Nutrition during Nutrition during pregnancy and pregnancy and

lactationlactation

MOHAN MOHAN LAL RAMAVATHLAL RAMAVATH

NUTRITIONISTNUTRITIONIST

“Nutrition requirements increases tremendously during pregnancy and lactation as the expectant or nursing

mother not only has to nourish herself but also growing fetus and the infant

who is being breast fed”.

PregnancyPregnancyPregnancy is a period of great physiological stress for woman as she is nurturing a growing fetus in her body.

Some changes occur in mother’s body which influences the need for nutrients & the efficacy with which the mother’s body uses the nutrients.

A. ↑Basal metabolic rate (BMR):Fetal growth & development increases the BMR by 5% during 1st trimester and 12% during 2nd & 3rd trimester. This increases the total energy requirement.

B. Gastrointestinal changes: There is an alteration in GI functions which causes nausea, constipation & vomiting. In later trimester of pregnancy absorption of nutrients like vitamin B12, iron and calcium increases in order to meet the increased needs of the mother & fetus.

C. Changes in body fluid: Mother’s blood volume increases so as to carry the appropriate amount of nutrients to the fetus and metabolic waste away from the fetus. With increase in the blood volume the concentrations of plasma proteins, hemoglobin and other blood constituents is lowered.

Importance of good Importance of good nutrition during nutrition during pregnancypregnancy• Mother has to nurture the fetus, health of the newborn depends on nutritional status of

the mother during and prior to conception.• A well nourished woman prior to conception enters pregnancy with reserve of several nutrients that meets the needs of the growing fetus without affecting her own health.• A well nourished woman suffers fewer complications during pregnancy & there are few chances of premature births.• A well nourished mother will give birth to a healthy child.• Maternal diet during pregnancy has a direct influence on fetal growth, size & health of the newborn.• Poor diet during pregnancy affects mother’s health, a malnourished mother provides nutrients to the fetus at the expense of her own tissues. • Poor nutrition during pregnancy increases the risk of complications such as prolonged labour and even death.• Inadequate diet during pregnancy affects the health of the baby during early infancy. If the infants survive they develop nutritional diseases like anemia, rickets etc or suffer from infectious diseases due to lack of good immunity.

• During pregnancy the nutrient needs increases

• To develop maternal organs such as uterus, placenta and breast tissues

• To build up body reserves to be utilized at the time of delivery and lactation.

• First trimester During 1st trimester there is no significant increase in the size of fetus thus only qualitative improvement in nutrients intake is required during this time.

• 2nd & 3rd trimester: An increased nutrient intake is suggested in second & third trimester of pregnancy thus need for almost all the nutrients is increased during pregnancy.

Nutritional needs Nutritional needs during pregnancyduring pregnancy

Energy requirement Energy requirement during pregnancyduring pregnancy

During pregnancy additional energy is required to support

• The growth of fetus, • Development of placenta & maternal tissues • To meet the needs for increased basal metabolic rate • To deposit fat which will be used during lactation.• Additional 300 kcal of energy is required during 2nd & 3rd trimester

of pregnancy.

Group Energy requirement (Kcal)

Sedentary worker 1875 +300= 2175

Moderate worker 2225 + 300 = 2525

Heavy worker 2925 + 300 = 3225

Protein and fat Protein and fat requirement s during requirement s during

pregnancypregnancyProtein requirement during pregnancy

During pregnancy additional protein is required for• Growth of fetus• Development of placenta• Enlargement of maternal tissues• Increased maternal blood volume• Formation of amniotic fluid• Protein reserves prepares the mother for labour, delivery and lactation

Additional 15g of protein is required 2nd & 3rd trimester of pregnancyGood quality protein rich foods should be eaten during pregnancy

Fat (omega-3 fatty acid) requirement during pregnancy

Omega-3 fatty acid (DHA): 300mg/d• Omega-3 fatty acid like DHA (Docosahexaenoic acid) supplementation during pregnancy is essential for brain development and prevents preterm births.• It is required for fetal visual development• It reduces the incidence of heart diseases & heart disease related deaths in

infants.

Calcium Calcium requirement during requirement during

pregnancypregnancyDuring pregnancy additional calcium is needed for

•Growth and development of bones as well as teeth of the fetus.

•Calcium intake decreases risk of hypertension, pre-eclampsia in mothers

and low birth weights and chronic hypertension in newborns.

•Maintaining bone strength

•Proper muscle contraction

•Blood clotting

If calcium intake is inadequate during pregnancy then calcium is mobilized from maternal bones to meet the fetal calcium needs and this demineralization of maternal bones leading to easy fractures.

Recommended daily allowance ( RDA) for calcium during pregnancy is 1g.

Iron requirement Iron requirement during pregnancyduring pregnancy

During pregnancy iron is essential for

•Fetal growth

•Expansion of maternal tissues including the red blood cell mass

•Maintaining additional iron content of placenta

•Building the iron stores in fetal liver

•Compensate blood loss during delivery

Group Pre pregnancy

body weight (kg)

Basal µg/kg

Iron requirement

Growth µg/kg

Total µg/kg

Total mg/d

Dietary iron requirement on mixed

cereal diet (mg/d)

Pregnant woman

50 14 46 60 3000 37.5

Mineral s Mineral s requirement during requirement during

pregnancypregnancyFolic acid (RDA- 400 µg/d):

•During pregnancy maternal blood formation increases thus folic acid requirement also

increases.

•Folic acid supplementation during pregnancy prevents fetal neural tube defects and improves

birth weights of the fetus.

Zinc (RDA-12mg/d) :

•It is required for synthesis of nucleic acids DNA & RNA and it is having important role in

reproduction.

