SESSION THREE:

MATERNAL NUTRITION

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 Maternal Nutrition
Brainstorming and Large Group Discussion:

1. What is the importance of nutrition during pregnancy for mothers?

2. What is the importance of nutrition during pregnancy for their child?
3. What are the consequences of poor maternal nutrition during
pregnancy for their child and mothers?
4. Energy Needs during Pregnancy and Lactation
5. What are the key nutrition messages for pregnant and lactating
mothers ?
 Learning Objective 3 -The Importance of Good Maternal Nutrition, and the
Consequences of Poor Maternal Nutrition

Resource 3.1- The Importance of Optimal Maternal Nutrition

• A mother’s nutritional status, diet and lifestyle influence pregnancy and
lactation outcomes and can have lasting effects on her offspring’s health.
• Evidence indicating that a woman’s nutritional status and health related
behaviors both prior to and during pregnancy influence pregnancy outcomes
and the child’s future health.
• Women’s nutrition also affects a wide range of health and social issues,
including family care and household food security.

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 Resource 3.2: The Consequences of Poor Maternal Nutrition

• Increased risk of maternal complications and death

• Increased infection

• Anemia

• Lethargy and weakness leading to lower productivity

• Complication during labor

• Reduced nutrient stores

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 Maternal Nutrition…

The Consequences of Poor Maternal Nutrition for Fetal & Infant Health

• Increased risk of fetal, neonatal, and infant death

• Intrauterine growth retardation, low birth weight

• Preterm birth

• Birth defects

• Brain damage and Increased risk of infection

 Learning Objective 3.1- The Situation of Maternal Nutrition in Ethiopia and Nutritional
Requirements during Pregnancy & Lactation

Resource 3.1: The Situation of Maternal Nutrition in Ethiopia

According to the 2011 EDHS
• 27% of women either thin or undernourished—BMI < 18.5 kg/m2.
• Prevalence of anemia among women in the reproductive age group (15–49)
was found to be 17%.
The recent (2013) food consumption survey also found that
• Carbohydrates contributed to 73.5% of the total energy intake of women
which is considerably higher than the recommended 45-65%
• Fat accounted for 16.5% of the total energy intake compared to the
recommended 20-35% necessary to obtain the essential fatty acids
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 …Cont
• Protein only accounted for 9.7% of the energy intake which is lower that
the recommendation of 10-35% of total energy
• The mean energy intake for women of reproductive age was 1,726
kcal/day which is less than the recommended mean intake of 2,000
kcal/day
For micronutrients,
• 13% of women were found to have inadequate iron intake,
• For zinc, 50% of women had an inadequate intake and
• 82% of women are not consuming sufficient vitamin A

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 Resource 3.2: Physiological changes that increase Nutritional requirement of
women during pregnancy and lactation
• During pregnancy, a women nutrient requirement increases. This is because
of
o The need of nutrient for the growing fetus during pregnancy as well as for her own energy need;
o Energy needs increase during the second and particularly the third trimester of pregnancy;
o There is increased red blood cell mass to cater for higher iron requirements
o Iron is also needed by the developing fetus, thus creating additional demand
• Lactation also places high demands on maternal stores of energy, protein,
and other nutrients.
o These stores need to be established, conserved, and replenished starting from pregnancy time.
o The energy, protein, and other nutrients in breast milk come from a mother’s own body stores, and to
a lesser extent, from her diet;

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 …Cont

Energy Needs during Pregnancy and Lactation

• Pregnancy weight gain
o Healthy, well-nourished women should gain 10 to 14 kg during pregnancy, with an
average of 12 kg in order to increase the probability of delivering full-term infants with
an average birth weight of 3.3 kg, and to reduce the risk of fetal and maternal
complications
o Ideal Weight gain during pregnancy based on maternal BMI status

BMI < 19.8 12.5-18 kg

BMI 19.8 to 26.0 11.5-16 kg
BMI > 26.0 to 29.0 7-11.5 kg
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 …Cont

