1.
Nutrition for pregnancy

2.
Eating Right During Pregnancy
• 40 weeks of pregnancy are a magical time.
• Keeping a healthy lifestyle throughout pregnancy,
as well as before and after
• Important steps to a healthy pregnancy include
– Eating a balanced diet;
– Gaining the right amount of weight;
– Enjoying light regular physical activity;
– Taking a vitamin and mineral supplement if
recommended by a physician;
– Avoiding alcohol, tobacco and other harmful
substances.

3.
Unhealthy eating trends
• Irregular meal time (skip main meal)
• Craving for sweet snack or drinks
• High fat food intake (fried foods and
processed foods)
• Imbalance meal

4.
• Sugary foods and beverages

5.
• Fat (fried foods or processed foods)

6.
Optimal weight gain during pregnancy
BMI before
pregnancy
Ideal weight gain Rate of weight gain
after 1st trimester
Underweight
(BMI <18.5)
12.5 – 18kg ~0.5kg/week
Normal
(BMI 18.5 – 24.9)
11.5 – 16kg ~0.4kg/week
Overweight
(BMI >25)
7 – 11.5kg ~0.3kg/week
Obesity
(BMI >30)
< 7.0kg ~0.3kg/week
IOM, 1990

7.
The First Trimester
• A time of rapid cell division, organ
development, and preparation for the
demands of rapid fetal growth that occur
during 2nd and 3rd trimester
• Critical nutrients during this phase include:
–Protein
–Folic acid
–Vitamin B12
–Zinc
King JC. Physiology of pregnancy and nutrient metabolism. Am J Clin Nutr 2000;71:1218S-1215S.

8.
The 2nd and 3rd Trimesters
• Energy intake is especially important since 90% of
fetal growth occurs during the last half of gestation.
• Critical nutrients during this phase include:
– Protein
– Iron
– Calcium
– Magnesium
– B vitamins
– Omega-3 fatty acid, docosahexaenoic acid (DHA)
King JC. Physiology of pregnancy and nutrient metabolism. Am J Clin Nutr 2000;71:1218S-1215S.
Kline DA. Macronutrient requirements during pregnancy. Today’s Dietitian Jan 2004:20-24.

9.
Energy Requirements
During Pregnancy
• Additional Energy Needs for Normal Weight
Women:1
– 2nd trimester + 360 kilocalories
– 3rd trimester + 470 kilocalories
– Lactation + 500 kilocalories RNI 2005
• Different Energy requirement for differences in age,
body size, pre-pregnancy weight and lifestyles.1
1. Butte NF, Wong WW, Treuth MS, Ellis KJ, Smith EO. Energy requirements during pregnancy based
on total energy expenditure and energy deposition. Am J Clin Nutr 2004;79:1078-1087.

10.
An Additional 300
Calories Isn’t Much!
• A more healthy food choices are:
1. Steam fish (240 Kcal) + fruit (1 slice) (60 Kcal)
2. Egg Sandwich (185 Kcal) + Milk (125 Kcal)

11.
Regular meal time to get
balance and complete nutrients

12.
My Plate Method

13.
CARBOHYDRATE
RNI for
pregnancy
50 – 60 %
Function Main energy supply
Promotes weight gain of the fetus,
placenta and other maternal tissues
Dietary
Sources
Rice, Noodles, Whole grain breads and
cereals (starch), milk , fruit, starchy
vegetables
Precaution Limit refined sugar intake (sweet
beverages and foods) that can increase
risk of gestational diabetes mellitus

14.
PROTEIN
RNI 15 – 20 % Pregnancy: 55 g +7.5 =62.5 g protein
Lactation : 1st 6 mths 55g + 20 g
2nd 6 mths 55g + 15 g
Function For growth an maintenance of tissue
and overall metabolism
Greatest need is in 3rd trimester
Dietary Sources Meat, poultry, fish and eggs
Milk
For vegetarian: Soybase milk and soy
products, beans, nuts and legumes
Precaution Commercial protein supplements are
not recommended

15.
1 piece
drumstick
2 piece chicken
breast
2 match box
lean meat
2 pieces
tempe
1 fish
( 6inches)
2 match box
fish
2 medium
eggs (hen)
1 ½ piece
tauhu
PROTEIN : 14 g/ serving
(2 – 4 serving/ day)

16.
Milk & Dairy products: 7 g PROTEIN
1 glass milk
(250ml)
4 rounded tablespoon
powdered milk
¾ cup yogurt 2 thin slices cheese

17.
Example: 60-65g protein
Breakfast @
7- 8 am
Morning Tea
@ 10 am
Lunch @
1 pm
Afternoon
snack @
4pm
Dinner @
7 pm
Supper @
9.30pm

