Nutrition Science in Midwifery

Chapter One: Basic Nutrition Science

Definition of Nutrition
 Nutrition may be defined as the science of food and its relationship to health.
Is the study of how food affects the health and survival of the human
body.Eating the right foods can help us avoid certain diseases or recover
faster when illness occurs. Without food our body could not stay warm,
build or repair tissue or maintain a heartbeat.
 Is the study of food in relation to the physiological process that depends on
its absorption of the growth tissue.
Definition of food
Food is what we eat and drink to help keep us alive and well, to help us grow,
develop work and play. All living things need food.
Function of food
The main functions of food are:
 To give energy for all types of activities
 To build and repair the body
 To protect the body from diseases.
 To maintain and regulate tissue function
Classification of food
There are many ways of classifying foods
1. Classification by origin
a) Food of animal origin
b) Foods of vegetable origin
2. Classification by chemical composition
a) Protein
b) Fats
c) Carbohydrates
d) Vitamins

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e) Minerals
3. Classification by predominant function
a) Body-building foods
b) Energy- yielding foods
c) Protective foods
Important terms of nutrition
o Nutrients: nutrients are chemical substances which are present in food what
we eat. They must be supplied to the body in appropriate amounts.
Example: Carbohydrate, Proteins, Fats, Vitamins, Minerals, Water.
o Malnutrition: It is an impairment of health resulting from a deficiency,
excess or imbalance of nutrients. It includes:
 Under Nutrition-The state in which either the food intake is
inadequate in some respect to meet the body demands or the
physiological and environmental conditions are such that the body is
unable to utilize the sufficient food material to provide for proper
growth, maintenance and repair.
 Over nutrition-It is an excess of one or more nutrients. Excess of
nutrients can also be harmful, which creates a stress in the body
functions.
o Diet: Whatever we eat or drink each day. It includes normal diet, diet in
groups (hostel diets). It may be modified and used for ill persons as a part
of diet therapy.(Therapeutic diet).
o Balanced Diet: It is the one which contains different types of foods (from
all food groups) in such quantities and proportions that the needs for all the
nutrients are
o Calories: the calorie is a unit of energy widely used in nutrition.

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Composition of Human Body

Constituent Percent
Water 62
Protein 18
Fat 14
Minerals 6

Components of food- nutrients

Nutrients are generally divided into two categories, macro-nutrients and micro-
nutrients.
1. Macro-nutrients
2. Micro-nutrients

MACRONUTRIENTS
Carbohydrates
Carbohydrates provide a great part of of the energy in all human
diets.Carbohydrates are components of body substances needed for the regulation
of body processes.
Carbon hydrate composed
 Carbon
 Hydrogen
 oxygen
Types of carbon hydrate
1.Starch (from plant and maize).
2.Sugar(sugar cane)
3.Fiber.
The digestion of carbohydrate beings
From mouth, stomach, small intestines and large intestines.

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Function of carbon hydrate

o Provides energy o Regulation of blood glucose.
o Energy storage and production o Break down fatty acids
o Saving protein in the body o Preventing Ketone.
Sources of carbohydrate
╟ Sugar ╟ White bread
╟ White flour ╟ Rice
╟ Honey ╟ Pasta
╟ Biscuit semi-sweet ╟ Maize
╟ Chocolate, milk

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Protein
Protein is composition
 Carbon
 Hydrogen
 Oxygen
 Nitrogen
Function protein
o To build new tissue fluids o To use as fuel for energy.
o To replace lost amino acids o Repair of muscle in pregnant
woman
o To help cell to work
o Help the growth of the fetus and
o To protect body against maintain maternal health.
infections.
Source of protein
1. Plant foods 2. Animal foods
a) Cereals a) Milk
b) Fruits b) Egg
c) Vegetables c) Fish
d) Beans
Fats(lipid)
Fat is rich source of energy the diet.
Fats are also made:
 Carbon
 Hydrogen
 Oxygen
 Fat is in water soluble.

