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Nutrisi Pada Ibu Hamil

dan Menyusui

Diki Ardiansyah, S.Kep., Ners., M.Kep


Departemen Keperawatan Kritis, Gawat Darurat dan
Bencana Program Studi Keperawatan (D-3) STIKes Jenderal
Achmad Yani Cimahi
© 2007 Thomson - Wadsworth
Nutrition Prior to
Pregnancy
• Achieve &
maintain a
healthy body
weight
• Choose an
adequate &
balanced diet
• Be physically
active
• Avoid harmful
substances
© 2007 Thomson - Wadsworth
Critical Periods

• Development of each organ


takes place at a certain time
(critical period)
• Effects of malnutrition at a
critical period are irreversible

© 2007 Thomson - Wadsworth


Healthy Support Tissues

• Prepregnancy • Umbilical cord


nutrition needed to  Pipeline from
support growth of a placenta to fetus
healthy placenta • Amniotic sac
• Placenta  Surrounds baby
 Supply depot  Cushions it
 Waste-removal with fluids
system

© 2007 Thomson - Wadsworth


The Events of Pregnancy

• Newly • Adverse influences


fertilized ovum can lead to
called a zygote  Failure to implant
• Implants in uterine  Neural tube deficits
wall in 2 weeks • Smoking
• Placenta begins to • Drug abuse
grow • Malnutrition
• Crucial time period

© 2007 Thomson - Wadsworth


The Embryo & Fetus
• Embryo develops • Last 7 months
into a fetus  Grows 50 times
• At 8 weeks fetus has heavier & 20 times
 Complete CNS longer
 Beating heart • Pregnancy
 Fully formed digestive  39-41 weeks
tract duration
 Well-defined fingers
& toes • Infant
 Beginning facial  Weight 6 ½ - 9
features pounds

© 2007 Thomson - Wadsworth


© 2007 Thomson - Wadsworth
Effects of Malnutrition
• Nervous system defects of
the embryo
• Child’s poor dental health
• Adolescent’s & adult’s
vulnerability to infection
• Higher risk of diabetes,
hypertension, stroke,
or heart disease

© 2007 Thomson - Wadsworth


© 2007 Thomson - Wadsworth
Nutrient Supplements

• Prenatal • Needed for


supplements  Those with poor diet
provide more  High-risk pregnancies
 Folate  Multiple fetuses
 Iron  Cigarette smokers
 Calcium  Alcohol & drug abusers
• Reduce risks of
 Preterm delivery
 Low birthweight
 Birth defects

© 2007 Thomson - Wadsworth


Prepregnancy Weight

• Underweight or
overweight before
pregnancy presents
medical risks

© 2007 Thomson - Wadsworth


© 2007 Thomson - Wadsworth
Weight Gain
• Essential for healthy pregnancy
• Normal-weight woman
 3 ½ pounds first trimester
 1 pound/week thereafter

© 2007 Thomson - Wadsworth


Underweight
• High risk of • Long-term effects
having a low-  Risk for obesity &
birthweight baby hypertension
later in life
• Low-birthweight
 Lower adult IQ
 More risk for
disease  Short stature
 40 times more  Educational
likely to die in disadvantages
first month

© 2007 Thomson - Wadsworth


Causes of Low-Birthweight

• Mother’s
Poor nutrition
Heredity
Disease conditions
Smoking
Drug & alcohol use

© 2007 Thomson - Wadsworth


Overweight & Obesity

• Babies • Mom
Are larger More likely to need
Twice as likely to labor induced
have neural tube May need C-section
deficits More post-partum
Greater risk of hypertension,
heart defects infections, &
gestational diabetes

© 2007 Thomson - Wadsworth


Nutrient Needs During
Pregnancy
• Some increase
• Must make careful choices
• Woman’s body
Maximizes absorption
Minimizes losses

© 2007 Thomson - Wadsworth


Nutrient Needs

• Energy (kcalories) • Protein


 Additional 340 in 2nd  Additional 25 g
trimester  Protein supplements
 Additional 450 in 3rd are discouraged
trimester • Fats
 Select nutrient-dense
 Little room for oil,
foods
margarine, & butter
• Carbohydrates  Need essential
 Additional 175 g fatty acids
 Fiber for constipation

© 2007 Thomson - Wadsworth


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Special Interest
• Folate • Vitamin B12
 Role in cell  Needed to assist
reproduction folate in manufacture
 Increased from 400- of new cells
600 mcg/day
 Found in animal
 Prevents neural
products
tube deficits
• Spina bifida  Vegans need fortified
• Anencephaly foods or supplements
 Supplements, fortified
foods or both