18.
Healthy choices:
ENCOURAGE
Take fish twice in a week
Take more beans and soy products (tofu, tempeh or dhall)
Priority fresh foods
Use natural spices, herbs and less seasonings in cooking
REDUCE
Red meat intake (beef/ pork)
Processed foods intake (sausage, nugget, canned foods)
Preserved foods (salted fish, salted eggs, pickled vegetables)
and junk foods (chips/ keropok)

19.
FAT
RNI for
pregnancy
20-30%
2nd trimester: 54- 82g/ day
3rd trimester: 57 – 85g/ day
Saturated fat < 10%
Monounsaturated fat 12 – 15 %
Polyunsaturated fat 5 – 7 %
Function
(energy)
Fat deposits in the fetus increase from 2%
at mid-pregnancy to almost 12% at term
Precaution More completely absorbed during
pregnancy causing marked increase in
serum lipids, and cholesterol

20.
FAT: Omega-3 (PUFA)
• Important for fetal’s brain and eye development
• Encourage take at least 8 to 12 ounces (240 to
360g) each week
• Good sources of Omega-3 fatty acids as following:
– Flaxseed oil (50 -60 % ALA)
– Canola oil, rapeseed oil (11% ALA)
– Soybean oil
– Deep sea colded fish (DHA+ EPA)
– Omega 3 enriched eggs( EPA + DHA)
– Fish oil (cod liver oil) EPA+ DHA
– Pulses (beans, dhall), nuts/ seeds (walnut, linseed)
American Dietetic Association

21.
Healthy fat choice:
• Choose healthy fat (vegetables oil and fish)
• Reduce fried foods intake, fatty foods, high in
saturated fat and cholesterol (internal organs,
skin of chicken, egg yolk, seafood)
• Reduce trans fat food sources (cake, fast foods
or creamy biscuit)

22.
Avoid empty calories food choices
• “Empty calories” means high-energy foods with
little nutritional value
• Example:
– Added sugars (soft drinks, desserts, sweet sugary
beverages or foods)
– Solid fats (Fried foods, cheese, whole milk, and fatty
meats)
• Look for choices that are low-fat, fat-free,
unsweetened, or with no added-sugars. They
have fewer or no "empty calories.“

23.
Kuih
Limit Healthy choice
POPIAH
BASAH
APAM
TANPA
KELAPA
SANDWICH
POPIA GORENG
KUIH MANIS/ BERSANTAN
KARIPAP

24.
Air
Limit Healthy choice

25.
Vitamin and Minerals that
necessary for pregnant women

26.
IRON
RDA for
pregnancy
27 mg/day
Function Carry oxygen to cells development
and for infants iron storage
Inadequate
intake
Anemia (Pale face, tired)
Measure through Hemoglobin level <
10.4 g/dl
Diet alone Not sufficient
Recommended Prenatal Supplements contain 27 mg
Excessive Constipation

27.
Heme iron and non heme iron
Heme iron (25 %
absorption)
Non Heme iron (< 25 %
absorption)
Fish / Seafood Dark green leafy
vegetables
(Spinach and Kangkung)
Meat (Beef/ Lamb/
Pork)
Legumes (Bean, dried
fruits and Seed)
Poultry Eggs

28.
Factors affect iron bioavaibility
Enhancer Inhibitor
Ascorbic acid
(vitamin C)
Phytates (wholegrain, legumes,
nuts and seed, soy protein)
Organic acids (citric acid,
lactic acid, stomach acid)
Phosphates (snack foods,
processed meats and cola drinks)
Heme iron (meat, poultry, fish
and other seafood)
Iron binding polyphenols
Fermented vegetables and
soy sauces
Calcium, caffeine, tannic acid
(tea)
EDTA (food addictives)
Oxalates (beets, nuts, chocolate)
FAO/WHO, 2002, RNI 2005
Take meat, poultry or fish together with
VEGETABLES AND FRUITS,
avoid together with COFFEE, TEA, SOFT
DRINKS OR MILK

29.
Dietary Sources of Iron DRI 15-30 mg/day
Food item Serving sie Food item Serving sie
Excellent > 4 mg Good 2- 4 mg
Beef liver 90 g Beef 90 g
Clams ½ cup Egg yolks 3 whole
Kidney beans 1 cup Lamb 90 g
Dried peaches 10 halves Oyster 90 g
Sunflower
seeds (dried)
2/3 cup Peas 1 cup
Raisins 2/3 cup

30.
Vitamin C
RNI pregnancy
RNI lactation
80 mg /day
95 mg/day
Function Aids in formulation of connective
tissue and vascular functioning
Enhance iron absorption
Recommended Supplements should take together
with iron supplements
Dietary
Sources
Vegetables and fruits (Citrus,
tomatoes, strawberries, potatoes,
broccoli, leafy greens)

