Module 2 - Maternal Health and Nutrition

MODULE 3
MATERNAL HEALTH
AND NUTRITION
1
OBJECTIVES
After completing this session, participants will be able to:
Describe the changes in a woman’s body during pregnancy and the

development of the fetus in the womb
Describe the undernutrition cycle and its consequences
Discuss the recommended care for pregnant and lactating women
Discuss family planning methods suitable for breastfeeding woman
2
DURATION OF PREGNANCY
How long does pregnancy last?
- A normal pregnancy lasts about 40 weeks from the first day of your last menstrual period (LMP).
How is the length of pregnancy measured?

- The 40 weeks of pregnancy are grouped into three trimesters. Each trimester lasts about 12–13
weeks (or about 3 months):
• First trimester: 0 weeks–13 and 6/7 weeks (Months 1–3)
• Second trimester: 14 and 0/7 weeks–27 and 6/7 weeks (Months 4 –7)
• Third trimester: 28 and 0/7 weeks– 40 and 6/7 weeks (Months 7–9)
3
DURATION OF PREGNANCY
What is the estimated due date (EDD)?
- This is the day a baby is due
- Estimates gestational age throughout pregnancy so that the fetus's growth can be tracked
- Provides a timeline for certain tests that a pregnant woman will have throughout pregnancy
- Around 1 in 20 women give birth on their due dates
How is my estimated due date calculated?

- From the first day of pregnant woman’s LMP
- Ultrasound exam in the first trimester
4
PHYSICAL CHANGES DURING PREGNANCY
During pregnancy
- breasts enlarge, nipples and areolas darken
- milk ducts grow in number and size (fully developed by the end of the second trimester)
- milk production starts as early as the second trimester, but becomes full-blown after delivery
5
NUTRITIONAL STATUS OF PREGNANT WOMEN
Nutritionally At-Risk Pregnant Women:

Trends, 1998-2018
Nutritionally at-risk
pregnant women refers to
pregnant women with a
low pre-pregnancy BMI
or those who do not gain
sufficient weight during
pregnancy.
Food and Nutrition Research Institute-Department of Science and Technology (FNRI-DOST). 2018. The Expanded National Nutrition Survey:
Nutrition Situation of Women of Reproductive Age in the Philippines.

6
Nutritionally At-Risk Pregnant Women, by Age Group,

2015 & 2018
7
NUTRITIONAL STATUS OF PLW
Anemia among Pregnant Women remains a

problem of moderate public health
significance
Nutrition Situation of Women of Reproductive Age in the Philippines. 8

NUTRITIONAL STATUS OF PLW
Iodine deficiency remains a

problem among Pregnant
and Lactating Women
Nutrition Situation of Women of Reproductive Age in the Philippines. 9

NUTRITIONAL STATUS OF LACTATING WOMEN
Prevalence of Chronic Energy Deficient Lactating Women,
2015 & 2018
Chronic Energy Deficient
refers to a condition where
there is negative energy
balance due to inadequate food
and nutrient intake, problems
in absorption, relatively rare or
excessive nutrient loss mostly
due to infections and
malignancies.

10
NUTRITIONAL STATUS OF LACTATING WOMEN
Prevalence of Overweight/Obese
Lactating Women,2015 & 2018
Overweight and obesity refer to

the abnormal or excessive fat
accumulation that may impair
health.