© 2007 Thomson - Wadsworth


© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Nutrients for Bones
• Vitamin D, calcium, • Increase milk
phosphorus, products
magnesium • May need
• Intestinal absorption supplements
of calcium doubles • Calcium-fortified
early in pregnancy soy milk & orange
• Final weeks, more juice
than 300 mg
transferred to fetus

© 2007 Thomson - Wadsworth


© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Fluoride
• Mineralization of teeth
begins in 5th month
• Fluoride supplements
Recommended if do not
have fluoridated water
Not recommended if
have fluoridated water

© 2007 Thomson - Wadsworth


Iron

• Absorption of iron • Iron-rich food


increases threefold  Liver, oysters
• Fetus draws heavily  Meat, fish
 Dried fruits
on mother’s stores
 Legumes
• Daily supplement  Dark green
 30 mg iron vegetables
 2nd & 3rd trimester • Vitamin C-rich
foods enhance
absorption

© 2007 Thomson - Wadsworth


© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
© 2007 Thomson - Wadsworth
Zinc
• Needed for DNA, RNA &
protein synthesis
• Deficiency predicts
low birthweight
• Found in foods of high
protein content
• Iron interferes with zinc
absorption
• May need zinc supplements

© 2007 Thomson - Wadsworth


© 2007 Thomson - Wadsworth
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Physical Activity

• Very important • Low-impact


 Improves her fitness activities
 Facilitates labor • Avoid
 Helps to prevent or  Activities with
manage gestational potential for falls or
diabetes being hit by others
 Reduces  Saunas
psychological stress  Steam rooms
 Whirlpools

© 2007 Thomson - Wadsworth


Common
Nutrition-Related Concerns

• Food sensitivities
• Nausea
• Heartburn
• Constipation

© 2007 Thomson - Wadsworth


Food Cravings & Aversions

• Cravings • Cravings &


Do not seem to aversions
reflect Probably due to
physiological
• Hormone-induced

needs changes in taste


• Sensitivities to
smells

© 2007 Thomson - Wadsworth


Nonfood Cravings

• Pica
Craving items such as
laundry starch,
clay, soil, or ice.
Common among
African American
women
Often associated
with iron deficiency

© 2007 Thomson - Wadsworth


Other Concerns

• Morning Sickness • Heartburn


 Comes from  Fetus puts
hormonal changes in pressure on
early pregnancy woman’s stomach
 Mild queasiness to  Acid may back up
debilitating nausea • Constipation
 Smells often trigger it
 High-fiber diet
 Physical activity
 Plentiful fluids

© 2007 Thomson - Wadsworth


Problems in Pregnancy

• Gestational • Hypertension
Diabetes Pre-existing
Usually resolves • Risk of low-birthweight
after the birth infant
Often leads to • Separation of placenta
Transient
surgical birth &
high infant • Usually resolves after
birthweight the birth

© 2007 Thomson - Wadsworth


Avoid Cigarette Smoking
• Nicotine & cyanide • Behavioral or
are toxic to a fetus intellectual
problems later in life
• Second-hand smoke
• Implicated in SIDS
is also problematic
(sudden infant death
• Blood flow is syndrome)
restricted • More complicated
• Slows fetal growth births
• Low birthweight

© 2007 Thomson - Wadsworth


Avoid
• Medicinal drugs • Drugs of abuse
 No over-the-counter  Cross the placenta
 No medicines  Impair growth &
not prescribed development
 No aspirin or ibuprofen • Environmenta
in last 3 months l
• Herbal supplements contaminants
 Almost none have  Lead & mercury
been tested for safety  Avoid certain
during pregnancy types of fish
© 2007 Thomson - Wadsworth
Avoid
• Foodborne illness • Dieting
 Listeriosis  Hazardous
• Can cause miscarriage, during pregnancy
stillbirth
• Sugar substitutes
• Severe brain injury,
other infections to fetus  Use in moderation
& newborn • Caffeine
• Vitamin-  Limit to one cup coffee
mineral or two 12-oz colas
megadoses
 Many are toxic in excess
 Need care with vitamin A
© 2007 Thomson - Wadsworth
Alcohol

• Fetal alcohol
syndrome (FAS)
Irreversible brain
damage
Mental retardation
Facial abnormalities
Vision abnormalities
• No amount is safe

© 2007 Thomson - Wadsworth


Adolescent Pregnancy

• Intense nutrient • Risks for


needs Low-birthweight
• Often deficient Miscarriage
before pregnancy Stillbirth
• Encouraged to Death of infant in
first year
gain about 35
pounds

© 2007 Thomson - Wadsworth


Breastfeeding

• Recommendation
Exclusive
breastfeeding for
6 months
Then
breastfeeding with
complementary
foods through 12
months

