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Pregnancy
 Pregnancy is a normal physiological process, “an
integrated maternal-cum-fetal system”
undergoing progressive change
 In order that the growth of the product of
conception may be safeguarded even under
conditions of environment stress, change in
ordinary physiological functions is not merely
normal, but necessary
 Critical periods that deverse special attention to
achieves & maintain optimum health
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 A person’s nutritional state can profoundly affect
ultimate height, age of sexual maturation, ability
to conceive & for a woman, the success of
childbearing, the length of time between
conceptions & the age of menopause

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Perhatian khusus
 Defisiensi gizi selama kehamilan dapat berefek
merugikan bagi ibu & janin
 BB ibu sebelum hamil dan kenaikan selama
kehamilan sangat mempengaruhi hasil kehamilan
tsb
 Studi eksperimental hewan (rat), diduga bahwa
inadekuat nutrisi maternal selama kehamilan
menyebabkan kelambatan pertumbuhan in utero &
mengganggu perkembangan otak fetal

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 Retardasi pertumbuhan intrauterin
mengiplikasikan beberapa faktor
membatasi pertumbuhan normal selama
fullterm pregnancy

 Faktor ini mungkin terkait dengan

inkapabilitas ibu untuk suplai nutrien ke
fetus atau inabilitas plasenta fetal untuk
menarik makanan dari ibu

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 Suplai nutrien pada pertumbuhan fetus
tergantung :
 Kualitas & komposisi darah maternal sampai
plasenta
 Integritas & kapabilitas plasenta untuk
memekatkan, sintesis & transpor nutrien
esensial dari maternal ke fetal
 Variasi pertumbuhan intrauterin sebagai cermin
berat lahir terkait beberapa faktor termasuk
nutrisi maternal selama kelaparan akut, kelahiran
berulang (multiparitas), usia dan ukuran maternal
& perokok
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Diet & pregnancy
 If a woman remains healthy during pregnancy, give
birth to a healthy, fullterm baby, is capable of
satisfactory lactation and shows normal recovery, then
her diet, is nutritionally adequate
 The effects of maternal malnutritional may be both
immediate & long term
 In the most severe cases, maternal starvation or acute
under nutrition can cause a cessation of mentruation
(amenorrhea) & conception cannot occur

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 If severe malnutrition is imposed upon a previously
well-nourished woman, a reduction infant birth weigh
will result

 When the woman has been chronically malnourished

for some time before the periode starvation, the results
will be increase in spontaneous abortions, stillbirths,
prematurity & LBW infant & increased maternal &
infant morbidity & mortality

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Studi in animals
 The nutrition deprivation (protein & calories) during
pregnancy, adversely effects cognitive, emotional &
neurologic development of the offspring

 The earlier & more prolonged the period of

deprivation, the more profound & irreversible are
abnormalities

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Nutritional Requirements During Pregnancy
Increase in weight (g) up to : (weeks)

10 20 30 40
Fetus 5 300 1500 3300
Placenta 20 170 430 650
Amnionic fluid 30 250 600 800
Uterus 135 585 810 900
Mammay glands 34 180 360 405
Maternal blood 100 600 1300 1250
No accounted 326 1915 3500 5195
for
Observed total 650 4000 8500 12500
gain

Heyten, FE & Leith, I., (1964)

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Energy needs & Weight gain
 An adequate intake of energy during pregnancy is
critical to meet the extra demands for
 The formation of new tissues in the mother & fetus
 The elevation of metabolism incurred by increaments of
new tissues
 Moving additional body mass associated with physical
activity

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 In early phase pregnancy, the weight increament of the
various component are minimal
 At 20 weeks of gestation, most of the gain reflects
increases in maternal component
 In the final phase, the predominant gain involves the
fetal compartment
 At 40 weeks, approximately 1 kg of the unexplained
gain of about 5 kg may be water & the rest is assumed
to be fat. These extra fat deposits may serve to
subsidize lactation

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If the pregnant woman is slighly overweigh (obese), weight
gain must be carefully monitored by adjusting both intake
& expenditure of energy
 Underweight woman who become pregnant also
need careful nutritional guidance to achieve
satisfactory weight gain