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Sources of fat
1. Animal foods including: e) Cheese
a) Meat 2. Plant foods Including:
b) chicken a) Maize
c) Fatty b) Coconut oil.
d) Milk

MICRONUTRIENTS
Vitamins
Definition
Vitamins are substances that our bodies need to develop and function normally.
Vitamin A
Vitamin A is an essential nutrient which is required in small amounts.
Types of vitamin A
There are two different types of vitamin A.
1. The first type, preformed vitamin A, is found in meat, poultry, fish, and
dairy products.
2. The second type, provitamin A, is found in fruits, vegetables, and other
plant-based products. The most common type of provitamin A in foods
and dietarysupplements
Function of vitamin A
 Normal functioning of the visual system it is also necessary for maintenance
of cell function
 Growth and reproduction of cell
 Reduces maternal mortality and foetul growth retardation
 It is necessary for embryo development and cell division
 Healthy Skin
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Sources
1. Animal Sources: f) Fish oil
a) Eggs g) Liver
b) Meat 2. Plant Sources
c) Cheese a) Sweatpotatous
d) Milk b) Broccoli
e) Kidney c) Carrot
How much is enough?
Children 2000 – 3500 I.U.
Men 5000 I.U.
Women 4000 I.U.
Hypervitaminosis A leads to toxic symptoms:
 Dry and itchy skin  Blurred vision
 Headaches and fatigue  Loss of appetite
 Hair loss  Skin coloration
 Liver damage

Other Side Effects

 Severe birth defects
 Women of child-bearing age should not consume more than 8000 IU per day
 Skin can take on a yellow
 Most cases of vitamin A overdose occur from supplements but can occur
from diet
Vitamin A Deficiency
 It increased risk of night blindness,
 It causes corneal scaring
 Sever cases blindness and death

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 Xephthalmia: abnormal dryness of the conjunctiva and cornea of the eye,

with inflammation and ridge formation, typically associated with vitamin A
deficiency.

Intake Recommendations
 The recommended daily intake of vitamin A varies according to age, sex,
risk group and other criteria applied in individual countries

Vitamin D

People obtain vitamin D:

 naturally through exposure to sunlight or in the diet

 through fortified foods
 as supplements
Types

Vitamin D is not a single substance but a group of compounds collectively known

as calciferol.

Two types occur naturally:

 vitamin D-3, found in animal fats

 vitamin D-2, found in plants, such as mushrooms
Function

Vitamin D has two main roles in the body:

 It maintains bone health.

 It supports the immune system.

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Sources

Dietary sources

A person can obtain some vitamin D from the sun, but most people will also need
to use other sources, too. The main alternative is food.

Dietary sources include:

 Oily fish and fish oils

 Fortified dairy products, plant-based milks, and cereals
 Beef liver
 Eggs
Deficiency

A vitamin D deficiency can affect:

 Older adults and children who do not spend much time out of doors
 People with darker skin
 Some people with chronic health conditions
 Those with obesity
The main effects of vitamin D deficiency include:

 Osteoporosis, (or loss of bone mass)

 Osteomalacia, (when bones become soft)
 Rickets, (when a child’s bones do not develop as they should increased risk
of infection and autoimmunity)
Recommended intake

Experts measure vitamin D in international units (IU).

Current guidelines recommend that people of all ages intake of 600 IU of vitamin
D daily. This is hard to measure, however, as it is not easy for a person to know
how much vitamin D they obtain from sunlight.
Overdose

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It is rare for a person to have too much vitamin D, but using supplements could
trigger this.

Having too much vitamin D could lead to high levels of calcium in the blood.

This can lead to:

 Nausea
 Headaches
 Low appetite and weight loss
 A buildup of calcium in tissues and blood vessels
 Heart or kidney damage
 High blood pressure
VitaminnB-1 (Thiamin)
Function
 Producing energy from carbohydrates
 Proper nerve function
 Stabilizing the appetite
 Promoting growth and good muscle tone

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Sources
 Fish, Liver and Nuts
 Whole grain breads and cereals
Recommendations vitamin B1
 Men 14mg/day
 Women 14-18 mg/day
Deficiency of vitamin B1
 Loss of appetite  Loss of weight
 Weakness  Depression
 Feeling tired  Heart & Gastrointestinal
problems
 Insomnia

Who’s at Risk?
 Homeless
 Malnourished
 Alcoholics
 People with mal absorption conditions
Warnings
 It is nontoxic even at high dosages

Vitamin B-2( Riboflavin)

Important in or function of vitamin B2:

 Energy production from Carbohydrate, fat, and protein metabolism
 Formation of antibodies and red blood cells
 Maintenance of vision, skin, nails, and hair

