A Meta Analysis Study of Nutrition and Physical Fitness During

Pregnancy

Ilham

, Wara Kushartanti

Faculty of Sport Sciences, Yogyakarta State University, Jl. Colombo No. 1 Yogyakarta, Indonesia

Keywords: Malnutrition, Physical fitness, Pregnancy, and Sports

Abstract: Malnutrition as the lack or the abundant flow of macro- and micronutrients increases the risk of gestational

anemia, hypertension, miscarriages and fetal deaths during pregnancy, pre-term delivery and maternal

mortality. For newborn, it can cause low birth weight, fetal intrauterine growth retardation. The purpose of

this study is to identify macro- and micronutrients which are needed to decrease the risk of gestational

anemia, hypertension, miscarriages and fetal deaths during pregnancy, to influence of sport on the

pregnancy. Methods used include Meta analyse study with literature review of 20 articles published in

different international journal related to Nutrition and sport science indexed Scopus from Q4 and by random

sampling. The data were analysed according to the general epidemiology of malnutrition. Results show

the Lack or surplus of adequate nutrition of good quality and quantity during pregnancy can cause health

problems for both the mother and her fetus. The effect of Exercise on Pregnancy is

Positive. Exercises during pregnancy help to alleviate many of the common problems of pregnancy. It

improves circulation, which helps prevent constipation, hemorrhoids, varicose veins, leg cramps, and

swelling of the ankles, physical exercise is very important on the pregnancy during delivery and to improve

the wellbeing.

1 INTRODUCTION

The problem of balanced nutrition in Indonesia

is still a fairly serious problem, specifically in

pregnancy women (Beal et al., 2018). Lack or

excess food during pregnancy can have adverse

effects on physical fitness for the mother and fetus.

Physical Fitness is the body's ability to perform

various activities properly without experiencing

fatigue (Castelli, Hillman, Buck, & Erwin, 2007;

Shahana, Nair, & Hasrani, 2010; Hashmi et al.,

2018). After doing activities optimally, the body still

has a reserve of energy to continue activities. In

general, physical fitness can be classified into two

parts, namely: the first Healthy, namely the

condition in which the body (physical and

psychological) is free from all subsequent diseases:

Second Fitter is a condition where the body is able

to carry out various daily activities optimal without

fatigue, and still has power reserves (Sawczuk et al.,

2018).

Balanced nutrition and exercise are the keys of

healthy living (Sousa, Teixeira and Soares, 2014).

But (Smith, Holmes and McAllister, 2015), their

research showed that during pregnancy, exercise is

one of the important things that can help pregnancy

to maintain her body healthy, especially if

pregnancy is still in the first trimester. Regular

exercise can help her to reduce sickness and can

improve function as a form of preparation for

childbirth (Charkamyani et al., 2019). The benefits

will not only be felt by the mother, but also felt by

the fetus (Wang et al., 2015). The health condition is

always based on a balance between Intake and Out

put. Since long ago, the food of pregnant women has

been considered very important, because people

believe that the right food will have a good impact

on the fetus. Therefore, people make various rules of

food that may be consumed by pregnant women

(Nana and Zema, 2018), and foods that are taboo,

which is apparently not true at all in terms of health.

For example, pregnant women should not eat a lot

with the aim that the baby is not big and easily born.

Nutritional status and type of exercise for the

mother before and during pregnancy can affect the

growth of the fetus and can also maintain and

improve maternal physical fitness (Mudd et al.,

2013)

. The normal nutritional status of the mother

before and during pregnancy is likely to give birth to

592

Ilham, . and Kushartanti, W.

A Meta Analysis Study of Nutrition and Physical Fitness During Pregnancy.

