“I'm passionate about the work that I do, and I speak up about maternal nutrition to push the agenda forward. Everything being done right now is limited and we need to double down.”

Dr. Parul Christian began her career in public health in the mid 1980s in India after being trained in foods and nutrition also from there, her home-country. Since that time, Christian, who is now Director of Program in Human Nutrition and Professor in the Department of International Health at the Bloomberg School of Public Health, has worked throughout South Asia on improving pregnancy-related outcomes and child growth and development through different types of nutritional interventions especially targeted towards alleviating micronutrient deficiencies in this context.

“If you look at the burden of disease, especially related to undernutrition in women and children on the Indian subcontinent, there is a high prevalence of childhood stunting and wasting and nutritional anemia in women of reproductive age,” Christian said.  She aspires to bring about transformative change to address this high burden of undernutrition and the gender inequality in nutrition that exists.

Christian notes that research and programmatic focus on maternal nutrition is a recent phenomenon, and still does not have adequate resources applied to it.

“Programs in the past several decades have focused on reducing child mortality. Increasingly we’re finding that maternal nutrition has a strong influence on size at birth and on infant and child growth such that there is need to focus attention on nutrition during pregnancy and lactation. Early life nutritional deprivation starting in utero determines the trajectory of growth and development during childhood and right into adulthood,” Christian explained.” You need to pay attention to the first thousand days (from conception through the first 2 years of postnatal life), which is a critical window of time that can influence the health and wellbeing of future generations. Ignoring maternal nutrition will not only impact a woman’s own health but that of her offspring, and in turn even the next generation.”

Following the Research

“Very early research we did looked at maternal night blindness during pregnancy which was linked to vitamin A deficiency and resulted in increased maternal morbidity and mortality and adverse birth outcomes. This condition of pregnancy was previously unknown and not studied,” Christian explained. “Another area of research I’ve been involved in provides evidence that antenatal multiple micronutrient supplementation is beneficial and reduces adverse birth outcomes, such as low birth weight and pre-term births.”

In an ongoing study in Bangladesh, Christian is testing nutritious, fortified food products that meet the energy, protein, and micronutrient requirement in pregnancy to impact adverse birth outcomes such as low birth weight.

“In many environments, women don’t increase their food intake during pregnancy and their dietary quality is poor,” Christian said. “Because food supplements can be expensive, targeting women with low body mass index (BMI) may also be more cost effective. You might also get a bigger benefit by targeting those most in need of the interventions, and our study will generate the evidence for this.”

Christian highlights that some challenges to implementing evidence-based interventions exist.

“It is hard when the evidence and science do not lead to action. Some of it is related to need for a policy change. Political will to improve public nutrition is limited, leading to inadequate resources to address undernutrition and in many places, advocacy for action is needed.” She also added, “We need a pipeline of, and leadership from, young professionals in the global nutrition space. In India, the solutions will come from people who are working on the ground and generating the evidence. Building a cadre of young professionals who are taking the field forward is critical.”

She says her favorite part of her work is getting to be in the field and talking to women and the community in her studies, as well as implementing research projects that have the potential to have direct impact on the health and nutrition of women and children in low-income settings.  Community-based research  comes with its own set of challenges, and being flexible and thinking on your feet is critical in the field.

“During the early 2000s, we were conducting a study in Nepal to test a micronutrient supplement intervention in pregnancy to see its impact on birth weight as an outcome. That called for an in-home birth assessment soon after a baby was born, which was a very challenging undertaking when houses are spread over 350 square kilometers. We imported these amazing pediatric scales from the US and created teams of people on motorcycles to visit homes and to take birth weight measurements. On the first day, five of the scales broke. The internal wiring had all come off and the batteries weren’t connected, so we sat there and repaired all the scales in the field. Later we padded the suitcases with sponge or put them in a car instead of on a motorcycle and now we do home-based birth weight assessment routinely in our studies.”

Dr. Christian continues to work in her group’s long-established sites in Nepal and Bangladesh to test and implement micronutrient and food-based interventions among women and children to improve maternal and child health, growth and development outcomes.