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Sources
• Large amounts in
 Dairy, eggs and meats
• Small amounts in
 leafy green vegetables
Recommendations
 Men 14-70 mg/day
 Women 14-70 -71 mg/day larger doses
Vitamin B-2 Deficiency
 Itching and burning eyes
 Cracks and sores in mouth and lips
 Bloodshot eyes
 Dermatitis
 Digestive disturbances
Who’s at Risk?
 People with cataracts
 People with Sickle Cell Anemia
 Alcoholics
Warnings
 It is nontoxic at supplemental and dietary levels.
Vitamin B-3 (Niacinamide)
Function
 Energy production  Maintenance of nervous
 Maintenance of skin and system
tongue  Health of the digestive
 Improves blood track
circulation

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Types
There are two types of vitamin B3
 Niacinamide (Nicotinamide)
 Niacin (Nicotinic Acid)
Highly toxic in large doses
Sources
Food sources of vitamin B3 include:Poultry, fish, meat, whole grains, and fortified
cereals.
Recommendations of vitaminB3
 Men 14+16=30 mg/day
 Women 14 +14 = 28mg/day
Vitamin B-3 Deficiency
 Gastrointestinal disturbance  Mental depression
 loss of appetite  Fatigue
 Headache  Aches and pains
 Insomnia  Nervousness irritability
Pellagra (4Ds)
• Diarrhea • Dementia
• Dermatitis • Death

Warnings of vitamin B3
 In doses of only 50-100 mg nicotinic acid can cause dilation of blood vessels
and potentially painful itchy, diarrhea, nausea, vomiting, and long term liver
damage.
 Nicotinamide is almost always safe to take, although a few cases of liver
damage have been reported in doses of over 1000 mg/day

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Vitamin B-6 Pyridoxine

Function:
 Production of red blood cells  Reducing muscle spasms,
 Improve immunity system cramps, and lack of feeling

 Nervous system functions  Maintaining proper balance of

sodium and phosphorous in the
body
Sources
Vitamin B6 is found in a wide variety of foods, including:
 poultry, such as chicken
 some fish.
 peanuts.
 soya beans.
 oats.
 bananas.

Recommendation
 Men 14-50mg/day  Women 14-18 mg/day
B-6 Deficiency
 Nervousness and Insomnia  Arm and leg cramps
 loss of muscle control and  Water retention and Skin
Muscle weakness lesions
Who’s at Risk vitamin B6?
 Very rare  Patients with kidney failure
 Alcoholics  Women using oral
contraceptives
Warnings of vitamin B6
 High doses of B-6 may be cause syndrome, and sleep disorders, but
continued use of high doses may result in permanent nerve damage.

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 Pregnant women should always consult their doctor before taking this
supplement and all others

Vitamin B-12 (Cobalamin)

Function:
 Proper nerve function  Prevention of anemia
 Production of red blood cells  DNA reproduction
 Metabolizing fats and proteins  Energy production
Sources
Vitamin B12 is naturally found in animal products, including fish, meat, poultry,
eggs, milk, and milk products. Vitamin B12 is generally not present in plant foods,
but fortified breakfast cereals are a readily available source of vitamin B12
Recommendations
 Men and Women 14mcg/day
Vitamin B-12 Deficiency
• Anemia • Hypersensitive skin
• Nerve damage
Who’s at Risk?
 Pernicious anemia (is a
decrease in red blood cells that
occurs when the intestine
cannot properly absorb vitamin
B12).
 Injections often taken regularly
 HIV patients and Chronic
Fatigue conditions

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What Is Folic Acid?

 Folic acid or folate is a type of B vitamin.
Function of folic acid
 Repair DNA

 Make DNA

 Production of red blood cells (RBCs)

 Reduces birth defects

 B Vitamin essential for healthy development

of unborn baby’s spine, brain and skull
Sources of folic acid
 Leafy green vegetables  Eggs
 Fruit such as bananas and  kidney and liver
melons
 Meat
 Tomato juice

What Causes Folic Acid Deficiency

 Genetic abnormalities.  Medication side effects
 Poor diet intake  Excessive alcohol Intake

 Disease

Symptoms of Folic Acid Deficiency
 fatigue  Tongue swelling
 aged hair  Growth problems

 Mouth sores  Spina Bifida

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Symptoms of anemia caused by folic acid deficiency include:

 Persistent fatigue  Tender tongue
 lethargy  Irritability
 Pale skin  Diarrhea
Complications of Folic Acid Deficiency?
 Megaloblastic anemia, where RBCs are larger than normal and not fully
developed

 Low white blood cells (WBCs) and platelets

 Serious birth defects in the spinal cord and brain of the fetus.These are
called neural tube defects.
Minerals
What are minerals?
Minerals are solid substances that are present in nature and can be made of one
element or more elements combined together (chemical compounds).
Minerals are important for your body to stay healthy. Your body uses minerals for
many different jobs, including keeping your bones, muscles, heart, and brain
working properly.

