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When a couple fails to conceive, the male is

responsible almost as often as the female.

Male infertility is said to be in the increase assperm counts have reduced by 53% in the

last 50 years.

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Having a child is a wonderfulexperience that will enrich your life

forever. But the decision to have a child

shouldnt be taken lightly.

Parenthood is a lot of work, and the best way to

approach it is by preparing yourself so that

youre as ready as possible for this big event.

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Preparing to

Become pregnant

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Why do I want to have a baby?

Does my partner feel the same way I

do? Do we share the same ideas about

how to raise a child? If not, have we

discussed our differences?

How will having a baby affect my

current and future lifestyles or career?

Am I ready and willing to make thosechanges?

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Is there are lot of stress is my liferight now that could interfere

with my ability to become

pregnant or enjoy my pregnancy?

What about for my partner? Is

stress an issue?

Emotionally, are we ready to take

on parenthood?

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Financially, can we afford to raise achild? If Im single, do I have the

necessary resources to care for a

child by myself?

Does my health insurance plan

cover maternity and newborn care?

If I decide to return to work, do I

have access to good child care?

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OK, so emotionally and

financially, youre ready to go.

Now its time to find out if

your body is primed for thetask at hand.

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So, how do you know if your

body is ready for pregnancy?

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Identify any potential risks to yourpregnancy and establish ways to minimize

those risks.

Your partners health and lifestyle including family medical history and risk

factors for infections or birth defects

are important because they, too, can affect

you and your baby.

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Risiko selama hamil

(a) usia di bawah 18 tahun,

(b) keluarga prasejahtera,

(c) food fadism,

(d) perokok berat,

(e) pecandu obat dan alkohol,(f) berat 120% berat baku,

(g) terlalu sering hamil:

>8 kali dengan sela waktu

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Risiko selama perawatan

Pertambahan berat tidak adekuat (1 kg/minggu),

dan Hb

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Risiko lain yang tidak langsung berkaitandengan gizi adalah

(1) tinggi badan 2+,

(5) presentasi bokong,

(6) janin kembar,(7) pendarahan vagina, dan

(8) malaria endemik.

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Whether you are underweight,

overweight, or simply could use a

nutritional boost to optimize yourchances of conception, nutrition

should be an important part of your

fertility journey.

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If you are obese, fat cells can produceenough estrogen to interfere with yourability to conceive. High estrogen levels

tell your brain to stop stimulating thedevelopment of follicles and as result,ovulation doesnt occur. This is

common in women with polycysticovary syndrome

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Weighing too little is not healthy either.Menstruation occurs at a critical level offatness. If you lose too much weight, or

you are already thin, your body fatdiminishes and hormone levels areaffected; this, in turn, can lead to the

inability to ovulate.

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There is a need to take a life-cycle approach

and recognize the importance of optimal

nutrition for women before they become

pregnant in order to minimize the risks

associated with malnutrition.

Securing the good nutritional status of

women across the life course will in the long

term reduce intrauterine growth restriction,child underweight and stunting.

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A womans nutritional status

can greatly influence the

outcome of her pregnancy asmost fetal tissues and organs

develop within the first two

months of pregnancy

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Mothers preconception weight

and weight gain during pregnancy

are two of the most importantprenatal determinants of

childhood obesity.

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Several factors may influence

the association of maternal

weight and weight gain duringpregnancy with long-term

child health outcomes.

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These factors include maternal and

paternal BMI, maternal smoking

during pregnancy, blood sugar levelsduring pregnancy, fetal growth, birth

weight, and infant feeding practices.

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Pertambahan Berat

Berdasarkan BMISebelum Hamil

(Dikutip dari Brown, JE, Carlson, M. Nutrition and multifetal pregnancy. J Am Diet Assoc, 2000; 100:343-348)

NILAI BMI BERAT BADAN

Rendah (19,8) 12,5 - 18,0 (kg)Normal (19,8 - 26,0) 11,5 - 16,0 (kg)

Tinggi (26,1 - 29,0) 7,0 - 11,5 (kg)

Obes (29,0) 7,0 (kg)

Kembar dua* 16,020,0 (kg)Kembar tiga* 23,0 (kg)* Tanpa memandang nilai BMI

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Pola pertambahan berat badan

Selama trimester I, kisaran pertambahanberat sebaiknya 1-2 kg (350-400 g/mg);

sementara trimester II & III sekitar 0,34-

0,50 kg tiap minggu.