DOI: 10.5220/0009798405920597

In Proceedings of the 3rd Yogyakarta International Seminar on Health, Physical Education, and Sport Science in conjunction with the 2nd Conference on Interdisciplinary Approach in Sports

(YISHPESS and CoIS 2019), pages 592-597

ISBN: 978-989-758-457-2

a healthy baby, just a month with a normal body

weight. In other words, babies born are very

dependent on the state of nutrition and physical

activity performed by the mother before and during

pregnancy. During pregnancy, the need for nutrients

increases (Bø et al., 2016). This is needed to meet

the growth needs of the fetus, maintain maternal

health, and supply lactation for both the mother and

fetus (Greenhill, 2016).

A study from (Hazart et al., 2017) showed that

nutritional deficiencies can result an anemia,

abortion, prematurous delivery, uterine inertia,

postpartum bleeding, puerperal sepsis, and others.

Excess of nutrition can result in obesity, pre-existing

lamsia, large fetuses, and others. Maternal nutrition

during pregnancy is very important for the growth of

the fetus it contains. The incidence of LBW (Low

Birth Weight) is higher in developing countries than

in developed countries. This is due to low social and

economic conditions affecting the mother's diet.

Good maternal nutrition is needed so that fetal

growth runs rapidly and does not experience

obstacles. Starting from one egg after fertilization

then it grows rapidly. So, it is estimated that the

growth of the fetus from conception to birth

(Bookari, Yeatman and Williamson, 2017).

Malnutrition is currently a problem of concern in

Indonesia. It is a problem that needs attention,

because it can cause the lost generation. The quality

of the nation in the future will be greatly influenced

by the current state or nutritional status, especially

toddlers. Poor nutrition and lack of nutrition for

someone would affect the quality of life later.

Malnutrition is still quite alarming based on the

problem above. The aims of this study are to identify

macro- and micronutrients which are needed to

decrease the risk of gestational anemia, hypertension,

miscarriages and fetal deaths during pregnancy, and

to influence the sport on the pregnancy. This study is

very important because it gives a guideless of

nutrition for pregnancy and Effects of Exercise on

Pregnancy and fetus.

2 METHODOLOGY

This research is a Meta analyse study with

literature review of 20 articles published in different

international journals related to Nutrition and sport

science indexed Scopus from Q4 and above by using

random sampling. The data were analysed according

to the general epidemiology of malnutrition. We

analysed articles by age to find out and show how

research on malnutrition of pregnancy has evolved,

to facilitate readings, and researchers to see angles

that are not yet solicited by research. This literature

review was to identify macro- and micronutrients

which are needed to decrease the risk of gestational

anemia, hypertension, miscarriages and fetal deaths

during pregnancy, and the influence of sport on the

pregnancy.

3 RESULTS

Table 1: Free Nutritional Needs of Pregnant Women

Food Material

First

Trimeste

Trimester II

and III

Rice / Exchan

3¼ cu

s 3½ cu

Meat / exchan

2½ cut ½

ieces

Tempe / Exchange

5 pieces 5 pieces

Vegetable 3 cups 3 cups

Fruit 2 pieces 2 pieces

Oil 2 tbs

2 tbs

Green beans ½ tbs

½ tbs

Mil

½ tbs

flour sarikedelai - 4 tbsp

Suga

1 tbsp 1 tbsp

Nutritional Value

First

Trimeste

Trimester II

and III

Energ

2095.8 cal 2164.5 cal

rotein 79.5 grams 82.5 grams

Fat 57

rams 65

rams

Carboh

drate 273.8

rams 275

rams

Vitamin C 70 m

70 m

Iron 31 mg 31 mg

This table showed how pregnancy should

consume food according to the different trimesters.

The main menu is constitute with (1) carbohydrate,

(2) fat, (3) protein, (4) mineral, (5) vitamin and (6)

drinks.