There are two kinds of minerals: macrominerals and trace minerals. You need
larger amounts of macrominerals. They include

 Calcium  Sodium
 Phosphorus  Potassium
 Magnesium
 Chloride and sulfur.
You only need small amounts of trace minerals. They include

 iron  Copper
 Manganese  Iodine

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 Zinc  fluoride and selenium.

 Cobalt

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Most people get the amount of minerals they need by eating a wide variety of
foods. In some cases, your doctor may recommend a mineral supplement.

Macro minerals
Magnesium (Mg)

How it functions in body metabolism Magnesium (Mg)

▒ Approximately 50% of total body magnesium is found in bone. The other

half is found mainly inside cells of body tissues and organs. Only 1% of
magnesium is found in blood, but the body works very hard to keep blood
levels of magnesium constant or regularly.

▒ Magnesium helps regulate blood sugar levels, promotes normal blood

pressure, and is known to be involved in energy metabolism and protein
synthesis.

▒ Magnesium is excreted through the kidneys.

▒ Magnesium is needed for more than 300 biochemical reactions in the body.
▒ Helps maintain normal muscle and nerve function.
▒ Keeps heart rhythm steady.

▒ Supports a healthy immune system.

▒ Keeps bones strong

▒ Can it be synthesized by the human body or must it come from other sources
Magnesium must be absorbed through dietary intake.

Food Sources of magnesium  Legumes (beans).

 Green vegetables.  Nuts.
Daily Requirement Allowance
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(RDA)
 Adult men 19 to 30- 400mg  Unrefined grains
 31 yrs and older 420mg  Varies water supply

 Adult women 19 to 30-310mg

 31 yrs and older 320mg

Deficiency/Disease of magnesium
Hypomagnesaemia, resulting:
 Low blood calcium levels.  Chronic diseases such as heart
 Muscle cramps, spasms or disease.
seizures.  High blood pressure,
 Nausea, weakness, irritability osteoporosis.
and confusion  Type 2 diabetes

Early signs of magnesium deficiency include:

 Loss of appetite.
 Nausea and vomiting
 fatigue and weakness
Hypomagnesaemia symptoms include:
 Weakness  Decreased reflexes
 Confusion  Complications may include:
 Decreased breathing rate low BP and cardiac arrest

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Micro minerals
What is Iodine?
Iodine is an essential micronutrient supporting some of the most vital functions of
the human body.
Function of iodine
 Iodine increases thyroid function if the individual is iodine deficient
 Iodine decreases thyroid function if the individual is sufficient
 Normal growth and development
The recommended daily allowance (RDA) of iodine is 150 mcg
From where do we normally get Iodine?
 Present natural state in the soil and in water.
 Normal requirement comes from crops grown on iodine-rich soil.
 People who live on iodine-deficient land and eat its crops regularly, do not
get their daily requirement of this essential element.
How do we know if salt contains Iodine?
• A low cost testing kit is available which allows to test for the iodine content
of the salt on the spot.
Iodine Deficiency Disorders
 Abortions  Neonatal Hypothyroidism(the
 Still Births disease that caused by
insufficient production of
 Congenital anomalies Thyroid hormone by the thyroid
 Neurological Cretinism gland).
 Neonatal goiter  Impaired Mental Function
 Retarded Physical development
Iron
Iron is needed by the fetus and mother as a reserve for blood loss during pregnancy.
Needs are normally met by an increase in absorption and absence of menstruation.
Good maternal iron stores and a good dietary intake are needed throughout
pregnancy. Lean red meat, chicken to a lesser extent, and fish are the best sources.
Iron from animal sources is better absorbed than that from green vegetables,

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fortified breakfast cereals, bread, pulses, and dried fruit. Vitamin C helps the
absorption of iron if taken at the same time.
Water
Water is a combination of hydrogen and oxygen. It is the basis for the fluids of the
body.
Functions of water
 Water makes up more than two –thirds of the weight of the human body.
 Without water human would die in a few days.
 All the cells and organs need water to function.
 Water serves as a lubricant.
 It makes up saliva and the fluids surrounding the joints
 Water regulates the body temperature through perspiration or sweets.
 It also helps prevent and relief constipation by moving food through the
intestines.
Recommendation
Although there is no research to identify the exact amount of water should drink,
experts usually recommends drinking six to eight glasses of water daily.