© 2007 Thomson - Wadsworth


Nutrition During Lactation

• Eat nutrient-
dense foods
• Enjoy ample food
& fluids at
frequent intervals

© 2007 Thomson - Wadsworth


Nutrition Needs
• Energy • Vitamins & minerals
 An extra 330  Milk quality is
kcalories/day maintained at expense
• Weight loss of maternal stores
 1 pound/week  Undernourished may
• Water need supplements
 Need about 13 • Particular foods
cups/day  Some might bother
baby

© 2007 Thomson - Wadsworth


Contraindications to
Breastfeeding
• Alcohol • May reduce milk
• Caffeine production
• Cigarette smoke • May enter breast
• Medications milk & impair
infant development
• Illicit drugs
• Some maternal
illnesses

© 2007 Thomson - Wadsworth


Nutrition of the Infant
• Affects later
development
• Sets the stage for
eating habits
• Provide a nurturing,
relaxing environment

© 2007 Thomson - Wadsworth


Nutrients to Support
Growth
• Weight doubles by 4-5
months
• Triples by 1 year
• BMR is very high
• Need
 100 kcalories/kg
 Adequate vitamin A,
D, & calcium
 Adequate water
 Dose of vitamin K
at birth

© 2007 Thomson - Wadsworth


Breast Milk
• Energy nutrients • Vitamins & Minerals
 Carbohydrates  Vitamin D
• Lactose supplement needed
• Enhances calcium
• If breastfed
absorption
• If not on vitamin D-
 Lipids fortified formula
• Generous amount
of essential fatty • Lower in sodium
acids
 Protein • Highly absorbable
• Alpha-lactalbumin iron & zinc
• Easily digestible

© 2007 Thomson - Wadsworth


© 2007 Thomson - Wadsworth
Supplements for Infants

• After 6 months
may need
Vitamin D
Iron
Fluoride

© 2007 Thomson - Wadsworth


Benefits of Breast Milk

• Immunological • Infant has less


protection Stomach &
Colostrum (premilk intestinal
substance) disorders
Maternal immune Middle ear
factors infections
Enzymes that offer Respiratory illness
protection

© 2007 Thomson - Wadsworth


Other Potential Benefits
• May protect
Against adult obesity
Cardiovascular disease
• May have a positive effect
On later intelligence

© 2007 Thomson - Wadsworth


Infant Formula

• Can offer the same


Closeness
Warmth
Stimulation

© 2007 Thomson - Wadsworth


Formula Composition
• Similar to breast milk
• Offers no immunity
• Standards have been set
• All need to be
iron fortified
• Are special formulas for
allergies & lactose
intolerance
• Risks of over-dilution &
contamination

© 2007 Thomson - Wadsworth


Nursing Bottle Tooth Decay
• Do not put infant
to bed with a
bottle
• Can cause
Dental caries
Bucktoothed
profile

© 2007 Thomson - Wadsworth


Transition to Cow’s Milk
• Not appropriate in • Cow’s milk
first year  Is a poor source
• 1-2 years need of iron
whole milk  Higher in calcium
but lower in
• 2-5 years can vitamin C (inhibits
transition to lower iron absorption)
fat  Higher protein can
stress infant’s
kidneys

© 2007 Thomson - Wadsworth


Introducing First Foods

• First foods can be


introduced between
4-6 months
• Can sit with support
& control head
movements

© 2007 Thomson - Wadsworth


Foods to Provide Iron
& Vitamin C
• Breast milk & iron-
fortified formula
• Iron-fortified cereals
• Meat & meat
alternatives
• Fruits & vegetables
for vitamin C

© 2007 Thomson - Wadsworth


Physical Readiness

• 4-6 months can


swallow solids
• 8-12 months
Can handle finger
foods
Begins to teethe
Hard crackers can
be introduced

© 2007 Thomson - Wadsworth


Infant Feeding

• Allergy- • Foods to omit


causing foods  Sweets of any kind
 Introduce foods  No canned vegetables
one at a time • High in sodium
 Honey
 Rice cereal first
• Risk of botulism
 Wheat last  Foods that cause risk
• Choice of foods for choking
 Baby foods • Foods at 1 year
 Blenderized table  Same foods as rest of
food family

© 2007 Thomson - Wadsworth


Looking Ahead

• Introduce a • Avoid food as


variety of A reward
nutritious foods Comfort for
• Don’t force to unhappiness
finish food & drink Deprivation for
punishment

© 2007 Thomson - Wadsworth


Feeding Guidelines
for Mealtime
• Discourage • Don’t force food
unacceptable on children
behavior
• Strictly limit
• Let the child sweets
explore & enjoy
food

© 2007 Thomson - Wadsworth

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