Nutritional- Pregnant Women

ASSESSING THE KNOWLEDGE OF PREGNANT WOMEN ON THE

NUTRITIONAL REQUIREMENT DURING PREGNANCY. A CASE

STUDY AT THE NEW JUABENG MUNICIPALITY

Godfred Kwame Abledu1*

Debora Akan2

Esenam Akou Ahoe3

1. School of Applied Science and Technology, Koforidua Polytechnic, PO Box 981, Koforidua, Ghana

* E-mail of the corresponding author: [email protected] (Tel: 233-244705093)

2. Hospitality Department, School of Applied Science and Technology, Koforidua Polytechnic, PO Box 981, Koforidua, Ghana

3. Hospitality Department, School of Applied Science and Technology, Koforidua Polytechnic, PO Box 981, Koforidua, Ghana

1.1. Background of the Study

The demand for both energy and nutrients is increased during pregnancy.

For well-nourished women, only a small amount of additional energy is

required because the body adapts to the increased energy requirements and

becomes more energy efficient through reduced physical activity and a

lowered metabolic rate. Although the average-sized, well-nourished woman

requires about 10460 kJ/d (2000 kcal/d) during the last trimester of

pregnancy, many women in developing countries restrict their food intake

during pregnancy to have smaller infants, with the idea that smaller infants

will carry a lower risk of delivery complications.

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According to http://intl.ajcn.org, recent evidence suggests, however, that

infants who are small or disproportionate at birth have increased health risks

later in life. The hypothesis is that such infants have had to adapt to a

limited supply of nutrients and that in so doing, their physiology and

metabolism are permanently changed, although the rational for this

hypothesis has been challenged.

Requirements for many, but not all, micronutrients increase during

pregnancy. Deficiencies can exist because of losses or malabsorption

associated with disease or inadequate intakes, lack of knowledge about

adequate prenatal nutrition, or dietary taboos associated with pregnancy,

with potential adverse consequences for both mothers and newborn infants.

Anemia in pregnancy and pregnancy-induced hypertension is common and

are thought to contribute significantly to maternal mortality and morbidity in

developing countries.

1.2. Statement of the Problem

The food that a pregnant woman eats are the main source of the nutrients

for the baby. But what foods should pregnant women eat? What foods a

pregnant woman should avoid?

It is important for pregnant women to understand what kind of food is best

for them and their baby. According to Hansjörg et al (1988) nutrition during

pregnancy is important. Pregnant women's food has an effect on the

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pregnancy, on the fetal development and also on the health of the mother

and child.

In the first half of pregnancy, nutritional requirements mainly concern

quality, while in the second half; quantity is also an issue, to ensure fetal

growth. Proper nutritional habits should already be established at the start of

this second life - if possible even before conception. Eating nutritious foods

before conception and throughout pregnancy is essential for a baby's health.

Carbohydrates, protein and fat fuel a healthy pregnancy, and eating a

variety of nutritious foods, including whole grains, fruits, vegetables, low-fat

dairy and lean protein, helps provide the vitamins and minerals needed for

the healthy development of a baby. Diets that restrict calories and

wholesome carbohydrates are not appropriate for women who are pregnant.

Eating nutritious food would prevent miscarriage from occurring and also

prevent the delivering of unhealthy babies.

1.2. Objectives of the Study

The objectives of the study are:

1. To assess the knowledge of pregnant women about their nutritional

requirement during pregnancy.

2. To identify the nutrients in the diet intake of pregnant women.

1.3. Research Questions.

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1. Do pregnant women know of their nutritional requirement during

pregnancy?

2. What are the nutrients in the diet intake of pregnant women?

1.3. Significant of the Study.

The research has been written with emphases on the nutrient of food intake

of pregnant women to enable them understand the value, principles behind

its selection and use. Also, it is expected to help pregnant women to improve

upon their knowledge of selection, preparation and service of their meal. The

research is very significant to the government, stakeholders, NGOs, firms

and businesses, the society and the researchers.

Stakeholders and non-governmental organization (NGOS) to the health care

would find this research very useful; this is because the research will equip

them with an intensive knowledge about the whole concept of nutritional

requirements for pregnant women. They would therefore be able to adopt

policies that can enable them to handle all issues associated with nutrient for

pregnant women professionally.

Firms and private businesses providing health services would also find this

research very useful because they would have an in depth knowledge about

the whole concept of nutritional requirement for pregnant women. They

would therefore be able to strategically formulate policies that will also

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enable them to tackle all issues associated with nutritional requirements in

pregnant women.

The society would also benefit from this research in diverse ways, for

instance the research will serve as a guide for future reference. Individual in

the society who aims at doing any research in the area of nutrition in

pregnant women can rely on this document as a guide, besides that, the

society would also be enlightened about the whole concept of nutrition in

pregnant women after reading this research material.

Finally, the researchers would have a broader knowledge about the whole

concept of nutrition at pregnancy; they will therefore be able to provide

some consultancy services in the area of child malnutrition. The researchers

would also be able to contribute meaningful to the media discussions

centered on nutrition in pregnant women.

1.5. Scope of the Study

The research was done at Koforidua, Regional Capital of the Eastern region.

The Koforidua Municipality has many hospitals, both private and public, but

this research focused on the Central Hospital.

1.6. Limitation of the Study

The researchers who are students from the hospitality department had

difficulties in combining academic work, practical work with this project work;

as a result they could not reach a sizeable number of the population. The

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time was not enough to make the researchers explore so much of the topic;

however with the guidance of the supervisor, the scope and the content of

the topic covered are quite good for any academic work.

1.7. Organization of the Study

The project is divided into five chapters. Chapter one, which in the

introduction, elaborates on the background of the study, the problem

statement, objectives of the study, research questions, significance of the

study, scope of the study, limitation of the study and the rganization of the

study.

