nutrition for pregnant and lactating woman

NUTRITION FOR PREGNANT AND LACTATING WOMAN

Presented by:Deepak Kumar Mandal

Madan PandeyB. Sc. Nutrition & Dietetics

Tribhuvan UniversityCentral Campus of Technology

Dharan, Sunsari, Nepal 1

PREGNANT WOMAN

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Contents

• Introduction

• Physiological changes

• Factors Affecting Pregnancy

• Complications

• Nutritional Requirement

• Balance diet

• Conclusion

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Introduction

Pregnancy is a normal physiological phase whererapid growth of fetus takes place in the mother’suterus along changes with in her body.

The physiological and hormonal changes help tobetter accommodate the fetus.

The blood sugar level, breathing & cardiac outputare also increased.

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Cont……

Level of progesterone & estrogen rise continuously.

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Physiological changes

Energy metabolism

• Basal metabolism increases due todevelopment of fetus and other physiologicalchanges.

• The increase in BMR relative to pre-pregnancyvalues are about 5.3%, 11.4% and 25.3%during the first, second and the third trimesterrespectively.

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Cont……

Growth of maternal tissues

• Maternal tissues including breasts, uterus and adipose tissues increase in size.

• Hormones promote growth and changes in breast tissues.

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Cont……

Alimentary Functions

• Reduced gastric tone, motility and secretion.

• Nausea and constipation are common.

• Efficiency of absorption of calcium, iron, vitamin B12 and other nutrients increases.

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Cont……Renal Function

• Glomerular filtration rate increases to clear substances such as creatinine, urea, uric acid etc.

• Rate of excretion of water is higher in mid-pregnancy, very low in advanced stage.

• Mild glycosuria is common.

• Increased loss of free amino acids and iodine in urine.

• Decreased excretion of calcium & B-vitamins.9

Cont……Blood Composition

• Increase in plasma volume about 50% and RBC mass by 20%.

• Increase in total haemoglobin but decrease in its concentration.

• Fall in total serum protein.

• Decrease in concentration of vitamin A, ascorbic acid and increase in concentration of carotene, tocopherols, cholesterol and N-methyl nicotinamide.

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Cont……

Water Balance and Weight Gain

• Average weight gain is about 12 Kg but it may range from 6 Kg to 18 Kg.

• Total body water increases by average 7 Kg.

• Kidney may have some difficulty in disposing surplus water.

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complications

Nausea & vomiting

• Due to nervous disturbance, placental proteinintoxication or derangement of carbohydratemetabolism.

• Feeling of nausea may be higher if food iseaten at too much hunger.

• Frequent and small meal should provided.

• Fat rich, fried, spicy foods should be restricted.

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Cont……

Leg cramps

• Due to sudden contraction of muscles.

• Related with decline in serum calcium level.

Fatigue

• Caused by progesterone disturbances.

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Cont……

Heart burn

• Due to increased progesterone levels whichdecreases smooth muscle mobility of stomachand pressure by growing uterus on stomach.

• Can be relieved by providing small & frequentmeals and drinking fluids between meals.

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Cont……

Pre-eclampsia & eclampsia

• Disorder of pregnancy characterized byhypertension and proteinuria.

• Symptoms may be swelling, convulsion(shaking of body), nausea, vomiting,headache, temporary loss of vision, or coma.

• Adequate amount of proteins, vitamins & minerals should be provided.

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Cont……

Constipation

• Due to pressure of enlarged uterus & effect of placental hormones on GI tract.

• Increment of fluid intake & fibre in diet, regular sleeping & exercise habit helps in elimination.

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Cont……

Anaemia

• According to WHO, a pregnant woman isanaemic if hemoglobin level is 11mg/dl orhaematocrit percent is below 33%.

• The concentration of haemoglobin in blood islowered due to increased plasma volume.

• May be due to iron deficiency, folatedeficiency (megaloblastic), less often due tovitamin B12 deficiency.

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Cont……

• Supplements of iron and folic acid shouldprovided.

• Regular consumption green leafy vegetables,whole cereal grains & pulses, animal meat &liver and vitamin C rich foods is to beincreased.

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Cont……

Gestational Diabetes Mellitus

• Refers to carbohydrate intolerance duringpregnancy.

• Caused due to impaired insulin action.

• Insulin antagonism is probably due tocombined effect of placental hormones.

• Resolves after delivery.

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Factors Affecting Pregnancy

Diet

• Diet is a main factor that influences in health of mother.

• Consumption of ill-balanced and inadequate diets leads to deterioration of physical and mental strength, development of anaemia and general weakness.

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Cont......

Socio-economic Factor

• Still birth and neonatal death rates are generally high among the pregnant women belonging to low socio-economic status.

• The low standard of living, living in insanitary surrounding and poor quality diets are reasons for high still birth and neonatal death.

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Cont……Mother body size• Generally tall women have babies with greater

body length and weight than those born to short women.

• It has been found that: a) Babies born to short women are 8% lighter than

those born to tall women.b) Babies born to under weight women are 8%

lighter than those born to over weight women.c) Babies born to tall and heavy women are about

14% heaver than those born to short and light women.