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Pemeriksaan antropometrik yang biasadilakukan ialah penimbangan berat,

pengukuran tinggi, penentuan berat

ideal, dan pola pertambahan berat.Berat pada kunjungan pertama

ditimbang, sementara berat sebelumnya

jangan terlewatkan untuk ditanya.

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Soal contoh

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Berat badan dalam penghitungan ini sebaiknyadigunakan berat ideal, yang diperoleh dengan rumus

Broca yang telah dimodifikasi oleh Katsura:

BB ideal = TB-105 (karena TB kurang dari 155 cm).Hasilnya: 153105= kg.

Ingat: wanita ini tengah hamil 16 minggu.

Artinya, BB yang tertimbang kini mencakup berat janinyang sedang tumbuh dan berkembang dalam

kandungan selama 16 minggu.

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Trimester I ( ke 12) sebanyak 1-2 kg (350-400 g/minggu).

Trimester II (minggu ke 16) ialah 2 kg (500 g/minggu).

Biladiasumsikan bahwa kehamilan wanita ini berlangsung

normal, berarti seharusnya BB telah bertambah sekitar 2-3

kg (1-2 kg merupakan pertambahan BB trimester I, dan 1 kg

trimester II selama 2 minggu).

Dari sini dapat diperkirakan BB si wanita sebelum hamil,

yaitu 50-3=47 kg

(angka 3 ialah pertambahan berat selama 16 minggu hamil).

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Menarche di usia tepat 14 tahun.

Pertambahan BB pada usia ini ialah 4,8 kg.

Pertambahan BB terkait usia ginekologik ialah 4,8 dibagi 12ialah 0,4 kg/bulan).

Pertambahan BB hamil 16 minggu: 16/4 dikali 0,4 kg = 1,6

kg (angka 4 merupakan jumlah minggu dalam 1 bulan,

karena pertambahan berat dihitung dalam bulan).

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Several studies have documented the relation

between maternal zinc status and pregnancyoutcome. The results are mixed and several

adverse effects have been associated with low

zinc status. These include congenital anomalies,reduced birth weight for gestational age and

preterm delivery. Maternal complications

include pregnancy-induced hypertension,

preeclampsia, intrapartum haemorrhage,infections, and prolonged labour .

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In a number of retrospective studies

magnesium levels during pregnancy

were found to be associated with therisk of seizures in pre-eclampsia,

prematurity and low birth weight

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A number of observation studies led to the

hypothesis that an increase in calcium

intake during pregnancy might reduce theincidence of high blood pressure and pre-

eclampsia among women with low calcium

intake

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The present evidence supports the

concept that calcium supplements

during pregnancy can reduce pre-

eclampsia when given to womenwith deficient calcium intake or

when they are at risk for pre-

eclampsia.

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Recent evidences from two, randomised,

double-blind, placebo-controlled trials

show how vitamin C (and other natural

antioxidants) could be effective indecreasing the oxidative stress and thereby

improving the course of pre-eclampsia.

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Ferrous sulfate 300 mg, yang mengandung 60 mgelemen besi (keterserapan 10%) diberikan sebanyak

3 kali sehari.

Dalam praktek, tablet yang tersedia di pasar (lebihdikenal sebagai tablet tambah darah) mengandung

200 mg ferrous sulfat dan 0,25 mg asam folat.

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Kekurangan asam folat secara marjinal berakibat

meningkatnya kepekaan, lelah berat, dan gangguan tidur.

Dua kondisi petama menyebabkan kaki kejang.

Kekejangan ini biasanya timbul pada malam hari,sehingga lama-kelamaan mengganggu tidur penderita,

yang dikenal sebagairestless leg syndrome. Jika

kekurangan bertambah parah, anemia akan terjadi, yang

menampilkan gejala kelelahan dan depresi.

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Kekurangan asam folat berpilin dengan berat

lahir rendah, ablasio plasenta, dan neural tube

defect. Bentuk konkrit neural tube defectialah

anencephaly dan spina bifida.

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There is no doubt that folic acid deficiency

is directly linked to neural tube defects.

Folate deficiency increases homocysteine

concentrations. Women with habitualabortions had a higher prevalence of

hyperhomocysteinemia as compared to

controls

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Tanda fisik defisiensi:

Mukosa dan kulit (terutama bagian dorsal jari tangan dan kaki, serta

lipatan telapak tangan dan kaki) mengalami hiperpigmentasi; yangmenghilang setelah pemberian (beberapa minggu hingga bulan)

suplementasi asam folat .

Suhu tubuh terkadang agak meningkat meski tanpa infeksi.