Chapter two talks about the literature review. Chapter three, also talks about

research methodologies. Findings are discussed in the fourth chapter.

Chapter five which is also the final chapter deals with the summary of the

findings, conclusion, recommendations and suggestions for further studies.

2. LITERATURE REVIEW

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2.0. Introduction

The chapter covers the research topic on the following: definition of concept,

nutrients in the diet intake of pregnant women in their right proportion, foods

that pregnant women should eat during pregnancy and to identify the

knowledge about diet intake of pregnant women in Koforidua.

2.1. Definition of Terms

Nutrition is the science of food nutrient and other substance within food and

their action, interaction and balance in relation to health and disease, and

the process by which organism ingests, absorbs, transport, uses and

excretes food substances (Guthrie , 1995).

According to Townsend(1985), nutrients are chemical substances found in

the food that are necessary for good health. There are five major groups of

nutrients; Proteins, fats, carbohydrate, vitamins, Minerals. Each group has

several members, which each have their own chemical names.

According to Tull(1987), food is any solid or liquid substance which when

taken in by the body provides it with the necessary materials to enable it to

grow, to replace worn-out and damaged parts and to function normally.

A balance diet is one that has all the essential nutrients required by the

body for proper growth and development in the appropriate amounts. A well

balanced diet consists of the right amount of carbohydrates, protein, fats,

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Vitamins, and minerals. A balanced diet also provides the body energy to

function (Alphonse, 2010).

2.2. Some of the Nutrients in the Diet of Pregnant Women

More calcium for pregnant women:

According to www.healthandage.com, a substantial transfer of calcium

occurs between the mother and the fetus throughout pregnancy, allowing

the baby's bone and teeth formation. In the first six months, the mother

stores up calcium in her own bones. When its skeletal growth reaches its

peak in the last three months, the fetus draws on the mother's store. This is

when the consumption of high calcium-containing foods such as milk and

milk products must be increased, since a calcium deficiency will damage the

mother's teeth and make her bones brittle. Grows strong bones and teeth,

healthy nerves, heart, and muscles. Also develops heart rhythm and blood

clotting of the fetus (arabiaenglish.babycenter.com).High calcium intake

during pregnancy might reduce non-heme iron absorption, leading to iron

deficiency (Robinson et al., 1998). Calcium builds your baby’s bones and

helps its brain and heart to function. Calcium intake increases dramatically

during pregnancy. Women with calcium deficiency at any point in their lives

are more likely to suffer from conditions such as osteoporosis which directly

affect the bones. (http://www.fitnesstipsforlife.com)

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Pregnant women should consume at least 1200 mg of these pregnancy

vitamins a day, nursing mothers 1000 mg per day.

.Good sources of calcium are:

Low-fat milk

Yoghurt

Cheese

Salmon (cooked)

Tinned fish

Dark green leafy vegetables are good sources of calcium.

More iron for pregnant women:

The demand for iron, essential for blood formation, is also increased during

pregnancy because the mother's blood volume increases, and the fetal red

blood cells have to be developed. The developing fetus draws iron from the

mother to last it through the first five or six months after birth so a woman

has an increased need for iron during pregnancy.

Iron losses are reduced during pregnancy because the woman is no longer

menstruating and so loses less iron from menstrual blood loss. It is useful to

include foods that are good sources of iron in the diet every day (for

example, red meat) and to have foods that are good sources of vitamin C

(like oranges) to help absorb the iron.

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The recommended daily intake (RDI) of iron during pregnancy is 27mg a day

(9mg a day more than that for non-pregnant women). The amount needed

depends on the amount of iron the woman has ‘stored’ in her body prior to

pregnancy. If your iron stores are very low, you may need to get more from

supplements. It is important to discuss your need for supplements with your

doctor as iron can be toxic in large amounts.(

http://www.betterhealth.vic.gov.au) Iron deficiency is associated with

adverse birth outcomes such as small for gestational age (SGA), preterm

birth and delayed offspring neurological development, particularly if present

during the first half of pregnancy (Zhou et al., 1998). Iron is available in

meat, fish, egg yolk, whole-grain products, and vegetables. Iron of plant

origin is not as well assimilated as iron of animal origin. However, if you

ingest vitamin C from raw food during the same meal, iron is more easily

absorbed. (www.healthandage.com) Makes red blood cells, supplies oxygen

to cells for energy and growth, and builds bones of the baby

(arabiaenglish.babycenter.com) Foods rich in iron include:

Meat (cooked)

Chicken (cooked)

Eggs (cooked)

Legumes

Dark green leafy vegetables (rinsed properly)

Fortified breads and cereals

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More zinc for pregnant women:

Zinc is important for the synthesis of DNA and is required for cell division and

growth.  Zinc deficiency in pregnancy can lead to congenital malformations

as well as abnormal foetal brain development. Your body needs zinc for the

production, repair, and functioning of DNA – the body's genetic blueprint and

a basic building block of cells. So getting enough zinc is particularly

important for the rapid cell growth that occurs during pregnancy. This

essential mineral also helps support your immune system, maintain your

sense of taste and smell, and heal wounds. Zinc deficiency is miscarriage,

toxemia, low birth weight, and other problems during pregnancy, labor, and

delivery (http://www.babycenter.com) .The recommended daily allowance for

zinc is 11mg per day. (www.healthandage.com). It helps form organs,

skeleton, nerves, and circulatory system of pregnant women

(arabiaenglish.babycenter.com) .Foods that is rich in zinc:

Meat (cooked)

Milk

Whole grains

Liver & shell fish are rich in zinc but to be avoided during

pregnancy.

