FATIN LAILI AHMAD BAHRI Editor

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UMI MARLINI IBRAHIM Pengarang

NUR NAZIRAH NGAH Pengarang

NORADLINA ROSEMI Pengarang

RUHAIDA MOHD RAWI Penasihat

SIDANG EDITORIAL

In this issue, Gestational diabe-

tes mellitus Pre-eclampsia &

eclampsia Anemia in preg-

nancy Urinary tract infec-

tions in pregnancy Pemakanan se-

masa mengandung Exercise during

pregnancy

Edisi Januari 2014 KKB KOTA BHARU

BULETIN FARMASI

PHARMACY BULLETIN

JANUARY 2014 1

GEStational Diabetes mellitus (gdm)

P regnant women who have never had diabetes be-

fore 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 usu-

ally 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 dur-

ing a future pregnancy and for developing diabetes later in

life.

What are the consequences of uncontrolled GDM to the mother and baby?

Maternal education on target blood glucose during pregnancy with GDM is vital to prevent risk and complica-tions 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 well-studied 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 hypoglyce-mia. 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 antidia-betic 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 preg-nancy especially in obese women.

Insulin use in pregnancy

The good news is that GDM can be kept under con-trol 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 whole-grain pasta, as well as striving for foods rich in dietary fibers and with low calorie content. Tak-ing 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.

Tips for controlling diabetes during pregnancy

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 preg-nancy

Risk of birth defects and miscarriage Macrosomia or ‘big baby syndrome’ Hypoglycemia (low blood sugar) at

birth Death after week 28th of pregnancy

(stillbirth)

TIMING GLUCOSE LEVEL (mmol/L)

Pre-breakfast & pre-prandial

3.5-5.9

1 hour post-prandial <7.8

2 hours post-prandial 4.4-6.7

2-4 hours post-prandial 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 Moderate GI Foods

High GI Foods

Most non-starchy vegetables Peanuts Low-fat yogurt Soy milk Apple, pear Whole wheat spaghetti, maca-roni Apple, grapes, pear Long grain rice Grapefruit juice Oat bran bread Green peas

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

Corn chips Watermelon Honey Mashed & baked Potatoes Puffed wheat Doughnuts French fries Vanilla wafers White breads Rice cakes Cornflakes Instant rice French bread Dates

Maternal education on GDM should be widespread and con-

ducted 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.

In a nutshell….

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JANUARY 2014 2

P reeclampsia is a condition that can develop during pregnancy character-ized 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 is preeclampsia?

Pre-eclampsia in a previous pregnancy

First pregnancy

Family history, such as a mother and sister who also had the condi-tion

Carrying multiple babies such as twins

Chronic high blood pressure

Obesity

Kidney diases

Diabetes

Antiphospholipid antibody syn-drome

Risk factors

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 poten-tially being involved in preeclampsia, and there is an increased risk for women with af-fected 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.

What causes preeclampsia?

PRE-ECLAMPSIA AND ECLAMPSIA

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JANUARY 2014 3

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 usu-ally considered after 34 weeks of gestation. The risks to the mother and baby from the

disease must be balanced against the risk of prema-turity 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 rec-ommended. 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 complica-tions 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.

What is the treatment for preeclampsia and eclampsia?

Prevention

To help reduce your chance of developing pre-eclampsia 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 prescrip-tion 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 sup-plement. In women who have a low calcium intake, supple-mentation 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. Melissa Conrad Stöppler, MD 2. Charles Patrick Davis, MD, PhD 3. Andrea Chisholm; Brian Randall, MD

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JANUARY 2014 4

A nemia is a decrease in the amount of hemoglobin and red blood cells which can lead to a lack of oxygen-carrying abil-ity. 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?

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 pregnan-cies 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 diffi-

cult getting enough nutrition and iron.

Causes 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, breath-

lessness and dizziness can occur, though they are un-usual.

Pale appearance to the skin Chest pain (angina) or headaches if the anemia is severe

Symptoms of anemia during pregnancy

ANEMIA IN PREGNANCY

Be sure to get a varied diet. If planning a pregnancy, talk to a doctor or midwife

about food and supplements – if possible, before be-coming pregnant.

Good sources of iron are beef, whole meal bread and cereals, eggs, spinach and dried fruit.

Supplementing the diet with iron, vitamins and espe-cially 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 preg-nant.

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 sig-nals 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 con-ception. This reduces the risk of spinal cord defects (spina bifida) developing in the fetus.

How to avoid anemia during pregnancy?

References:

1. Evans, Arthur T., et al. Manual of Obstetrics. 7th ed. Philadelphia: Lippincott Williams & Wilkins, 2007. 2. Albert L.Golderberg et al. The Effect of Zinc Supplement in Pregnancy Outcome. 1995. 3. http://www.netdoctor.co.uk/diseases/facts/anaemiapregnancy.

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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.