 The size of baby is affected both by the mother’s

weight gain during pregnancy & by her pregravid
weight

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 It has been found :
 The average weight of the baby born to a woman
who gains < 4,5 kg during pregnancy will weight
about 0,45 kg less than a baby born to a woman
gains 18,0 kg
 Short women give birth to babies who are about 8%
lighter than those of all women
 Underweight women give birth to babies who are
about 8% lighter than those of overweight women
 Women who are both short & light give birth to
babies who are about 14% lighter than those of all &
heavy women

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 Nutritional Risk Factors
 1. Before pregnancy
 These factors can & do influence the course &
outcome of her pregancy as well as her ability to
handle the physical & emotional demands of
motherhood
 Nutritional & health habits

 Emotional, psychological, educational

maturity &
 Experience

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– Kekurangan BB sbl hamil
• Cenderung melahirkan lebih cepat (prematur)
• BBLR (resiko tinggi kelangsungan hidup)

– Kelebihan BB sbl hamil

• Lebih mungkin mendapat hipertensi & diabetes

• AKA tertinggi pd ibu dg BB > 77,3 kg

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 1.a. Adolescence/age
 A pregnant woman 18 years of age or younger is
often termed a Juvenile gravida, she is at
nutritional risk by virtue of her age
 Chronological age is not as important as her
reproductive biological age (chronological age
minus age of menarche)
 Female with a reproductive age less than 3 years
at particular risk for reproductive problems

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 The risk of infant death is twice as high for
teenage mother as for those in their twenties
 Mother age 15 & younger are twice as likely to
have LBW babies
 During this time, the woman is still growing
herself & pregnancy imposes additional
nutritional demands

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 1.b. deviation in Pregravid Weight
 The 2 best predictors of infant birth weight are the
maternal pregravid weight & the amount of weight
gained during gestation
 Underweight (10% or more below ideal weight for
height) & overweight (20% or more above ideal
weight for height) women are at special risk during
pregnancy
 Despite normal :
 Weight gain, some degree of intrauterine growth
retardation is often seen in the infants of these women

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 For underweight woman, a large proportion of the
gained during gestation is diverted to correct her
own weight deficit
 The obese woman requires a large provision of
calories just for her own metabolic maintenance
 In both instances, less nutrients are available for
developing fetus, resulting in less than optimal
intrauterine growth
 It is best to begin pregnancy within the normal
weight range

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 1.c. Obstetric & medical history
 The total number of pregnancies is important,
since high parity (number of pregnancies)
carries the risk of depletion of maternal store,
especially with interconception intervals of less
than 1 year
 The outcome of previous pregnancies &
complications in the infants are also important,
because many problems related to maternal
nutrition will manifest themselves in condition
of the infant
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Withdrawal symptons may result from maternal drug
use, fetal alcohol syndrome from maternal alcoholism
 Stillbirth or infants greater than 9 lb may be
related to undiagnosed or uncontrolled
maternal diabetes
 Prematurity or intrauterine growth retardation
can result from poor maternal nutrition or
anemia
 A history of such complications in previous
pregnancies indicates the need from preventive
measure during present pregnancy
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 The maternal course & complications may be
caused or influenced by inadequate meternal
nutrition

 Some of these complications include premature

labor & birth, preeclampsia, anemia,
hemorraghe, postpartum infections & poor
wound healing

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 1.d. life style & habits
 The excessive use alcohol, cigarettes & even
coffee (& other coffeine containing foods) has
been shown to have an adverse effect on the
growth & development of unborn child

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 2. during pregnancy
– Kenaikan BB tidak adekuat
• BB normal/kurang, kenaikan selama hamil
berhubungan langsung dengan BB bayi
• Kenaikan ≤ 1 kg/bl pada TM 2/3 BB normal &
≤ 0,5 kg obesitas perlu diselidiki
• Inadequate weight gain (<20-25 lb) & excessive
weight gain (>35 lb) have both been associated
with increased fetal & maternal complications &
taxemia with are hypertensive disease of
pregnancy

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• Weight reduction should never be attempted
during pregnancy because of potential adverse
effects on fetal growth & development
• Morning sickness, excessive vomiting, usually
seen during early pregnancy but may continue
until delivery, is though to be related to rising
hormone level & may cause weight loss
• If the vomiting is severe enough to cause ketosis,
intravenous feedings may be necessary

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- Kenaikan BB berlebihan
 Kenaikan ≥3 kg/bulan akibat makan berlebih,
depot cairan & mungkin kehamilan menginduksi
hipertensi & kehamilan kembar
 Tinggi badan (pendek < 157 cm)  resiko
disproporsi fetopelvis, seksio sesar, trauma
kelahiran & kematian bayi.
 Kelebihan lemak tubuh  cenderung
menetap  obesitas

