MANAJEMEN GIZI IBU HAMIL

Prof Nur Indrawaty Lipoeto MD, PhD

Faculty of Medicine - Andalas University
Padang
 PRESENTASI

Kenaikan
Anemia Vitamin D
BB

Kalsium Vitamin A
Nutrition through the life cycle (Ahmed et al, Nutrition & Metabolism, 2013)
•Defisiensi Zat Besi
The Prevalence of maternal anemia
worldwide
Maternal anemia
Maternal
micronutrient
status

Maternal Maternal
Perinatal
mortality &
mortality anemia morbidity

Child growth
and
development
 Zat Besi
• Untuk menambah volume darah
• mempersiapkan cadangan kebutuhan janin
• Selama hamil: tubuh ibu berubah
• Daya absorpsi besi meningkat 3 x
• Suplemen zat besi dibutuhkan pada trimester
2 dan 3
• Tablet besi: diantara waktu makan, sebelum
tidur
 Berat badan ibu
• Menggambarkan keadaan janin dan status gizi
ibu

• Untuk mengetahui, perlu:

– BB Sebelum hamil
– BB Selama hamil
 Jika BB sebelum hamil…
• Underweight
– Risiko BBLR
– Risiko prematur
• Overweight
– Risiko hipertensi
– Diabetes
– Infeksi postpartum
– stillbirth
 Kenaikan BB selama hamil
BB sebelum hamil Kenaikan BB yang
dianjurkan
underweight 12,5 – 18 kg

Normal 11,5 – 16 kg

Overweight 7,0 – 11,5 kg

obese 6,8 kg maximum

Weight gain during pregnancy (n: 529): a cohort study in West Sumatra
Defisiensi Vitamin D
Mtabolisme vitamin D
 Defisiensi Vitamin D

• Personal, lifestyle, environment and cultural factors are important

determinants of vitamin D availability through their effects from sun
exposure and dietary intake.
 Iskemia plasenta
Vasokontriksi arteri
Defisiensi vitamin → radikal hidroksil
spiralis → darah
D → kadar kalsium → outcome
uteroplasenta
kehamilan
 Efek suplementasi vitamin D nilai
antropometri BBL (Kalra et al, BJN, 2011)
N=49 N=49 N=43 p
(60.000U) (120.000U) Kontrol

Lingkar Kepala 34.5 34.4 33.6 0.00

(cm)

Fontanela (cm) 2.6 2.3 3.3 0.000

Panjang Badan 50.3 50.1 49.4 0.000

(cm)

Berat Badan 3.1 3.0 2.8 0.000

(kg)
• Dina Keumala et al: defisiensi vitamin D
wanita muda 92 persen (2013)
• Fanny A et al: defisiensi vitamin D pada ibu
hamil 94.6 persen (2014)
• → kadar vitamin D berhubungan dengan
tekanan darah ibu
Perbedaan Rata-rata kadar 1,25 (OH)2VitD
ibu Hamil Hipertensi dan Normotensi



80 .0 00

60 .0 00
vit d 125

40 .0 00

Ket :
1 = Normal (37 pg/dl)
20 .0 00
2 = Hipertensi (17 pg/dl)
P<0.001
1 2

te kanan darah

Aji, Lipoeto et al, BMC Pregnant, 2019

 Defisiensi vitamin D
• Ibu Hamil: pre-ekslampsia, diabetes hamil,
seksio-sesaria dan vaginosis.
• Bayi: berat badan lahir rendah dan berisiko
tinggi menderita riketsia,
• Bayi: infeksi saluran pernafasan dan gangguan
lain yang berhubungan dengan imunitas
Sumber Vitamin D
25-hydroxyvitamin
Source of Vitamin D
D
- Skin’s synthesis of
• A Common form vitamin from sunlight
that circulating Fat soluble vitamin
and pre-hormone
(Sunshine vitamin)
- Natural Food
in our body
- Vitamin D fortified
• As VD food
level/status 90% proportion from
Sunlight
indicator Exogenous
10% proportion from
production
1,25- Food
dihydroxyvitamin D
• The active form Endogenous
production
of vitamin D
Bagaimana
mendapatkan
Vitamin D
secara optimal?
Kalsium
 Calsium
• Absorpsi meningkat selama hamil
• Pada trimester 3: ibu mentransfer Ca ke janin
• Jika hamil dibawah 25 tahun, tulang masih
terdeposit → perlu tambah susu, keju, yogurt
dll
 Regulation

• Compensatory responses to decreased plasma ionized calcium

concentration mediated by PTH & vitamin D
• PTH regulates through 3 main effects:
- By stimulating bone resorption
- By stimulating activation of vitamin D → ↑ intestinal Ca reabsorption
- By directly increasing renal tubular calcium reabsorption
 Suggested scheme for calcium
supplementation in pregnant women
Dosage 1.5–2.0 g elemental calcium/day
Frequency Daily, with the total daily dosage
divided into 3 doses (preferably
taken at mealtimes)

Duration From 20 weeks’ gestation until the

end of pregnancy

Target group All pregnant women, particularly

those at higher risk of gestational
hypertension

Setting Settings Areas with low calcium

intake
•Vitamin A
 Vitamin A dan Kehamilan

Skeletal
Cell division Fetal Organ growth,
maturation

Immune
Maternal eye
function, fetal
health
vision
• Terjadi peningkatan kebutuhan vitamin A
selama hamil

• Peningkatan kebutuhan yang terbatas pada

trimester 3

• Kebutuhan 800 mcg RE/hari

 Sumber
Nabati Hewani

• wortel, • Susu full cream,

• pepaya, • yogurt,
• minyak kelapa sawit, • keju,
• hati,
• minyak ikan,
• Air Susu Ibu
 Rekomendasi Suplementasi Vitamin A
(WHO, 2011)
Dosage Up to 10 000 IU vitamin A (daily dose) OR
Up to 25 000 IU vitamin A (weekly dose)
Frequency Daily or weekly
Route of Oral liquid, oil-based preparation of
administration retinyl palmitate or retinyl
acetate
Duration A minimum of 12 weeks during
pregnancy until delivery
Settings Populations where the prevalence of
night blindness is 5% or higher
in pregnant women or 5% or higher in
children 24–59 months of age
 Perhatikan
• A single dose of a vitamin A supplement > 25
000 IU is not advisable,
• particularly between day 15 and day 60
following conception
• Beyond 60 days after conception, the safety of a
single dose of vitamin A greater than 25 000 IU
is uncertain.
• The risk for non-teratogenic developmental
toxicity is likely to diminish as pregnancy
advances