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Nutritional RequirementsCalories

• Approximately 77,000 Kcal energy is required perpregnancy if weight gain is supposed to be 12Kg.

• More than 40,000 Kcal is accounted by protein &fat storage.

• For this, ICMR (2010) has recommended additional calorie intake as below:

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Trimester Additional Requirement

First 85Kcal/day

Second 280Kcal/day

Third 470Kcal/day

Cont……

• Further allowance has to be made for spontaneous decrease in physical activity particularly occurs in third trimester.

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Cont……

Carbohydrate

• It is main source of extra calories during pregnancy.

• A fiber rich diet is recommended to help prevention of constipation and hemorrhoids.

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Cont…… Fat

• Dietary fats provide vital fuel for the mother and development of fetus.

• Need of essential fatty acid is slightly higher than those of non-pregnant women during pregnancy.

• Very low fat diets (which provide less than 10%daily calories from fat) do not supply sufficientessential fatty acid, fat-soluble vitamins or calories.

• Diet should contain at least 30 gm visible fat(ICMR,2010)

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Cont…… Protein

• About 597 g of protein is deposited during pregnancy in fetus and maternal tissues.

• To fulfill this requirement, ICMR(2010) has recommended an extra allowance of dietary protein as below:

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Trimester Additionalrequirement(gm/day)

First 0.6

Second 8.1

Third 27

Cont……

Calcium

• About 30g of calcium is deposited in fetus during pregnancy.

• Maternal reserves are in positive balance.

• Absorption is not less than 40% of calcium available in diet during pregnancy.

• ICMR(2010) has recommended an extra 600mg (total-1200mg) calcium per day.

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Cont……Iron

• Fetus and placenta contain about 230mg and100mg of iron respectively.

• Increment of RBC mass increases about296mg of iron.

• Since menstruation stops iron losses isminimized to 234mg for period of pregnancy.

• The additional 860mg of iron is requiredwhen above factors are considered.

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Cont……

• This requirement is fulfilled by providingadditional 14mg (total 35mg) iron per day indiet (recommended by ICMR,2010).

• Here, it is supposed only 8% of iron isabsorbed from diet.

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Cont……

Vitamin A

• The liver of infant at birth contain about 5,400µg to 7,200 µg of retinol.

• To fulfill this requirement ICMR (2010) hasrecommended following additional dietaryallowances:

a. 200µg (800 µg total) as retinol

b. 1600 µg (6400µg total) as β-carotene

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Cont……

Thiamine

• Small amounts of thiamine are stored intissue of new born infant.

• Extra calorie allowance requires extrathiamine.

• Thus, ICMR(2010) has recommended an extraallowance of 0.2 mg per day of thiamine.

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Cont……

Riboflavin

• Small amounts of riboflavin are found intissues of new born infant.

• Extra calorie allowance requires extrariboflavin.

• Thus, ICMR(2010) has recommended an extra0.3mg per day of riboflavin.

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Cont……Niacin

• Nicotinic acid and coenzymes I & II containingnicotinamide are found in tissues of new borninfants.

• Extra calorie allowance requires extra niacin.

• To fulfill this requirement, ICMR(2010) hasrecommended extra allowance of 2mg perday.

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Cont……

Folic acid

• There is rapid growth of fetus.

• Total number of RBCs also increases.

• Folic acid is required for synthesis of DNAs &RNAs.

• ICMR(2010) has recommended an extraallowance of 300 µg (total 500 µg) of folicacid per day.

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Cont……

Vitamin B6: ICMR(2010) has recommendedadditional 0.5 mg (total 2.5 mg) of vitamin B6

per day.

Vitamin B12: Extra 0.2 µg (total 1.2 µg) of thisvitamin has been recommended.

Ascorbic acid: 20mg extra requirement (total60 mg) during pregnancy.

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Items QuantityCereals 475gmsPulses 55gmsLeafy vegetables 100gmsOther vegetables 40gmsRoots and tubers 50gmsMilk and milk products 250mlOils and fats 40gmsFruits 60gms Sugar and Jaggery 40gms

Composition of Balanced Diet during Pregnancy

Source: ICMR- 198437

Conclusion

Pregnancy is stage of rapid growth of infant inmother’s body.

Her body itself changes physiologically to helpgrowth of fetus & for preparation of lactation.

Thus, sufficient nutrients from diet, properhealth care & sanitary conditions shouldmaintained for safe delivery.

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LACTATING WOMAN

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contents

• Introduction

• Hormonal control of lactation

• Lactation and growth of infant

• Nutritional requirements

• Benefits of breast feeding

• Practices to avoid during lactation

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Introduction

Lactation is a normal physiological process inwhich there is production of milk bymammary glands of mother after delivery ofher child.

Milk is only source of energy and nutrients forthe newly born baby.

It promotes optimal physical and mentalgrowth of infant.

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Hormonal control of lactationSucking infant

Hypothalamus stimulated

causes release of milk from alveolus

Pituitary stimulatedProlactin produced by anterior

pituitary

Facilitates uterus to return in normal size

Stimulates milk production in alveolus

Oxytocin produced by posterior pituitary

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Lactation and growth of infant

Milk yield is 500ml in first month, & reaches up to 1litre in fifth month and declines steadily later.

