Definition

Nutritional status is crucial as it impacts both physical and cognitive health and affects the body's resistance to both infectious and non-communicable diseases. A pregnant woman is considered to be suffering from malnutrition if she experiences anemia, Chronic Energy Deficiency (CED), and Iodine Deficiency Disorders (IDD).

Pregnant women require more nutritional intake than other groups due to their susceptibility to malnutrition. Adequate nutrition is also necessary because the fetus will draw on the mother's nutritional reserves to prepare for breastfeeding.

Therefore, it is vital to meet the nutritional needs during pregnancy to ensure a safe delivery. The following provides a detailed definition of the types of malnutrition most commonly encountered during pregnancy in Indonesia.

Anemia

During pregnancy, anemia is a frequent occurrence as a normal response of the body to pregnancy. However, anemia needs to be managed and monitored carefully as it affects the baby's future growth and development. A pregnant woman is considered anemic if her hemoglobin level falls below 11 grams/dL.

Chronic Energy Deficiency (CED)

This condition arises when a woman suffers from prolonged food deprivation, leading to health issues.

Iodine Deficiency Disorders (IDD)

This condition occurs when a pregnant woman is deficient in iodine. Iodine is a mineral essential for the production of thyroid hormones, which are necessary for the smooth growth and development of the fetus.

Here are additional articles regarding anemia during pregnancy: Anemia In Pregnancy - Understanding, Cause, Symptoms And Treatment.

Causes

Several factors can lead to malnutrition in pregnant women:

• Lack of education on the importance of maintaining nutritional intake during pregnancy
• Conditions such as diarrhea and excessive nausea and vomiting during pregnancy
• Dental issues during pregnancy
• Insufficient intake of iron supplements during pregnancy
• Use of certain medications during pregnancy that may decrease appetite

Pregnant women are typically given antihypertensive medications or iron supplements. Read here : Iron - How To Work, Indication And Drug Provision.

Risk Factor

Factors that may increase the risk of malnutrition during pregnancy include:

• Poor nutritional status prior to pregnancy
• Very young maternal age (under 18 years)
• Multiple pregnancies
• Low socio-economic status
• Low educational status
• Closely spaced pregnancies
• High levels of physical activity
• Certain diseases that impair the body’s ability to absorb nutrients
• Smoking and alcohol consumption
• Use of medications not prescribed by a doctor
• Irregular antenatal care according to the recommended schedule

Symptoms

Symptoms of malnutrition in pregnant women include:

• Loss of appetite
• Weakness, lethargy, and fatigue
• Dizziness
• Persistent headaches and drowsiness despite adequate sleep
• Exhaustion and irritability
• Poor concentration
• Feeling cold
• Loss of body fat, muscle mass, and body tissue
• Increased susceptibility to illness and prolonged recovery times
• Depression
• Decreased sexual drive
• Skin becoming thinner, drier, less elastic, pale, and cold
• Sunken cheeks due to loss of facial fat
• Dry and brittle hair

Diagnosis

Diagnosing malnutrition during pregnancy involves medical history, physical examination, and supplementary tests. This process is typically carried out during routine antenatal care.

Medical history is crucial to identify risk factors, including questions about pregnancy duration, current complaints, previous pregnancies, medical history, family medical history, medication and supplementation history, daily activities, and dietary patterns.

The physical examination includes measuring blood pressure, weight, respiratory rate, body temperature, and pulse. The healthcare provider will also inspect the face and extremities for pallor and swelling.

A thorough examination of the abdomen will assess the uterus's length to estimate gestational age and fetal position. If visiting an obstetrician, an ultrasound may be used to assess the fetus's age, weight, and position.

Laboratory tests may include blood tests to measure iron levels and other hormones that could indicate nutritional deficiencies. These tests are usually performed during routine check-ups in the first and third trimesters but may be conducted at other times if indicated.

Management

Treatment for malnutrition during pregnancy must be initiated promptly to ensure the fetus is born with optimal physical and cognitive development. Management strategies include:

Consuming nutritionally balanced foods

A balanced diet includes daily intake of carbohydrates, proteins, minerals, fiber, and fats to prevent deficiencies in one particular component. Recommended foods for pregnant women include vegetables, red meat, chicken liver, fully cooked eggs, and fruits, consumed in appropriate amounts, neither too little nor too much.

Taking Iron Supplements

If anemia is present, iron supplements are recommended to increase hemoglobin levels, alongside iron-rich foods.

Regular Antenatal Care

Routine antenatal care is necessary to monitor the health of both mother and baby and to reduce mortality rates. Recommended visit frequencies are monthly until 27 weeks, biweekly from 28 to 36 weeks, and weekly after 37 weeks.

Complications

Complications from malnutrition during pregnancy include:

• Preeclampsia (high blood pressure during pregnancy)
• Premature birth
• Stillbirth or dead baby
• Maternal and fetal death
• Postpartum hemorrhage
• Congenital hypothyroidism (deficiency in thyroid hormone from birth)
• Physical defects in the baby
• Low cognitive ability in the baby
• Impaired immune systems result in increased susceptibility to diseases in infants
• Intrauterine Growth Retardation (IUGR), a condition when the fetus grows not according to gestational age
• Stunting (short stature in children under 5 years old)

For information regarding preeclampsia, please refer to the following source: Preeclampsia - Definition, Cause, Symptoms and Treatment.

Prevention

Preventive measures for malnutrition during pregnancy include:

• Assessing nutritional status before marriage and conceiving
• Regular antenatal check-ups as recommended
• Educating about the complications of malnutrition during pregnancy
• Consuming a balanced diet before and during pregnancy
• Avoiding exposure to tobacco and alcohol before and during pregnancy
• Reducing coffee and tea consumption during pregnancy to ensure adequate nutrient absorption

When to See a Doctor?

Seek medical attention immediately if you experience weakness, shortness of breath, and difficulty concentrating. Visit the nearest emergency department if you experience these symptoms.

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