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.

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

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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 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,

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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.

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.

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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 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

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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 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.

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2. LITERATURE REVIEW 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.

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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, 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)

Pregnant women should consume at least 1200 mg of these pregnancy vitamins a day, nursing mothers 1000 mg per day.

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.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.

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

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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

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,
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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 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
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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 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
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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)

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. Some nutrients dissolve in water for proper absorption.
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 Potassium

Lubricates joints and membranes. (Tull, 1987).

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

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
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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 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

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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 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).
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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.

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).

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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 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.

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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 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 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
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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, 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.
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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 34 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 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.

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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 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:

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

Soft cheeses, such as brie, camembert and ricotta – these are safe if served cooked and hot



Precooked or pre-prepared cold foods that will not be reheated – for example, preprepared 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. Suck something sour like a lemon.
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

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.

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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.


Drink 1.5 liters (3¼ pints) daily

Food cravings for Pregnant Women


Maintain a regular schedule of meals.

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

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 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.

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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 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).

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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. 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:
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Internal Medical including Anti-Retroviral Therapy, Pediatric, Surgical, Medicine, Dental, Ophthalmology, Physiotherapy, Ear, nose and Throat, Pharmacy, Laboratory, XRay, 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.  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.

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3.2. Hospital Organizational Structure Regional hospital – Foforidua .

REGIONAL DIRECTOR OF HEALTH SERVICES

LEVEL 1 1 LEVEL 2 1 MATRON HD OF NURSING

MEDICAL DIRECTOR/SUPERINTENDENT

ADVISORY

CME COORDINAT OR

DIRECTOR OF ADMINISTRA TION

DIRECTION ADMINISTRA TION

HEAD OF FIANANCE

LEVEL 3 1

DEPARTMEN T/SUPERVISO RS/BLOCK LEADERS

HEAD OF DEPARTMEN T

SUPREVISOR S

SUPERVISOR S OF DEPARTMEN T

SUPERVISOR S

WARD IN CHARGE

UNITS HEADS

UNITS HEADS

UNITS HEADS

UNITS HEADS

LEVEL 4 1 LEVEL 5 1 NURSING STAFF/MIDW IVES/STAFF ROTATION/S TUDENTS MEDICAL STAFF/RESID ENTS/HOUSE OFFICER ADMINISTRA TIVE AND OTHER SUPPORT 30 PHARMACY DISPENSERY STAFF ACCOUNTIN G STAFF

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. 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.
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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 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.

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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

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 Number Percentage (%) RECEIVED 30 60 NOT RECEIVED 20 40 TOTAL 50 100

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
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AGE 18 - 25 years 26 – 33 yeas 34 – 41 years 42 above Total

NUMBER OF RESPONDENTS 25 15 7 3 50

PERCENTAGE (%) 50 30 14 6 100

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 RICE DISHES CORN DOUGH DISHES FUFU AMPESI DISHES Total NUMBER OF RESPONDENTS 15 13 12 10 50 PERCENTAGE (%) 30 26 24 20 100

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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 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 Pineapple Orange Babanna Water – melon Mango Apple Paer TOTAL RESP ONDENTS 15 10 8 6 5 5 1 50 PERCENTAGE % 30 20 16 12 10 10 2 100

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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.

Table 4.5: Vegetables intake of Respondent VEGETABLES Nkontomire and Garden eggs Cabbage Carrots French beans and Cucumber Lectuce Green peper Total RESPONDENTS 13 12 10 7 4 4 50 PERCENTAGES (%) 26 24 20 14 8 8 100%

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

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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 Carbonhydrate Proteins Vitamins Folic Acid Calcium Iron Iodine Total 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 nutrientsi. ii. Carbohydrates provide heat and energy for the body. Protein helps in the growth and repair of worn-out tissues.
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RESPONDENTS 15 10 6 5 5 5 4 50

PERCENTAGES 30 20 12 10 10 10 8 100%

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iii. iv.

Vitamins give vitality to the body and protect the body against diseases. Folic acid promotes the development of the fetal nervouse and prevents developmental defect of the neutral tube.

v. vi.

Calcium helps build strong bones and teeth 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.

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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 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.

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 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

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.

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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.

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REFERENCE

Brems S, Berg A. Eating down during pregnancy: nutrition, obstetric and cultural considerations in the third world. Discussion paper prepared for the ACC/ACN. Washington, DC: World Bank, 1988.

Barker DJ. Maternal nutrition, fetal nutrition and disease in later life. Nutrition 1997; 13:807–13 Scholl TO, Hediger ML. Anemia and iron-deficiency anemia: compilation of data on pregnancy outcome. Am J Clin Nutr 1994; 59(suppl):492S–501S

Kirke PN, Daly LE, Molloy A, Weir DG, Scott JM. Maternal folate status and risk of neural tube defects. Lancet 1996;348:67–8

Picciano MF. Pregnancy and lactation. In: Ziegler EE, Filer LJ, eds. Present knowledge in nutrition. Washington, DC: ILSI Press, 1996: 384–95.

World Health Organization. Coverage of maternity care: a listing of available information. 4th ed. Geneva: WHO, 1997. (WHO/RHT/ MSM/96.28.) Jill Davies ,Hammonds cooking, forth edition. Ronald kinton et al,theory of catering, ninth edition (http://www.pregnancydietmealplan.com). Pregnancy and diet ( http://www.promiseprenatal.com) http://EzineArticles.com/?expert=Eric_C_Hoffman
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(http://PregnancyAdvice.co!)

(Guthrie and picciano, 1997).Nutrition in pregnant women

(Hansjörg et al, 1988) Nutrition in pregnancy (Townsend, 1985), Nutrients (Guthrie, 1995).Nutrition (Tull, 1987)Food and water (Alphonse, 2010). Balance diet (arabiaenglish.babycenter.com) (Robinson et al., 1998). Calcium (http://www.fitnesstipsforlife.com) Recommended food for pregnant women ( http://www.betterhealth.vic.gov.au) Nutrition and Pregnancy (Zhou et al., 1998) Folic acid (http://www.babycenter.com) (Gentili et al, 2009). National Health Service UK Folic acid (Scholl et al, 2000). (Goh et al, 2008)

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(McGuire et al, 2010 Folic acid (Bazzano et al, 2011 Aug) Folic acid (http://www.birth.com) Nutrients and pregnancy (Institute of Medicine 2004) (Beall MH, 2007) (EFSA Journal, 2010) European Food Safety Authority (www.mayoclinic.com/health/pregnancy) Nutrients and food for pregnant women Swiss Association for Nutrition Why it important to eat well during pregnancy (www.healthandage.com/nutrition-for-pregnant-women) http://www.betterhealth.vic.gov.au). Measures to reduce pregnancy discomfort (Giddens, 2005). Research design (Bower man and O‟Connell, 2007). Definition for populati

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