nutrition in pregnancy

Pregnancy Nutrition Growth & Development of fetus

Dr Nupur Gupta, Consultant & Unit Head

MOTHER’S MILK IS BEST FOR THE BABY

Pregnancy & Lactation: First 4 Trimesters of Growth

Pregnancy – importance of Nutrients

Maternal nutrition-Impact on Fetal health

Lactation – importance of Nutrients

Clinical evidences

Breastfeeding Benefits – Mother & Child

Overview

Proprietary and confidential — do not distribute

Nutrition during pregnancy & lactation

• 2nd trimester to 6 months of lactation is a critical period for an infant’s growth.

• 70% of brain development happens by birth & an infant doubles its birth weight during 1st 6months

• Many mothers don’t get the extra nutrients they need during this period


The human growth velocity - most rapid during 3rd trimester & 4-5 months after birth

Nutrition during pregnancy & lactation

It is measured as gains in length, skull circumference and weight


Pregnancy & Lactation: Physiology

• Nutrition demand increases

• For normal growth of infants in utero and during early post-natal life

• The increased need for nutrients cannot always be met from the maternal diet, however ample it may be.


• Indian Mom* needs 31% extra energy & 41% extra protein

during lactation along with incr requirement of Calcium

(100%), Iron (19%), Vit B12 (50%) & Folic acid (50%)

Pregnancy & Lactation: Physiology


Dietary gaps in India: Birth Outcomes

30% Incidence of IUGR

26% prevalence of LBW

21% prevalence of pre-term


One of the most vulnerable segments of the

population for micronutrient deficiencies

Pregnant and lactating women


~27 million pregnancies/year

India contributes about 20% of births worldwide

India has the highest proportion of children < 5 years.

We need to improve maternal nutrition


Pregnancy- Recommended protein intake

Maximum during 3rd Trimester

For 10 kg gestational wt gain - 1, 7 and 23 g/day in 1st, 2nd, and 3rd trimesters respectively.


NutrientsFOLIC ACID• Reduces the risk of congenital malformations and increases the birth weight

IRON• Meet the high demands of erythropoiesis (RBC formation).

CALCIUM• Proper formation of bones and teeth of the offspring, for secretion of breast-milk

rich in calcium and to prevent osteoporosis in the mother.

IODINE• Ensures proper mental health of the growing foetus and infant.

VITAMINS• Vitamin A is required during lactation to improve child survival. Besides these,

nutrients like vitamins B and C need to be taken by the lactating mother


Pregnancy– Nutrient deficiency

• Increased risk of premature birth and low birth

weight, neurodevelopmental problems and poor

growth outcomes in infants .

• Need in pregnancy

– Protein,

– Vitamin A, B12, C, D

– Folic acid, zinc, iron and choline


Maternal weight gain & fetal body weight

Gestational weight gain

of 10 to 14 kg,

average 12 kg

Birth weight of 3.1 - 3.6

kg with a desirable birth

weight of 3.3 kg

1kg = 20 to 25 gm birthweight



• Energy + weight gain = protein, fat and water

• Protein - deposited in fetus (42%), uterus (17%), blood (14%) placenta (10%) and breast (8%)

• Fat – mainly in fetus and maternal tissues & contributes substantially to overall energy cost of pregnancy



Tissue deposition max during 2nd & 3rd trimester


Lactation – importance of nutrients

There is growing evidence that optimal dietary

intake of important nutrients, like iodine, DHA,

choline, and folate, is necessary during pregnancy

and lactation

Ziessel et al. Am J Clin Nutr 2009;89(suppl):685S–7S


Lactation- Recommended protein intake


Nutrients affecting infant health

• The main nutrients include – Vitamins A, C, and D– B vitamins,– Iodine, and – Choline


ESPGHAN COMMITTEE ON NUTRITION

The provision of supplemental food is able to improve

milk production and the duration of exclusive

breastfeeding among undernourished women.


Maternal nutritional risk factors for SGA babies in a developed country.

This study has shown that eating more fish and carbohydrate rich foods and taking folate

supplements around the time of conception is associated with a reduced risk of having an SGA

baby.

Methods: Case-control study of 844 cases (SGA) and 870 controls (appropriate size for gestational age (AGA)). Only term (37+ completed weeks of gestation) infants were included. Retrospective food frequency questionnaires were completed at birth on the diet at the time of conception and in the last month of pregnancy.


preterm birth (A), low birth weight (B)

Preconception dietary patterns Preterm Delivery


The Barker theory (Fetal origin of adult diesase)

Fetal Malnutrition & Adult Metabolic Diseases


Consequences Of Maternal Anemia

Foetal Outcomes

Reduced Cognitive

DevelopmentLBW &

SGA

Prone to Infection

after birth

Maternal Outcomes

Abruptio Placenta

Prolonged labour &

PPH

Compromised

Physical capacity

Clinical evidence Iron supplementation


Balanced energy Supplementation

WHO & Cochrane review• Balanced energy and protein supplementation

improves fetal growth, reduces risk of stillbirth, LBW, SGA infants, especially among undernourished pregnant women.

• Antenatal nutritional advice - to reduce risk of preterm birth.


Benefits of Breastfeeding to Babies

Incidence and severity of infections

Growth until one year of age

Incidence of obesity in adulthood

Improves mentaldevelopment


Not breastfeeding is associated with health risks for babies

Increased incidence of

Infectious morbidity (otitis media, GE, pneumonia)

Elevated risks of

Childhood obesity,

Type 1 & type 2 diabetes,

Leukemia

Sudden infant death syndrome (SIDS).

Rev Obstet Gynecol. 2009;2(4):222-231


In India, preferred alternative to Human Milk is: Bovine Milk

American Academy of Pediatrics (AAP) states that:

Unmodified cow's milk is not recommended for

infants less than 12mo of age


g/dl Human milk Cow milk Total proteins 0.89 3.30Caseins 0.25 2.60Whey proteins 0.70 0.67 -Lactalbumin 0.26 0.12 ß-Lactoglobulin - 0.30 Lactoferrin 0.17 trace Serum albumin 0.05 0.03 Lysozyme 0.05 trace Immunoglobulin 0.105 0.066

Protein composition of mature HM and cow milk is very different

(Hambaeus Nutr Abstr Rev, Rev Clin Nutr 1984;54:219-236)


Psychological benefitsfor mother, child

& father

LAM – Contraception

Benefits of Breastfeeding to mother

Weight loss after

delivery


If mother is not breastfeeding

• Epidemiologic data suggest that women who do not breastfeed face higher risk of – Breast and ovarian cancer, – Obesity, – Type 2 diabetes, – Metabolic syndrome, and – Cardiovascular disease.

Rev Obstet Gynecol. 2009;2(4):222-231


Maternal Counseling

Reasons for early breastfeeding discontinuation:

– Lack of confidence in mothers' ability to breastfeed,

– Problems with the infant latching or suckling, breast

pain or soreness,

– Perceptions of insufficient milk supply, and

– Lack of individualized encouragement from their

clinicians in the early post discharge period.


Summary

Maternal Nutrition is one of the indicators for improving Maternal and Child Health Care.

The last two trimesters of pregnancy and first two trimesters of lactation are most critical periods for Infants growth & development.

The increased need for energy, protein, and micronutrients cannot always be met from the maternal diet, however ample it may be.


Summary

Inadequate nutrition may affect and lead to adverse outcomes both in mother as well as fetus.

In addition to adequate nutrition, maternal counseling for breastfeeding plays a very important role in effective lactation.


THANKS

nutrition in pregnancy

Health & Medicine