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Vol. 5, No. 2, 2023, pp. 90-97 ISSN 2656-6052 (online) | 2656-1107 (print) 
      http://journal2.uad.ac.id/index.php/eshr/index                                                   eshr@ikm.uad.ac.id 

 

 

      10.26555/eshr.v5i2.7301  

 
 

90 

 
  

  

 
Review Article 
 
Relationship Between Energy, Fat, and Carbohydrate 
Consumption Habits in Pregnant Women Chronic Energy 
Deficiency during the COVID-19 Pandemic: A Systematic 
Review 
 
Wahyu Trecy Indriani1*, Vitri Widyaningsih2, Anik Lestari2 
1 Postgraduate Program of Nutrition Science, Universitas Sebelas Maret, Surakarta, 

Indonesia  
2 Department of Public Health Sciences, Faculty of Medicine, Universitas Sebelas Maret, 

Surakarta, Indonesia 
 
* Correspondence: wahyutrecy7@gmail.com. Phone +6282264290248 
 
Received 11 January 2023; Accepted 02 September 2023; Published 05 September 2023 
 

ABSTRACT 

Background: Chronic Energy Deficiency (CED) during the COVID-19 pandemic has an 
impact on pregnant women's nutritional status. The size of LiLA 23.5 cm indicates CED. 
The goal of this study is to improve the nutritional status of pregnant women suffering from 
chronic energy deficiency. 

Method: A systematic review of relevant articles from databases (Pubmed, ScienceDirect, 
and Google Scholar) using keywords in Indonesian and English was used in the study. The 
following inclusion criteria were used to select nine articles: publication from 2017 to 2021, 
discussion of food consumption habits in pregnant women, articles in English or Indonesian, 
full text, open access, and scientific journals.   

Results: The findings of this study can be used to assess the consumption habits of 
pregnant women who have CED as a result of insufficient food intake and a lack of variety 
in their diet. Low family income, human resources, education, and a lack of family support 
led to less food consumption habits in pregnant women. 

Conclusion: The study concludes that adequate food intake and good human resource 
consumption habits can affect the nutritional status of pregnant women. 

 
Keywords: Energy consumption habit; Fat consumption habit; Carbohydrate consumption 
habit; Pregnant women; Chronic Energy Deficiency 

http://journal2.uad.ac.id/index.php/eshr/index
mailto:eshr@ikm.uad.ac.id
https://doi.org/10.26555/eshr.v3i1.3629
https://doi.org/10.26555/eshr.v3i1.3629
mailto:wahyutrecy7@gmail.com


 
Indriani et al. (Relationship Between Energy, Fat, and Carbohydrate Consumption Habits….) 

 
 

 
Vol. 5, No. 2, 2023, pp. 90-97 91   10.26555/eshr.v5i2.7301 

  

 

INTRODUCTION 

Maternal mortality in developing countries can reach 40%, with chronic energy deficiency 
being one of the causes.1 Maternal mortality is directly caused by bleeding, infection, and 
eclampsia. Chronic energy deficiency causes maternal mortality indirectly.2 The Maternal 
Mortality Rate (MMR) ratio will be reduced to 70 per 100,000 live births by 2030, according to 
the Sustainable Development Goals. According to Basic Health Research, the prevalence of 
CED in pregnant women was 17.3% in 2018.3 

Regulation Minister of Health of the Republic of Indonesia No. 97 of 2014 describes the 
examination of pregnant women's nutritional status by measuring the upper arm 
circumference, with the goal of detecting chronic energy deficiency (CED). CED occurs in 
pregnant women for an extended period of time due to insufficient food intake, with a 
significant upper arm circumference of 23.5 cm.4 Macro and micronutrient deficiencies are 
direct causes of chronic energy deficiency in pregnant women. Knowledge, antenatal care 
visits, occupation, family income, attitude, maternal age, parity, and environmental health are 
all indirect causes.5,6 

