BULETIN FARMASI

SIDANG EDITORIAL
Edisi Januari 2014
KKB KOTA BHARU

RUHAIDA MOHD RAWI Penasihat UMI MARLINI IBRAHIM Pengarang FATIN LAILI AHMAD BAHRI Editor NUR NAZIRAH NGAH Pengarang NOR AKILA MAHMOOD Pengarang

In this issue,

NORADLINA ROSEMI Pengarang LAU YI VUN Pengarang

Gestational diabetes mellitus Pre-eclampsia & eclampsia Anemia in pregnancy Urinary tract infections in pregnancy Pemakanan semasa mengandung Exercise during pregnancy

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G E S tat i o na l D i a b e t e s m e l l i t u s ( g d m )
Insulin use in pregnancy
Maternal education on target blood glucose during pregnancy with GDM is vital to prevent risk and complications to the baby. Therefore, early institution of insulin therapy is essential when diet modification fails to provide optimal glycemic control. The use of insulin lispro, aspart, regular and neutral protamine hagedorn (NPH) are wellstudied in pregnancy and regarded as safe and effective. However, the use of insulin glargine is less recommended due to lack of study and possibility of maternal hypoglycemia. Sometimes, the usage of insulin did not stop at post partum during breastfeeding. This is when the mother still failed to achieve sufficient glycemic control and thus insulin therapy should be continued at a lower dose. Oral antidiabetic agents (OADs) are generally not recommended in pregnancies. In non-breast feeding mothers, OAD agents can be used post-partum. The common insulin regime used in pregnancy is basal bolus regime which enables easier insulin dose adjustment. As pregnancy progresses, there is an increase requirement for insulin as a result of insulin resistance. Maternal weight and pregnancy trimester must be taken into consideration when estimating the starting insulin dose. In certain patients, there may be a need for more than 1 unit/kg total daily dose of insulin during pregnancy especially in obese women.

regnant women who have never had diabetes before but who have high blood glucose levels during pregnancy are said to have gestational diabetes. GDM is defined as having glucose intolerance or carbohydrate intolerance of variable severity, with onset or first recognition of hyperglycemia during pregnancy. This usually affects about 3-6 percent of pregnancies. GDM usually occurs around the 24th weeks to 28th weeks of pregnancy. This is because by this time the placenta has begun to make the hormones that lead to insulin resistance. However, GDM usually disappears shortly after delivery. Once a mother has had GDM, she will be at a higher risk for getting it again during a future pregnancy and for developing diabetes later in life.

Tips for controlling diabetes during pregnancy What are the consequences of uncontrolled GDM to the mother and baby?

Increase the chance of needing a cesarean birth due to large baby size Increase risk of preeclampsia in the mother Risk of having diabetes after pregnancy Risk of birth defects and miscarriage Macrosomia or big baby syndrome Hypoglycemia (low blood sugar) at birth Death after week 28th of pregnancy (stillbirth)

The good news is that GDM can be kept under control by practicing healthy dietary intake, exercising and if necessary, by using medication. To keep GDM at bay or reduce the likelihood of getting GDM, pregnant mothers should adopt a meal planning which involve taking slow release carbohydrates like brown rice and wholegrain pasta, as well as striving for foods rich in dietary fibers and with low calorie content. Taking regular exercise that is safe for pregnancy such as yoga, pilates, walking and swimming can help to promote healthy blood sugar controls. As for pregnant mothers who inject insulin at home, frequently testing blood glucose levels at specific times or after meals will help to determine whether blood glucose profiles are within the recommended limits.

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TIMING Pre-breakfast & preprandial 1 hour post-prandial 2 hours post-prandial 2-4 hours post-prandial

GLUCOSE LEVEL (mmol/L) 3.5-5.9 <7.8 4.4-6.7 3.9

Focusing back on a healthy diet plan to keep blood glucose levels in check, healthcare professionals should provide information regarding the glycemic index of foods. Glycemic index (GI) is the ranking of foods according to the effect they have on blood glucose concentration. Foods are ranked from 0-100 according to the extent they raise blood sugar levels after eating.