Carbohydrate: The table above showed that the

food which contains carbohydrates is very important

for the pregnancy and the fetus. The fetus has about

9 g of carbohydrates at week 33 of pregnancy, and at

birth it increases to 34 g. The concentration of

glycogen in the liver and skeletal muscles increases

at the end of pregnancy. The carbohydrate

metabolism of pregnant women is very complex

because there is a tendency to increase dextrose

excretion in urine. This is indicated by the relatively

high frequency of glycosuria in pregnant women and

the presence of glycosuria in most pregnant women

after receiving 100 grams of dextrose per oral.

Normally, in pregnant women, there is no glucose.

Carbohydrate needs are approximately 65% of total

calories, so you need to add protein (Institute of

Medicine, National Academy (2005)).

A Meta Analysis Study of Nutrition and Physical Fitness During Pregnancy

593

Protein: Food which contains protein is very

needed to build the baby, to protect pregnancy and

foetus from diseases. Protein transport through the

placenta is mainly amino acids, which are then

synthesized by the foetus into tissue proteins.

Protein is needed for foetal growth, uterus, breast,

hormones, addition of maternal blood fluids, and

lactation preparation. Protein requirements are 9

grams / day. 1/3 of animal protein has a high

biological value (Institute of Medicine, National

Academy (2005)). Protein requirements for the

foetus are 925 grams for 9 months. The protein

efficiency is 70%. There is protein loss in urine +

30%. WHO recommends protein intake for pregnant

women around 1.01 g / kg. BB / day and calories

around 46 kcal / kg.BB / day for the average woman

weigh 55 kg.

Fat: During pregnancy, there is 2-2.5 kg of fat

and the increase starts from the 3rd month of

pregnancy. The addition of fat is unknown, but it is

likely to be needed for future lactation. 500 g of

foetal body fat is stocked between week’s 35-40

pregnancies. In the early stages of pregnancy, there

is no fat accumulated except essential lipids and

phospholipids for growth of the central nervous

system (CNS) and nerve cell walls. Until

mid-pregnancy, only about 0.5% of fat in the body

of the foetus, after which the number increases,

reaches 7.8% at 34 weeks and 16% before birth. In

the last month of pregnancy, around 14 g of mother's

milk per day are piled up. Fatty acid transport

through the placenta is about 40% of maternal fat;

and the rest is synthesized by the foetus. Both fat

and protein increase rapidly in the last three months

of pregnancy along with increased foetal weight.

Most of the fat is deposited in the subcutaneous area;

therefore 80% of body fat tissue is present in body

infants in subcutaneous tissue. So, there is a great

need of fat for the pregnancy.

Iron (Fe): Needed for haemoglobin, (Hb)

formation, especially hem dilution, intake must be

sufficient during pregnancy in order to prevent

anaemia. Pregnant women need 800 mg or 30-50

grams / day (Irianto, 2017). Maximum

recommendations: additions from the beginning of

pregnancy, because administration of only the third

trimester cannot pursue the needs of the mother /

fetus and also for foetal reserves. Iron requirements

increase, so that it takes an additional 700-800 mg or

30-60 mg per day obtained from supplements to

replace iron use by the bone marrow, foetus, and

placenta. Pregnant women who are anaemic due to

iron deficiency will have an impact on increasing

spontaneous abortion, early birth, low birth weight

(LBW), infant mortality at birth, and infant mortality

before birth. Iron sources are obtained from the liver,

bone marrow, eggs, meat, fish, chicken, and dark

green vegetables.

Calcium (Ca): Calcium needs in pregnant

women have increased due to an increase in bone

turnover (turn over), decreased calcium absorption,

and calcium retention due to hormonal changes.

Calcium is needed for the growth of bones and teeth,

vitamin D helps to absorb calcium, needs 30-40 g /

day for the foetus, pregnant women need an

additional 600 mg / day and the total need for

pregnant women during pregnancy is 1200 mg / day.

Calcium can be obtained by consuming milk, cheese,

anchovy, dried dried or wet soybeans, and fresh

broccoli (Irianto, 2017).