Food consumption and the use of less diverse ingredients can have an impact on pregnant 
women's nutritional problems and chronic energy deficiency.7,8 Beginning during pregnancy, 
a well-balanced nutritional intake is required for brain development and physical growth.9 
Energy, protein, fat, and carbohydrates are macronutrients that contribute to nutrient intake.10 
According to Regulation Minister of Health, Republic of Indonesia No. 28 of 2019, each 
trimester recommends nutrients in additional energy for pregnant women who require 180, 
300, and 300 kcal/day. Pregnant women require 1, 10, and 30 grams of protein per day. 
Pregnant women gain 2.3 grams of fat per day and 25, 40, and 40 grams of carbohydrates 
per day.11 

The government declared the COVID-19 Public Health Emergency in Presidential Decree 
Number 11 of 2020. Because of government regulations governing large-scale social 
restrictions, community access has been limited. The COVID-19 pandemic causes low 
macronutrient consumption, limiting access to food nutrition. The COVID-19 pandemic has 
had an impact on low-income families, reducing their purchasing power for food nutrition.12 
Meanwhile, prior to the COVID-19 pandemic, all food-related activities were free of charge. 
This study looked at the relationship between pregnant women's eating habits and the 
occurrence of chronic energy deficiency during COVID-19. 

METHOD 

This study analyzed the relationship between energy, fat, and carbohydrate consumption 
habits in pregnant women with chronic energy deficiency. This research used Systematic 
Review using PISMA guideline, a literature review method with several characteristics such 
as a precise formulation of research questions, specific inclusion and exclusion, and 
systematic and transparent reporting.13 

https://doi.org/10.26555/eshr.v3i1.3629
https://doi.org/10.26555/eshr.v3i1.3629


 
Indriani et al. (Relationship Between Energy, Fat, and Carbohydrate Consumption Habits….) 

 
 

 
Vol. 5, No. 2, 2023, pp. 90-97 92   10.26555/eshr.v5i2.7301 

  

 

Search methods  

The articles were found using keywords in three databases: PubMed 
(https://pubmed.ncbi.nlm.nih.gov/), Google Scholar (https://scholar.google.com/), and 
ScienceDirect (https://www.sciencedirect.com/). The keywords used are "consumption 
habits", "eating habits", "food intake", "pregnant women" and "chronic energy deficiency". For 
relevant articles, the title, keyword, abstract, language, and year of publication were screened 
in the first stage. The second stage involved screening articles based on the corresponding 
variable, and the final stage involved selecting papers based on the full text. During the 
keyword search, nine articles were found that discussed the relationship between pregnant 
women's consumption habits and chronic energy deficiency. 

Study selection 

The study's inclusion criteria were health articles from 2017 to 2021 discussing pregnant 
eating habits, articles in English or Indonesia, full text and accessibility, and scientific articles.  

This study excludes studies such as reviews, case reports, editorials, commentaries, 
perspectives, and articles with methodological flaws from its analysis of adolescents with 
chronic energy deficiency.  

The PCO table is created using a systematic review method to identify the independent and 
dependent variables. PCOs are structured to determine keywords for literature searches 
based on the population (P), context (C), and outcome (O). Steps, writing, protocols, and 
research were among the keywords used to search the literature.14 

The PCO of energy, fat, and carbohydrate consumption habits in pregnant women with 
chronic energy deficiency was used in Table 1.  

 
Table 1. Search term (keyword) used in this research 

PCO Search Term  
Population  Pregnant women 
Context  Food consumption habits, food intake, eating 

habits 
Outcome  Nutritional status of pregnant women, chronic 

energy deficiency  
 
 
  

https://doi.org/10.26555/eshr.v3i1.3629
https://doi.org/10.26555/eshr.v3i1.3629


 
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Vol. 5, No. 2, 2023, pp. 90-97 93   10.26555/eshr.v5i2.7301 

  

RESULTS 

The PRISMA method for reviewing article search results in the PubMed, Google Scholar, and 
ScienceDirect databases is depicted in Figure 1. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
Figure 1. PRISMA method flow 

 
The PRISMA method flow is used to evaluate systematic reviews or meta-analyses. PRISMA 
assists authors and researchers in creating high-quality systematic reviews and meta-
analyses.15 The identification stage was found in 1760 articles using the keywords food 
consumption, pregnant women, and chronic energy deficiency in the Google Scholar, 
PubMed, and ScienceDirect databases. Then, 1654 articles were published because they did 
not meet the inclusion criteria, were about the health of pregnant women with chronic energy 
deficiency, were written in English or Indonesian, had full text, and were easily accessible. 
Unmatched inclusion of 197 articles was excluded. At the eligibility stage, 9 articles were 
obtained for analysis based on critical appraisal and code ethics. 