High GI> foods that are rapidly digested and absorbed and they raise blood sugar quickly Low GI> foods that are digested and absorbed slowly and they raise blood sugar gradually Low GI Foods Most non-starchy vegetables Peanuts Low-fat yogurt Soy milk Apple, pear Whole wheat spaghetti, macaroni Apple, grapes, pear Long grain rice Grapefruit juice Oat bran bread Green peas Moderate GI Foods Canned kidney beans Kiwi, banana Sweet potato Brown rice Sweet corn White rice Ice cream Canned apricots, light syrup Raisins Couscous Table sugar (sucrose) Pineapple Whole wheat breads High GI Foods Corn chips Watermelon Honey Mashed & baked Potatoes Puffed wheat Doughnuts French fries Vanilla wafers White breads Rice cakes Cornflakes Instant rice French bread Dates

In a nutshell.

Maternal education on GDM should be widespread and conducted at the expense of good cooperation between healthcare professionals to ensure blood glucose profiles at every stage of pregnancies are well taken care of. As for pregnant mothers, proper dietary measures and compliance to treatment should be practiced at all times. This will ensure a healthy pregnancy so that a mother can bring out the best for her newborn.

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PRE-ECLAMPSIA AND ECLAMPSIA

What is preeclampsia?

reeclampsia is a condition that can develop during pregnancy characterized by high blood pressure (hypertension) and protein in the urine (proteinuria). If not properly recognized and managed, preeclampsia can progress to eclampsia, which involves the development of seizures in a woman with preeclampsia. Preeclampsia occurs after the 20th week of pregnancy and can even occur in the days following birth. Some reports describe preeclampsia as occurring up to 4 to 6 weeks after birth, although most cases of postpartum preeclampsia occur within 48 hours of births. Ninety percent of cases occur after the 34th week of gestation, and 5% occur after birth.

What causes preeclampsia? Risk factors

Pre-eclampsia in a previous pregnancy First pregnancy Family history, such as a mother and sister who also had the condition Carrying multiple babies such as twins Chronic high blood pressure Obesity Kidney diases Diabetes Antiphospholipid antibody syndrome

The exact cause of preeclampsia and eclampsia is not fully understood, but it is believed to be a disorder of the lining of blood vessels. Abnormalities of the placenta have also been described. It likely arises due to a combination of factors, including both genetic and environmental influences. A number of genes have been studied as potentially being involved in preeclampsia, and there is an increased risk for women with affected family members. Nutritional factors, obesity and the immune system may also play a role in its development although this is not yet fully understood. Some studies of the immune response in preeclampsia have shown problems in the way certain cells of the immune system interact with each other to regulate the immune response.

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What is the treatment for preeclampsia and eclampsia?

There is no cure for preeclampsia and eclampsia other than delivery of the baby. The decision about whether to induce labor or perform a Cesarean section depends upon the severity of the condition and the gestational age and health of the fetus. Women with mild preeclampsia are often induced at 37 weeks' gestation. Prior to this time, they can be managed at home or in the hospital with close monitoring. During this time steroid drugs will be given to promote maturation of the baby's lungs. Women with mild preeclampsia prior to 37 weeks' gestation are often prescribed bed rest with frequent medical monitoring. In severe preeclampsia, delivery (induction of labor or Cesarean delivery) is usually considered after 34 weeks of gestation. The risks to the mother and baby from the disease must be balanced against the risk of prematurity in this case. Intravenous magnesium sulfate can be given to women with severe preeclampsia to prevent seizures. This medication is safe for the baby. Oral supplements containing magnesium are not effective in preventing seizures and are not recommended. Medications such as hydralazine to lower blood pressure may also be given. Eclampsia is a medical emergency. It is treated with medications to control seizures and maintain a stable blood pressure with the goal of minimizing complications for both mother and baby. Magnesium sulfate is used as a first-line treatment when eclamptic seizures do occur. If the seizures are not controlled by magnesium sulfate, other medications such a lorazepam and phenytoin may be administered.