1 cup fully fortified breakfast cereal: 15 mg

1 cup canned baked beans with pork: 14 mg

3 ounces Alaskan king crab meat: 6.5 mg

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3 ounces lamb shoulder: 6.2 mg

3 ounces braised pot roast, fat trimmed: 5.7 mg

3 ounces ground beef (85 percent lean): 5.5 mg

3 ounces roasted turkey, dark meat: 3.8 mg

1/4 cup raw pumpkin seeds: 2.6 mg

 More folic acid pregnant women:

This vitamin promotes the development of the fetal central nervous system

and prevents developmental defects of the neural tube (spina bifida). A

complete lack of dietary folate takes months before deficiency develops as

normal individuals have about 500–20,000 g of folate in body stores (Gentili

et al, 2009).This deficiency can result in many health problems, the most

notable one being neural tube defects in developing embryos( National

Health Service U.k).Folate deficiency during pregnancy may also increase the

risk of preterm delivery, infant low birth weight and fetal growth retardation,

as well as increasing homocysteine level in the blood, which may lead to

spontaneous abortion and pregnancy complications, such as placental

abruption and pre-eclampsia (Goh et al,2008).Women who could become

pregnant are advised to eat foods fortified with folic acid or take

supplements in addition to eating folate-rich foods to reduce the risk of

serious birth defects (Scholl et al,2000). Folic acid supplements may also

protect the fetus against disease when the mother is battling a disease or

taking medications or smoking during pregnancy(McGuire et al, 2010). Folic

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acid supplements consumed before and during pregnancy may reduce the

risk of heart defects in infants (Bazzano et al, 2011 Aug). Folic acid is

contained in vegetables, wheat germ, tropical fruits, and in eggs. However,

routine nutrition does not always supply enough folic acid (vitamin B9) to

meet the requirements of a pregnant woman. Additional folic acid intake is

necessary in the months before pregnancy and during the first trimester.

(www.healthandage.com)Foods rich in folic acid include:

Spinach

Brussels sprouts

Cabbage

Beans

Lentils

Fortified cereals

Iodine

Iodine is an important mineral needed for the production of thyroid hormone,

which is important for growth and development. Inadequate iodine intake

during pregnancy increases the risk of mental impairment and cretinism in

the newborn baby. A chronic lack of iodine can enlarge the thyroid gland in

the throat (known as goitre) creating low thyroid hormones (hypothyroidism),

causing a person to become sluggish and gain weight, affecting their general

health, fertility and for women the ability to carry a pregnancy.

(http://www.birth.com)

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Foods that are good sources of iodine include seafood and seaweed

(including nori and kelp), eggs, meat and dairy products. Women who are

pregnant should also use iodized table salt when cooking or adding salt to

food (http://www.betterhealth.vic.gov.au)

Water

During pregnancy, one's mass increases by about 12 kg (Institute of

Medicine 2004). Most of this added weight (6 to 9 L) is water because the

plasma volume increases, 85% of the placenta is water and the fetus itself is

70-90% water (Beall MH, 2007). This means that hydration should also be

considered an important aspect of nutrition throughout pregnancy. To ensure

healthy hydration during pregnancy, the European Food Safety Authority

recommends an increase of 300 mL per day compared to the normal intake

for non-pregnant women, taking the total adequate water intake (from food

and fluids) to 2,300 mL, or approximately 1,850 mL/ day from fluids alone(

EFSA Journal ,2010).

Water is life. 70% of the human body is water.

Required for all body fluids e.g. digestive juices, mucus, saliva,

blood lymph, sweat, and urine.

Required as part of many metabolic reaction.

Keep linings of mucus membranes, digestive tract and bronchial

tube moist.

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Some nutrients dissolve in water for proper absorption.

Lubricates joints and membranes. (Tull, 1987).

Potassium

Potassium, a mineral found in many types of food, plays an important role in

maintaining fluid and electrolyte balance in your body's cells. Potassium is

also important in sending nerve impulses, helping your muscles contract,

and releasing energy from protein, fat, and carbohydrates.

Since your blood volume expands by up to 50 percent during pregnancy,

you'll need slightly more electrolytes (sodium, potassium, and chloride,

working together) to keep the extra fluid in the right chemical balance.

If you suffer from leg cramps during pregnancy, you might take a look at

your potassium intake, because a lack of potassium (or sodium, calcium, or

magnesium) could be the culprit. (http://www.babycenter.com)

Low potassium is most often the result of chronic or severe vomiting or

diarrhea, or the use of certain diuretics, rather than a shortage in your diet. A

shortage of potassium could cause weakness, fatigue, muscle cramps,

constipation, and abnormal heart rhythms. Talk with your doctor if you

suspect that you're short on potassium or any other nutrient.

Protein

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Protein is vital for growth, repair and maintenance of the body. Protein can

also be used to provide the body with energy once it has been used for its

main functions of growth and repair (Tull, 1987).Lack or insufficient intake of

protein can result in giving your child to be born kwashiorkor. Protein is the

building block of the body’s cells, and as such it is very important to the

growth and development of every part of your baby’s body during

pregnancy. This is especially important in the second and third trimester,

when both Mom and baby are growing the fastest.

Pregnant and nursing women should consume at least 70g of protein per

day, which is about 25g more than the average women needs before

pregnancy. Protein can be found naturally in beans, poultry, red meats, fish,

shellfish, eggs, milk, cheese, tofu and yogurt. It is also available in

supplements, fortified cereals and protein bars.

(http://www.fitnesstipsforlife.com)

Magnesium

There are many benefits to ensuring that you are receiving sufficient

magnesium in your diet. Manganese plays an important role in the formation

of bone, teeth, cartilage, development of your baby’s inner and outer ears as

well as the assists certain enzymes to function properly.

Not only will Magnesium help with those developmental functions, but taking

a magnesium supplement while pregnant may also help prevent premature

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labor. One other pleasant effect of taking magnesium is that it could possibly

reduce pregnancy related leg cramping and heartburn.(

www.americanpregnancy.org ) Some of the food sources are:

Whole grain breads

Eggs

Vitamins A

Vitamin A improves vision and maintains the integrity of cells. .

