and lactation
dr. Marlina Dewiastuti M.Kes
Nutritional Needs
During Pregnancy
Energy:
First Trimester - no change
Second Trimester - increases 340 kcal/day
Third Trimester - increases 450 kcal/day
Protein:
Increases from 46 g/day to 71 g/day
Recommendations are:
Iron increases to 27 g/day
Folate increases to 0.6 mg/day
Calcium - 1000 mg/day
Magnesium - increases to 360 mg/day
Vitamin C - increases to 85 mg/day
Weight Gain
(kg)
Weight Gain
(lbs)
Underweight
BMI < 18.5
12.7-18.2
28-40
Normal Weight
BMI 19-24.9
11.4-15.9
25-35
Overweight
BMI 25-29.9
6.8-11.4
15-25
Obese
BMI > 30.0
6.8
<15
InstituteofMedicine.WeightGainDuringPregnancy.NationalAcademyPress.1999.
Importance of Good
Nutrition during Pregnancy
Important before, during and after pregnancy
Good control of weight, blood pressure and blood
glucose increase chances of healthy, normal weight,
term infant
Affects fetal and placental growth
Importance of Good
Nutrition during Pregnancy
Affects maternal well being and maternal outcomes
Not getting enough micronutrients causes low birth
weight, premature birth, and other fetal problems
Micronutrients include: folic acid, iron, omega-3 fatty
acids, Vitamin A, calcium, Vitamin D and iodine
Role in Prevention:
NTD are thought to result from a dietary deficiency of folate and/or a
genetic defect affecting folate metabolism.
During pregnancy, the neural tube is formed from the 18 th to the 26th
DAY of gestation.
Folic Acid
Reduces risk of having a baby with neural tube defects
Reduces the risk of premature birth
Recommended amount of folic acid is 0.4 milligrams (400
micrograms) per day
Most drugstores carry off-brands of this micronutrient
Even some dollar stores carry Folic Acid
Folic Acid
Supplement should be started at least one month before
getting pregnant
It is recommended that any woman of childbearing
age should be taking folic acid supplements because
they may not know they are pregnant until it is too
late.
Iron in Pregnancy
Iron is an essential element in all cells of the body.
During pregnancy, maternal blood volume increases
20-30%.
Iron needs increase from 18 to 27 g/day during
pregnancy.
Deficiency increases risk of maternal and infant
death, preterm delivery, and low birth weight babies.
Iron
Reduces the risk of premature birth and low birth weight
Not getting enough iron could cause anemia
Could contribute to developmental delays and
behavioral disturbances in the infant and poor health
in the mother
Contributes to death and other disease development
Iron
Essential for normal
infant brain
development
Iron helps create
blood that is
necessary for fetal
demands and blood
loss during delivery.
Diagnosis of Iron
Deficiency Anemia
Iodine
Lack of iodine could contribute to stillbirth, birth defects,
and decreased brain development
Iodine is important for brain development
Constipation
Constipation during pregnancy is
associated with:
increased progesterone levels and
smooth-muscle relaxation of the GI tract.
This results in GI discomfort, a bloated
sensation, increased hemorrhoids, and
decreased appetite.
Increase fluid and fiber intake to reduce
constipation.
What is toxoplasmosis?
Toxoplasmosis is caused by a parasite found in
raw meat, cat faeces and occasionally in
unpasteurised goats milk.
In rare cases, the infection can be passed on to
an unborn baby and cause eye and brain
damage.
A high regard for food hygiene is therefore very
important for pregnant women .
In particular, they should avoid eating raw or
uncooked meat, unpasteurised goats milk or
goats cheese, or unwashed fruit and
vegetables.
After handling raw meat, chopping boards,
utensils and hands should be washed
thoroughly.
When gardening or emptying cat litter trays,
rubber gloves should always be worn.
Physiology of Lactation
Hypothala
mus
Pituitary
Gland
Prolact
in
Oxytoc
in
Uter
us
Myoepith
elial Cell
Lactea
l
General Benefits
of Breastfeeding
Maternal-infant bonding
Inexpensive
Convenient (no preparation)
Perfect temperature
Easily digested
Immunological protection
Allergy prophylaxis
Breastfeeding
Advantages for Mothers
Immunological Contents
of Breast Milk
Immunoglobulins
IgA, IgG, IgM, leukocytes, cytokines
Host resistance factors
Complement macrophages, lymphocytes, lactoferrin
Anti-inflammatory components
Enzymes: catalase, histaminase, lysozymes,
lactoperoxidase
Antioxidants: acsorbic acid, alpha-tocopherol
Prostoglandins
Interleukin-6
Stimulates an increase in mononuclear cells in breast
milk.
Breastfeeding
Advantages for Baby
Decreased incidence and/or severity of otitis media,
diarrhea, lower respiratory infections, bacteremia,
bacterial meningitis, botulism, urinary tract infections,
and necrotizing enterocolitis.
Less hospitalization in first 6 months.
Possible protective effect against sudden infant death
syndrome, type 1 diabetes, Crohns disease, ulcerative
colitis, lymphoma, allergies, and chronic digestive
diseases.
Nutritional Requirements
During Lactation
Protein = 71 g/day