Prevention
To help reduce your chance of developing preeclampsia or other pregnancy complications, take these steps: Get early and regular prenatal care. Early treatment of pre-eclampsia may prevent eclampsia. If you have chronic high blood pressure, keep it under control during pregnancy. Get your doctor's approval before taking any prescription or over-the-counter medications. Do not smoke or drink alcohol during pregnancy. Eat regular, healthful meals, and take prenatal vitamins. Ask your doctor if you should take a daily calcium supplement. In women who have a low calcium intake, supplementation may reduce the risk of pre-eclampsia, eclampsia, and premature birth. Your doctor may recommend that you take aspirin to lower your risk of pre-eclampsia.

References:
1. 2. 3. Melissa Conrad Stppler, MD Charles Patrick Davis, MD, PhD Andrea Chisholm; Brian Randall, MD

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A N E M I A I N P R E G NA N C Y

nemia is a decrease in the amount of hemoglobin and red blood cells which can lead to a lack of oxygen-carrying ability. To produce red blood cells, the body needs (among other things) iron, vitamin B12 and folic acid. Anemia is a relatively normal finding in pregnancy. Plasma is the watery, noncellular component of blood. In pregnancy, there is an increase in plasma volume of the blood in order to help supply oxygen and nutrients to mother and baby. There can be a 20% increase in the total number of red blood cells but the amount of plasma increases even more causing dilution of those red cells in the body. A hemoglobin level of pregnancy can naturally lower to 10.5 gm/dL representing a normal anemia of pregnancy.

What is anemia in pregnancy?

Causes of anemia during pregnancy

How to avoid anemia during pregnancy?

Demand for iron and other vitamins is increased. Diet low in iron. Vegetarians and dieters in particular, should make sure their diet provides them with enough iron Lack of folic acid in the diet, or more rarely, a lack of vitamin B12 Loss of blood due to bleeding from hemorrhoids (piles) of stomach ulcer Anemia is more common in women who have pregnancies close together, the mother's body may not yet have recovered, increasing the chances for anemia Pregnancies in women carrying twins or triplets. Pregnancies with morning sickness which may be difficult getting enough nutrition and iron.

Symptoms of anemia during pregnancy

The woman rarely have any symptoms of anemia unless her hemoglobin is < 8g/dl: Weak, tiredness and paleness. Palpitations the awareness of the heartbeat, breathlessness and dizziness can occur, though they are unusual. Pale appearance to the skin Chest pain (angina) or headaches if the anemia is severe References:
1. 2. 3.

Be sure to get a varied diet. If planning a pregnancy, talk to a doctor or midwife about food and supplements if possible, before becoming pregnant. Good sources of iron are beef, whole meal bread and cereals, eggs, spinach and dried fruit. Supplementing the diet with iron, vitamins and especially folic acid. Taking 400 micrograms folic acid when pregnant is important to reduce the risk of having child with spina bifida. A doctor may advise taking combined iron and folic acid supplements before becoming pregnant. To absorb the maximum amount of iron from the diet, it will help to also eat a diet rich in vitamin C (eg; Raw vegetables, potatoes, lemon, lime and oranges) Foods rich in folic acid include beans, muesli, broccoli, beef, Brussels sprouts and asparagus. A pregnant woman should take notice of her body's signals and consult a doctor if any symptoms occur. It is now routine to recommend to women planning a pregnancy to take a folic acid supplement for the first 12 weeks of pregnancy and preferably starting before conception. This reduces the risk of spinal cord defects (spina bifida) developing in the fetus.

Evans, Arthur T., et al. Manual of Obstetrics. 7th ed. Philadelphia: Lippincott Williams & Wilkins, 2007. Albert L.Golderberg et al. The Effect of Zinc Supplement in Pregnancy Outcome. 1995. http://www.netdoctor.co.uk/diseases/facts/anaemiapregnancy.