11
Gestational diabetes mellitus (GDM)
- Diabetes first diagnosed during pregnancy
- Around 14% of Filipino PW had GDM in one study
- Higher risk of having a large baby, complications in giving birth, increased rate of caesarian
sections, preeclampsia/gestational hypertension
- Screening for GDM on second ANC visit (between 24 - 28 weeks) with an oral glucose challenge
test (OGCT) as necessary (DOH AO 2016-0035)
12
UNDERNUTRITION CYCLE
Undernourished child
Teenage Pregnancy
Undernourished baby Undernourished teenager
Undernourished adult
woman who becomes
pregnant
13
CONSEQUENCES OF MATERNAL UNDERNUTRITION
Increased rate of infection due to weakened immune system
Weakness and tiredness leading to lower productivity
Difficult labor due to small bone structure
Increased risk of complications in the mother leading to death during labor and delivery
Increased risk of death if mother bleeds during or after delivery
Increased risk of giving birth to an underweight child who, if female, will be at greater risk of a more
difficult labor during her own pregnancy unless the undernutrition cycle is broken
14
RECOMMENDED CARE FOR PREGNANT WOMEN
Antenatal Care (ANC)
• regular check-ups to allow health care provider to identify, prevent and treat potential health
problems during pregnancy
• promotion of healthy lifestyles that will benefit both mother and child
15
DOH Administrative Order 2016-0035: Guidelines on the Provision of Quality Antenatal Care in All
Birthing Centers and Health Facilities Providing Maternity Care Services
ANC Components include:
• Developing a Birth Plan
• History taking
• Complete vital signs, general OB examination including nutritional assessment
• Compute for BMI at first ANC visit
• Monitor weight gain based on pre-pregnancy weight

16
DOH Administrative Order 2016-0035: Guidelines on the Provision of Quality Antenatal Care in All
Birthing Centers and Health Facilities Providing Maternity Care Services
ANC Components include:
• Screening and laboratory exams
• Hemoglobin, CBC, urinalysis, stool exam, Hepatitis B, HIV, syphilis, STIs
• Preventive measures
• tetanus/diptheria immunization, iron/folic acid supplements, calcium supplements, oral
health check-up/prophylaxis
17
RECOMMENDED CARE FOR PW AND LW
Life stage/age group Energy (kcal) for PW Energy (kcal) for LW

2170 + 300
<15 2170 + 500
(for 2nd and 3rd trimesters only)
2280 + 300
16-18 (for 2nd and 3rd trimesters only) 2280 + 500
1930 + 300
19-29 1930 + 500
1870 + 300
30-49 1870 + 500
Food and Nutrition Research Institute-Department of Science and Technology (FNRI-DOST). Philippine Dietary
Reference Intakes 2015: Summary of Recommendations; 2015.
18
Food and Nutrition Research Institute. Department of Science and Technology (2016). Pinggang Pinoy. A Healthy Plate
for a Well-Nourished Nation. Taguig City, Philippines. DOST-FNRI.
19
20
HOW TO FILL UP YOUR PLATE
PREGNANT
LACTATING

21
FATHERS’ ROLES IN SUPPORTING A HEALTHY PREGNANCY
NUTRITION
• Attend ANC visits and/or antenatal classes

• Participate in birth planning
• Assist in household chores and let his wife rest more than usual
• Help provide nutritious food
22
OPTIMAL BIRTH INTERVAL
Recovery
EBF BF & CF Pregnancy
>6 months, the longer
6 months 18 months 9 months
the better
? Months Birth
Birth
23
BREASTFEEDING AND FAMILY PLANNING
Luteinizing
Lactation Amenorrhea Method (LAM) Hormone (LH)
and
Follicle
Stimulating
Hormone
(FSH)
• Breastfeeding is essential to child survival. prevent

menstruation
• It has many benefits for the child as well as

for the mother, including postnatal infertility
making it a natural birth spacing method.
24
LAM is more than 98% effective if the following criteria are met:
• Amenorrhea (no menses)

• Exclusive breastfeeding
• The infant is less than 6 months of age
In the event that one of the 3 criteria is no longer met at any point during the first six months, there is
an immediate need to discuss with the couple to begin other family planning methods.
The use of LAM and its efficacy is dependent on intensity of the breastfeeding. This method
therefore is not suitable for women who for any reason cannot fully or nearly fully breastfeed her
infant.
25
• Universally available
Advantages: LAM
• 98% effective (or more)
• Begins immediately postpartum
• Natural (no hormonal side effects)
• No commodities/supplies required/ no cost
• Does not interfere with intercourse
• Bridge to other contraceptives
• Builds on established cultural and religious practices
• Improves breastfeeding and weaning patterns 26
Challenges: LAM
• Breastfeeding pattern may be difficult to maintain