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Jenis makanan yang banyak mengandung asam folat

antara lain ialah ragi (1000 g/ 100 g), hati (250 g/100 g),

brocolli, sayur berdaun hijau: bayam, asparagus dan

kacang-kacangan, misalnya kacang kering, kacang kedele

(100 g/100 g). Sumber lain ialah ikan, daging, jeruk, dan

telur. Jeruk ukuran sedang, atau secangkir air jeruk

mengandung 70 g; sete-ngah cangkir brocolli masak

mengandung 50 g; telur 25 g; dan setengah cangkirkacang tanah mengandung 70 g asam folat.

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Vitamin B12

Vitamin B12 penting sekali bagi pertumbuhkembangan

normal RBC, dan keberfungsian sel-sel sumsum tulang,

sistem persyarafan, dan saluran cerna. Tubuh dapat

menyimpan B12 di hati dalam jumlah adekuat untuk

persediaaan selama 5 tahun. Itulah sebabnya mengapa de-

fisiensi berat jarang terjadi.

Pangan sumber vitamin B12 ialah hati, telur, ikan

(terutama tuna), kerang, daging, unggas, susu, keju, dan ikan.

Asupan yang dianjurkan sekitar 3 g sehari. Sebutir telur me-ngandung 1 g, secangkir susu menyimpan 1 g; 85 g daging

babi menyembunyikan 2 g asam folat.

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For many people, milk and milk

products, like yogurt and cheese,

are important sources of calcium,

vitamins, minerals and protein.However,what if you are one who

does not eat or drink dairy

products?

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Vitamin D penting dalam penyerapan kalsium dan

fosfat, serta perkembangan tulang dan gigi janin.Kekurangan vitamin D selama hamil terkait dengan

gangguan metabolisme kalsium pada ibu dan janin.

Gangguan ini berupa hipokalsemia dan tetani pada

bayi baru lahir, hipoplasia enamel gigi bayi, dan

osteomalasea pada ibu. Insidensi bisa ditekan dengan

pemberian 10 ug (400 IU) per hari. Kekurangan

vitamin D kerap menjangkiti wanita hamil yang

mukim di daerah yang hanya sedikit bersentuhan

dengan sinar matahari, sehingga sintesis vitamin D di

kulit tidak terjadi.

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Sumber vitamin D yang penting ialah susuyang telah diperkaya dengan vitamin D; di

samping telur, mentega dan alfalfa.

Perhatian khusus perlu diberikan pada

mereka yang tidak minum susu, semisal

kelompok vegetarian. Kepada mereka perlu

diberi suplementasi kalsium sebanyak 5-10

g per hari.

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Maternal trans-fatty acid

consumption increases

vascular diseases, breastcancer, and preeclampsia

risk.

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Pregnant women consumingprepared meat increase babys

brain-cancer risk. Though

prepared meat contains mostmutagenic heterocyclic amines,

other prepared foods contain

such chemicals too.

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HIPEREMESIS GRAVIDARUM

Hiperemesis gravidarum diartikan sebagai muntah persistenselama kehamilan yang berlangsung begitu parah sehinggacukup tangguh untuk mengurangi berat badan, dehidrasi,

asidosis yang dilatari kelaparan, alkalosis akibat kehilanganHCl melalui muntah, serta hipokalemia. Berat badan susut 5% berat sebelum hamil (R Gadsby, 1993) dengan penyertaangangguan keseimbangan elektrolit serta ketosis.Penyimpangan ini menimpa setidaknya 50-90% wanita hamil,

yang biasanya reda sendiri (self-limited) menjelang bulanketiga kehamilan, meskipun sebagian (3) terus berlanjut.

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Who suffer from migraines

women who have previously suffered frommotion sickness

Woman with a family history of hyperemesis

gravidarum

Women with a multiple pregnancy such as

twins or triplets

Increased bodyweight a female fetus women who

have had hyperemesis gravidarum in a previouspregnancy

Molar pregnancies

http://www.news-medical.net/health/What-are-Migraines.aspxhttp://www.news-medical.net/health/Motion-sickness-e28093-What-is-motion-sickness.aspxhttp://www.news-medical.net/health/Motion-sickness-e28093-What-is-motion-sickness.aspxhttp://www.news-medical.net/health/What-are-Migraines.aspx

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eating small pieces of dry toast, crackers, orbananas before getting out of bed

consuming ginger-containing foods or drinks

eating small meals several times a day and not

allowing yourself to get too hungry or too full eating a diet high in protein and complex

carbohydrates and low in fatty foods

eating bland or dry foods; drinking plenty of water

acupressure on the inside of the wrist

anti-nausea medications

http://www.news-medical.net/health/What-are-Carbohydrates.aspxhttp://www.news-medical.net/health/What-are-Carbohydrates.aspx

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Seorang wanita hamil sebaiknya mengobatkan

dirinya manakala ditemukan keadaan seperti:(1) Muntah lebih dari 12 jam.