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Tips to increase iron absorption from dietary

Iron from meat, poultry, and fish (i.e., heme iron) is absorbed two to three times more efficiently than iron from plants (i.e., non-heme iron). The amount of iron absorbed from plant foods (non-heme iron) depends on the other types of foods eaten at the same meal. Foods containing heme iron (meat, poultry, and fish) enhance iron absorption from foods that contain non-heme iron (e.g., fortified cereals, some beans, and spinach). Foods containing vitamin C also enhance non-heme iron absorption when eaten at the same meal. Substances (such as polyphenols, phytates, or calcium) that are part of some foods or drinks such as tea, coffee, whole grains, legumes and milk or dairy products can decrease the amount of non-heme iron absorbed at a meal. Vegetarian diets are low in heme iron, but careful meal planning can help increase the amount of iron absorbed. Some other factors (such as taking antacids beyond the recommended dose or medicine used to treat peptic ulcer disease and acid reflux) can reduce the amount of acid in the stomach and the iron absorbed.

Indication of Minerals in Pregnancy

Ferrous Prevention and treatment of iron deficiency anemias Folic acid For the prevention of neural tube defect in the fetus Vitamin C Enhance absorption of iron Vitamin B complex Prophylaxis and treatment of vitamin B deficiency Zinc Prevent low birth weights and preterm birth Initiates DNA, RNA synthesis and ensures proper fetus formation IBERET FOLIC 500 Ferrous (elemental): Vit C Folic acid Zinc Vit B1 Vit B2 Vit B3 Vit B6 105 mg (as controlled release ferrous sulphate 525 mg) 500 mg 0.8 mg 0 mg 6 mg 6 mg 30mg 5 mg ZINCOFER 115 mg (as ferrous fumarate 350 mg) 75 mg 1 mg 12.5 mg (as zinc sulphate 55 mg) 0 mg 0 mg 1.5 mg OBIMIN 30mg HEMATINIC 65 mg (as ferrous fumarate 200 mg) 100mg 5mg 1.0 mg 1.5 mg 10mg -

100mg 1mg 10mg 2.5mg 20mg 15mg

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U r i na ry t r ac t i n f e c t i o n s i n p r e g na n c y

rinary tract infections (UTIs) occur commonly during pregnancy. UTIs include acute cystitis, pyelonephritis and asymptomatic bacteriuria (positive urine culture in an asymptomatic woman). Approximately 14 % of pregnant women experience acute cystitis and the incidence of asymptomatic bacteriuria during pregnancy ranges from 210 %1.

Bacteriology
E coli is the most common cause of urinary tract infection (UTI), accounting for approximately 80-90% of cases2,3. It originates from fecal flora colonizing the periurethral area, causing an ascending infection. Other pathogens include the following: Klebsiella pneumoniae (5%). Proteus mirabilis (5%) Enterobacter species (3%). Group B beta-hemolytic Streptococcus (GBS; 1%). Pale appearance to the skin

Pathogenesis
Many factors may contribute to the development of UTIs during pregnancy. One important factor is ureteral dilatation, thought to occur due to hormonal effects and mechanical compression from the growing uterus1. Beginning in week 6 and peaking during weeks 22 to 24, approximately 90 percent of pregnant women develop ureteral dilatation, which will remain until delivery (hydronephrosis of pregnancy)2. Increased bladder volume and decreased bladder tone, along with decreased ureteral tone, contribute to increased urinary stasis and ureterovesical reflux. Additionally, the physiologic increase in plasma volume during pregnancy decreases urine concentration. Up to 70 percent of pregnant women develop glycosuria, which encourages bacterial growth in the urine. Increases in urinary progestins and estrogens may lead to a decreased ability of the lower urinary tract to resist invading bacteria. This decreased ability may be caused by decreased ureteral tone or possibly by allowing some strains of bacteria to selectively grow. These factors may all contribute to the development of UTIs during pregnancy.