  

Search by keywords 
Google Scholar: 1.760 

ScienceDirect: 96 
PubMed: 14 
Total 1870 

1.654 articles were excluded 
because it is not according to 

the research 
216, according to research 

197 articles were excluded 
because of unmatched 

inclusion criteria 

19 articles, full text, and open-access 

9 articles 

According to critical appraisal 
and code of ethics 

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Vol. 5, No. 2, 2023, pp. 90-97 94   10.26555/eshr.v5i2.7301 

  

Table 2 shows the outcomes of 9 article reviews conducted using the PRISMA method flow, 
which discussed consumption habits in pregnant women with chronic energy deficiency. 
 

Table 2. Result of articles review  
Title and Researcher  Design Intervention Result  

Consumption of macronutrients 
in pregnant women with chronic 
energy deficiency during the 
Covid-19 pandemic.12 

With survey design 
using a saturated 
sample 

Interview using 2 x 24-
hour recall form, 
anthropometric 
measurement with 
body weight scale, and 
microtome 

Level consumption of 
macronutrients in pregnant 
women with chronic energy 
deficiency in energy and 
carbohydrate intake 100%, 
protein intake 91.4%, and 
fat intake 57.1% are high 
deficit categories. 

The factor of maternal and 
dietary habits with chronic 
energy deficiency in pregnant 
women in the UPTD of 
Kangkung Health Center.16 

Correlational 
descriptive with 
cross-sectional and 
using nonprobability 
sampling 

Interview using the 
characteristic of 
respondent, maternal 
and dietary habits 
questionnaire 

Significant between the age 
of pregnant women, parity, 
education, history of 
comorbidities, and bad 
dietary habits with chronic 
energy deficiency. 

Health outcomes and socio-
economic status among the mid-
aged and elderly in China: 
Evidence from the CHARLS 
Nasional Baseline Data.17  

Research design 
using cross-
sectional with 
purposive sampling 
technique 

Interview using 
questionnaire  

Dietary habits and low-
income families can affect 
chronic energy deficiency.  

The relationship of dietary habits 
between carbohydrate and 
protein with chronic energy 
deficiency pregnant women in 
the Pajangan Health Center, 
Bantul, Yogyakarta.18 

Research design 
using case-control 
with quota sampling 
technique 

Interview using 
questionnaire 

Dietary habits of intake of 
carbohydrate and protein 
low category are related to 
chronic energy deficiency in 
pregnant women. 

Analysis of eating habits of 
pregnant women with chronic 
energy deficiency in the Palubala 
Health Center, Gorontalo 
Regency.19 

Research design 
using qualitative 
with snowball 
sampling technique 

Interview and 
observation with 
pregnant women 

Pregnant women do not 
apply eating habits with 
family, dietary habits are not 
variative, and they have 
inadequate food.  
Food taboos with intake 
energy and protein sources 
are fish, egg, and pineapple. 
Distribution of family meals 
and food selection not 
appropriate because of 
chronic energy deficiency 

The relationship between food 
intake and chronic energy 
deficiency in pregnant women at 
the Simpang Tiga Health Center, 
Pekanbaru City, in 2019.20 

Analytical 
descriptive design 
with cross-sectional 
and total sampling 
technique 

Interview using recall 
questionnaire  

Average pregnant women 
with chronic energy 
deficiency have less food 
intake. 

Energy, Protein Intake and Mid-
Upper Arm Circumference in 
Pregnant Women in Boyolali 
Regency, Indonesia. 21  

Cross-sectional 
study and simple 
random sampling 
technique 

Interview using Semi-
Quantitative Food 
Frequency 
Questionnaire (SQ-
FFQ) form.  