(2) Terdapat bercak darah dalam muntahan.

(3) Ditemukan tanda dehidrasi.(4) Demam lebih dari 38,8 0C.

(5) Berat badan berkurang lebih dari 5%.

(6) Pusing, kepala terasa ringan, atau pingsan.(7) Tidak terjadi perbaikan selama berapa hari.

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Penanganan

Penting sekali dimengerti bahwa pengobatan HG (muntahpada umumnya) tidak bisa digeneralisir: tidak semuapengobatan cocok bagi segala penderita. Strategi utama ialahmengujicobakan berbagai langkah untuk kemudianmenetapkan mana yang paling tepat bagi seseorang.

Penanganan dapat berupa pengobatan maupun pencegahan.Pemberian jahe (ginger), teh herbal, akupresur, dan obatmerupakan upaya pengobatan; di samping upaya rehidrasi,pemberian vitamin B6 dan wild yam, serta upaya lain.Pencegahan dapat diupayakan dengan cara menyantap camilansedikit-sedikit tapi sering, makanan yang kaya akan

karbohidrat dan protein, banyak minum, menghidari bautertentu yang menimbulkan mual, istirahat cukup, serta ber-olahraga.

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Promethazine (Phenergan)

Cara kerja Bersifat antidopaminergik, yang efektif mengobati muntah. Memblok reseptor

dopaminergik mesolimbik possinaptik dan mengurangi rangsangan pada system

reticular batang otak.

Dosis dewasa 12,5 mg oral/rectal 3 kali sehari

Indikasikontra Hipesensitif.

Interaksi Efek akan bertambah jika digunakan bersama dengan obat penekan CNS atau

antikejang. Penggunaan bersama dengan epinefrin menyebabkan hipotensi.

Kehamilan Keamanan belum didukung oleh kajian ilmiah.

Peringatan Hati-hati bila digunakan untuk penderita penyakit jantung, gangguan fungsi hati,

kejang,sleep apnoe, asma, danacute-angle glaucoma; dapat menyebabkanngantuk.

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Obat antimuntah boleh diberikan bersama

dengan supplementasi vitamin. Antimuntah

lain ialah promethazine, meclizine,ondansetron, diphenhydra-mine,

droperidol, dan metoclopramide

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Breastfeeding

Mohammad, The prophet (peacebe upon him): There is no milk for

infants, better than their own

mothers milk.

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F l f di i i k f

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Formula feeding increase risk of

obesity

eczema

allergies

lung infections leukemia

heart disease

bowel diseases

childhood cancers

ingesting contaminated products

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Breastfeeding

is also goodfor moms.

It helps mom return to pre-pregnancy weight.

It helps prevent postpartum

depression.

It decreases the risk of diabetes,

breast cancer & heart disease.

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By giving birth,

lots of oxytocin is released.

Anaesthesia however, inhibits this

release of oxytocin.

Oxytocin inhibits appetite. and

enhances post-natal uterus shrinking.

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Leptin is produced in adipose tissue,and signals at different neuropeptides

and hormones to inhibit appetite. The

release of leptin is however inhibitedwhen mama does not breast-feed her

baby.

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Babies fed with cows-milk-based formula

milk already become addicted to cows

milk-opioid peptides in their very first stage

of life, guaranteeing increased cravings forfood products containing milk protein in

adult life, and thus enhancing obesity.

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Formula milk averagely contains 21

to 28 times as much vitamin D as

mothers milk maximally does.

Vitamin D excess causes arthritis

and arteriosclerosis.

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Formula milk contains twice as

much calcium and 3 times as

much phosphorus, causing botharteriosclerosis and bone-

decalcification.

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The reason why they put so manydifferent metals in formula milk is

because bioavailability of iron, zinc,

copper, manganese, selenium andvitamin B9 (folic acid) in cow's and

formula milk averagely is much lower.

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Soy-based formula milk is even worsethan cows milk-based formula milk.

Like soy, soy-based formula milk

contains phyto-estrogens disturbinghormone levels.

Some phytoestrogens are mutagenic

and can enhance brain tumors.

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To make sure you will producesufficient milk and your baby will

not reject it, you have to consume

extremely little prepared food andno dairy- or wheat-products when

pregnant, before, and when

lactating.