Asymptomatic Bacteriuria
Asymptomatic bacteriuria during pregnancy has been associated with an increased risk of pre-term delivery and low birth weight1. In addition, if untreated, 2040% of pregnant women with asymptomatic bacteriuria may develop pyelonephritis later in pregnancy. Antibiotic treatment for asymptomatic bacteriuria is therefore indicated in pregnant women to reduce the risk of pyelonephritis. A urine culture should be used to screen for asymptomatic bacteriuria at 12 to 16 weeks gestation. It is recommended that all pregnant women who have confirmed asymptomatic bacteriuria are treated with antibiotics. The choice of antibiotic can be guided by the known sensitivities

Acute Pyelonephritis
A diagnosis of acute pyelonephritis should be considered if a patient presents with systemic symptoms such as fever (> 38C), flank pain and nausea or vomiting1. Symptoms of lower UTI such as frequency and dysuria may or may not be present. Pyelonephritis in pregnancy can have serious consequences such as maternal sepsis, pre-term labour and premature delivery and requires prompt and aggressive treatment. Hospital admission and intravenous antibiotics are usually required. Intravenous antibiotics are usually continued until the patient has been afebrile for 48 hours. Oral antibiotics are then used for 1014 days.

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Acute Cystitis
Women with acute cystitis commonly present with symptoms of dysuria, urgency and frequency, without evidence of systemic illness1. However, these symptoms can be reported by pregnant women without acute cystitis. A urine sample should be sent for culture and, in the case of a pregnant woman, empiric treatment is required while waiting for the results. Antibiotic choice should cover common pathogens and can be changed if required after the organism is identified and sensitivities are determined. A seven day treatment period is required to ensure eradication. Studies in non-pregnant women with acute cystitis show that treatment with antibiotics for three days is as effective as longer courses (e.g. seven to ten days), however, the risk of relapse is higher. Recurrent infections may have serious consequences for pregnant women therefore a longer course of antibiotics is used to avoid the higher rate of relapse with short courses. A follow up urine culture can be requested one to two weeks after the antibiotic course has been completed to ensure eradication. Paracetamol can be used to relieve pain associated with acute cystitis. Other measures to relieve symptoms such as increasing fluid intake, urinary alkalinisation products and cranberry products are not recommended because evidence of their effectiveness is lacking and some products may interact with antibiotic treatment.

Antibiotic Recommendation
INFECTION/CONDITION Asymptomatic bacteriuria Acute cystitis Preferred Cefuroxime 250mg PO q12h for 7 days Cefuroxime 250mg PO q12h for 7 days SUGGESTED TREATMENT Alternative Nitrofurantoin 50mg PO q6h for 7 days or -lactam/ -lactamase inhibitors, eg Amoxycillin/Clavulanate 625mg PO for 7 days Nitrofurantoin 50mg PO q6h for 7 days or Cephalexin 500mg PO q12h for 7 days or -lactam/ -lactamase inhibitors, eg Amoxycillin/Clavulanate 625mg PO for 7 days -lactam/ -lactamase inhibitors, eg Amoxycillin/Clavulanate 1.2g IV q8h for 2 weeks or 3rd gen Cephalosporins, eg Ceftriaxone 1-2g IV q24h for 2 weeks

Acute pyelonephritis

Cefuroxime 750mg IV q8h for 2 weeks

CHOICES OF ANTIBIOTICS FOR UTI

*Cefuroxime (Pregnancy Cat B) *Cephalexin (Pregnancy Cat B) Ceftriaxone (Pregnancy Cat B) Nitrofurantoin (Pregnancy Cat B) *Amoxicillin/Clavulanate (Pregnancy Cat B) *Sulphamethoxazole/Trimethoprim (Pregnancy Cat C) *Erythromycin (Pregnancy Cat B) * Available in KKB KB Azithromycin (Pregnancy Cat B) Clarithromycin (Pregnancy Cat C) Ciprofloxacin (Pregnancy Cat C) Levofloxacin (Pregnancy Cat C) Norfloxacin (Pregnancy Cat C) Ofloxacin (Pregnancy Cat C) *Doxycycline (Pregnancy Cat D)

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Non-Pharmacological Management
Strategies which may help to reduce the discomfort of UTIs include7: An analgesic such as paracetamol may be taken to relieve the pain associated with a UTI. A warm bath or a hot water bottle or heating pad on the suprapubic area or lower back may help to ease the pain. Drink plenty of water to help flush out the urinary system Avoid coffee, alcohol and spicy foods, which irritate the bladder. Smokers should stop smoking as smoking irritates the bladder. Strategies which may help to prevent UTIs include: Drink plenty of fluids. Avoid delaying urinating and ensure the bladder is as empty as possible. Women should wipe from the front to the back after urinating. Empty the bladder immediately after sexual intercourse. Wash hands well after going to the toilet. Wear cotton underwear and do not wear tight fitting trousers or tights