(www.mayoclinic.com/health/pregnancy). Vitamin A helps the development

of baby’s bones and teeth, as well as their heart, ears, eyes and immune

system (the body system that fights infection). Vitamin A deficiency has

been associated with vision problems. Getting enough Vitamin A during

pregnancy will also help your body repair the damage caused by childbirth.

Pregnant women should consume at least 770 micrograms (or 2565 IU, as it

is labeled on nutritional labels) of Vitamin A per day, and that number almost

doubles when nursing to 1300 micrograms (4,330 IU). Be aware, however,

that overdosing on Vitamin A can cause birth defects and liver toxicity. Your

maximum intake should be 3000 mcg (10,000 IU) per day.

Vitamin A can be found in liver, carrots, sweet potatoes, kale spinach collard

greens, cantaloupe, eggs, mangos and peas.

(http://www.fitnesstipsforlife.com). Although vitamin A requirements do

increase during pregnancy, vitamin A supplements are rarely recommended

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for pregnant women. This is because an excessive intake of vitamin A may

cause birth deformities. The best way to increase your intake of vitamin A, if

it is low, is through food sources like milk, fish, eggs and margarine.

(http://www.betterhealth.vic.gov.au/bhcv).

Vitamin B6

Also known as Pyridoxine, Vitamin B6 helps your baby’s brain and nervous

system develop. It also helps Mother and baby develop new red blood cells.

Oddly enough, B6 has been known to help alleviate morning sickness in

some pregnant women. Pregnant women should consume at least 1.9 mg of

this pregnancy vitamin per day of Vitamin B6. That amount rises slightly

when nursing to 2.0 mg per day. Vitamin B6 can be found in fortified cereals,

as well as bananas, baked potatoes, watermelon, chick peas and chicken

breast. (http://www.fitnesstipsforlife.com).

Vitamin B12 during pregnancy

Vitamin B12 works hand in hand with folic acid to help both Mother and baby

produce healthy red blood cells, and it helps develop the fetal brain and

nervous system. The body stores years’ worth of B12 away, so unless you

are a vegan or suffer from pernicious anemia the likelihood of a B12

deficiency is very slim.

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Pregnant women should consume at least 2.6 mcg (104 IU) of B12per day,

nursing mothers 2.8 mcg (112 IU).Vitamin B12 can be found in red meat,

poultry, fish, shellfish, eggs and dairy foods. If you are a vegan you will be

able to find B12 fortified tofu and soymilk. Other foods are fortified at the

manufacturer’s discretion. (http://www.fitnesstipsforlife.com).

Vitamin C during Pregnancy

Vitamin C helps the body to absorb iron and build a healthy immune system

in both mother and baby. It also holds the cells together, helping the body to

build tissue. Since the Daily Recommended Allowance of Vitamin C is so easy

to consume by eating the right foods supplementation is rarely needed.

Pregnant women should consume at least 80-85 mg of Vitamin C per day,

nursing mothers no less than 120 mg per day. Vitamin C can be found in

citrus fruits, raspberries, bell peppers, green beans, strawberries, papaya,

potatoes, broccoli and tomatoes, as well as in many cough drops and other

supplements.(http://www.fitnesstipsforlife.com).

Vitamin D during pregnancy

Vitamin D helps the body absorb calcium, leading to healthy bones for both

mother and baby.Women who are pregnant or nursing should consume at

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least 2000 IU of Vitamin D per day. Since babies need more Vitamin D than

adults babies that are only breastfeeding may need a Vitamin D supplement,

so if your doctor recommends this don’t worry. You haven’t done anything

wrong! Formula is fortified with Vitamin D, so if you are bottle feeding or

supplementing with formula your baby is probably getting sufficient amounts

of this vital nutrient.

Vitamin D is rarely found in sufficient amounts in ordinary foods. It can,

however, be found in milk (most milk is fortified) as well as fortified cereals,

eggs and fatty fish like salmon, catfish and mackerel. Vitamin D is also found

in sunshine, so women and children found to have a mild Vitamin D

deficiency may be told to spend more time in the sun.

(http://www.fitnesstipsforlife.com)

.Vitamin E during pregnancy

Vitamin E helps baby’s body to form and use its muscles and red blood cells.

Lack of Vitamin E during pregnancy has been associated with pre-eclampsia

(a condition causing excessively high blood pressure and fluid retention) and

low birth weight. On the other hand, Vitamin E overdose has been tentatively

associated with stillbirth in mothers who “self medicated” with supplements.

Pregnant women should consume at least 20 mg of Vitamin E per day but

not more than 540 mg. Vitamin E can be found in naturally in vegetable oil,

wheat germ, nuts, spinach and fortified cereals as well as in supplemental

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form. Natural Vitamin E is better for your baby than synthetic, so be sure to

eat lots of Vitamin E rich foods before you reach for your bottle of

supplements.(http://www.fitnesstipsforlife.com).

Riboflavin during pregnancy

Also known as Vitamin B2, Riboflavin helps the body produce the energy it

needs to develop your baby’s bones, muscles and nervous system. Women

with Riboflavin deficiency may be at risk for preeclampsia, and when baby is

delivered it will be prone to anemia, digestive problems, poor growth and a

suppressed immune system, making it more vulnerable to infection.

Pregnant women should consume at least 1.4 mg of Riboflavin per day,

nursing mothers 1.6 mg. Riboflavin can be found in whole grains, dairy

products, red meat, pork and poultry, fish, fortified cereals and eggs.

(http://www.fitnesstipsforlife.com).

