All knowledge about maternal malnutrition.

1. 1
Maternal
Nutrition

2. 2
Introduction
The term ‘maternal nutrition’ focuses attention on women as
mothers, on their nutritional status as it relates to bearing and
nurturing of children.
Maternal nutrition comprises anthropometric factors such as
pre-pregnancy weight for height and gestational weight gain, as
well as intake of protein and micronutrients.

3. 3
Changes During Pregnancy Period
During pregnancy, body goes through emotional and physiological
changes.
Major three changes occur during pregnancy period. They are
A. Physiological changes
B. Gastrointestinal changes
C. Changes in body fluid

4. Maternal physiological changes in pregnancy are the normal adaptions that a
women undergoes during pregnancy to better accommodate the embryo or fetus.
They are physiological changes, that is, they are entirely normal and include
cardiovascular, hematologic , metabolic, renal and respiratory changes.
Physiological changes
4
Hormonal Changes
Pregnant women experience numerous adjustment in their endocrine system.
Level of progesterone and estrogens rise continually throughout pregnancy.
Estrogen is mainly produce by the placenta.
Estrogen maintains progesterone production by the corpus lutenum.

5. Body weight
One of the most noticeable alterations in pregnancy is the gain in
weight.
The enlarging uterus, the growing fetus, the placenta, the acquisition of
fat and water retention, all contribute to this increase in weight.
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Breast size
A women breast’s grow during pregnancy.
Once lactation begins, the women breast swell significantly and can feel
achy, lumpy and heavy.
Cardiovascular
During the course of pregnancy, blood volume slowly increases by 40-
50%.It results in an increase in heart rate, stroke volume and cardiac

6. Hematology
During pregnancy the plasma volume increases by 50% and RBC volume
increases only by 20-30%. Edema or swelling of the feet is common
during pregnancy, partly because the enlarging uterus compresses veins
and lymphatic drainage from the legs.
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BMR
Fetal growth and development increase the BMR by 5% during 1st
trimester and 12% during 2nd and 3rd trimester. This increases the total
energy requirement.

7. Gastrointestinal changes
The following are some of the changes observed during pregnancy:
 Nausea and vomiting
 Heart burn
 Constipation
 Diarrhea
 Gallbladder stones
 Excess saliva
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8. Changes in Body Fluid
Estrogen and progesterone changes:
The estrogen and progesterone are chief pregnancy hormones.
Estrogen is thought to play an important role in helping the fetus develop
and mature.
High level of progesterone cause internal structures to increasing size, such
as ureters.
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Weight gain, Fluid retention and physical activity:
Weight and gravity slow down the circulation of blood and body
fluid, particularly in lower limbs.
As a result pregnant women retain fluids and experience swelling of
legs, feet, hands and even face.

9. Total energy:
Before 2002 the advise for pregnant women increase their energy
intake by 300 kcal/day
The energy requirement during pregnancy are as follows
 Heavy worker: (2925+300) kcal/day
 Moderate worker: (2225+300) kcal/day
 Sedentary worker: (1875+300) kcal/day
Nutritional Requirement During Pregnancy
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Lipids and fats:
The mother to be must include enough fat in her diet to meet the needs of
her growing baby.
There are no separate RDA for fat intake during pregnancy and the
recommendations remain 20-35% of total calories.

10. Nutritional Requirement During Pregnancy
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Essential fatty acids:
The EFAs linoleic acid (omega-6) and linolenic acid (omega-3) are
necessary for optimal formation of the brain and eyes.
RDA:
Omega-6 13 g/day and 1.4 g/day omega-3
Fiber:
It is important for prenatal diet. Pregnant women needs 28 g/day.
Carbohydrate:
Dietary carbohydrate is broken-down to form glucose, also known as blood
sugar. The RDA for carbohydrate during pregnancy is 175g/day.

11. Vitamin A
RDA for pregnant women is 770 micro gram per day
Vitamin D
RDA for pregnant women is 5 micro gram per day
Calcium
RDA for pregnant women is 1 g/day
B Vitamins
RDA for pregnant women is 770 micro gram per day
Nutritional Requirement During
Pregnancy
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12. B Vitamins
B1: RDA for pregnant women is +0.2 mg/day
B2: RDA for pregnant women is +0.2 mg/day
B3: RDA for pregnant women is 2 mg/day
B6: RDA for pregnant women is 2.5 mg/day
B12: RDA for pregnant women is 2.6 micro gram per day
Vitamin C: RDA is 60 mg/day
Folate: In preconception and early pregnancy 400 micro gram per day is
recommended
Iron: RDA is 27 mg/day
Magnesium: Most prenatal vitamins contains only 10% to 25% of the RDA for
magnesium
Nutritional Requirement During
Pregnancy
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13. Importance of good nutrition during
pregnancy
 Mother has to nurture the fetus, health of the newborn depends on
nutritional status of the mother during and prior to conception.
 A well nourish woman prior to conception enters pregnancy with reserve
of several nutrients that meets the needs of the growing fetus without
affecting her own health.
 A well-nourished woman suffers fewer complication during pregnancy
and there are few chances of premature births.
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14.  A well-nourished mother will give birth to a healthy child. Maternal
diet during pregnancy has a direct influence on fetal growth, size
and health of the newborn.
 Poor nutrition during pregnancy increases the risk of complications
such as prolonged labor and even death.
 Inadequate diet during pregnancy affects the health of the baby
during early infancy. If the infants survive they develop nutritional
disease like anemia, rickets etc. on suffer from infectious diseases
due to lack of good immunity.
Importance of good nutrition during
pregnancy
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15. During pregnancy the nutrient needs
increases
 To develop maternal organs such as uterus, placenta and breast
tissues.
 To build up body reserves to be utilized at the time of delivery and
lactation.
 First trimester: During 1st trimester, there is no significant increase in
the size of the fetus thus only quantitative improvement in nutrients
intake is required during this time.
 2nd and 3rd trimester: An increased nutrient intake is suggested in 2nd
and 3rd trimester and pregnancy thus need for almost all the nutrient is
increased during pregnancy. 15

16. Consequences of Maternal nutrition &
pregnancy outcome
 Pregnant women who receive inadequate nutrient experience greater
maternal morbidity and have a higher risk of poor pregnancy
outcome (e.g. premature birth, miscarriage).
 Malnutrition is highly prevalent in low-income and middle-income
countries resulting in substantial increases in mortality and overall
disease burden.
 Poor maternal nutrition intake alter the preconception period
during pregnancy can also negatively impact fetal genetic growth
trajectory and can result in fetal growth restriction.
 The effect of maternal protein restriction during pregnancy on fetal
development that increase the risk of cardio muscular disease.
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17. Effect of Maternal Malnutrition on Fetal
Outcome
 The possible harmful effect observed in experimental animals is a
deficit in brain growth associated with maternal malnutrition.
 It has also been observe that the lower the birth weight of term
infants the greater deficit in mental capacity.
 In general birth weight as a reflection of intra-uterine growth.
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18. Supplementation
Iron and folic acid are the major supplement during pregnancy.
Iron: During pregnancy iron is essential for fetal growth. Having
anemia can cause a baby to be born too small or too early. One should
start taking a low dose iron supplement when became first prenatal
appointment.
Folic acid: Folic acid is important for pregnancy, as it can help to
prevent birth defects known as neural tube defects, including spina
bifida.
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19. THANKS
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Mohammad Hasan Chowdhury
Dept. of Food Technology & Nutrition Science
Noakhali Science & Technology University
Noakhali-3814, Bangladesh.