• Recommended Energy intake and Caloric needs for pregnant and lactating
women
o Women are advised to increase their daily calorie intakes during pregnancy according
to their pre-pregnancy body weight, physical activity level, and week gestation.
o The suggested calorie increase for women who conceive at a body weight in the
normal range is 360 calories / day in the second trimester and 475 calories / day in
the third trimester
o Well-nourished women with adequate gestational weight gain should increase their
food intake by 505 kcal/day for the first six months of lactation, while
o Undernourished women and those with insufficient gestational weight gain should add
to their personal energy demands 675 kcal/day during the first semester of lactation.
o Energy requirements for milk production in the second six months are dependent on
rates of milk production, which are highly variable among women and populations
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 Micronutrient requirements during pregnancy and lactation

Folic Acid
o Adequate folic acid intake prior to conception and during the first 28 to 30 days of
pregnancy is associated with a reduced risk of neural Tube Defects (NTDs).
o The recommended intake of folate that women of childbearing age, with no history of
a NTD-affected pregnancy, have to consume is 400 to 800 μg of folic acid daily from
foods and/or vitamin supplements before and during early pregnancy, while
o Women with a history of a NTD-affected pregnancy should consult with their
physician about taking 4 mg of folic acid daily to prevent a recurrence of NTD.

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 …Cont

• Improving iron intake

o Iron-deficiency anemia during pregnancy has been associated with an increased risk for
preterm birth, low birth weight, and perinatal mortality.
o The recommended iron intakes is 30-60mg of elemental iron for pregnant and 15 mg/day
for lactating.
o If a woman is diagnosed with anemia, she should be treated with 120 mg of elemental iron
and folic acid (400 μg or 0.4 mg) daily until her hemoglobin concentration rises to normal.
She can then switch to the standard antenatal dose to prevent recurrence of anemia
• Preventing iron loss
o Schistosomiasis and soil-transmitted helminthic infections are among the most common
infections and can impair nutritional status by causing:
Internal bleeding which can lead to loss of iron and anemia;
Malabsorption of nutrients;
Diarrhea; and Loss of appetite which can lead to a reduction in energy intake
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 …Cont

o WHO recommends periodic treatment with anthelminthic (deworming)

medicines, without previous individual diagnosis to all at-risk people.
o The recommended drug for pregnant women is a single doze albendazole
during the second trimester.
• Calcium
o The recommended intake for pregnant and lactating women is 1,000
mg/day.
o This increases to 1,200 mg/day during the last trimester of pregnancy

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 Learning objective 3.3: Key nutrition practices during pregnancy and counseling a
pregnant woman
Resource 3.3: The Nutritional Practices of Pregnant & Lactating Women in East & West
Hararghe Zones, Oromia Region and Gewane Woreda, Afar Region
A rapid assessment recently carried out by CARE Ethiopia in East and West
ararghe zones of Oromia region and Gewane woreda of Afar showed that;
• The feeding habit of pregnant and lactating women is not different from
other segment of the community
• Pregnant women are not seen taking daytime rest during pregnancy.
• Pregnant women are also expected to gather chat from the garden and sell it
in the local market daily to fulfill her family’s household needs. These
responsibilities take away her time and she will not have time to take
daytime rest.
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 Cont…

• Usually after birth, a mother is treated with porridge made from wheat, maize
or barley with butter, but, this will only last for about a week; after that she
will continue consuming the food found in the house as other members of the
family.
• There is very low awareness in the community regarding nutrition during
lactation and the need for day time rest for lactating mothers.
• Most peoples don’t practice the recommendations because of lack of
awareness, negligence and in some cases lack of access and economic
reasons.
 …Cont

• pregnant women do not get balanced diet as well as rest because they
have a lot of burden to work at home and no one shares their chores at
home.
• There a gap in knowledge about use of ITN and feeding habit and there is
a great work load on females.
• pregnant women don’t consume additional meals during pregnancy and
they don’t take rest because they generate low income and are busy
selling fuel wood and digging holes even during pregnancy.
• the community perceives that if pregnant women eat fruit and vegetable
the fetus gets bigger and she will face difficulty during delivery
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 Learning objective 3.6: The Recommended Nutritional Practices during Pregnancy
brain storming