Urinary Alkaliniser Use in UTIs

Urinary alkalinisers such as Ural, Citravescent and Citralite, may be used to reduce symptoms of dysuria and/or frequency; however, there is evidence that casts doubt on the effectiveness of this strategy7. Although urinary alkalinisers are considered as safe in pregnancy, sodium content should also be considered as pregnant woman are susceptible to preeclampsia. They should not be used with quinolone antibiotics (e.g., ciprofloxacin, norfloxacin) as crystalluria may occur. alkalinisation of the urine may reduce the effect of tetracyclines, lithium and salicylates and increase the effect of amphetamines and pseudoephedrine. Concomitant use with antacids may result in systemic alkalosis, hypernatraemia or aluminium toxicity and use with laxatives may have an additive effect. They should be used with caution in patients with cardiac failure, hypertension and renal impairment. Longterm use may result in hypernatraemia and alkalosis.

Recurrence & Prophylaxis

The majority of UTIs are caused by gastrointestinal organisms2. Even with appropriate treatment, the patient may experience a reinfection of the urinary tract from the rectal reservoir. UTIs recur in approximately 4 to 5 percent of pregnancies, and the risk of developing pyelonephritis is the same as the risk with primary UTIs. A single, postcoital dose or daily suppression with cephalexin or nitrofurantoin in patients with recurrent UTIs is effective preventive therapy. References; A postpartum urologic evaluation may be 1. Managing urinary tract infections in pregnancy. BPJ. 2011 [cited 2013 necessary in patients with recurrent infections because Dec 19]; April 35: 20-23. Available from: they are more likely to have structural abnormalities of http://www.bpac.org.nz/bpj/2011/april/pregnant-uti.aspx the renal system. Patients who are found to have urinary 2. Delzell JE & Lefevre ML. Urinary tract infections during pregnancy. Am Fam Physician. 2000 Feb 1[cited 2013 Dec 19];61(3):713-720. stones, who have more than one recurrent UTI or who Available from: have a recurrent UTI while on suppressive antibiotic http://www.aafp.org/afp/2000/0201/p713.html therapy should undergo a postpartum evaluation. 3. Johnson EK. Urinary tract infections in pregnancy.2012 Apr 11 [cited
2013 Dec 19]. Available from: http://emedicine.medscape.com/ article/452604-overview 4.National Antibiotic Guideline. Malaysia; Kementerian Kesihatan Malaysia. 2008.Urinary Tract Infections;p160-163 5.Lacy FP, Armstrong LL, Goldman MP & Lance LL. Drug Information Handbook with International Trade Names Index. 19th edition. Ohio; LexiComp. 2010

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P e m a k a na n s e m a s a m e n g a n d u n g
Pemakanan yang baik penting untuk kesihatan anda dan bayi anda. Ibu yang mengandung perlu mengambil makanan seimbang yang terdiri dari semua zat makanan kerana ini akan mempengaruhi kesihatan mereka.

KALSIUM Berfungsi untuk membina tulang & gigi yang kuat dan sihat . Jika kalsium dr diet ibu tidak mencukupi , kalsium dalam badan

ibu akan disalurkan kpd bayi dan boleh menyebabkan paras kalsium dlm tulang ibu akan menurun dan berisiko mengalami osteoporosis. Sumber utamanya:susu,keju, yogurt, sayuran hijau, ikan (sardin, bilis, tuna), produk soya (air soya, tauhu, tempeh)
ZAT BESI Berfungsi menyokong pertambahan isipadu darah yang dihasilkan oleh ibu &

bayi dan untuk membentuk hemoglobin dalam darah yang berfungsi membawa oksigen ke seluruh tubuh. Sekiranya tidak mendapat zat besi yang cukup anemia (kekurangan darah) akan berlaku. Tingkatkan penyerapan zat besi ini dengan pengambilan makanan yg tinggi vitamin C

VITAMIN C Menguatkan sistem pertahanan ibu terhadap infeksi. Meningkatkan penyerapan zat besi dalam badan. Menggalakan pembentukan tulang,ligamen dan gigi bayi.

