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Abstract
from the nutritional point of view ttd nins ~ont~a 01
pregnancy, although physiologically normal, rnuat be consider•;d
a period of stress during which the nutrient demands of the
developing fetus are superimposed on those for normal maintenance
of e adult woman.
!he pregnant wmr.an experiences a series of physiological
adaptation t improved uti~ization of nutrients
either tnrou , decreased excreation. or
alterac~ons in mei:.auuJ.J.om. en addition, che mot’:ler who has
been well
a reserve of
growing fetus v:ithout
conception enters pregnancy with
a:an ~~teat -the neefd of th”’
• ( Guthrie.l983)
Physiological change that happen pregnancy.
Pregnancy from the physiological point of view can be
di’iided into three main phases, each with fie ·nutrient needs.
1- Implantation:
·rhe first two weeks of gestation is a period during
which the fertilized ovum oecomes embedded in the wall of the
uterus. Ac this time the fetus is nourished fror:, the outer
layers of LI:.e germ plasm and from the secreti_on of uterine
glands, know1. as uterine oilk. (Guthrie,1983)Organoge~esis:
rhe next six ·,~eeks are known ~s c~·.e p-eri-od of orgar_,_Dg-E<!8Sis,
wheL the de>”eloping fetal tissue known as the embryo, undergdes
differentiation into ’ful’lCt·ional cunte. DUri!lgc.th:la period,
nourishment is obtained from the ’blood and degenerating cells
in the space between the em·oryo and· mat&rnal tiss:u.a. The
beginning of the individual organ and the various aspects of
skeleta: for~ation are established. The presence or absence of
specifit :mtrients n:ay be very important for the ::ontinued
e;rowth of a nor~1al fetus. (Guthrie.l933)
3- Growtn:
·s:he remaining seven :nontha· of pregnancy are known ”!S
growth period. During :h’cs tiree the jifferentiated tissues
continue to grov: until they reach a functioal size capable
of supporting extrauterine life, The needs for nutrien’ts at
this time are high DOt.h quantitatively and qualitatively.
A deficiency will usually result only in a premature or
smaller infant, rather than in the serious deficiency symptomsobserved as a result of a dietary laDk during organogenesis.
(Guthrie. 1983)
The placenta is the tissue to w~.ich the fetus i.s attached
ay.rr:eans of the umbilical cord, and by which the transfer
between the two circulatory systems of the li..Oth8r ’<-”.d fec.us
occurs, Jlutrients are transported to the ;·etua, and the metabolic
wastes of the fetus· are carried to the maternal circulation.
Undernourishment leads to a smaller placental size. There will
be:!ewer cells available for the transfer of nutrients and
oxygen to the fetus, thus leads to lower birth weight.
(Robinson&Lawler, 1982)
Change in blood:
During pregnancy there is a gradual increase in the volume
of intracellular and extracellular fluid which account for
several pounds of total increase in mother’s body weight.
(Robinson& Lawler, 1982)
· ·rhe maternal blood volume starts to increase during the
first trimester, expands most rapidly during the second trimester,
and then ris·es at a much slower rate during the third
trimester, attaining a plate~u during the last several weekspregnapcy. (PRichard K- H’lcdonald,l980)The increase in blood volume results. fro• an increase in
both plasma and erythrocytes. The usual pattern is. that of an
initial rise in the plasma volume, followed. by an increase in
the volume of circulating erythrocytes. The increase in the
volume of circulating erythrocytes in pregnaiJ.cy is: accomplished
by accelerated production, rather than hy prolongation of life
span of the erythrocytes.(PRichard & Macdonald,l980)The total blood volume is increased by as much aa one thi.r•i
by the end o:f pregnancy •. ’Nith -che increase in blood volume,
the concentration of serum albumin• haemoglobin and other
blood constituents are reduced. The average ha.emoglobin level
of l3.7g/l00ml blood for healthy nonpregnant woman drops to
about 12.0g/100ml blood throughout pregnancy. despite the
ingestion of supplemental Iron.(Committee on Maternal nutrition,
1970). The increasing plasma volume, however, produces an apparent
reduction in haemoglobin. This apparent reduction
continues throughout pregnancy until the last four weeks, when
there may be a slight rise. The fall in haemoglobin could be
detected by the 12th week, and the mi.nimum value is reached
at 32nd week. (Garry, e--t a-l ,1977). A l.evel of’ ll.Og haemoglobin
per lOOml blood is considered to he the border line, below
\~hich true anemia exists. (Robinson & Lawler, 1980)
Fetus weight gain:
The ,gain in weight of the fetus is not uniform. It takes
2 months to reach a weight of one gram, after 3 months it
reaches thirty gram, after 6 months it reachs one kilogram, and
at full term its weight is about three to three ,.nd half !<.:nograms.
A large part of the ;l!ain in 1•reight occurs during the
last trimester, hence accumulation of nutrients takes place
during the last 3 mohths• (Widdowson, 1982)During the last 60 years the attitude have ch:;nged !rom
the concept that the :’etus is CJ_ parasite and able to obtai[[
the nutrients which it aeeds regardless of nutritional status
of the mother, to the concept that proper nutrition of the
mother during pregna.llcy has an important: innue.t~.e:e .. on pregnancy
outcome. (Anderson, 1979)
With the onset of pregnancy, the normal physiological
processes of the body 3.re altered and a.:J,”,i tional dem.ands are
imposed on maternal organism. During the gestational periodt
the. mother and child he.ve an intimate and inseperab1e rel”’_tLmship;
this in addition to the physiological needs of the fetal
growth which show the importance of considering the d:iet of
pregnant woman with care. (Vermeersch, 1977}. ’J:he evidence now
shows that birth weight is influenced by mother’s u.terine environment
and her external environment particularl_y nu tri ti·::n.
(Jacobson, l97lb) • The nutritional he”l th of :he ccc-ther before
pr.,gnancy ·is chought to be neBrly as impoPtsn t as during pregnancy.
rhe nutri lional health of the mother 3Jld birth weight
are closely related. Birth weight has been found to ;:,e vit9clly
important in deterrdning the health of the individual throughout
his life (Wenck, et, al,l980)
The pattern of weight gain :i.a more important than the
tot.al \’Ieight gain, and the componants of weight gain are n:ore than ;;h-3 actuol Ei.L’Jlber of kilogr’9.ms that worrall puts on.
Pregnancy should be a positive period of growth, in ’llhici: ::10st
of the gain is in lean body tis.sue. A gain of too much fl:~id
or too much fat is not conductive to good health.(Vermeerscfi,
1.977).