Average milk production is about 650ml.

Doubling of weight in first six months indicates infant is getting sufficient nutrient.

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Cont……

Growth can be monitored by using growthchart.

Along with age of infant, other factors such as age, health and nutrition of mother influences the volume of milk produced.

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Cont……

The composition and output of milk are likely to be affected by mother’s diet and state of nutrition.

Studies have shown that:

• High fat diets slightly increase the fat content of milk and its output.

• High protein diet slightly increase milk output.

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Nutritional requirements

Lactating woman’s nutritional supplies should:

• Meet her own body needs.

• Provide enough nutrients in milk.

• Furnish energy for mechanism of milk production.

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Cont……

Calorie

• Nursing mother needs more than 1000kcal extra energy for

a) metabolic work to produce milk and

b) calorie content in milk.

• It is partly fulfilled by mobilization of fat stores in body and partly by dietary supply.

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Cont…

• Thus, ICMR(2010) has recommended additional:

a) 600Kcal energy for first 6 months

b) 520Kcal energy for next 6 months

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Cont……Protein

• Protein requirement of lactating mother iscalculated on the basis of milk output andprotein concentration in it.

• ICMR(2010) has recommended followingallowance of protein:

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Lactation period Additional Requirement

0-6 months 22.9g

6-12 months 15.2g

Cont……

Fat

• Quantity of fat in mother’s diet does notinfluence the fat content of milk

• Composition of milk fat reflects compositionof fat in mother’s diet.

• Sufficient amount of fat should be consumedin order to get sufficient unsaturated fattyacids & fat soluble vitamins.

• Diet should contain at least 30 gm visible fat.

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Cont……

Calcium

• Breast feeding is associated with transfer of approximately 200mg calcium per day.

• Supposing the retention of dietary calcium about 30% in pregnant mother, ICMR(2010) has recommended additional 600mg (total-1200mg) calcium per day.

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Cont……

Iron

• Mother’s milk is not a good source of iron.

• It contains about 0.78 mg/l iron, so loss iron from milk is about 0.5mg a day.

• Loss of iron from body is 0.77mg/day.

• To compensate these loss, ICMR(2010) has recommended total 25mg iron per day.

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Cont……

Vitamin A

• The quantity of retinol in milk is about 50μg/dl;total about 350μg.

• Thus, ICMR(2010) has recommendedadditional vitamin A requirement as below:

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Additional Requirement

Retinol 350μg (total 950μg)

β-carotene 2800μg (total 7600μg)

Cont……

B-vitamins

• Breast milk contains all types of B-vitamins.

• Increased energy need also increases need of these vitamins.

• Content of these vitamins in milk depends upon content in mother’s diet.

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Cont……Thiamine

• About 0.2mg thiamine per day is secreted via milk.

• Additional recommendations are:

a. For 0-6 months of lactation: +0.3mg

b. For 6-12 months of lactation: +0.2mg

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Cont……

Riboflavin

• About 0.3mg riboflavin is secreted in milk per day.

• ICMR(2010) has recommended:

a. Additional 0.4mg for first six months

b. Additional 0.3mg for next six months

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Cont……

Niacin

• Nicotinic acid secreted in milk per day is about 0.9 to 1.2mg.

• Allowance of niacin is:

a. Additional 4mg for first six months

b. Additional 3mg for next six months

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Cont……

• Vitamin B6: Additional 0.5 mg pyridoxine has been recommended.

• Vitamin B12 : Additional 0.5µg is recommended.

Ascorbic acid: About 3mg/dl ascorbic acid is secreted in milk.

• Additional 40mg has been recommended,(with consideration of cooking loss)

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Benefits of breast feeding

Benefits to infant

• Protects from infections & illness including diarrhea, pneumonia, asthma.

• Decreases risk of obesity.

• Reduced risk of diabetes & cardiovascular diseases.

• Decreases health care costs.

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Cont……

Benefits to mother

• Stimulates uterine contraction.

• Convenient because no requirement of preparing, mixing & heating.

• Less expensive than formula feeding.

• Reduces risk of breast cancer, ovarian cancer, osteoporosis.

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Practices to Avoid

If mother drinks alcohol or use drugs they are seen in milk.

So illicit drugs, alcohol, smoking should avoided.

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conclusion

Milk is exclusive source of nutrients and energy for infant.

Proper nutritional care is required for both infant and mother.

Breast feeding benefits both mother and infant.

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REFRENCES

• Essentials of Food and Nutrition(volume 1);Dr. M swaminthan

• Dietetics; B. Srilakshami; New age International

• Discovering Nutrition; Paul Insel, Don Ross, Kimberley McMahon, Melissa Bernstein; Jones & Bartlett Learning

• NUTRIENT REQUIREMENTS AND RECOMMENDED DIETARY ALLOWANCES FOR INDIANS, 2009 ;Indian Council of Medical Research; Jamai-Osmania PO, Hyderabad – 500 604

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THANK YOU