Case Report: Midwifery Care with Local Food-Based Intervention Improves Nutritional Status in a Primigravida with Chronic Energy Deficiency and Emesis Gravidarum

Abstract

Pregnancy is a critical period requiring adequate nutrition to maintain maternal and fetal health. Chronic Energy Deficiency (CED) remains a major maternal health problem in Indonesia, often worsened by emesis gravidarum. This case report describes midwifery care in a primigravida woman with CED and persistent emesis gravidarum during the second trimester. A descriptive case report was conducted at Plaosan Primary Health Center, Magetan District, Indonesia, from March 1–15, 2026. The subject was a 23-year-old primigravida at 21 weeks of gestation. Data were collected through interviews, physical examinations, supporting investigations, and documentation review using the SOAP approach. Interventions included nutritional counseling, recommendations for small frequent meals, monitoring of weight and Mid-Upper Arm Circumference (MUAC), supplementation with multiple micronutrients (MMS), and provision of 200 g/day of boiled purple sweet potato for 14 days as a locally sourced supplementary food. The patient’s MUAC was 20 cm, confirming CED, while hemoglobin levels were 12 g/dL, indicating no anemia. After two weeks of intervention with three follow-up visits, improvements were observed: reduced frequency of nausea and vomiting, increased appetite, improved dietary patterns, and enhanced nutritional adequacy. Maternal weight gain was achieved, serving as an indicator of improved nutritional status. CED in this case was influenced by irregular pre-pregnancy dietary habits and reduced intake due to prolonged emesis gravidarum. The management strategy was consistent with evidence-based practice, as purple sweet potato supplementation provided essential nutrients and antioxidants that improved maternal nutritional status. The success of care was supported by adherence to nutritional counseling, supplementation compliance, family support, and continuous midwifery monitoring. Comprehensive midwifery careintegrating nutritional education, supplementation, local food-based interventions, and ongoing monitoring-proved effective in managing CED and emesis gravidarum. This approach improved maternal nutritional status, reduced pregnancy-related complaints, and minimized the risk of complications, supporting maternal and fetal health.