Nutrition Prior to

and During
Pregnancy
Nutrition Department : Modul 6.1
Medical Faculty of Diponegoro University
2018
Nutrition Prior to
Pregnancy
Preparation for Healthy
Pregnancy
• Achieve and maintain a healthy body
weight.

• Choose an adequate
• Underweight and balanced
and overweight diet.
 associated
with infertility, increased risk of complications
•• Malnutrition
Overweight
• Receive and
regularreduces obese
medical men
fertility and
care. low sperm
impairs infant
counts
early and hormonal changes  reduce
development
• Manage chronic
• Healthy diet  conditions.
MUFA, vegetable proteins, low
fertility.
• Avoid harmful
• glycemic
Excess carb
body influences
fat
a better (alcohol,
fertility
in women disrupts menstrual
• Diets rich in antioxidant nutrients have higher
smoking,etc)
regularity and ovarian hormone production.
sperm numbers and motility.
 Dietary Guidelines (for Americans)
Women of childbearing age who may become
pregnant should eat foods high in heme-iron
and/or consume iron-rich plant foods or iron-
fortified foods with an enhancer of iron
absorption, such as vitamin C–rich foods.
Women of childbearing age who may become
pregnant should consume adequate synthetic
folate daily from fortified foods or supplements
in addition to naturally occurring folate from a
variety of foods.
Growth & Development during
Pregnancy
1. Placental Development
• amniotic sac, a fluid-filled balloonlike structure that
houses the developing fetus.
• umbilical cord, a ropelike structure containing fetal
blood
• By exchanging oxygen, nutrients, and waste products,
the placenta performs the respiratory, absorptive, and
excretory functions that the fetus’s lungs, digestive
system, and kidneys will provide after birth.
• The placenta is a versatile, metabolically active organ.
placenta uses energy and nutrients to support its work.
2. EMBRIONIC & FETAL DEVELOPMENT
 CRITICAL
PERIOD

Critical Periods Times of

intense development and
rapid cell division are called
critical. If cell division and
number are limited during a
critical period, full recovery is
not possible
Neural Tube Development
Neural Tube Defect
Spina Bifida
RISK FACTORS
• A personal or family history of a pregnancy
affected by a neural tube defect
• Maternal diabetes
• Maternal use of certain antiseizure
medications
• Mutations in folate-related enzymes
• Maternal obesity
Folate supplementation reduces the risk.
Fetal Programming
• Nutrients influence the development of obesity
and diseases later on
• In the case of pregnancy, the mother’s nutrition
can change gene expression in the fetus.
• Such epigenetic changes during pregnancy can
affect the infant’s development of obesity and
related adult diseases.
• Some research suggests that fetal programming
may influence succeeding generations.
Recommended Weight Gain Based
on Prepregnancy Weight
Nutrition during
Pregnancy
Energy and Nutrient Needs during
Pregnancy
• For most women, nutrient needs during
pregnancy and lactation are higher than at
anyAn additional
other time 340 kcalories per day
duringthe
• To meet thehigh
second trimester
nutrient and an
demands of
extra 450a kcalories
pregnancy, perneed
woman will day during
to makethe
thirdfood choices, her body will also
careful
help by maximizing absorption and
minimizing losses.
Comparison of Nutrient Recommendations
for Nonpregnant, Pregnant, and Lactating Women
Carbohydrate
• Ideally, 175 grams or more per day
and certainly no less than 135 grams
is necessary to fuel the fetal brain.
• Sufficient carbohydrate also ensures
that the protein needed for growth
will not be broken down and used to
make glucose.
Protein
• The protein RDA for pregnancy is an additional
25 grams per day higher than for nonpregnant
women.
• Pregnant women can easily meet their protein
needs by selecting meats, milk products, and
protein-containing plant foods such as legumes,
whole grains, nuts, and seeds.
Essential Fatty Acids
• The high nutrient requirements of
pregnancy leave little room in the diet for
excess fat, but the essential long-chain
polyunsaturated fatty acids are particularly
important to the growth and development
of the fetus.
• The brain is largely made of lipid material,
and it depends heavily on the long-chain
omega-3 and omega-6 fatty acids for its
growth, function, and structure
Sources of Omega-3 and Omega-
6 Fatty Acids
Folate
• The requirement for folate increases
dramatically during pregnancy. It is
best to obtain sufficient folate from a
combination of supplements, fortifi
ed foods, and a diet that includes
fruits, juices, green vegetables, and
whole grains
• Folate RDA during pregnancy: 600
μg/day
Akibat Folat Deficiency