Thiamin during pregnancy

Also known as Vitamin B1, thiamin helps develop your baby’s organs and

central nervous system. Pregnant women and nursing mothers should

consume at least 1.4 mg of Thiamin a day. Nursing mothers who are Thiamin

deficient are at risk for having babies with beriberi, a disease which may

affect the baby’s cardiovascular system (lungs and heart) or the nervous

system. Thiamin can be found in whole grain foods, pork, fortified cereals,

wheat germ and eggs. (http://www.fitnesstipsforlife.com)

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Multivitamin supplements

Multivitamin supplements may be recommended for the following groups of

pregnant women:

Vegetarians

Teenagers who may have an inadequate food intake

Substance misusers (of drugs, tobacco and alcohol)

Obese pregnant women who are restricting their energy intake to prevent

large weight gains. (http://www.betterhealth.vic.gov.au/bhcv)

2.3. The Importance of Eating Well During Pregnancy

Nutrition during pregnancy is important. Pregnant women's food has an

effect on the pregnancy, on the fetal development and also on the health of

the mother and child.

The foods a pregnant woman eats are the main source of the nutrients for

the baby. But what foods should pregnant women eat? What foods a

pregnant woman should avoid?

It is important for pregnant women to understand what kind of food is best

for them and their baby. (Swiss Association for Nutrition)

Here is the Swiss Association for Nutrition's recommendations for correct

nutrition for pregnant women. If followed, they will fully protect the health of

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the mother and provide optimal growth and development of her unborn

baby.

A pregnant woman's nutrition directly influences the course of the pregnancy

and normal fetal development, and also the long-term health of the mother

and child. In the first half of pregnancy, nutrition requirements mainly

concern quality, while in the second half; quantity is also an issue, to ensure

fetal growth. Proper nutritional habits should already be established at the

start of this second life - if possible even before conception.

2.4. Some Foods Pregnant Women Should Eat During Pregnancy

Many factors affect our eating behavior: individual needs and wants, health

status, social environment, selection of available foods, advertising, etc. The

following recommendations (a sort of Nutrition Guide for Pregnant Women)

ensure (in the form of a balanced diet) an adequate supply of energy, and

nutritional and protective elements, and therefore represent healthy

nutrition. The listed amounts and portions are averages; it is no possible to

follow them exactly day by day. (www.healthandage.com/nutrition-for-

pregnant-women)

Fibres

A common problem during pregnancy is constipation. Therefore the diet

should contain plenty of fibres in the form of whole fruits and vegetables,

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whole grain cereals, vegetable soups and whole pulses.

(www.mayoclinic.com/health/pregnancy).

Oils and Fats during Pregnancy:

Daily consumption: 2 teaspoons (10 g) nutritious vegetable oil such as sunflower oil, thistle oil,

corn oil, unprocessed olive or canola oil, e.g., for salad dressings.

Daily consumption: at most 2 teaspoons (10 g) grease or cooking oil, such as peanut oil, or olive

oil for hot meal preparation. Daily consumption: at most 2 teaspoons (10 g) spread, i.e., butter or

margarine. Daily maximum: one m www.healthandage.com/nutrition-for-pregnant-women meal

heavy in fat such as deep fried or breaded foods, cheese dishes, fried potato cakes, bratwurst or

hot dogs, cold cuts, dishes with sauces, shortcake or pastry dough, cake, pies, chocolate, etc.

Pastries/Snacks:

Use them in moderation - most sweets contain hidden fat. At most eat 1

small portion of sweet snacks daily (e.g. 1 chocolate bar, 1 piece of cake or a

pastry, an ice cream).

Meat, Fish, Eggs, Legumes:

2 - 4 times per week: 1 portion meat (1 portion = 80-120 g, or 3-4 oz). More

is unnecessary, less is permitted. At most, one meal of cured meats such as

ham, sausage or bacon in place of meat.

At most, one meal per month of offal, such as kidney, tripe, or brains (1

portion = 80-120 g, or 3-4 oz).

Avoid liver 1-2 portions fish per week (1 portion = 100-120 g, or 3½ -4 oz).

2-3 eggs per week, including those used in baked goods, soufflés, or cream

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sauces.

They should be cooked to avoid food poisoning:

Per week: 1-2 portions legumes and derivates e.g., lentils, chickpeas, beans

(1 portion = 40-60 g, or 1½ -2 oz, dry weight), tofu (1 portion = 100-120 g,

or 3½ -4 oz)

Milk and Milk products:

Per day: 3-4 portions of milk products (1 portion = 0.2 liter or ½ pint of milk,

or 1 cup of yogurt, or 30 g= 1 oz hard cheese or 60 g = 2 oz soft cheese).

Grain Products and Potatoes:

Daily consumption: eat 3-4 portions of starchy foods such as bread,

potatoes, rice, cereals or pastas, preferably whole-grain products. The

portion size depends on the frequency and amount of physical activity

practiced.

Fruits for Pregnant Women:

Per day: 2-3 portions of fruit, raw if at all possible (1 portion = 1 apple, 1

banana, 3 plums or a bowl of berries).

Vegetables Per day:

2-3 portions of vegetables, one of which should be raw, e.g., as a dip

vegetable or a mixed salad (1 portion = 100 g = 3½ oz raw vegetables, or

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150-200 g = 5-7 oz cooked vegetables, 50 g = 1¾ oz green salad or 100 g =

3½ oz mixed salad).

Alcoholic and Nonalcoholic Drinks:

Drink at least 1.5 liters (3¼ pints) of liquid per day, preferably unsweetened

nonalcoholic drinks.

Replace fluids in the case of vomiting, diarrhea, or heavy perspiration.

Alcohol: for her own benefit and that of her unborn child, the pregnant

mother should avoid alcohol consumption, as it is assimilated by the fetus.

(http://EzineArticles.com/6692240)

Listeria infection and pregnancy

Listeria infection, or listeriosis, is an illness usually caused by eating food

contaminated with bacteria known as Listeria monocytogenes. Healthy

people may experience no ill-effects from listeria infection at all, but the risks

are substantial for pregnant women. The greatest danger is to the unborn

baby, with increased risk of miscarriage, stillbirth or premature labour. A

listeria infection is easily treated with antibiotics, but prevention is best.