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Chapter Two:Nutrition during Pregnancy and Lactation

Nutrition during pregnancy
Pregnancy is one of the most dangerous periods in the life of a woman. Teenage
pregnancies are of particular concern since adolescent girls who fall pregnant may
not yet have reached their full growth potential.
Good nutrition is essential for a successful and healthy pregnancy, as poor nutrition
is associated with adverse pregnancy outcomes. Increases in specific nutrients are
recommended during pregnancy, but these are not difficult to attain in a well-
balanced diet.
The estimated average requirement (EAR) for energy during pregnancy is
2000kcal/day in the last trimester only, therefore it is not necessary for a woman to
‘eat for two’. Nutritional requirements also vary due to changes in basal metabolic
rate, which varies widely, increasing in some women and decreasing in others.

Indicators of good nutritional status during pregnancy include:

1. Weight gain: between 11.5–16 kg for the duration of pregnancy
 Components of weight gain during a normal pregnancy are:
 Fetus, placenta, amniotic fluid = 4750 gm
 Uterus and breasts = 1300 gm
 Blood = 1250 gm
 Water = 1200 gm
 Fat = 4000 gm
 Total = 12500 gm
2. Hemoglobin level ≥ 11g/dl
3. Absence of clinical signs of micronutrient deficiencies

Antenatal Nutrition Counseling

 Assess the nutritional status of all pregnant women Treat, educate and
provide nutrition counseling
 Discuss benefits of exclusive breastfeeding for six months and continued
breastfeeding for two years and beyond, to the baby and to the mother

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Some general nutrition recommendations for pregnant women

 Daily additional energy intake:
300kcal/day
 on and folic acid
supplementation: 60mg of
iron and 5mg folic acid
every day

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 Daily consumption of iodized  e-worming (Mebendazole

salt given during 2nd trimester)
 Prevention and treatment of  Adequate rest
malaria

Nutrition care during labour and delivery

 Labour and delivery is a period of high energy costs. At this time, the
woman needs more energy should be provided the form of slight foods and
drinks that are high in energy such as: yoghurt, milk, fruits, and fruit juice.
 Restricting food and fluids can be distressing to the labouring women
 Higher intake of fluids helps prevent dehydration and is associated with
shorter duration of labour and reduced need for augmentation of labour with
oxytocin.
 A normal delivery a woman may be hungry and should have access to food.
Maternity units should therefore ensure that some food is available for
women who deliver at night.

Nutrition during Lactation

All new mothers need to eat a healthy diet for their own well-being and to help
them to replenish stores of certain nutrients that become depleted during pregnancy.
They also need a healthy diet to assist them to cope with the demands of a new
baby and possibly older siblings. Even if eating a suboptimal diet, either in calories
or content, they will still produce high quality milk which will satisfy their infant’s
nutrition requirements. A healthy diet should be based on the five food groups and
a breastfeeding mother should include:
1. Carbohydrates. 4. Protein
2. Fruit and vegetables 5. High fat and sugar foods and
3. Dairy products drinks
Fluids and breastfeeding
Breastfeeding mothers do not need to drink excessive amounts of fluid but should
drink to their thirst. A minimum of eight drinks a day is recommended and can
include a range of sources including water, fruit juice, milk, tea, coffee, and soups.
Milk is not necessary to produce breast milk. In hot weather more fluid may be
required to quench the mother's thirst.

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Food to avoid whilst breastfeeding

 Oily fish  Peanuts
 Large fish  Caffeine
 Alcohol

Breast feeding
 Feeding after birth it is important to start feeding immediately before
expulsion of the placenta that increases uterine contraction.
• Breast milk: is substance secreted from the in breast nipple and it consist of
colostrums.
• Lactation: is secretion of milk by the breast that period during which the
baby is sucking.
• Colostrums: is a thick and yellowish fluid secreted by mammary gland at
16 weeks in pregnancy up to 3-4 days after birth.

Classification of breastfeeding
Feeding was classified into 3 categories:
1. Exclusive breastfeeding during the first six months, only breast-milk being
given to infant for 6 months,
2. Predominant breastfeeding, breast-milk with liquid-based items being given,
and
3. Mixed feeding, other non-breast milk or solid food being given in addition.

Types of Breast Milk

 Colostrum or Early Milk: is produced in the late stage of pregnancy till 4
days after delivery; and is rich in antibodies.
 Transitional Milk: produced from day 4 – 10 is lower in protein in
comparison to Colostrum.
 Mature milk: is produced from approximately ten days after delivery up
until the termination of the breastfeeding.