31.
FOLIC ACID/ FOLATE
RNI / CDC 600 mcg (pregnancy)
500 mcg (lactation)
Function Vitamin B (water soluble) for synthesis
nucleotide and cells division to prevent
serious birth defects
Inadequate
intake
Neural tube defects - cleft lip and congenital
heart disease
Diet alone Not sufficient due to low bioavailability
Need take fortified folate foods
Recommended Important for any women who prepare to
pregnant and during pregnant period
Prenatal supplements contain up to 600
micrograms
CDC (Center for disease control)

32.
Food item Serving
size
Food item Serving
size
Excellent > 100 ug
Asparagus/ Spinach ½ cup Kidney beans/
peanuts
1 cup
(120g)
Baked beans/
Black eye peas
1 cup Lentils 1 cup
Fortified grain and
cereal products
depend
label
Beef/chicken 105 g
Good 15-99 ug
Broccoli/cauliflower ½ cup Orange 1
medium
Dietary Sources of Folate DRI 500-600 ug/day
Complete your meal with vegetables
and fruits (3 main meal)

33.
CALCIUM
RNI 1000 mg/day
Function Involved in mineralization of bones and teeth,
energy and cell production
Fetal bone and teeth calcification primarily
occurs in last trimester of pregnancy
Inadequate
intake
Demineralization of mothers bones and teeth
may occur
Recommended Calcium supplementation is recommended
for those diet deficient in calcium
(<900mg/day), adolescent, have
prepregnancy hypertension, history of
preeclampsia (IOM, 1991)
Institute of Medicine, Subcommirrww on Nutrition and Lactation, 1991

34.
Dietary Sources of Calcium DRI 1000-1300 mg/day
Food item Serving size
Good > 200 mg
Milk 1 cup (250 ml)
Yogurt 240 ml
Cheese (cheddar, parmesan, mozzarella) 30 g
Ice cream 1 cup
Canned salmon/ tuna with bones/ anchovies 90 g
Calcium fortified foods (juice, cereal) Depend label
Broccoli/ Chinese kale (Kailan)/ Spinach 2 cups
Tofu (+ calcium sulfate)/tempeh(fermented soybeans)
Soybeans, black eyed peas (cow peas), and white beans

35.
Factors affecting calcium absorption
Enhancer Calcium chelators from plants
sources (Bind to calcium, reduce
absorption)
Recommended vitamin D is
similar non pregnant to 5
ug/day(RNI 2005)
Phytate (wholegrain, legumes,
nuts and seed, soy protein)
Stomach acid Phosphates (snack foods,
processed meats and cola drinks)
Lactose Iron
Growth hormone Oxalate
Tannic acid (tea)
Sodium (competes with calcium
reabsorption in renal)RNI 2005
Reduce snack/ junk foods, processed
meats and cola drinks

36.
Caffeine intake
Moderate intake
(< 300 mg/day)
2 to 3 servings consumption not
linked to adverse effects on
pregnancy
High intake
(> 500 mg/day)
6 to 18 servings consumption is inked
to increase rsk 2.2x of first trimester
spontaneous abortions (Goldenberg, R. et al 1995)
Side effects Decrease bioavailability of iron,
calcium and zinc
Precaution Caffeine does pass into breast milk,
consumption during lactation should
be limited

37.
Caffeinated beverages
Type of Caffeinated
beverages (150 ml)
Caffeine
Coffee 115 mg
Iced Tea 40 mg
Cola 15 mg
Hot chocolate 4 mg

38.
ZINC
RNI for pregnancy (Requirement increases due to accrual of fetal
and maternal tissues)
Function Synthesis of nucleic acids DNA and RNA and
important in reproduction
Inadequate intake Few case reports severe human zinc deficiency in
pregnancy led to major obstetric complication
and congenital malformation in fetus
Diet Vegetarians may need more zinc
Recommended Zinc supplementation is recommended when
iron supplementation > 30 mg/day (IOM, 1991)
as large amount iron supplement decrease zinc
1st trimester 5.5 mg 3rd trimester 10 mg
2nd trimester 7 mg Lactation 9.5 mg

39.
Dietary Sources of Zinc DRI 15-19 mg/day
Food item Serving size Mg/ serving
Excellent > 4 mg
Beef (lean, cooked) 90 g 5.1
Lamb (lean, cooked) 90 g 4
Oyster/ shellfish 90 g 6.3
Good 0.9- 3.4 mg
Black-eye peas (cooked) ½ cup 3.4
Chicken 90 g 2.4
Green peas (cooked) ½ cup 0.9
Milk 1 cup (250 ml) 0.9
Yogurt 1 cup (250 ml) 1.1