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RDA 1989, selama TM 2-3 konsumsi 300 kkal/hari lebih
dari sebelum hamil  kenaikan BB adekuat
 Protein
 Total protein 60 g/hari  pertumbuhan normal
janin, pembesaran uterus & payudara,
pembentukan sel darah & produksi cairan
amnion
 Zat besi
 Massa sel darah merah mengembang 15%
selama kehamilan  perlu kenaikan substansi
Fe ibu & deposisi simpanan bayi
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 Seng
 Absorpsi Zn dihambat dg masuknya Fe & asam folat
dlm jumlah besar  perlu konsumsi makanan kaya Zn
(daging) setiap hari
 Fitat & oksalat (buah/biji padi-an, sayur) menghambat
absorpsi Zn
 Kalsium
 Kebutuhan meningkat per hari pada kalsifikasi fetalis,
RDA wamil 1200 mg
 Asam folat
 RDA 180 ug tak hamil  400 ug pada kehamilan 
produksi sel darah merah, sintesis DNA janin &
pertumbuhan plasenta
 Defisiensi asam folat  kelainan neural tube

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Potensi toksin
 Kafein
 Efek terhadap janin tak diketahui pasti
 Konsumsi berat  kenaikan bayi mati, abortus
spontan & persalinan prematur

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 Alkohol
 Peminum berat  sindroma fetal alkohol
(mikrosefalus, kegagalan pertumbuhan sebelum
& sesudah persalinan, retardasi mental,
abnormalitas okular, celah palatum, kelainan
sendi tulang/jantung)
 Peminum sedang  beberapa sindroma fetal
alkohol
 Tak diketahui batas aman asupan alkohol saat
hamil

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 Alkohol
 Peminum berat  sindroma fetal alkohol
(mikrosefalus, kegagalan pertumbuhan sebelum
& sesudah persalinan, retardasi mental,
abnormalitas okular, celah palatum, kelainan
sendi tulang/jantung)
 Peminum sedang  beberapa sindroma fetal
alkohol
 Tak diketahui batas aman asupan alkohol saat
hamil

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 Merokok
 BB Bayi lahir < non perokok
 Resiko tinggi prematur, mortalitas perinatal &
kemungkinan abortus spontan
 Meningkatkan kecepatan metabolisme &
kebutuhan kalori
 Kenaikan BB/BB pra hamil < non perokok
 Penurunan kadar zat gizi (vit c, asam folat, Zn &
Fe)

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 Penggunaan obat terlarang
 Meningkatnya resiko retardasi pertumbuhan
intrauterin (IUGR) & persalinan preterm
(marihuana/ganja)
 Resiko erupsio plasenta (kokain)
 Abnormalitas pengetahuan & tingkah laku
menetap (crack cocaine)

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Komplikasi kehamilan dengan implikasi
gizi
 Mual muntah
 Jarang berlangsung lama sering tak ganggu
status gizi
 Hiperemesis gravidarum  kehilangan cairan,
elektrolit & menghambat asupan seluruh gizi
lain

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 Konstipasi
 Terjadi penurunan motilitas GI, karena
meningkatkan kadar progesteron
 Meningkatnya tekanan pada saluran cerna, krn
membesarnya uterus & menurunnya aktivitas
fisik

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 Hipertensi yang diinduksi kehamilan
(preeklamsia/toksemia)
 Ditandai hipertensi, albuminuria dan edema
yang berlebihan terutama TM-3

 Makanan cukup protein, kalori, Ca & Na

dihubungkan dengan rendahnya insidens

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 Diabetes
 Wanita dengan diabetes/intoleran terhadap
glukosa atau diabetes gestasional, kebutuhan
insulin turun saat awal kehamilan, tapi naik
TM-2 & tetap tinggi sampai persalinan
 Kontrol kadar gula darah yang buruk
meningkatkan jumlah malformasi kongenital &
kematian janin
 Penting kontrol kadar gula sebelum hamil
cegah resiko preeklamsia & malformasi janin