Supplement: Multivitamin and mineral

supplements are supplements that contain a

combination of vitamins and minerals, and do not

contain other active ingredients. Vitamin and

mineral supplements are recommended to contain at

least 10 vitamins or minerals with varying doses,

which can be vitamin C, vitamin B complex, vitamin

D, zinc, selenium, magnesium, iron and calcium

(Irianto, D. J. 2017). The Role of Multivitamin

Minerals in Physical Fitness The role of vitamin

minerals is as an antioxidant which greatly affects

the quality of human life. Some mineral vitamins

have a role as antioxidants are vitamin E, vitamin C,

vitamin A, selenium, iron and zinc. These

substances are often called antioxidant nutrients

(Yaya et al., 2018).

How do you exercise during pregnancy?:

Exercise is needed during pregnancy; its function is

for maternal and fetal fitness (Gregg and Ferguson,

2017). Besides that, there are several types of

exercise such as yoga that trains breathing to help

mothers relax, relieve stress, fatigue, calm the mind

and train mothers to control breathing well because

during the pregnancy process maternal breathing

arrangements are very essential (Wen, Flood,

Simpson, Rissel, & Baur, 2010; Babbar & Chauhan,

2015). Besides yoga, Pilates are quite popular with

pregnant women. Pilate’s exercises are focused on

the hips in the hope of being able to train the

mother's hips to be more flexible during the birth

delivery process. Kegel is also included in the

exercise during the pregnancy process. Kegel

exercises focused on female organs to be prepared

when facing the pregnancy process. And the latest is

exercise in water (aerobics-aquatic) (Riaz et al.,

2018). Besides that, Active video games or exercise

apps have the potential to overcome some of the

barriers to exercise, while pregnant as addition to

YISHPESS and CoIS 2019 - The 3rd Yogyakarta International Seminar on Health, Physical Education, and Sport Science (YISHPESS

2019) in conjunction with The 2nd Conference on Interdisciplinary Approach in Sports (CoIS 2019)

594

enhance the motivation factors in encouragement

doing physical activity (Trevorrow, 2016). In

addition, (Ruchat et al., 2012) Prenatal nutrition and

exercise program however of exercise intensity,

reduced excessive gestational weight gain (GWG)

and decreased weight storage at 2 mopp in women

of normal weight before pregnancy.

Increasing Body Energy: However, pregnant

women still need to do regular exercises so that her

body is always fit and energized. This is because,

exercising regularly, can strengthen the

cardiovascular system, and make the mother not

easily tired. That is why, with stronger and more

formed muscles, she can do various daily activities

with increased energy. No need to exercise too hard,

just do a light activity such as walking around the

area of residence, approximately 20 minutes three

times per week.

Reducing discomfort during pregnancy: During

pregnancy, daily activities become more difficult

because of the increased body weight. This

increased weight, often causes discomfort, such as

feeling tired easily, back ache, morning sickness,

and so forth (Nana and Zema, 2018). Well,

pregnancy can reduce the discomfort by exercising

regularly. The muscles might experience stretching

and adjustments to make the body stronger and

tolerant of the pain experienced during pregnancy.

Running, for example, can help you improve blood

circulation or you can choose to swim to strengthen

your abdominal muscles. By minimizing the

discomfort that arises, the development of the foetus

in the womb can also be maintained properly.

Helping Facilitate Labor: The course of labor

will be largely determined by the condition of the

body of the mother. The better the stamina, the

stronger the body will be to undergo labor. That is

one of the main reasons, why exercise regularly is

recommended as a form of preparation for childbirth

(Nana and Zema, 2018).

Improving Sleep Quality: The size of the

stomach, certainly affects the daily activities, one of

them is when sleeping. It feels like the eyes are hard

to close, because you have to try to find a

comfortable position, both for the mother and the

fetus. (Castelli et al., 2007) Well, one way to

overcome this is to exercise. As mentioned earlier,

exercises would indeed make you feel tired, but it is

precisely this feeling of fatigue that will make you

able to fall asleep faster and soundly. The quality of

sleep increases and the health of the mother during

pregnancy would be maintained before the birth of

the children.