40.
IODINE
• Iodine requirement increased
– To provide the needs of the fetus
– To compensate for the increased loss of iodine
in the urine due to increased renal clearance
– To prevent hypothyroidism of mother and
fetus during pregnancy (risk of brain damage)
• 3.5 ug/kg/day or 200 ug/day
• Food sources: Seaweed, fish, eggs, meat, milk,
dried legumes, dried vegetables and fruits.
FAO/WHO, 2002

41.
VITAMIN A
• Vitamin A- most pregnant women do not need
supplemental vitamin A
• Essential for embryogenesis, growth and
epithelial differentiation
• High doses (> 25,000 IU/ 3000 ug/day Retinol)
might relate with birth defects (fetal toxicity)

42.
REMINDER
• Don't rely on supplements to make up for an
unhealthy diet.
• Vitamin and mineral supplements cannot replace
a healthy diet.
• Most pregnant women are recommend to take
a prenatal vitamin and mineral supplement every
day in addition to eating a healthy diet.
• Taking a supplement ensures that you and your
baby get enough important nutrients like folic
acid and iron. But don't overdo it. Taking extra
can be harmful for you and your baby.

43.
Complications of Pregnancy that may
Impact Nutritional Status
• Nausea and Vomiting
• Constipation
• Food safety -food borne illness (high risk
getting sick from eating unsafe food)
– Pregnant mother have low ability to fight off
infection.
– Unborn baby's immune system is not fully
developed
– Increase risk of miscarriage or premature delivery

44.
Nausea and vomiting
• Small and frequent meal
• Eat dry/cold foods
• Add ginger into meal
• Sniff lemon
• Suck on candy
• Supplement with vitamin B6 (25 mg, 3x/day)
• Avoid spicy, acidic foods and strong odors
• Low fat diet
• Avoid caffeine
• Drink plenty of fluids to avoid dehydration

45.
Food to avoid
• Raw or unpasteurized milk
• Raw or partially cooked eggs
• Undercooked meat and poultry
• Raw or undercooked fish or shellfish
• Mercury can harm the developing nervous
system in an unborn child or young baby.
– Choices that are lower in mercury include salmon,
tilapia, trout, pollock, and catfish.
– Avoid eat fish high in mercury like shark,
swordfish, tilefish, and King mackerel.

46.
Constipation
• Foods high in dietary fiber, including cereals,
bread, fruits and vegetables
• Choose high fiber snacks such as wholegrain
bread/ biscuits or fruits rather than sweets,
creamy biscuits or cake
• Adequate fluids

47.
CONCLUSION
• Pregnant mother are encourage to get a balance diet
to ensure sufficient nutrients for fetal growth and
development.
• Those extra nutrients that essential included extra
energy, protein (iron, zinc), healthy fat (omega-3 fatty
acids), variety vegetables and fruits (folate, vitamin B,
vitamin C) milk (calcium) and adequate fluid intake
• Reduce unhealthy food choices such as high refined
sugar beverage/ foods (empty nutrients dense calorie),
high saturated fat (deep-fried foods, coconut milk) and
salty foods (processed, preserved and canned foods)

48.
Example of one day MENU
(1800 kcal/hari)
• BREAKFAST
Roti Bijirin Penuh 3 keping
Marjerin 1 sudu teh
Atau Oat 9 sudu makan
Atau Bubur nasi 3 cawan
Atau Capati (kecil) 1 ½ keping
Atau Mee/bihun 1 chinese bowl
susu tepung (tanpa gula) 2 sudu makan

49.
• LUNCH AND DINNER
Nasi 1 chinese bowl
Ikan/ayam/daging 1 hidangan
Sayur 2 hidangan
Buah-buahan 1 hidangan
Minuman (tanpa gula)

50.
• Minum Pagi/ Minum Petang / Minum Malam
Crackers 3 keping
Atau Popiah Basah 2 ketul
Atau Kacang Kuda Rebus ½ cawan
Susu Tepung 2 sudu makan

51.
My Plate Method

52.
REFERENCES
• Malaysia Dietary Guidelines, 2010
• Institute of Medicine, Subcommirrww on Nutrition and Lactation. National
Academy Press, Washington, DC, 1991
• Goldenberg, R., Tamura, T., and Neggers, Y., et al. JAMA 274:4631, 1995.
• Recommended Nutrients Intake (RNI), 2005
• Judith E.Brown. Nutrtion thoughout the life cycle, second edition, 2005
• FAO/WHO (2002). Iron. In: Human vitamin and mineral requirements.
Report of Joint FAO/WHO Expert Consultation. FAO, Rome; pp195 – 221.
• Position of the American Dietetic Association: Nutrition and lifestyle for a
healthy pregnancy outcome. J Am Diet Assoc 2002;102(10):1479-1490.
• King JC. Physiology of pregnancy and nutrient metabolism. Am J Clin Nutr
2000;71:1218S-1225S
• Whittaker P. Iron and zinc interactions in humans. Am J Clin Nutr
1998;68:442S-6S.