Download PREGNANCY AND LACTATION

PREGNANCY
AND
LACTATION
PGND Ist SEMESTER
APPLIED NUTRITION-I
NUTRITION DURING PREGNANCY
AND LACTATION

Optimum nutrition is a great importance for women, due to their
special nutritional needs associated with physiology changes such as
menstruation, pregnancy, lactation and menopause.

Pregnancy and lactation are normal physiological processes, they
increase considerably the nutritional requirement of the mother. Due
to vomiting and loss of appetite generally reduced.

Further, additional nutrients are required for the growth of foetus.
The baby weighing about 3.2kg at birth will contain about 500 g
protein, 30 g calcium and 0.4 g of iron and varying quantities of
different vitamins.

The increased nutritional requirements during lactation are due to
the milk secreted by mother for feeding the baby.
Physiologic changes of pregnancy
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Blood volume and composition- many physical and
biological changes occur in normal pregnancy. Blood
volume expands by 50% resulting in decrease in
hemoglobin levels, blood glucose values, and serum
level of albumin, other serum proteins and watersoluble vitamins.
Gastrointestinal changes- The functions of
gastrointestinal system changes in several ways that
affect nutritional status. Nausea, vomiting and
constipation occur. It has been observed that the
pregnant women often show craving for some foods
and aversion to others.
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Renal function- due to foetal and maternal
metabolism during pregnancy, there is an increased
production of various metabolites like creatinine, urea
and other waste products. To facilitate their clearance,
the rate of blood flow through the kidneys is increased
with a subsequent increase in the rate of glomerular
filtration in the nephrons
Increased basal metabolic rate- due to foetal
growth and development there is an increase in basal
metabolic rate which rises by about 5% in the 1st
trimester reaching to as high a level as 12% during
later stages of pregnancy, when the rate of foetal
growth is very high.
Rate of growth during pregnancy
New life is created from the moment the ovum gets
fertilized. The fertilized ovum or embryo grows and the
process of making an individual starts. The embryo
which is about 2” long and weighs about 15 g around
12th week grows to a full grown baby weighing about
3kgs by full term.
Table: Fatal weight and maternal weight
gains at different ages in gestation
Nutritional requirements during
pregnancy

Energy- during pregnancy
additional energy is required to
support the growth of the foetus,
development of placenta and
maternal tissues and to meet the
needs for increased BMR. The
total calories cost of supplying
and maintaining the foetus has
been estimated to be about
40,000 Kcal. Since the greater
part of calories will be required
mostly during the 2nd and 3rd
trimesters, the additional
requirements will work out to 200
Kcal per day.

Protein- Available evidence would indicate about
910 g of protein is deposited in the foetus and
maternal tissues during pregnancy. The average daily
increment is estimated to be about 5 g during the
last six months of pregnancy. The I.C.M.R. nutrition
expert group recommended an extra allowance of
10 g per day.
Iron- it has been estimated that about 540 mg iron is
found in the foetus and maternal tissues. This will work out
to about 2-3 mg iron per day during the last six months of
pregnancy. Since, the iron from diets is utilized only to an
extent of about 20% in pregnant women, the extra dietary
iron requirements will be about 10-15 mg per day.
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Calcium- it has been estimated that about 30 g calcium
is deposited in the foetus during pregnancy. This will
work out to about 150 mg of extra calcium during the last
6 months of pregnancy. Since dietary calcium is utilized to
the extent of about 25% in pregnancy, the additional
requirements will work out to 600 mg in terms of dietary
calcium.
Vitamin A- the quantity of vitamin a is found in the liver
of infant about 5400 – 7200 µg of retinol and this will
work out to about 25-35µg additional retinol per day.
Since the requirement are small as compared with the
daily requirements of 750 µg for a normal woman.
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Thiamine, riboflavin and nicotinic acid- small
quantities of these vitamins are present in the tissues of
new born infants. The extra calorie allowance of 300 Kcal
per day for pregnant woman will need an increase in the
requirements of these vitamins. The I.C.M.R. nutrition
expert group has recommended can additional allowance
of 0.2 mg thiamine, 0.2 mg riboflavin and 2.0 mg
nicotinic acid per day.
Folic acid and vitamin - small amounts of folic acid
and vitamin are present in the tissues of new born
infants. The I.C.M.R. nutrition expert group has
recommended an additional daily allowance of 50-200 µg
of free acid and 0.5 µg of vitamin.