Optimizing Foetal Brain Development: In

addition to increasing maternal stamina, regular

exercise can also maintain foetal development in the

womb. Based on a study presented at the Society for

Neuroscience, San Diego, ten-day-old babies have

better brain maturity levels if their mothers

diligently exercise during pregnancy compared to

those who do not. This would have an impact on the

Little's hearing, vision, and motor skills in the future

of growth so that they are more maximal. Mothers

can try to start exercising regularly, as a form of

preparation for childbirth. Mothers can walk, swim,

or take yoga classes at hospitals or various studios

that are now widely available. However, before

starting, you should first consult your obstetrician so

that you can exercise safely (Riaz et al., 2018).

4 DISCUSSION

High food quality, together with adequate macro-

and micronutrient intake in pregnancy, is crucial for

the health status of the mother and child, the result

from the research above showed that (1)

carbohydrate, (2) fat, (3) protein, (4) mineral, (5)

vitamin and (6) drinks are the common food needed

to take care for pregnancy and foetus.This review

provides researchers and practitioners with an

overview of the physical activity and pregnancy

literature to promote prenatal physical activity,

improve measurement, further elucidate the role of

activity in reducing maternal health complications,

and inform future research.

To assess the effects of advising healthy

pregnant women to engage in regular aerobic

exercise (at least two to three times per week), or to

increase or reduce the intensity, duration, or

frequency of such exercise, on physical fitness, the

course of labour and delivery, and the outcome of

pregnancy (Kramer and McDonald, 2009).

There is a direct link between healthy mothers

and healthy infants. Exercise and appropriate

nutrition are important contributors to maternal

physical and psychological health. The benefits and

potential risks of exercise during pregnancy have

gained (Prather, Spitznagle and Hunt, 2012).

During pregnancy, such as hyperthermia,

shortened gestational age and decreased birth weight

are not supported by the most recent scientific

reviews. The physiological adaptations to exercise

during pregnancy appear to protect the foetus from

potential harm and, while an upper level of safe

activity has not been established, the benefits of

continuing to be active during pregnancy appear to

A Meta Analysis Study of Nutrition and Physical Fitness During Pregnancy

595

outweigh any potential risks. All decisions about

participation in physical activity during pregnancy

should however be made by women in consultation

with their medical advisers (Brown, 2002). The

amount of time pregnant women spend in

moderate-vigorous physical activity or volitional

exercise varies drastically depending upon what

guideline is used.

5 CONCLUSION

Nutritional adequacy is essential in ensuring the

normal growth and development of the fetus.

Perceived benefits will be able to strengthen

pregnant women to meet optimum nutritional intake

to prevent anemia. Adequacy of protein, vitamin C

and iron will reduce the risk of iron deficiency

anemia in pregnancy. This study aims to examine

the association between perceived benefits with

protein, vitamin C, and iron intake in preventing

pregnancy anemia. Healthy weight and healthy

lifestyle behaviours are considered as essential

prerequisites for a successful pregnancy. The

importance of maternal lifestyle includes nutrition

and physical activity in relation to the short- and

long-term birth. Therefore each country can make

recommendations that are specific to the food

patterns in the country and the circumstances of the

people. The amount of basic food recommended in

the table must be adjusted to the biological value of

the human body. Maternal nutrition during

pregnancy is of considerable interest to women, their

partners and their health care professionals; however,

it is a complex issue. In developing countries,

maternal malnutrition is a major concern. However,

with the increased prevalence of overweight and

obesity in developed countries, the impact of

abundant high calorie diet upon pregnancy outcome

is of interest and practitioners should also consider

the multifaceted determinants and outcomes of

prenatal physical activity and intervening to promote

physical activity before, during, and after pregnancy.

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