (T3). Iodine forpregnant woman is need to prevent cretinism in newborn baby. Maternal andfoetal thyroid hormones regulate key processes in the development of the foetalbrain and nervous system, including the growth of nerve cells, the formation ofsynapses and myelination.

Iron

Iron is a vital nutrient andcofactor for the synthesis of haemoglobin, as well as several cellularfunctions including oxygen transport, respiration, growth, gene regulation andthe proper functioning of iron-dependent enzymes. Iron deficiency and/oranaemia have been associated with greater risk of preterm birth, LBW or SGAinfants, impaired maternal function and decreased defences against infection,as well as abnormal psychomotor development and cognitive function in infancy.

Vitamin B12

Vitamin B12during pregnancy is essential for your baby's developing brain and spinal cord.It also helps make healthy red blood cells and DNA.

Calcium, Vitamin D, andVitamin K2

In pregnancy, calcium is activelytransported across the placenta and maternal calcium demands increase,particularly during the third semester. Low maternal calcium intake cancontribute to osteopenia, paresthesia, muscle cramps, tetanus and tremor in thetremor in the mother, as well as delayed growth, LBW and poor mineralisation inthe foetus. Calcium supplementation reduced the risk of preeclampsia by morethan 50% in all women. Maternal vitamin D deficiency has been associated withneonatal rickets as well as multiple adverse pregnancy outcomes including gestationaldiabetes mellitus, preeclampsia, and preterm birth. Whereas vitamin K2 alsopromotes bone and heart health. So, calcium, vitamin D, and vitamin K2 workssynergistic.

Vitamin C and Vitamin E

Vitamin C (ascorbic acid) is anessential water-soluble vitamin, whereas vitamin E represents eightfat-soluble, plant-derived compounds: four tocopherols and four tocotrienols(alpha, beta, gamma, delta), with naturally sourced alpha-tocopherol as the mostbiologically active form. Oxidative stress is thought to be a key mechanismunderlying the pathophysiology of several pregnancy complications includingpreeclampsia, preterm birth, intrauterine growth restriction (IUGR) andpremature rupture of membranes. Both vitamins C and E function synergisticallyto promote antioxidant defences and inhibit free radical formation to preventoxidative stress.

Vitamin B1, Vitamin B2,Vitamin B3, and Vitamin B6

B-complex vitamins includingvitamins B1 (thiamine), B2 (riboflavin), B3 (niacin), and B6 (pyridoxine) arewater-soluble vitamins required for the production and release of energy incells and for the metabolism of protein, fat and carbohydrates. These vitaminsact as coenzymes in several intermediary metabolic pathways for energygeneration and blood cell formation. The requirement for these vitamins isheightened in pregnancy due to increased energy and protein needs, particularlyduring the third trimester.

Vitamin A

Vitamin A is a fat-solublevitamin derived from retinoids or provitamin carotenoids. Physiologicalfunctions of vitamin A include vision, growth, bone metabolism, immune functionand gene transcription as well as antioxidant activities. Some additionalvitamin A is needed during pregnancy to support growth and tissue maintenancein the foetus and to provide foetal reserves and aid in maternal metabolism.

Magnesium

Magnesium (Mg) is one of theessential minerals needed by humans in substantial large amounts. Mg work withmany enzymes to regulate body temperature, synthesis nucleic acids, andproteins as well maintaining electrical potentials in nerves and musclemembranes. Common causes of Mg deficiency include inadequate dietary intake orgastrointestinal absorption, increased losses through the gastrointestinal orrenal systems, and increased the requirement for Mg, such as in pregnancy.

Biotin

Biotin is a water-soluble vitamin(B7) that acts as a coenzyme for multiple carboxylases involved in fatty acidmetabolism, amino acid metabolism and gluconeogenesis. Biotin deficiency causeimmunodeficiency and infection is regarded as a major risk of preterm birth.

Zinc

The central role of zinc in celldivision, protein synthesis and growth means that an adequate supply of zinc isespecially important for pregnant women. During pregnancy, zinc and othermicronutrient deficiencies are common due to increased nutrient requirements ofthe mother and the developing fetus. These deficiencies can negatively impactpregnancy outcomes including the health of the mother and newborn infant. Poormaternal zinc status has been associated with foetal loss, congenitalmalformations, intrauterine growth retardation, reduced birth weight, prolongedlabour and preterm or post-term deliveries.

DHA

Docosahexaenoic acid (DHA)supplementation is recommended for women during pregnancy because of itsneurological, visual, and cognitive effects. DHA is rapidly integrated intoretinal and brain neural tissue during the last three months of pregnancy andplays a significant role in early fetal neurodevelopment.

The prevention of stunting needscoordination between sectors and involves various stakeholders such as theGovernment, Local Government, the business world, the general public, andothers. PT Simex Pharmaceutical Indonesia as one of the pharmaceuticalcompanies in Indonesia also helps to support the government's plan to preventstunting in children for a better future of the Indonesia. It is better toprevent than to cure, therefore fulfill children's nutrition as early aspossible since they are still in the womb!

Reference

https://www.kemenkopmk.go.id/membangun-sdm-indonesia-membangun-sinergitas

https://www.who.int/tools/elena/interventions/micronutrients-pregnancy

Kementerian Koordinator BidangPembangunan Manusia dan Kebudayaan. Strategi Nasional Percepatan PencegahanAnak Kerdil (Stunting) Periode 2018-2024

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