Some foods are more prone to contamination with listeria than others.

Exclude these foods from your diet if you are pregnant:

Soft cheeses, such as brie, camembert and ricotta – these are

safe if served cooked and hot

26

Precooked or pre-prepared cold foods that will not be reheated –

for example, pre-prepared salads, pate, quiches and delicatessen

meats like ham and salami

Raw seafood such as oysters and sashimi or smoked seafood

such as salmon (canned varieties are safe)

Unpasteurized foods

Soft-serve ice-cream.

The organism that causes listeria infection is destroyed by heat, so properly

cooked foods are not a risk. (http://www.betterhealth.vic.gov.au)

Nausea and vomiting

These symptoms are common, especially at the beginning of pregnancy.

Small carbohydrate snacks (a sandwich or fruit) every two to three hours

may provide some relief.

Plan light and more frequent meals.

Avoid fatty foods, fried foods, sauces, and hot spices.

Have breakfast 15 minutes before getting up to offset morning

sickness.

Eat some dry bread, biscuits or cereal before getting up in the

morning. Get up slowly, avoiding sudden movements.

Drink liquids between rather than with meals to avoid bloating as

this can trigger vomiting.

Avoid large meals and greasy, highly spiced foods.

27

Suck something sour like a lemon.

Relax rest and get into the fresh air as much as possible. Keep

rooms well ventilated and odour free.

Slowly sip a fizzy drink when feeling nauseated.

Try food and drinks containing ginger as these sometimes relieve

nausea. (http://www.betterhealth.vic.gov.au).

Heartburn

Heartburn is common in pregnancy because, as the baby grows, there is

more pressure on the abdomen. Small, frequent meals may be better than

large meals. (http://www.betterhealth.vic.gov.au)

Try to avoid:

Eating late at night

Bending, lifting or lying down after meals

Excessive consumption of tea or coffee.

You may also like to try sleeping with your bedhead raised a few inches. You

can do this by putting a folded blanket or pillow under your mattress.

(http://www.betterhealth.vic.gov.au)

Eat light and more frequent meals.

Eat in the evening, at least 2 hours before going to bed.

Avoid fatty foods, coffee and cola drinks.

28

Flatulence

Avoid foods with a fermentative effect, such as cabbage, leeks,

garlic, onions, and legumes.

Drink tap water or non-carbonated mineral water.

Eat slowly and in peace and quiet.

Constipation

Intestinal movement is slowed during pregnancy, and this may result in, or

worsen, digestive disorders.

Drink at least 1.5 liters (3¼ pints) of fluids per day (water, herbal

tea, fruit juice, milk).

Eat fiber-rich food: whole-grain bread, vegetables, fruit, and

legumes.

Drink a glass of cold water when you get up in the morning, and

eat dried fruits (prunes).

Edema

This swelling of the legs, arms, and sometimes the face are due to water

retention.

Do not go without salt except in special cases.

29

Drink 1.5 liters (3¼ pints) daily

Food cravings for Pregnant Women

Maintain a regular schedule of meals.

Take small snacks between meals consisting of fruit, milk,

yogurt, bread with cottage cheese, or whey.

Food Poisoning/ infections: toxoplasmosis, listeriosis

some infections have serious effects on the embryo, but they can be

prevented by observing the rules of hygiene.

Always carefully peel and wash raw vegetables, fruit, and herbs

(parsley, basil).

Always wash your hands carefully before cooking, eating, after

you have handled raw meat, or have touched sand or soil.

Eat only well-cooked meat. Avoid tartar steak, fried sausage,

meat fondue, rare steak, Carpaccio.

Avoid cats and their litter, as toxoplasmosis pathogens

propagate in the cats' intestines.

Do not eat uncooked fish, meat, milk, and eggs.

Do not eat cheese rind.

Alcohol

Consumption of alcohol during pregnancy should be avoided if possible, as it

affects the physical and mental development of the fetus. The risk of injury is

30

particularly high in the early months. There is no known completely safe

level of alcohol consumption for women who are pregnant. Consuming

alcohol during pregnancy increases the risk of miscarriage, low birth weight,

congenital deformities and effects on the baby’s intelligence.

Australian Alcohol Guidelines advise women who are pregnant or who are

considering pregnancy that they:

Consider not drinking at all

Should never become intoxicated (drunk)

If they choose to drink, should have less than seven standard

drinks over a week and no more than two standard drinks on any

one day (at least two hours apart)

Should note that the risk is highest in the earlier stages of

pregnancy, including the time from conception to the first missed

period.

A standard drink contains 10g of alcohol.

(http://www.betterhealth.vic.gov.au)

Caffeine

Caffeine is found in coffee, black tea, cola drinks, energy drinks, and cocoa

(chocolate) as well as other foods. It has a stimulating effect and therefore

speeds up the heart rate. Caffeine in the blood of a pregnant woman affects

31

the heartbeat of the baby, which almost doubles. Pregnant women may take

two cups of coffee or four cups of tea a day without endangering the fetus.

Tobacco

With each inhalation from a cigarette, nicotine enters the mother's

circulatory system and also that of the fetus through the placenta. The blood

vessels contract and the oxygen supply of the fetus is compromised. For this

reason, tobacco is contraindicated during pregnancy (and this includes

secondhand smoke).

3. RESEARCH METHODOLOGY

3.0. Introduction

Methodology can be defined, as the branch of philosophy that analysis

the principles and procedures of inquiry in a particular (word net,

2005). This chapter is divided into two main parts: the first part would

deal with the research methodology, whilst the second part outlined

the profile of the institution under study. This section will discuss the

research, sources and methods of data collection, sample population,

sampling technique as well as how the data would be analyzed.

