Page 2:

• Title: Lifecycle of Humans

• Stages:

  • Preconception

  • Pregnancy

  • Infancy

  • Breastfeeding

  • Toddler

  • School-age

  • Adolescence

  • Adulthood

  • Elderly

• Different nutritional needs at each stage

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• Preconceptional period:

  • Anytime before pregnancy

  • Time period of 2-6 months prior to pregnancy

• Periconceptional period:

  • Period ranging from at least 2 months prior to conception through 4 months of pregnancy

  • Period ranging from 1 month prior to conception through 2-3 months of pregnancy

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• Continuum of critical periods:

  • Preconception

  • Conception

  • Postpartum

  • Delivery

  • Pregnancy

  • Periconception

• 1000 days of life: 2 years to 6 months, 2 months, 4 months

Page 5:

• Importance of preconceptional nutrition for pregnancy outcome

• Neglected issues in preconceptional nutrition

• Most nutrition interventions focus on pregnancy only

Page 6:

• Diagram of female reproductive organs

Page 7:

• Diagram of female sexual cycle

Page 8:

• Diagram of ovulation, fertilization, and implantation

Page 9:

• Micronutrients and their role in implantation

• List of micronutrients and their functions

Page 10:

• Nutritional problems during preconceptional period

• Anemia and other micronutrient deficiencies are prevalent among women in reproductive age

• Chronic energy deficiency (CED) is also a common nutrition problem

Page 11:

• Anemia is a condition of low hemoglobin level

• Anemia has multifactor causes

Page 12:

• Factors affecting anemia

• Protein, heme synthesis, vitamin B complex, zinc, vitamin A, transferin, copper, iron, genetic factors, vitamin B12, bleeding, infection, parasites, inhibitor, kidney failure, erythropoiesis

Page 13:

• Prevalence of anemia in Indonesia:

  • Infants: >70%

  • Pregnant women: 43%

  • Women in reproductive age: 29%

Page 14:

• Prevalence of anemia in Indonesia by age group

Page 15:

• Chronic energy deficiency (CED) defined as Mid Upper Arms Circumference (MUAC) ≤ 23.5 cm

• Measurement method for CED

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• Prevalence of CED among women in reproductive age is about 30%

• CED is greater in rural and suburban areas compared to urban areas

• Low energy and protein intake contribute to CED

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• Poor nutrition during preconception can lead to:

  1. Low birth weight

  2. Pregnancy complications such as pre-eclampsia, pre & postpartum hemorrhage, premature delivery, miscarriage

Page 18:

• Determinants of low birth weight in developing countries

• Nutritional factors play a role in low birth weight

Page 19:

• Intergenerational cycle of low birth weight

• Effects of low birth weight on different stages of life

Page 20:

• Low birth weight can be categorized as premature or intrauterine growth retardation (IUGR)

• Maternal malnutrition is a major cause of IUGR in developing countries

Page 21:

• Premature delivery defined as babies born ≤ 37 weeks of pregnancy

• Early preterm: born < 35 weeks

• Late preterm: born 35-37 weeks

Page 22:

• Maternal size (anthropometric) as a predictor for birth weight

Page 23:

• Four maternal components derived from pre-conception anthropometric measurements:

  • Weight

  • Height

  • Fat mass (calculated from skinfolds)

  • Muscle mass (calculated from arm muscle area)

Page 24:

• Prepregnancy weight can be used to predict low birthweight.

• In a US study, women with a prepregnancy weight below 59 kg were more than twice as likely to have LBW infants compared to women with prepregnancy weights >59 kg.

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• Prepregnancy weight of less than 40 kg is a useful cutoff to predict women who will deliver low birthweight babies.

• Tripathi, et al. (1987) found that 60% of small-for-date Indian infants had mothers with prepregnancy weights less than 40 kg and a weight gain of less than 5 kg.

• Anderson (1989) estimated that Indian women weighing less than 40 kg during the first 6 months postpartum had twice the risk of delivering low birthweight infants.

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• Weight gain in the second and third trimester is of greater importance for ensuring fetal growth than weight gain during the first trimester.

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• Maternal height predicted neonatal length.

• Maternal fat mass predicted neonatal skinfold thickness.

Page 28:

• Intervention to promote optimal fetal growth:

  • Nutritional health care

  • Health-related behavior

  • Infection control

Page 29:

• Nutritional intervention:

  1. Food (nutrient) supplement

  2. Nutrition education

Page 30:

• Food supplementation during preconception aims to prepare the body's stores for the increasing need of nutrition during pregnancy.

• Food supplementation during pregnancy aims to prevent low birth weight and not promote fetal overgrowth.

Page 31:

• Fe supplementation interventions throughout the life cycle:

  • Infancy

  • Pre-school children

  • School children

  • Adolescence

  • Pregnancy

  • Pre-pregnancy

• Strategic entry points for Fe supplementation:

  • Intervention Fe syrup in selected areas

  • Intervention: school feeding

  • Intervention among senior high school students

  • Daily Fe supplementation

  • To make body iron store prior to pregnancy

Page 32:

• Existing programs for Fe supplementation:

  • Suplementasi tablet besi dosis: Kel. Sasaran WUS & remaja putri

  • Frekuensi 1x/mg selama 16 mg, 10 hari selama mens

  • Dosis Pencegahan 1x1 tab

  • Dosis pengobatan 3x1 tab

  • 1 tab (200 mg fero sulfat) mengandung 60 mg Fe, 0,25 mg Folat

  • 1 sendok sirop mengandung 30 mg Fe

Page 33:

• Multi micronutrient (MMN) supplementation:

  • MMN supplementation for pregnant women in developing countries (Indonesia: Lombok Tengah, Sika, Belu, Klaten; other countries: Nepal, Mexico, Zimbabwe)

  • MMN contains a daily dose of 15 vitamins and minerals, including retinol, vitamin E, vitamin D, vitamin B1, vitamin B2, niacin, vitamin B6, vitamin B12, folic acid, vitamin C, iron, zinc, copper, selenium, and iodine

Page 34:

• Tasks related to preconceptional nutrition:

  • Preconceptional nutrition & LBW

  • Preconceptional nutrition & preterm

  • Preconceptional nutrition & pre eclampsia

  • Preconceptional nutrition & anemia/iron deficiency

  • Program intervensi multi micronutrients pra