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Hormones during breastfeeding

 Prolactin: levels rise with nipple stimulation
 Alveolar cells make milk in response to prolactin when the baby
sucks
 Oxytocin: causes the alveoli to squeeze the newly produced milk into
the duct system

Why breast feeding is best for the baby

Because of:
1. It is always available and fresh 6. It contains some antibodies
2. It safe and free from germs against disease
3. It is digested by nature for baby 7. It helps the baby and mother
relationship
4. It is easy to digest
8. The baby receives love from his
5. It has right temperature mother
Why breast feeding is best for the mother
• It is no cost or cheep  Mother has time to spend for the
• It always ready. care of different members of the
family.
• Sucking helps uterine retract.
 Mother has time to participate
• It helps the mother to express social activities.
love her baby.
 Less postpartum bleeding
• Breast sucking prevent ovulation
through the hormone of prolactin  More rapid uterine involution

 Recovers from stress of  Weight loss

pregnancy:  Decreased premenopausal breast
 Labor and delivery cancer rates

 Reduces health problems  Decreased ovarian cancer rates

related pregnancies.  Lactation amenorrhea

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Parent benefits for breastfeeding

• Saves money
• Babies love it
• Mother and father will have more time to discuses on family affairs and to
look after the children.
• Breast feeding also known as traditional method.
Attaching the baby to the breast
 Baby’s mouth wide open  More areal above the baby’s
mouth than below
 Baby’s lower lip turned out
 Baby makes slow deep sucks,
 Baby’s chain touching the breast sometimes pausing.
Skin to skin benefits
• Infants gets warmth • Enhanced train maturation
• Security, calming and less crying • Promotes self regulation
• Enhanced early feeding • Longer duration of breast
feeding
• New born weight gain
• Improved Mantel self confidence
Benefits of rooming
o Reduces costs o Reduces infection
o Requires minimal equipment o Helps establish and maintain
breastfeeding
o Requires no additional personnel
o Facilitates the bonding process
Breast care
 The mother should prepare her  Wash hands
self
 Change cloth
 Avoid uses soap to clean the
breast specially nipples.  Avoid any microorganisms to
reach her breast milk
 Avoid cream lotion

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Baby needs for glucose

 The early introduction of supplementary feeding
 Glucose water should be discourage that reduce milk production.
 Breast milk contains sufficient water for normal new born infant
Position of the bay for breast feeding
 The mother should comfortable after delivery
 Setting up may be painful
 The mother and baby may be supported billows
 She may feed baby while lying down with her side the baby be side her
 The dark skin around the nipples must be in the baby’s mouth
 The baby chine should pressed up against the breast, if the breast are very
full
 It may be pressed up against baby’s nose and make it difficult for him to
breast
Failure of breast feeding
Cause by the baby:
 Prematurity  Infection
 Birth injuries  Congenital abnormality and etc.
Cause by the mother
• Hard swelling of the breast • Wrong believes
• Cracked nipples • Death of the mother
• Inverted flat nipple

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Weaning Food for infants

o Weaning: is the process of o The baby may develop diarrhea
change from any type of milk to and vomiting.
solid food.
o If mother started weaning early
o Starts: 6months of life because
of the digestion system is ready o the baby became diarrhea a sick
to digest food. because of the digestion system
is not ready to digest food.
o Weaning time is dangerous, b/c
many germs inter the baby’s o If you start too late the baby
stomach. become malnutrition, under
weight and may develop diarrhea,
o The mother may not wash her
hand properly. o Weaning does not mean the dis-
continuation of the breast
o The food may contaminate by feeding as is commonly mis-
dirty. understand in many community
Why start weaning at 6 months

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 Breast milk sufficient for the

growth of the baby only till 6
months of age.
 Breast milk output starts to
decline or decrease.
 But baby’s physical and
mental development
continues at a very fast pace
orspeed till the end of 2 years.
 Weaning latest by 6 months -
failing which will lead to
malnutrition.