3.1. Profile of Eastern Regional Hospital-Koforidua.

32

The Eastern Regional hospital was established in 1926, and double as

the Municipal hospital for the New Juabeng municipality with its

155000 inhabitants. There have been two major structural additions to

it since its establishment. The first was in 1972 when an Administration

block, Dental unit, Laboratory department, Adult OPD with Medical

Records, Internal Medicine, Kids, Surgical and Maternity Wards with

Theater were added.

In 1998 additional Kitchen, Main Theater, X Ray Department, Laundry

and Mortuary Departments were included. There has been neither

rehabilitation nor additional structures since then.

The 323-bed hospital compared to 314 in 2004 now serves as a referral

point for about sixteen district hospitals in the Eastern Region. The

hospital offers the following services: Internal Medical including Anti-

Retroviral Therapy, Pediatric, Surgical, Medicine, Dental,

Ophthalmology, Physiotherapy, Ear, nose and Throat, Pharmacy,

Laboratory, X-Ray, Ultrasound, catering and Hospital, Laundry,

Mortuary, and Primary Health care services.

The Regional hospital is a Ghana Health Services facility-A secondary

referral level not for profit healthcare organization. The hospitals

intention is to satisfy their numerous customers, patients, Vision to

patients, inpatients, Corporations, Suppliers maintenance team, staff

and employers to Ghana Health Service and Ministry of Health.

33

VISION

To develop the hospital into a modern medical center of ‘BEST’

practice in health care provision in Ghana.

MISSION

To provide comprehensive secondary level inpatient and out patients

health care services of high quality to the people and communities in

and around Eastern Region in a patient friendly atmosphere by a

motivated, contented staff in a well maintained hospital infrastructure.

3.2. Hospital Organizational Structure Regional hospital – Foforidua .

34

REGIONAL DIRECTOR OF HEALTH SERVICES

MEDICAL DIRECTOR/SUPERINTENDENT

ADVISORYLEVEL1

1

LEVEL2

1

MATRON

HD OF NURSING

CME

COORDINATOR

DIRECTION

ADMINISTRATION

DIRECTOR OF ADMINISTRATION

HEAD OF FIANANCE

3.3. Target Population

Population is a set of unit under consideration and can be people, objects or events. (Bowerman

and O’Connell, 2007). The target population was pregnant women within the Koforidua

Regional Hospital. In all, there were 100 pregnant women at the time of the research.

3.4. Sample Size

Taking into account time and academic pressure, a sample population of 50 people was selected

as the total respondents from the total population for the study.

35

LEVEL 4

1

3.5. Sampling Technique

The researchers adopted random sampling in selecting the respondents. The simple random

method was adopted because the target population does not require any stratification.

3.6. Research Design

Research design involves how the research materials are to be collected. (Giddens, 2005).The

research design used was case study. The researchers used case study because they identified a

problem within the case study area and would love to find a solution to it.

3.7. Data Collection Technique

The secondary source of information was drawn from textbooks, journal, articles and the

internet. The secondary data constituted the core of the literature review. The researchers decided

to use questionnaires and interviews because, taking into knowledge the level of literacy of the

respondents Pregnant women in Koforidua Regional hospital, questionnaires and interviews

would be appropriate.

3.7. Sources Of Data Collection

Information for the study will be obtained from both primary and secondary sources.

3.7.1 Primary Sources

Is firsthand information obtained by the researchers on the variables of interest for a specific

purpose of the study. Surveys administered by the author are examples of primary source. If

surveys are carried out on the internet or phone, the information received is also a primary data.

3.7.2 Secondary Sources

36

Sources of information are textbooks, published journal, dissertation of past students,

government publications, industry analysis offered by media and web sites.

3.8. Data Collection Procedure

The data collected will be carefully examined to ensure accuracy, consistency and completeness

since any deficiency may render the resultant findings inaccurate. The researchers will approach

respondents personally to explain things to them before delivering the questionnaires. The

researchers will interview the illiterate and write the information obtained down.

3.9.3. Data Analysis

Excel was used to draw all the bar charts, histogram, pie chart and all diagrams related to the

data.

4. ANALYSIS OF DATA

4.0. Introduction

This chapter gives the presentation and analysis of data and findings through questionnaire and

interviews. Both statistical and descriptive analyses were employed in analyzing the data

collected. Statistical tools such as tables and diagrams were used to aid quick visual display of

the results.

4.1. Data Presentation and Analysis

37

The data analysis focuses on the examination of the data obtained through administering of

questionnaire and interviews conducted. Data is presented in simple tables and the corresponding

responses converted into percentages. The table 4.1 below shows the number of questionnaires

administered by the researcher.

Table 4.1

QUESTIONNAIRES RECEIVED NOT RECEIVED TOTAL

Number 30 20 50

Percentage (%) 60 40 100

Out of the total number of 50 questionnaires administered, 30 were returned completed. These

represent 60% of the total distribution. 20 out of the 50 were not received; this accounted for

40%.

Table 4.2: Age Distribution of Respondents

AGE NUMBER OF RESPONDENTS PERCENTAGE (%)

18 - 25 years 25 50

26 – 33 yeas 15 30

34 – 41 years 7 14

42 above 3 6

Total 50 100

38

Out of the 50 respondents, 25 respondent were in the range 18 to 25 years representing 50%; 15

respondent were in the range of 26 to 33years representing 30%; 7 out of 50 respondent were in

the range of 34 to 41years representing 14% and out of the 50 respondent 3 were in the range of

42 years and above representing 6%.

From the findings the researchers noticed that, respondents aging from 18-25years mark the

highest age of respondents. This implies that women at this age get pregnant more than that of

the ages above.

Table 4.3: Dishes intake of Respondents

DISHES NUMBER OF RESPONDENTS PERCENTAGE (%)

RICE DISHES 15 30

CORN DOUGH DISHES 13 26

FUFU 12 24

AMPESI DISHES 10 20

Total 50 100

From the table out of the 50 respondents of women who are pregnant 15 take in rice dishes

representing 30%; 13 respondent take in corn dough dishes representing 26%; 12 respondent

take in fufu dish representing 24% and 10 respondent take in Ampesi dishes representing 20%.

