For pregnant patients, iron and other nutrient deficiencies pose a threat. These groups are fighting back.
By Talya Meyers
Dr Nathana Lurvey was on duty at a Los Angeles area hospital when a pregnant woman walked in. She had not received prenatal care and her hemoglobin level was half of what it should have been, indicating that she had anemia.
“The baby looked terrible on the monitor,” Dr Lurvey recalled. The mother had so few red blood cells that it hindered the ability of these cells to reach the fetus. Dr. Lurvey transfused the patient, and both she and her baby improved.
But Dr. Lurvey has seen a lot of anemia in the mothers she treats, both at the hospital and at Eisner Health, a federally-licensed health center that serves many low-income expectant mothers, mostly Latin. About 10 to 15 percent of pregnant women Eisner Health providers see already have anemia when they give birth.
“For many, many years, people have recognized that members of certain socioeconomic groups are more likely to have anemia,” Dr. Lurvey said. “Between food deserts and cultural perspectives… many [the women Eisner Health serves] don’t have an ideal diet.”
Despite the risks to mother and baby, which include premature birth, low birth weight and slower recovery, Dr. Lurvey said anemia in pregnancy hasn’t received much attention: “It’s not sexy, it’s not a big picture, and people don’t do walks.”
The local level
Instead, anemia – and other micronutrient deficiencies, such as folate, vitamin D and iodine – during pregnancy are often addressed locally by organizations that care for pregnant women medically. underserved. Dr. Lurvey wanted to implement a program to address the anemia she frequently saw in Eisner Health patients and find a way to do it without straying from the life-saving care her health center provided to patients every day.
With funding from the life sciences company Bayer, as part of The Nutrient Gap Initiative, Direct Relief identified four California health centers working to treat micronutrient deficiencies in pregnant patients. Each of them received a grant of $50,000 through dedicated community health awards. The awards are intended to help fund or expand programs that aim to improve pregnancy outcomes in medically underserved communities by educating patients or providing nutritional interventions.
Eisner Health was one of them, adding a new perinatal nutrition case manager to its Women’s Health Center, with the goal of halving anemia in pregnant patients. (“Perinatal” refers to the period before and after birth.)
“I need someone to follow [the patients] during the off weeks between when they identify anemia and when they deliver,” Lurvey said. “The problem with big systemic changes is that they are really difficult to achieve. This is a targeted intervention in a time-sensitive population.”
“Struggling to keep anything in their stomachs”
At Camarena Health in Madera, Claudia Arrellano, an educator in the comprehensive perinatal services program, noticed that a number of pregnant patients were not taking their prenatal vitamins. “In the first trimester, most of the time, we see a lot of moms struggling to keep anything down in their stomachs, and one thing they often shut down is their pregnancies,” she said. .
Staff members at the health center were particularly concerned that the patients were lacking in folate, iron and vitamin D. But Arrellano and his colleagues sympathized with the patients and wanted to teach them how to maximize their micronutrient intake.
Camarena Health staff are developing an interactive program to teach pregnant patients about these vital nutrients. Emily Valdez, a registered dietitian, explained that some of the patients at the health center are illiterate and many have low levels of health literacy. For this reason, she and her colleagues did not want to simply hand out fact sheets on the importance of micronutrients.
“We don’t just hand people out a handout…but have interactive education while they’re there in the office with our educators,” she said. Patients can learn about different micronutrients through sound features and tap into foods that contain high levels of a nutrient like folate. “I sometimes think with our patients, less is more — give them a thing or two to take home,” Valdez said.
Arrellano said the pregnant women she works with are very receptive to learning about nutrition, in part because they feel responsible for the health of their babies. “They like to learn about it, that [prenatal multivitamins] aren’t the only way for them to get these nutrients,” she said. “There’s a lot of vague information they have, and I see the ‘Aha’ moment when they see what foods are recommended for pregnancy.”
Overcoming “linguistic and cultural isolation”
At Asian Health Services in Oakland, the focus is on providing culturally and linguistically appropriate information for their primarily Asian and Pacific Islander perinatal patients. In particular, explained family medicine specialist Dr. Emily Guh, the federally licensed health center emphasizes participation in its Mommies 2 Be program, which provides patient education, support and community. pregnant.
“Many of our patients face linguistic and cultural isolation, so pregnancy can be a very difficult time,” she said.
Asian Health Services is partnering with a local chapter of WIC – the government’s Supplemental Nutrition Program for Women, Infants and Children – to add a culturally appropriate nutrition element to Mommies 2 Be group meetings.
“It’s not lecture-based, it’s really discussion-based,” Guh said, explaining that a typical conversation might involve asking the women in the discussion what foods they consider nutritious, or bringing up examples of what they’re talking about. familiar foods. Before a group leader answers a question, they can open the forum to other participants to share their own answers, and pregnant women can discuss together how they will incorporate healthy foods into their diet.
“A lot of routine counseling…can be done in groups,” Guh said.
The health center is working to improve the community by grouping pregnant women with similar due dates together, in hopes that they will also graduate together in a new group for mothers of new children. They also work with student volunteers from nearby UC Berkeley who act as labor coaches and translators for women in labor. Part of the students’ responsibility is to help pregnant patients develop a birth plan, so they can think through some of the important decisions they will need to make during the birthing process in advance.
“Another life depends on them”
According to Ivan Flores, associate director of prenatal support services at San Diego Family Health Centers, iron, folic acid and vitamin B12 deficiencies are common among the approximately 3,500 pregnant patients his health center treats each year. Many patients eat few fruits and vegetables. And many are overweight.
In response, Family Health Centers are ensuring patients have access to healthy foods through a local WIC program, helping eligible patients navigate the complex registration process “to ensure they actually receive the benefits,” Flores said. He estimated that 80 to 90 percent of pregnant women that Family Health Services works with are eligible for WIC, although some decline this option because they are concerned about their immigration status.
They combine access to nutrition with high levels of monitoring and education, see some patients as often as once a week, work to get needed supplies – like blood glucose monitoring equipment for patients with gestational diabetes – and teach patients how to get the most out of their nutrition, for example by combining acid-rich foods like orange juice with meat.
Part of their process is being realistic about patient needs, said Gina Parra, manager of the health center’s prenatal support program, which oversees its nutritionists and dieticians.
“Even if we want them to eat five meals a day, or eat your fruit, or eat your veg…tell that to a homeless mom,” she said.
Yet, she says, it can be especially rewarding to work with pregnant women precisely because their nutrition and health are so important to them.
“These are patients who, for the most part, are listening to you because another life depends on them,” she said.