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To prevent mother's milk from

being rejected by the baby,women should not consume any

dairy products while pregnant or

lactating, and that is true way

before. She should consume as

much fruits, vegetables and nuts

as well as other brainfood,

containing all the nutrients sheand her baby need.

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Contaminants in Infant Formula

Youll never find these listed on the label

Aluminum (Aluminum interferes

with cellular metabolic processesand information transfer from

DNA):

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Contaminants in Infant Formula

Youll never find these listed on the label!!

Cadmium levels can be 6 times higher in soy

formula compared to milk- based

formula. Cadmium is also found in cereals

with the exposure of dietary cadmium from

weaning diets up to

12 times higher in children fed infant formula

compared to breast milk.

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Wanita Menyusui

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Wanita Menyusui

Penambahan kalori sepanjang 3 bulan pertamapasca partum sebanyak500 kkal. Reko-

mendasi ini didasarkan pada asumsi, bahwa

tiap 100 cc ASI berkemampuan memasok 67-77 kkal. Keefisienan konversi energi yang

terkandung dalam makanan menjadi energi

susu se-besar rata-rata 80%, dengan kisaran76-94%.

Wanita Menyusui

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Wanita Menyusui

Dari sini bisa diperkirakan besaran energi yangdiperlukan untuk menghasilkan 100 cc susu,

yaitu sekitar 85 kkal. Rataan produksi ASI se-

hari 850 cc, yang berarti mengandung 600kkal. Sementara kalori yang dihabiskan untuk

menghasilkan ASI sebanyak itu sebesar 750

kkal.

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Soal latihanSeorang wanita menyusui bayinya secara

ekslusif, dengan niat agar berat badannya

kembali ke ukuran sebelum hamil. Dia ingintahu berapa lama berat badan normalnya bisa

kembali, coba jelaskan?

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JawabanPrinsip pengurangan berat badan (BB) di masa menyusui ialah

memberikan ASI secara ekslusif dan melakukan olahraga

sebisanya (bergantung pada kemauan dan kesanggupan

wanita yang bersangkutan). ASI ekslusif diartikan sebagai

pemberian ASI selama 4-6 bulan secara terus menerus tanpajeda susu formula atau makanan selain ASI. Keinginan untuk

mengembalikan BB ke bilangan sebelum hamil berarti upaya

menghabiskan bobot pertambahan BB selama kehamilan

berlangsung, yaitu berat yang tersisa setelah bayi lahir.

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Materi yang dilahirkan berbobot sekitar 4,95 kg.Materi yang terlahir ini terdiri atas ja-nin 3,4 kg,

plasenta 0,45 kg, cairan amnion 0,9 kg, dan darah

(kehilangan darah pada persalinan normal rata-rata

500 cc) 0,6 kg. Sementara, pertambahan BB selama

hamil (dianggap) sekitar 12 kg. Sisa BB (tertimbun

sebagai lemak) ialah 7,05 kg.

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Meski dianjurkan penambahan asupan kalori sebesar500 kkal (dengan efisiensi konversi enersi sebesar 80-

90%) selama penyusuan, energi sebesar ini tetap saja

tidak cukup untuk mem-produksi ASI yang akan

diberikan ekslusif selama 24 jam. Untuk

menghasilkan air susu seba-nyak 100 cc dibutuhkan

85 kkal.

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Ol h di j k k l bih b ik b

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Olahraga yang dianjurkan akan lebih baik berupa

gerakan fisik yang tertali dengan pekerjaan rumah

tangga. Menyapu akan menghabiskan energi

sebanyak 2,0 kkal semenit, mengepel lantai

memerlukan energi sebesar 3,4 kkal semenit, dan

menyikat lantai 4,0 kkal semenit (lihat tabel 59 Nilai

perkiraan keluaran energi pada kegiatan tertentu

dalam bab 11). Jika si wanita berkenan mengerjakan

kegiatan itu, tentu saja sembari mengasuh bayi,

selama 30 menit saja sehari, berarti sejumlah 282 kkalenergi akan terkuras dari tubuhnya, yang setara

dengan (282/9) 31 g lemak (dibulatkan).

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Jika kegiatan fisik dipadukan dengan pemberian ASIekslusif, dalam sehari akan ter-buang sebanyak 52 g

lemak. Menjawab pertanyaan di atas, BB akan

kembali ke BB semula setelah (7,05 kg/52 g) 135

hari. Seandainya si wanita mempunyai banyak waktu

untuk berolah-raga, pengembalian BB pun cepat

terwujud (lihat juga penjelasan dalam teks).