1. What good or bad nutritional practices are there in your area when a woman gets pregnant?
For lactating mothers?

2. Are there any practices that hinder the promotion of good nutrition during pregnancy?
Lactation?

3. Are there certain foods that pregnant/lactating women eat and/or foods that are avoided?

4. What are the reasons that women choose or avoid certain foods during pregnancy/lactation?

5. Do pregnant/lactating women consume extra meal other than the normal? If not, why
pregnant /lactating women do not have extra meal?
 Resource 3.6: The Recommended Nutritional Practices during
Pregnancy cont…

PREGNANT MOTHERS SHOULD

• Eat one extra meal each day, eating more helps the baby to develop well
and strengthens the woman for delivery.
o Eat more food than usual rather than decrease their intake.
o Eating an extra meal will not cause your baby to grow too big.

• Eat a variety of foods to remain healthy and strong and to help the baby
grow and develop properly including
o Animal products - meat, cow/goat/camel milk, eggs, etc.
o Fruits and vegetables - Gomen, kale/selata, swiss chard/Kosta, cabbage, lettuce, Papaya, Mango,
Banana, tomato, Orange, Ambeshock, Gishita, orange-fleshed sweet potatoes, carrot, and pumpkin
o Cereals - injera, bread, kolo, nifro/Garow, kita, rice etc
o Legumes - beans, peas, chickpeas, lentils
o Oils and fats - butter, cooking oil, sesame, nuts, groundnuts, linseed 18
 ……recommended nutrition practice

• Take iron supplements as soon as you find out you are pregnant and continue for at least
3 months after delivery. ???????????
• Take deworming pills during the second and third trimester of pregnancy to protect
mother and baby from infections.
• Use iodized salt to help your baby‘s brain and body develop properly.
• Visit a health center regularly to monitor your weight & health/pregnancy
• Use mosquito nets to prevent malaria.
• Wash hands with soap and water before preparing food and before eating.
• Decrease workload and get plenty of rest.
• Avoid being near cigarette smoke during pregnancy.
o Cigarette smoking can harm the health of the fetus in the womb.

• Avoid drinking tea and coffee during meals. Tea and coffee change the way your body
uses the food you eat.
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 …Cont
• It is better to drink tea and coffee at least one or more hours before or after a meal. Tea is not
appropriate for babies or children
• For Husband:
o The support of husbands and other family members is crucial for a pregnant woman to
eat balanced diet and stay healthy and strong.
o Make sure your wife gets one extra meal each day as well as to take a variety of foods.
o Support your wife so she can rest more during pregnancy.
o Rest/avoiding hard labor helps to have a healthy, normal-size baby.
• It is very important to focus on appropriate nutrition during pregnancy in
order to:
o Enable mothers to be healthy and the fetus to grow well
o Enable mothers to be healthy at delivery
• Enable mothers to be healthy to breastfeed their children
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 Learning Objective 4: Key Nutrition Practices During Lactation
LACTATING/BREASTFEEDING MOTHERS SHOULD
• Eat two additional meals each day.
• Eat a variety of foods to support the production of breast milk including:

o Animal products - meat, cow/goat/camel milk, eggs, etc

o Fruits and vegetables - Gomen, kale/selata, swiss chard/Kosta, cabbage, lettuce, Papaya,

Mango, Banana, tomato, Orange, Ambeshock, Gishita, orange-fleshed sweet potatoes, carrot,
and pumpkin
o Cereals - injera, bread, kolo, nifro/Garow, kita/, rice etc

o Legumes - beans, peas, chickpeas, lentils

o Oils and fats - butter, cooking oil, sesame, nuts, groundnuts, linseed

• Use iodized salt to help your baby‘s brain and body develop properly. 21
 …Cont

• Avoid drinking tea and coffee during and immediately after meals.
o Tea and coffee change the way your body uses the food you eat. It is
better to drink tea and coffee at least one or more hours before or after a
meal.

• Visit a health center regularly for assessment and treatment of malnutrition.

• Use mosquito nets to prevent malaria and Decrease workload and get
plenty of rest

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Thank you !!!