Rice dishes-Most pregnant women eat rice and stew. The rice contains carbohydrates and the

stew contains protein, vitamins and mineral elements.

Corn dough dishes-Example banku and okro soup. The banku contains starch in the form of

carbohydrates and the soup contains vitamins, protein and calcium. Fufu with goat light

39

soup.Fufu contains starch and iron as carbohydrates and the soup contains protein, iodine and

calcium. Ampesi and kontomire stew. The ampesi contains iron and carbohydrates whiles the

kontomire contains vitamins, mineral elements and protein. This shows that the food pregnant

women eat are well balanced.

Table 4.4: Fruits intake of Respondents

FRUITS RESP ONDENTS PERCENTAGE %

Pineapple 15 30

Orange 10 20

Babanna 8 16

Water – melon 6 12

Mango 5 10

Apple 5 10

Paer 1 2

TOTAL 50 100

The table above depicts fruits distribution that women take during pregnancy; Out of the 50

respondents, 15 respondents take Pineapple representing 30%; 10 respondents takes orange

representing 20%; 8 respondents take Banana representing 16%; 6 respondents take water –

melon representing 12%; 5 respondents take mango representing 10%; 5 respondents take Apple

representing 10% ;and 1 respondent takes pear representing 2%. All the fruits contain the same

nutrients which is vitamins, some mineral elements and water. It also contains fibre which

prevents constipation; it regulates the body processes and protects the body against diseases.

40

Table 4.5: Vegetables intake of Respondent

VEGETABLES RESPONDENTS PERCENTAGES (%)

Nkontomire and Garden eggs 13 26

Cabbage 12 24

Carrots 10 20

French beans and Cucumber 7 14

Lectuce 4 8

Green peper 4 8

Total 50 100%

The table above depicts Vegetables intake of respondente during pregnancy; out of the 50

respondents, 13 respondents takes Nkontomire and Garden Eggs representing 26%; 12

respondents takes Cabbage representing 24%; 10 respondents take Carrots representing 20%; 7

respondents take French beans and Cucumber representing 14%; 4 respondents take Lectuce

representing 8%; and 4 respondents take Green paper representing 8%. They also perform the

same duty as for fruits. Some contain carotene and others also give blood, example kontomire

and carrot. It contains fibre and vitamin which promote the development of the central nervous

system and prevent developmental defect of the neutral tube.

Table 4.6: Nutrients intake of the Respondents

NUTRIENTS RESPONDENTS PERCENTAGES

Carbonhydrate 15 30

Proteins 10 20

41

Vitamins 6 12

Folic Acid 5 10

Calcium 5 10

Iron 5 10

Iodine 4 8

Total 50 100%

Source; field study 2012

Table4.6 above shows nutrients in take of pregnant women; out of the 50 respondents, 15

respondents take Carbohydrate representing 30%; 10 respondents take Proteins representing

20%; 6 respondents take Vitamins representing12%; 5 respondents take Folic Acid representing

10%; 5 respondents take Calcium representing 10%; 5 respondents take Iron representing 10%;

and 4 respondents take Iodine representing 8%. These are the functions of the above nutrients-

i. Carbohydrates provide heat and energy for the body.

ii. Protein helps in the growth and repair of worn-out tissues.

iii. Vitamins give vitality to the body and protect the body against diseases.

iv. Folic acid promotes the development of the fetal nervouse and prevents

developmental defect of the neutral tube.

v. Calcium helps build strong bones and teeth

vi. Iron is essential for blood formation and also increases in fetal red blood cells

developments.

vii. Iodine is an important mineral needed for growth and development and

prevents goiter deficiency.

42

5. SUMMARY CONCLUSIONS AND RECOMMENDATIONS

5.0. Introduction

This chapter contains the summary, recommendations and conclusions in relation to the findings

from the research work.

5.1. Summary

After the data presentation and analysis, the following findings were discovered upon assessing

the knowledge of pregnant women on their nutritional intake during pregnancy. The study was

conducted because the researchers wanted to identify some of the nutrients in the diet

43

intake of pregnant women in their right proportion, identify some of the food

that pregnant women should eat during pregnancy and identify some of the

factors that can be adopted in order to reduce the incidence of pregnant

women resulting in giving birth to unhealthy new born babies in Koforidua.

5.2. Conclusion

The following conclusions were drawn based on the findings of the study.

The researchers noticed that most pregnant women do not have

the knowledge about nutritional intake at pregnancy.

The researchers observed that some pregnant women do not

know the nutrients they should eat during pregnancy.

Pregnant women should eat a balanced diet. Especially include

more fruits and vegetables each day in their diet.

We say that nutrients are useful to pregnant women during

pregnancy.

The revealed that, the main problem faced by pregnant women

is that they do not eat well during pregnancy.

We hope that the ante- natal will provide a quality service for

pregnant women so that they can be healthy and strong

resulting in giving birth to healthy babies.

5.4. Recommendations

44

In respect of the findings, the researchers seek to recommend the

following to the Koforidua Central Hospital. Although the hospital has

an anti-natal care department, it should be renovated with a well

planned or structured block and should be given the same recognition

accorded to other departments.

We also recommend that there should be training programmes for

management and staff at least once a year in order to abreast them

with current changing techniques with various types of food, nutrition

and cooking processes.

We also appeal to NGOs to the hospital that there should be effective

counseling or conversation between the pregnant women and

management so as to identify their problems and help them solve.

It is the wish of the researchers that various food stuffs should be

introduced to the pregnant women during anti- natal care, such as

fruits and vegetables because some do not know their names, value

and their uses.

Due to pregnancy discomfort and scientific research, women should be

able to give birth at the early ages from 18-35years so that proper care

and attention will be given to the children.

We also congratulate the staff and management for their good work

done.

45

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49