• Anemia (megaloblastic type)

• Neural tube defect
• Non NTD birth defects
• Homocysteinemia – cardiovascular diseases
• Cancer
Vitamin B12
• The pregnant woman also has a slightly greater need for
the B vitamin that activates the folate enzyme—vitamin
B12.
• Generally, even modest amounts of meat, fish, eggs, or
milk products together with body stores easily meet the
need for vitamin B12.
• Vegans who exclude all foods of animal origin, however,
need daily supplements of vitamin B12 or vitamin B12–
fortified foods to prevent the neurological complications
of a deficiency.
• Vitamin B12 RDA during pregnancy: 2.6 μg/day
Folate absorption and activation
Iron
• Pregnant women need iron to support
their enlarged blood volume and to
provide for placental and fetal needs
• Pregnant women need iron to support
their enlarged blood volume and to
provide for placental and fetal needs
• a daily iron supplement is recommended
during the second and third trimesters for
all pregnant women.
• Iron RDA during pregnancy: 27 mg/day
Sintesis Hemoglobin
Perubahan kadar Hb ibu hamil yang
mendapat suplementasi besi
Iodine : Daily requirements
Iodine Requirement
Age Group
(µg/day)
0 – 11 months 50
12 – 59 months 90
6 – 12 years 120
> 12 years 150

Pregnant & Lactating

200
Women
Goitre
 GAKY= Iodine deficiency disorders
Adalah sekumpulan gejala yang timbul karena tubuh seseorang
kekurangan unsur yodium secara terus menerus dalam jangka waktu
yang cukup lama
Thyroxin and gene
expression
Brain development period

Fetal stage up to
3rd month of
birth

IQ loss by 13.5 points

Spectrum of IDD
Proportion of prevalence
 Zinc
• Zinc is required for DNA and RNA synthesis and thus for
protein synthesis and cell development.
• Typical zinc intakes for pregnant women are lower than
recommendations, but fortunately, zinc absorption
increases when zinc intakes are low.
• Routine supplementation is not advised.
• Women taking iron supplements (more than 30 milligrams
per day), however, may need zinc supplementation
because large doses of iron can interfere with the body’s
absorption and use of zinc.
• Zinc RDA during pregnancy:• 12 mg/day (≤18 yr)
• 11 mg/day (19–50 yr)
Peran seng dalam enzim dan
pembelahan sel

Zinc Finger
 Defisiensi seng

• Gangguan
imunnokompetensi
• Cacat lahir
• Stunting
Vit D
• Vitamin D plays a vital role in calcium absorption and
utilization.
• severe maternal vitamin D deficiency interferes with
normal calcium metabolism, resulting in rickets in the
infant and osteomalacia in the mother.
• Regular exposure to sunlight and consumption of vitamin
D–fortified milk are usually sufficient to provide the
recommended amount of vitamin D during pregnancy
• The AI (Adequate Intake) for vitamin D does not increase
during pregnancy
Calcium
• Calcium absorption and retention increase dramatically in
pregnancy, helping the mother to meet the calcium needs of
pregnancy.
• Calcium intakes for pregnant women typically fall below
recommendations.
• Because bones are still actively depositing minerals until about
age 30, adequate calcium is especially important for young
women.
• Pregnant women younger than age 25 who receive less than
600 milligrams of dietary calcium daily need to increase their
intake of milk, cheese, yogurt, and other calcium-rich foods
• Alternatively, and less preferably, they may need a daily
supplement of 600 milligrams of calcium.
• The AI for calcium does not increase during pregnancy
Rickets
Common Nutrition-Related Concerns
of Pregnancy
• Nausea, constipation, heartburn, and food sensitivities
are common nutrition-related concerns during
pregnancy
Thank you..