VITAMIN B9/ASID FOLIK Penting untuk pembentukan sel darah merah. Membantu mengelakkan kecacatan saluran saraf

(neural tube defects) pada bayi.

Boleh juga mengambil buah/ jus prun. VITAMIN A Penting untuk pembentukan kulit,

mata, jantung, organ perkumuhan serta pembiakan. Pengambilan Supplement vitamin A secara berlebihan tanpa nasihat doktor boleh menyebabkan kecacatan pada bayi.
VITAMIN B12 Penting untuk sistem saraf dan

membantu pembentukan sel darah merah.

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Pertambahan Berat Badan Semasa Mengandung

Pertambahan berat badan yang sesuai adalah penting untuk pertumbuhan dan perkembangan fetus. Ini adalah kerana bayi anda memerlukan tenaga serta zat makanan untuk membesar. Jadual Saranan Pertambahan Berat Badan

Keadaan berat badan sebelum hamil KURUS BERAT BADAN NORMAL BERLEBIHAN BERAT BADAN

BMI (kg/m2) <18.5 18.5-24.9 > 25

Pertambahan berat badan yang disarankan (kg) 13-18 12-16 11

Masalah Pemakanan Ketika Mengandung

Loya atau muntah-muntah Keadaan ini berlaku disebabkan perubahan hormon yg biasanya terjadi pada 3 bulan pertama mengandung. Makan dalam hidangan yang kecil beberapa kali sehari berbanding 3 hidangan yang besar. Ambil makanan dan minuman secara berasingan. Contohnya minum jam sebelum @ 1 jam selepas makan. Makan makanan yang kering contohnya biskut tawar di awal pagi untuk mengurangkan rasa loya Elakkan makanan yang terlalu berminyak atau berlemak. Minum banyak air untuk mengelakkan dehidrasi. Elakkan makanan atau minuman yang boleh menyebabkan rasa loya. Pedih Ulu hati Biasanya berlaku pada bulan-bulan terakhir kehamilan. Elakkan makanan yang berminyak atau makanan yang diketahui menimbulkan masalah. Makan sedikit-sedikit tetapi kerap. Makan dengan perlahan dan tidak gopoh. Elakkan berbaring sejurus selepas makan. Sembelit Biasanya berlaku pada 3 bulan terakhir hehamilan yang juga disebabkan oleh perubahan hormon dalam badan. Kurangkan masalah sembelit dengan mengambil makanan yang tinggi serat. Boleh juga mengambil buah/jus prun. Amalkan senaman yang berpatutan Elakkan mengambil sebarang ubat untuk memudahkan pembuangan air besar tanpa nasihat doktor kerana dikhuatiri akan memberi kesan kepada bayi.

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E X E RC I S E S D U R I N G P R E G NA N C Y
Maintaining a regular exercise routine throughout your pregnancy can help you stay healthy and feel your best. It can also improve your posture and decrease some common discomforts like backaches and fatigue. There is evidence that it may prevent gestational diabetes (diabetes that develops during pregnancy), relieve stress, and build more stamina needed for labor and delivery.

General Guidelines

Wear loose fitting, comfortable clothes as well as good support bra. Choose shoes that are designed for the type of exercise you do. Proper shoes are your best protection against injury. Exercise on a flat, level surface to prevent injury. Consume enough calories to meet the needs of your pregnancy (300 more calories per day before you were pregnant) as well as your exercise program. Finish eating at least one hour before exercising.

Exercises Strengthen Muscle During Pregnancy

Modified push-up

Wall squat

Heel raise

Quadruped arm/leg raises

Lunges

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Exercises during pregnancy

Quadruped arm/leg raises

Modified push-up

Lunges

Wall slide

Heel raises

Rowing

Thoracic extension

Arm slides on wall

Shoulder abduction

Biceps curls