Tips to increase iron absorption from dietary

Indication of Minerals in Pregnancy

IBERET FOLIC 500 ZINCOFER OBIMIN HEMATINIC

Ferrous (elemental):

105 mg (as controlled release fer-

rous sulphate 525 mg)

115 mg (as ferrous fumarate 350

mg)

30mg 65 mg (as ferrous fumarate

200 mg)

Vit C 500 mg 75 mg 100mg 100mg

Folic acid 0.8 mg 1 mg 1mg 5mg

Zinc 0 mg 12.5 mg (as zinc sulphate 55 mg)

- -

Vit B1 6 mg 0 mg 10mg 1.0 mg

Vit B2 6 mg 0 mg 2.5mg 1.5 mg

Vit B3 30mg - 20mg 10mg

Vit B6 5 mg 1.5 mg 15mg -

Vit B12 25 mcg 5 mcg 4mcg -

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 defi-

ciency Zinc Prevent low birth weights and preterm birth Initiates DNA, RNA synthesis and ensures

proper fetus formation

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U rinary tract infections (UTIs) occur commonly during pregnancy. UTIs include acute cystitis, pyelonephritis and asymptomatic bacteriuria (positive urine culture in an asymptomatic woman). Approximately 1–4 % of

pregnant women experience acute cystitis and the incidence of asymptomatic bacteriuria during pregnancy ranges from 2–10 %1.

Pathogenesis

Urinary tract infections in pregnancy

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.

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 colo-nizing 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

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, 20–40% 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 (> 38°C), 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 10–14 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.

INFECTION/CONDITION SUGGESTED TREATMENT

Preferred Alternative

Asymptomatic bacteriuria

Cefuroxime 250mg PO q12h for 7 days

Nitrofurantoin 50mg PO q6h for 7 days or β-lactam/ β-lactamase inhibitors, eg Amoxycillin/Clavulanate 625mg PO for 7 days

Acute cystitis Cefuroxime 250mg PO q12h for 7 days

Nitrofurantoin 50mg PO q6h for 7 days or Cephalexin 500mg PO q12h for 7 days or β-lactam/ β-lactamase inhibitors, eg Amoxycillin/Clavulanate 625mg PO for 7 days

Acute pyelonephritis Cefuroxime 750mg IV q8h for 2 weeks

β-lactam/ β-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

Antibiotic Recommendation

CHOICES OF ANTIBIOTICS FOR UTI

*Cefuroxime (Pregnancy Cat B) Azithromycin (Pregnancy Cat B)

*Cephalexin (Pregnancy Cat B) Clarithromycin (Pregnancy Cat C)

Ceftriaxone (Pregnancy Cat B) Ciprofloxacin (Pregnancy Cat C)

Nitrofurantoin (Pregnancy Cat B) Levofloxacin (Pregnancy Cat C)

*Amoxicillin/Clavulanate (Pregnancy Cat B) Norfloxacin (Pregnancy Cat C)

*Sulphamethoxazole/Trimethoprim (Pregnancy Cat C) Ofloxacin (Pregnancy Cat C)

*Erythromycin (Pregnancy Cat B) *Doxycycline (Pregnancy Cat D)

* Available in KKB KB

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JANUARY 2014 8

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 pre-eclampsia.

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

References;

1. Managing urinary tract infections in pregnancy. BPJ. 2011 [cited 2013 Dec 19]; April 35: 20-23. Available from: http://www.bpac.org.nz/bpj/2011/april/pregnant-uti.aspx 2. Delzell JE & Lefevre ML. Urinary tract infections during pregnancy. Am Fam Physician. 2000 Feb 1[cited 2013 Dec 19];61(3):713-720. Available from: http://www.aafp.org/afp/2000/0201/p713.html 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; Lexi-Comp. 2010

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.

A postpartum urologic evaluation may be necessary in patients with recurrent infections because they are more likely to have structural abnormalities of the renal system. Patients who are found to have urinary stones, who have more than one recurrent UTI or who have a recurrent UTI while on suppressive antibiotic therapy should undergo a postpartum evaluation.

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Pemakanan semasa mengandung

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.

ZAT BESI Berfungsi menyokong pertambahan isipadu darah yang dihasilkan oleh ibu &

bayi dan untuk membentuk hemoglobin dalam darah yang berfungsi mem-bawa 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.

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 kal-sium dlm tulang ibu akan menurun dan berisiko mengalami os-teoporosis.

Sumber utamanya:susu,keju, yogurt, sayuran hijau, ikan (sardin, bilis, tuna), produk soya (air soya, tauhu, tempeh)

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 dok-tor boleh menyebabkan kecacatan pada bayi.

VITAMIN B12 Penting untuk sistem saraf dan

membantu pembentukan sel darah merah.

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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

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Pertambahan Berat Badan Semasa Mengandung

Keadaan berat badan sebelum hamil

BMI (kg/m2)

Pertambahan berat badan yang disarankan (kg)

KURUS <18.5 13-18

BERAT BADAN NORMAL

18.5-24.9 12-16

BERLEBIHAN BERAT BADAN

> 25 11

Loya atau muntah-muntah Keadaan ini berlaku disebabkan perubahan hormon yg biasanya terjadi pada 3 bulan pertama men-

gandung. Makan dalam hidangan yang kecil beberapa kali sehari berbanding 3 hidangan yang besar. Ambil makanan dan minuman secara berasingan. Contohnya minum ½ 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.

Masalah Pemakanan Ketika Mengandung

EXERCISES DURING PREGNANCY

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 gesta-tional diabetes (diabetes that develops during pregnancy), relieve stress, and build more stamina needed for labor and delivery.

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 exer-cise program.

Finish eating at least one hour before exercising.

General Guidelines

Exercises Strengthen Muscle During Pregnancy

1 2 3 4

Quadruped arm/leg raises Lunges

Modified push-up

Wall squat Heel raise

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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

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