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Ten steps to successful breastfeeding

The ‘Ten Steps to Successful Breastfeeding’ are the foundation of the
WHO/UNICEF Baby Friendly Hospital Initiative (BFHI). They are a summary
of the maternity practices necessary to support breastfeeding. Every facility
providing maternity services and care for newborn infants should:

Step 1: Have a written breastfeeding policy that is routinely

communicated to all health care staff.
Step 2: Train all health-care staff in skills necessary to implement this
policy.
Step 3: Inform all pregnant women about the benefits of breastfeeding.
Step 4: Help mothers initiate breastfeeding within a half-hour of birth.
Step 5: Show mothers how to breastfeed and how to maintain lactation,
even if they should be separated from their infants.
Step 6: Give newborn infants no food or drink other than breast milk
unless medically indicated.
Step 7: Practice rooming-in allow mothers and infants to remain together
24 hours a day.
Step 8: Encourage breastfeeding on demand.
Step 9: Give no artificial teats or pacifiers (also called dummies and
soothers) to breastfeeding infants.
Step 10: Foster the establishment of breastfeeding support groups.

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 Nutrition Science in Midwifery

Chapter Three:Nutrition-related disorders

Malnutrition
Definition

Malnutrition is a group of conditions in children and adults generally related to

poor quality or insufficient quantity of nutrient intake, absorption, or utilization.

Types of malnutrition
There are two major types of malnutrition:

1. Protein-energy malnutrition - resulting from deficiencies in any or all

nutrients
There are three types of protein-energy malnutrition in children:
 Acute malnutrition
 Chronic malnutrition
 Acute and chronic malnutrition
2. Micronutrient deficiency diseases - resulting from a deficiency of specific
micronutrients

Kwashiorkor and Marasmus are diseases of severe malnutrition.

Kwashiorkor is caused by protein deficiency, and symptoms include swelling of

the belly secondary to fluid leakage (edema), skin lesions, fatty liver change,
and anemia. Marasmus is caused by a deficiency of all nutrients, or a total
caloric deficiency.

Malnutrition in pregnancy women

The term malnutrition generally refers both to under nutrition and over nutrition,
but in this guide we use the term to refer only to a deficiency of nutrition.
Body Mass Index (BMI pre-conception)
 Underweight (BMI<18.5).
 Normal weight (BMI 18.5-24.9).
 Overweight (25-29).
 Obese (BMI >30)

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What Causes Malnutrition?

1. Ignorance
2. Illness and Infections
3. Socio-Economic Conditions
4. Dental Problems
5. Medication
6. Morning Sickness
Severe morning sickness during pregnancy can hamper a woman’s ability
to consume healthy food and may lead to malnutrition.
7. Insufficient Intake
During pregnancy, a woman requires around 300 extra calories a day. If
the woman does not consume adequate quantities of healthy food, it can
lead to malnutrition.

Indicators of malnutrition in pregnant women include

 Weight gain ≤ 11.5 kg
 Weight gain ≤ 500gm/month in the 1st trimester and ≤ 1kg/month in the
2nd and 3rd trimester of the pregnancy
 Mid-upper arm circumference (MUAC) < 23 cm
 Hemoglobin level < 11g/dl
 Presence of goiter
 Presence of clinical signs of micronutrient deficiencies
Health Risks of Malnutrition in Pregnancy
Malnutrition during pregnancy can cause several health problems in both the
mother-to-be and her developing baby. Here are the health risks of malnutrition
during pregnancy:

Risks for the Mother

 Maternal Mortality

 Risk of Miscarriage

 Dental Problems
 Osteomalacia
 Toxaemia

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 Nutrition Science in Midwifery

Risks for the Baby

Malnutrition during pregnancy effects on the baby inside the womb, too.

 Stillbirth
 Premature Birth
 Perinatal mortality
 Birth Defects
 Underdeveloped Organs

How Can Malnutrition Be Prevented?

To prevent malnutrition, women who plan to conceive should take prenatal
vitamins, eat healthy food and exercise regularly. During the pregnancy, they
should eat nutritious food and continue to take their pregnancy vitamins. This
ensures that both mother and the newborn are hale and healthy.

Remember
 Low weight gain is associated with low birth weight and preterm delivery
 Excessive weight gain causes macrosomia and increased cesarean
delivery
Consequences of malnutrition during pregnancy
 Intra-uterine growth retardation  Brain damage
 Low birth weight  Increased risk of infection
 Prematurity  Neonatal death
 Birth defects for baby

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 Nutrition Science in Midwifery