Pregnant women 
experienced deficient 
energy and protein intake of 
97.6% and 73.2%. A 
relationship exists between 
energy and protein intake 
with MUAC in pregnant 
women. 

https://doi.org/10.26555/eshr.v3i1.3629
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Vol. 5, No. 2, 2023, pp. 90-97 95   10.26555/eshr.v5i2.7301 

  

Household Food Security, 
Nutritional Intake and Nutritional 
Status of Pregnant Women in the 
Central Tapanuli Regency. 22 

Form of action 
research 

The study used 
observation and 
interviews with a 
questionnaire to 
measure LiLA. 

A significant relationship 
exists between food 
security status and energy 
and protein intake.  

Nutrition Assistance Increases 
the Size of Middle-Upper Arm 
Circumference of Pregnant 
Women with Chronic Energy 
Deficiency. 23 

Pre-experimental 
study and using a 
purposive sampling 
technique 

The study used both 
flyers and leaflets as 
media and the MUAC 
tape 

There was an effect of 
nutrition support on the size 
of the mid-upper arm 
circumference of pregnant 
women at CED p = 0.000 

 

DISCUSSION  

The purpose of this systematic review study is to discuss the food consumption habits of 
pregnant women with chronic energy deficiency in order to improve nutrient intake during the 
COVID-19 pandemic. The government declared the COVID-19 Public Health Emergency in 
Presidential Decree Number 11 of 2020. Because of government regulations governing large-
scale social restrictions, community access has been limited. The primary key to breaking the 
chain of transmission covid-19 is public awareness to keep their distance and implement 
health protocols. Public awareness and understanding of the coronavirus can provide greater 
insight into current perceptions and practice habits for COVID-19 prevention.24,25 To predict 
possible adverse outcomes during the COVID-19 pandemic, the impact of viremia during the 
first and second trimesters must be investigated.26 Higher rates of asymptomatic COVID-19 
infection may pose a challenge due to the lack of recommendations for routine COVID-19 
detection or screening during the first and second trimesters of pregnancy.27 

Using the Google Scholar, PubMed, and ScienceDirect databases, nine articles were obtained 
based on the research findings. Pregnant women meet nutritional intake needs and aim to 
prevent undernutrition, according to one of our eight articles on eating habits. Due to 
insufficient family income, poor food ingredient selection, and a lack of family support to 
consume food nutrition, the average intake of energy, fat, and carbohydrates needs to be 
increased. The COVID-19 pandemic causes low macronutrient consumption, limiting access 
to food nutrition. The COVID-19 pandemic has had an impact on low-income families, reducing 
their purchasing power for food nutrition.12 

One article discusses how to improve low nutritional status in pregnant women by measuring 
upper arm circumference chronic energy deficiency. Inadequate human resources lead to a 
lack of knowledge about pregnant women's nutritional needs. The level of education 
influences a person's attitude and behavior toward health. Pregnant women with a higher level 
of education are more likely to find pregnancy-related information. Providing education can 
help to increase pregnant women's knowledge about nutrition during pregnancy. Food 
education is provided to the community and families.25 Knowledge is one factor associated 
with pregnant women's nutritional status because a good mother's knowledge influences the 
mother's daily dietary habits. So that the mother can manage her diet and avoid food rejection 
during pregnancy. As a result, the nutritional status during pregnancy can be adequately 
met.28 In this case, knowledge is increased through the lecture method, which employs sheet 
media and leaflets. 

https://doi.org/10.26555/eshr.v3i1.3629
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Vol. 5, No. 2, 2023, pp. 90-97 96   10.26555/eshr.v5i2.7301 

  

CONCLUSION 

Adequate eating habits for food intake and quality human resources can affect pregnant 
women's normal nutritional status. 

Declarations 

Authors' contribution 

WTI: data collection, research design, manuscript writing, and analysis; VW and AL performed 
the analysis. All authors contributed to reviewing and evaluating this manuscript for 
publication. 

Funding statement 

This research has not received external funding.  

Conflict of interest 

There is no conflict of interest in this research.  

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