•Zinc deficiency during pregnancy can cause poor pregnancy outcomes and abnormal

deliveries including congenital malformations.

Iodine : Lack of iodine causes still birth, birth defects & decreased fetal brain development.

Vitamin requirement Vitamin requirement during pregnancyduring pregnancyVitamins A (600 µg/d retinol): It is needed in small amounts to protect the fetus

from immune system problems, blindness, infections and death.

Vitamin D (5µg/d): It is required for formation of fetal bones.

Vitamin K: Vitamin K is required for normal coagulation of blood & prevents new born infants hemorrhages.

Vit B12 (1.2 µg/d) : Vitamin B12 supplementation during pregnancy helps in brain & nervous system development of the fetus.

Vit C (60mg/d): It increase iron absorption and also helps in fetal growth. Deficiency of vitamin C increases the chances of preterm delivery.

Vit B6 (2.5mg/d): It is required for normal fetal development & positive pregnancy outcomes.

Vit B1 (+0.2mg/d), B2 (+0.2 mg/d), B3(+2mg/d): As total energy requirement increases during pregnancy so B vitamin requirement also increases.

Other Other considerations considerations

during pregnancyduring pregnancyCaffeine: Coffee should be avoided during pregnancy as it can cross the placenta & enter fetal

circulation and

increases the risk of miscarriages, premature deliveries and small for date infants.

Smoking: During pregnancy smoking results in placental abnormalities & fetal damage, including

prematurely & low birth weights. Smoking impairs oxygen & nutrient transport through the placenta due to

reduced blood flow.

Alcohol: During pregnancy alcohol consumption causes low birth weight infants & growth retardation, fetal

impaired central & nervous system performance including growth retardation.

Drugs: During pregnancy drugs consumption lead to poor prenatal weight gain, very short or prolonged

labour, operative delivery and other perinatal problems.

Diet & feeding pattern:

1. To meet the increased nutrients need during pregnancy mother should increase her feeding.

2. Pregnant woman should consume 5-6 meals a day and snacks in between the main meals.

3. To meet the increased protein demand good quality protein rich foods like milk, meat, eggs, fish should be included.

4. Nutrient rich foods specially iron, calcium, folic acid , calcium & DHA rich foods should be included in the diet during pregnancy.

Importance of Importance of nutrition during nutrition during

lactation lactation 1. During lactation adequate nutrition is required as infant derives all its nutrition from the mother’s milk.

2. Mother needs extra nutrition as she has to nourish a fully developed & rapidly growing infant. She needs extra nutrients to meet baby’s needs in addition to her own requirements.

3. Any inadequacy in mothers diet influence both the quality & quantity of mother’s milk secreted.

4. If mother’s diet is inadequate then she will draw her own body reserves to meet the needs of lactation at the cost of her own health.

5. Nutrient deficiency can lead to lower levels of nutrients in the mother’s milk.

Nutritional Nutritional requirement during requirement during

lactationlactation

Energy requirement:

1. Lactating mothers need additional energy for production of milk.

2. During pregnancy approximately 600-850 ml milk is secreted daily.

3. Energy content of mother’s milk and efficacy of conversion of food energy into milk energy determines the energy requirement of a lactating woman.

4. During first 6 months of lactation – additional 550 kcal/d energy is required

5. During 6-12 months of lactation- additional 400 kcal/d energy is required

Protein requirement:

During lactation protein needs also increases as mothers milk contains 1.15g of

protein/100ml.

For proper milk production, adequate amounts of good quality protein or good quality

protein should be included in the mother’s diet.

During first 6 months of lactation- 75g of protein is required everyday

During 6-12 months of lactation – 68g of protein is required everyday

Nutritional Nutritional requirement during requirement during

lactationlactationCalcium: 1g /d

Additional calcium is required for breast milk secretion. 30-40mg of calcium is secreted per 100ml or 300mg of calcium per 850 ml of milk.

Additional intake of calcium is essential to enable the retention of calcium in breast milk.

Adequate dietary calcium intake during lactation meets the mother’s calcium needs and extra calcium requirement for breast milk production.

Iron: 30mg/d

Iron requirement during lactation is the addition of the requirement of the mother & required to make up the iron secreted in breast milk.

Most of the lactating woman have lactation amenorrhea, resulting in saving of 1mg of iron per day which would otherwise lost in the menstrual blood.

The requirement of iron is same as the non pregnant woman

Nutritional Nutritional requirement during requirement during

lactationlactationVitamin A (950µg/d):

•Breast milk is rich in vit A so lactating mother needs adequate amount of vitamin A in

their diet.

•Average amount of vitamin A secreted in mother’s milk is 350µg/d retinol.

Vitamin B6 (2.5mg/d): It’s requirement increases during lactation.

Vitamin B12 (1.5mg/d): Additional Vitamin B12 is required to meet the needs of the lactation.

Folic acid (150µg/d): Additional folic acid intake will meet the needs of the lactation.

Vitamin C (25mg/d): Appreciable amount of vitamin C is secreted in breast milk. Additional intake will meet the need of the lactation.

Nutritional Nutritional requirement during requirement during

lactationlactationDiet and feeding patterns:

1. Lactating mother requires larger quantities of body building and protective foods & additional energy yielding foods to facilitate the formation & secretion of breast milk.

2. Fluid intake should be increased as fluids are essential for adequate quantity of milk production.

3. No food should be restricted except highly spiced & strongly flavored food, as they impart flavor to milk which may be repulsive to the baby.

4. Nutrient needs of lactating mother are greatly enhanced during lactation hence she should have snacks in between the meals. Lactating mother should have 5-6 meals in a day.

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