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Penatalaksanaan gizi kehamilan
 1. Pendidikan & intervensi pasien
 Tujuan :
 Mengenal atau mengubah kebiasaan atau
temuan yang dapat mengganggu status gizi &
hasil kehamilan yang optimal
 Menetapkan sasaran kenaikan BB dengan batas
yang dianjurkan & kenaikan BB sesuai harapan
 Mempersiapkan mental terhadap perubahan
fisiologis yang dapat mengganggu masuknya
makanan bergizi
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 2. Memilih makanan seimbang
 Wanita sehat, kebutuhan zat bergizi dipenuhi
dari makanan normal yang bervariasi (piramida
pedoman makanan), kecuali zat besi

 Bila makanan buruk dan sedikit menunjukkan

perbaikan atau bila ada faktor resiko, diperlukan
suplemen vitamin dan mineral

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 A. Kilokalori
 Diperlukan ekstra 300 kkal, dengan menambah
2 gelas susu setiap hari dan kenaikan jumlah
kecil makanan mengandung protein, buah atau
sayuran
 Bila aktivitas turun, kebutuhan kalori turun
 Wamil perlu rencana olah raga 3 -4 x seminggu,
tidak > 35 menit
 Hindari denyut > 140/menit, kepanasan

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 B. Protein
 Ekstra protein 1 gelas susu & 28,3 g daging per
hari
 Masukan protein lebih dari dianjurkan  tidak
manfaat

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 C. Mineral dan vitamin
 Fe
 Suplemen 30 mg(150 mg fero sulfat)/hari TM2-3

 Absorpsi maksimal diantara makan/waktu tidur,

tanpa susu, kopi atau teh
 Konsumsi makanan (daging), vit c

 Zn
 Kerang, daging merah, ayam, telur, ikan susu, keju,
polong-polongan & biji padian
 Ca
 Susu, buttermilk & keju

 Intolerans laktose pakai susu dengan laktase (lacta-

aid/laktrase)
 Asam folat, vit C dan vit D 43
Suplemen multivitamin dan multimineral bila ada resiko
tak lazim
 Suplemen setiap hari terutama wamil dengan
konsumsi makanan buruk atau resiko tinggi
 Diberikan diantara waktu makan atau sebelum tidur
 Suplemen tak akan mencegah komplikasi akibat
alkohol, rokok & penyalahgunaan obat

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 3. Hindari/batasi agen yang membahayakan janin
 Batasi kafein (mak 300 mg/hari)
 Pantang alkohol (sedikit dan sejarang mungkin)
 Merokok & penggunaan obat terlarang sangat
merugikan janin
 Aspartam meski tak ada efek merugikan tapi dihindari
wamil homozigot karena fenilketon urea
 Sakarin tidak menunjukkan aman bagi wamil

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 Penggunaan pengukuran gizi untuk
mengatasi perasaan tak enak
 1. Mual muntah
 Porsi kecil & sering, lapar perburuk mual
 Hindari cairan 1-2 jam sebelum/setelah makan
 Makan makanan tak berlemak & terbuat dari tepung 
mudah dicerna, tak iritatif
 Hindari makanan berempah & pedas, makanan
berlemak (lemak menunda pengosongan lambung,
meningkatkan mual)
 Kurangi kontak makanan berbau keras, merangsang

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 2. Hiperemesis gravidarum
 Perlu rawat inap dengan cairan iv untuk rehidrasi
 Gizi parenteral perifer (glukosa, asam amino, vitamin,
elektrolit) digunakan awal perawatan
 Makanan oral dengan porsi kecil & rendah lemak,
tepung-tepungan yang mudah dicerna, ayam tanpa
kulit, daging tak berlemak
 Bila parah perlu gizi parenteral secara total (Total
parenteral nutrition, TPN)

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 3. Konstipasi
 Naikkan makanan berserat tinggi (bijian, polongan,
buah, sayuran segar)
 Minimal 50 ml/kg/hari untuk membantu konstipasi
 Olah raga teratur membantu fungsi pencernaan

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 Penggunaan pengukuran gizi untuk membantu
mengontrol hipertensi yang diinduksi oleh
kehamilan dan diabetes
 Hipertensi yang diinduksi kehamilan
 Batasi Natrium 2-3 g/hari
 Diet rendah garam
 Hindari garam & makanan asin (keripik, kue asin),
daging, ayam yang diasap/dikaleng , bumbu masak,
sayur kalengan
 Buah segar, sayuran segar tanpa garam dan daging,
ikan, ayam belum diproses merupakan makanan
rendah garam
 Diabetes
 Pengontrolan gula darah ketat
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