Ascorbic acid- small amounts of ascorbic acid are
present in the tissues of new born infants. The I.C.M.R.
nutrition expert group was of the opinion that the daily
allowance of 50 mg for a normal woman would meet
the additional requirement during pregnancy.
Table: Balanced Diet for a pregnant
woman (Sedentary work)
For Non-vegetarians 30 g of pulses can be substituted
with 50 g of meat / chicken / fish / egg
Diet during pregnancy:
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The basic principle of meal planning remains the same,
but since the nutritional requirements increase during
pregnancy, emphasis should be in including nutrient
dense foods i.e., foods that give more nutrients per
calorie consumed.
During early months, the mother often suffers from
morning sickness due to the hormonal and physiological
changes, when she should be given small amounts of
foods with increased frequency. Solid carbohydrate rich
foods like bread, biscuit and fruit given in the morning
or before meals helps to relieve nausea. Also fried, rich,
strongly flavored and spicy foods need to be avoided.
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To meet increased requirements the mother should
consume extra food. Her feeding pattern should be 5-6
meals a day. Protein needs can be met by including good
quality protein foods like meat, milk, egg, fish. Protein can
also be obtained from pulses like soya bean and
groundnut at a lower cost.
To meet additional iron needs foodstuffs like whole grain
cereals, rice flakes, puffed rice, dried fruits, green leafy
vegetables, eggs, enriched cereals and organ meats can
be given.
Food rich in dietary fibre like fresh fruits, vegetables,
whole grain cereals with plenty of fluids need to be
included. This is to ward off constipation which is a
common problem during pregnancy
Problem during Pregnancy
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Nausea and vomiting- Generally it is mild and
occurs during early pregnancy and is commonly called
“morning sickness” as it tends to occur early in the
day, but can occur at any time. At least 50% of all
pregnant women, most of them in their first
pregnancy, experience this condition.
Constipation- is common during the later half of
pregnancy. Hormonal changes in pregnancy tend to
increase relaxation of gastrointestinal muscles.
Pressure of developing foetus on the digestive tract
may make elimination difficult at times.
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Hear burn or gastric pressure- Some pregnant
women may complain of “feeling of fullness” or “heart
burn” during later half of pregnancy. This is usually
due to the pressure of the enlarging uterus crowding
the stomach.
Anaemia- A pregnant woman is labelled anaemic if
the blood hemoglobin is less than 10g/100ml from the
28th week onwards.
A significant fall in birth weight due to
increase in prematurity rate and intrauterine growth
retardation can occur if the haemoglobin level goes
below 8 g / 100 ml.
Other consideration:
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Alcohol- the habitual use of alcohol during
pregnancy can cause foetal damage. Extensive or
habitual alcohol use may produce offspring with
foetal alcohol syndrome (FAS). Infants with FAS are
premature and have low birth weight.
Caffeine can cross the placenta and enter foetal
circulation. Pregnant women who are heavy coffee
drinkers are considered at risk for miscarriages,
premature deliveries and may give birth to small for
date infants.
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Drugs- drug use pregnancy-medical or recreationalalso leads to numerous problems. Recreational drugs
like heroin, LSD, marijuana lead to poor prenatal
weight, short or prolonged labour and other prenatal
problems.
Smoking during pregnancy results in placental
abnormalities and foetal damage including
prematurity and low birth weight. This is mainly due
to reduced blood flow, which affects the oxygen and
nutrient transport through the placenta.
Recommended dietary allowance of various
nutrients during pregnancy (ICMR,1990)
LACTATION
Milk output varies in the
lactating mother. The WHO
expert committee assumed the
average output to be 850 ml
per day while the I.C.M.R.
nutrition expert group
assumed an output of 600 ml
per day.
Composition of breast milk
Soon after delivery small quantities of
thick, yellowish, viscous liquid called
colostrum is secreted which is rich in
antibodies and Vitamin A. This should be
given to the baby and not discarded.
After a few days of lactation the
mother secretes larger amounts of less
viscous and whitish milk known as
“mature milk” which is more or less a complete food
nutritionally. A healthy mother secretes 850ml of milk
daily for which her nutritional needs are increased
enormously
Table : Composition of mother’s milk
Nutritional requirements during
lactation
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Calories- it has been estimated that the efficiency of
conversion of diet calories to human milk calories is only
60%. On the basis, production of 420 milk calories will
need 700 diet calories. The I.C.M.R. nutrition expert
group recommended an additional 700 Kcal during
lactation.
Protein- the average NPU of the diets consumed in
India is about 50. For the production of 7.2 g of milk
proteins, about 14.4 g of dietary proteins will be
required. The I.C.M.R. nutrition expert group
recommended an extra allowance of 20 g of protein per
day.
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Calcium- the quantity of calcium present in 600 ml of
human milk is 205 mg. since the retention of dietary
calcium in lactating women is about 30 per cent, the
additional dietary calcium requirement will be about
700mg per day. The I.C.M.R. nutrition expert group
recommended an extra allowance 500-600 mg daily.
Iron- the iron content of 600 ml of human milk is about
0.72mg. Since only about 20 percent of the dietary iron
is retained in lactating women, it will be essential to
provide about 3.6 mg of extra iron in the diet. The
I.C.M.R. nutrition expert group recommended an extra
allowance for iron for the lactating women.
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Vitamin A- the quantity of vitamin A present in 600 ml
of human milk is 300 µg. The I.C.M.R. nutrition expert
group recommended an additional allowance of 400of
vitamin A.
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Thiamine, riboflavin and nicotinic acid- Additional
calorie requirements during lactation are 700 Kcal. The
extra requirements of thiamine, riboflavin and nicotinic
acid to meet the needs of extra calories will be 0.3 mg,
0.4 mg, and 4.6mg/day respectively.