ANEMIA IN PREGNANCY
 Definition's a reduction in the oxygen carrying capacity of the blood; this
may be caused by a decrease in RBC production or reduction in
hemoglobin content in the or a combination of these.
 These cells are manufactured in the bone marrow and have a life
expectancy of approximately four months.
Types of anemia
A. Iron deficiency anemia
B. Folate deficiency anemia
C. Vitamin B12 deficiency
Iron deficiency anemia
 This type of anemia occur s when the body does not have enough iron to
produce adequate amount of hemoglobin and the blood cannot carry
enough oxygen to the tissues throughout the body.
 Iron deficiency is the common cause of anemia in pregnancy.
Folate deficiency
 Folate deficiency: can directly contribute to certain types of birth defects.
 Vitamin B12 deficiency:
 The body need vitamin B12 for healthy as whole, and lack of vitamin
B12 pernicious anemia and degeneration of nervous system.
Causes of Anemia
o Women become anemic during pregnancy due to Increased demand
for iron and other vitamins.
o Diet low in iron.
o Lack of folic acid in the diet or more rarely.
o Lack of vitamin B12 and other essential vitamins.
o Loss of blood due to bleeding from Hemorrhoids or stomach ulcers
and parasites.
o Women who have pregnancies close together and also women
carrying twins or triplets.
o More vomiting due to morning sickness.
o Loss of blood resulting from an accident or operation
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 Nutrition Science in Midwifery

Symptoms & signs of Anemia

 Pallor of mucous membrane
 Fatigue, dizziness and fainting.
 Headache.
 Shortness of breath.
 Tachycardia and palpitations.
 If the anemia is severe (less than 6g )it may cause chest pain
 Poor resistance to infection

Risk factors for anemia in pregnancy

 Pregnancy with more than one child.
 Two pregnancies closed to gather.
 Lot of vomiting because morning sickness hypermensis.
 Young women who is pregnancy.
 Don’t eat enough food that are rich in iron and vitamin B12.
 Heavy periods before become pregnancy.
 Unhealthy lifestyle.

Management and Treatment

 It depends on the cause of the anemia.
 If the Mother is mild anemic give oral iron supplement and advise to
eat balanced diet
 If the oral iron is ineffective prenatal can used.
 If the mother is severe anemia less than 6mmHg during late pregnancy
blood transfusion can be done.

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 Nutrition Science in Midwifery

Prevention of anemia in pregnancy

 Varied balanced diet intake to the mother any time needs arise.
 If planning a pregnancy talk about the nutrition and supplement of
possible before becoming a pregnant.
 Tell the Mother good sources of iron like liver, red meat, fish, eggs, and
green vegetables..
 Supplementary with iron vitamins especially folic acid takes 400mg to
reduce the risk of having child with congenital abnormalities.
Complications of anemia in pregnancy
 Fetal growth retardation
 Preterm labour
 Low immunity to the mother
 Postpartum hemorrhage

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 Nutrition Science in Midwifery

Chapter Four :Safety of food

Food Safety
What is Food Safety?
Food Safety refers to handling, preparing and storing food in a way to best
reduce the risk individuals becoming sick from food borne illnesses.

Food hygiene is the conditions and measures necessary to ensure the safety of
food from production to consumption. Food can become contaminated at any
point during slaughtering or harvesting, processing, storage, distribution,
transportation and preparation.

What is Food Contamination?

Food contamination refers to food that has been corrupted with another
substance – either physical, biological or chemical.

 Biological Contamination
 Physical Contamination
 Chemical Contamination
 Cross-contamination

Cross-contamination is when biological, physical or chemical contaminants get

into food, making it unsafe to eat and putting people at risk of food-borne
diseases.

Preparation of food
In every step of food preparation, follow the four steps of the Food Safe
Families campaign to keep food safe:

1. Clean — Wash hands and surfaces often.

2. Separate — don’t cross-contaminate.
3. Cook — Cook to the right temperature.
4. Chill — refrigerate promptly.

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Preparation
Always wash hands with warm water and soap for 20 seconds before
and after handling food.
Don't cross-contaminate. Keep raw meat, poultry, fish, and their juices
away from other food. After cutting raw meats, wash cutting board,
utensils, and countertops with hot, soapy water.
Cutting boards, utensils, and countertops can be sanitized by using a
solution of 1 tablespoon of unscented, liquid chlorine bleach in 1
gallon of water.
Marinate meat and poultry in a covered dish in the refrigerator.

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 Nutrition Science in Midwifery

Food taboos
Food taboo is abstaining people from food and/or beverage consuming due to
religious and cultural reasons. It can be permanent or temporal. Permanent food
taboos are avoiding food and/or drinks throughout their life, while
some foods are avoided for certain periods of time.

Somalis are Sunni Muslems and under Islamic Law (or Shar'iah), they are
prohibited from eating pork, drinking alcohol or smoking cigarettes.

Example of food taboos

 Honey during pregnancy

 Kidney

 Beef

 Dik-dik

 Liver

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