• Duration of method limited
• Only useful for breastfeeding women
27
When Should Women Start Practicing Another Method
• When she has resumed her menses, OR

• When the frequency of breastfeeding has decreased as follows:
• Any 2 breastfeeding are regularly more than six (6) hours apart
• The mother starts regularly giving her baby food or liquids as substitutes for breast milk
meals, OR
• When the baby is six (6) months old or older.
28
29
KEY MESSAGES
During pregnancy, a woman’s body changes to accommodate and share

nutrients with the growing fetus, and prepares for lactation.
Pregnant and lactating women need additional nutrients for themselves

and their babies. Pregnant adolescents are more likely to not meet their
nutritional requirements.
Nutritional assessment and counseling should be an integral part of
antenatal and postnatal care.
30

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MODULE 3

After completing this session, participants will be able to:

Describe the changes in a woman’s body during pregnancy and the

Discuss the recommended care for pregnant and lactating women

Discuss family planning methods suitable for breastfeeding woman

How long does pregnancy last?

How is the length of pregnancy measured?

What is the estimated due date (EDD)?

- This is the day a baby is due

- Around 1 in 20 women give birth on their due dates

How is my estimated due date calculated?

- breasts enlarge, nipples and areolas darken

Nutritionally At-Risk Pregnant Women:

Nutrition Situation of Women of Reproductive Age in the Philippines.

Nutritionally At-Risk Pregnant Women, by Age Group,

Nutrition Situation of Women of Reproductive Age in the Philippines.

Anemia among Pregnant Women remains a

Nutrition Situation of Women of Reproductive Age in the Philippines. 8

Iodine deficiency remains a

Nutrition Situation of Women of Reproductive Age in the Philippines. 9

Nutrition Situation of Women of Reproductive Age in the Philippines.

Overweight and obesity refer to

Nutrition Situation of Women of Reproductive Age in the Philippines.

- Diabetes first diagnosed during pregnancy

- Around 14% of Filipino PW had GDM in one study

sections, preeclampsia/gestational hypertension

test (OGCT) as necessary (DOH AO 2016-0035)

woman who becomes

Weakness and tiredness leading to lower productivity

Difficult labor due to small bone structure

Increased risk of death if mother bleeds during or after delivery

Antenatal Care (ANC)

problems during pregnancy

Birthing Centers and Health Facilities Providing Maternity Care Services

ANC Components include:

• Developing a Birth Plan

• Complete vital signs, general OB examination including nutritional assessment

• Compute for BMI at first ANC visit

• Monitor weight gain based on pre-pregnancy weight

Birthing Centers and Health Facilities Providing Maternity Care Services

ANC Components include:

• Screening and laboratory exams

• Hemoglobin, CBC, urinalysis, stool exam, Hepatitis B, HIV, syphilis, STIs

• tetanus/diptheria immunization, iron/folic acid supplements, calcium supplements, oral

Life stage/age group Energy (kcal) for PW Energy (kcal) for LW

Reference Intakes 2015: Summary of Recommendations; 2015.

for a Well-Nourished Nation. Taguig City, Philippines. DOST-FNRI.

for a Well-Nourished Nation. Taguig City, Philippines. DOST-FNRI.

for a Well-Nourished Nation. Taguig City, Philippines. DOST-FNRI.

• Attend ANC visits and/or antenatal classes

• Breastfeeding is essential to child survival. prevent

• It has many benefits for the child as well as

making it a natural birth spacing method.

• Amenorrhea (no menses)

• Breastfeeding pattern may be difficult to maintain

• When she has resumed her menses, OR

• When the baby is six (6) months old or older.

During pregnancy, a woman’s body changes to accommodate and share

Pregnant and lactating women need additional nutrients for themselves

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