Ascorbic acid- the quantity of ascorbic acid present in
600 ml of human milk varies from 15-30 mg. The
I.C.M.R. nutrition expert group recommended an
additional allowance of 30 mg of ascorbic acid.

Folic acid and vitamin- the quantities of folic acid and
vitamin present in 600 ml of human milk will be 6and
0.14µg respectively. The I.C.M.R. nutrition expert group
recommended an additional allowance of 50µg of folic
acid and 0.5µg of vitamin.
Diet during lactation:
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A lactating mother requires not only large
quantities of body building and protective
foods but also additional energy yielding
foods to facilitate copious formation and
secretion of breast milk. Besides adhering
to the basic principles of meal planning the
following guidelines need to be
considered.
Large amount of fluids are essential for
milk production. Therefore adequate fluids
such as milk, fruit juice, milk based
beverages and even water must be
encouraged.
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The choice of food is wide during lactation. No food
need to be restricted except spicy and strong
flavored foods which might impart flavour to milk
that may be repulsive to the baby and that may
cause gastric distress to the mother.
Almost all medicines taken during lactation are
absorbed into mother’s blood and are secreted in the
milk. Hence any medicine during lactation must be
avoided or taken under strict medical supervision.
Since the nutrient needs are enhanced, the meal
pattern may be changed to 5-7 meals a day by
introducing in between snack between the meals
Table: A balanced vegetarian diet for a
nursing mother doing sedentary work
For Non-vegetarian substitute 30 g of pulse with 50 g of
meat / fish / chicken / egg.
Recommended dietary allowances of various
nutrients during lactation(0-12 months)