Pregnancy and lactation

Characteristics of Pregnancy

Pregnancy or Gestation
Period when the fertilized ovum
implants itself in the uterus,
undergoes differentiation and
grows until it can support extra-
uterine life
Human pregnancy last for a period
of 37-40 weeks
 Characteristics of Pregnancy

3 Trimesters
– First –
implantation
– Second –
organogenesis
– Third - growth
 Maternal Diet

 Maternal diet and nutritional status have

a direct impact on the course of
pregnancy and its outcome. Malnutrition
which occurs in the early months of
pregnancy affects development and the
capacity of the embryo to survive; poor
nutrition in the latter part of pregnancy
affects fetal growth.
 NUTRITION IN PREGNANCY

The total energy cost of storage

plus maintenance amounts to
approximately 80,000 Kcal
Energy cost of pregnancy - 300
Kcal/day
Energy intake – 36 Kcal/kg of
pregnant weight per day
 WEIGHT GAIN

 All pregnant women need to gain

weight during pregnancy for fetal
growth and maternal health.
 The weight of the blood volume and
the enlargement of the reproductive
organs are fairly constant.
 WEIGHT GAIN

 An average gain in weight during

pregnancy is 24 lbs
 A gain of 1.5-3 lbs during the first
trimester
 A gain of 0.8 lbs/week during the
remainder of the pregnancy
 A sudden weight gain after the 20th week
of pregnancy may indicate water retention
and possible onset of pre-eclampsia
 WEIGHT GAIN

 Tissue Weight (Pounds)

Fetus 7.5
Uterus 2.0
Placenta 1.5
Amniotic Fluid 2.0
Blood Volume 3.0
Extra cellular Fluid accretion 2.0
Breast Tissue 1.0
Fat 9.0
Total 28.0
 Recommended WEIGHT GAIN
during pregnancy

 Pre Pregnancy Weight Recommended

Weight Gain
Underweight BMI < 18.5 28 – 40 lb
Healthy Weight BMI 18.5 – 24.9 25 – 35 lb
Overweight BMI 25.0 – 29.9 15 – 25 lb
Obese BMI ≥ 30 15 lb
 WEIGHT GAIN PATTERNS

First 3 ½ lb
Normal Trimester
Thereafter 1 lb per week
First 5 lb
Underweight Trimester
Thereafter 1 lb per week
First
2 lb 2/3 per
Overweight Trimester
week
Thereafter
 WEIGHT GAIN
 Weight gain during the first ten weeks is
small and this is due to the growth of the
uterus and expansion of the mother’s
blood
 Weight gain toward the end of pregnancy,
growth of the fetus accounts for the
greatest increase in weight gain
 The total weight gain for a normal
pregnant woman is kept ideally between
15-20 lbs, the gain is divided into 3, 7 and
7 lbs in the 3 trimester
 MATERNAL WEIGHT

Underweight
– Low birth weight infants ( <5 lbs)
– Preterm infant (born 38 weeks)
– Higher infant mortality rates
 MATERNAL WEIGHT

 Overweight and Obesity

– High risk of complications like
hypertension, gestational diabetes, and
post partum infections
– Complications of labor and delivery
– Large newborn increase the likelihood of a
difficult labor and delivery, birth trauma
and caesarian section
– May double the risk of neutral tube defects
 ENERGY
Increase in the metabolic rate to
support the growth of the fetus and
the accessory tissues = 80,000
calories or extra 300 kcal/day
During the 2nd and 3rd trimester,
deposition of 3.5 kg of fat account
for 2/3 of the total energy needs
 ENERGY
Energy needs differ due to
pregnancy weight and body
composition, stage of pregnancy
and activity level
If the rate of weight gain is
appropriate for the rate of
pregnancy, energy intake is
adequate
PROTEIN ALLOWANCES

 The additional allowance of protein

takes into account the increased
nitrogen content of the fetus and its
membranes, maternal tissues and the
added protection of the mother against
complications
 Estimated that 950g are deposited
during the last 6 months of gestation
 PROTEIN ALLOWANCES

 FAO/WHO recommends an additional

9g of protein/day for the latter part of
pregnancy
 The protein needs of a normal woman
is 1.1g/kg BW; a normal pregnant
woman requires an additional 9.5g/day
or a total of 900-950gms for the 9
months gestation period
 REASONS FOR ADDITIONAL
PROTEIN

 To provide for the storage of nitrogen

 To protect the mother against many of the
complications of pregnancy
 For the growth of the women’s uterus,
placenta and associated tissues
 To meet the needs for the fetal growth and
repair
 For the growth of the mammary tissues
 For the hormonal preparation for lactation
COMPLETE PROTEIN MEAL
 NUTRITIONAL NEEDS DURING
PREGNANCY

The normal requirements of the

mother
Those of developing fetus
(including also the uterus and
placenta)
Building up reserves in preparation
for labor and lactation
CALCIUM ALLOWANCES

 During the later half of pregnancy the

intake and retention of calcium increased.
 An adequate supply of Vit. D is essential
in the use of calcium and phosphorus
needed to calcify the fetal bones and
teeth.
 If the diet of pregnant women is
inadequate in calcium, she will have to
sacrifice the calcium of her bones in favor
of the developing fetus
CALCIUM ALLOWANCES

64-65% retained in the fetus during

the last two months
The daily intake of calcium must be
increased from 0.5-0.9 to that of
the non-pregnant adult’s daily
allowance.
IRON ALLOWANCES

 At least 700-100mg of Fe must be

absorbed and utilized by the mother
throughout her pregnancy.
 About 240mg are spared by the
cessation of the menstrual flow
 The rate of absorption is increased in
the third trimester when the needs of
the fetus are highest
IODINE ALLOWANCES

 Specially important to meet the needs

for fetal development
 An inadequate intake of iodine may
result in goiter in the mother or child
 The increased need for iodine can be
met by regular use of iodized salt in
food
 VITAMIN ALLOWANCES

 Thiamin and niacin allowances are increased

in proportion to the calorie increase, while
riboflavin allowances increased according to
the higher protein level.
 Vit D and Ascorbic acid should be also
increased
 Vit A is especially important in the epithelial
cells during organogenesis and ensure good
vision
 VITAMIN ALLOWANCES

 Folic acid and Vit B12 are important in

synthesis of RBC
 Vit B6 should be greater during pregnancy
 Vit K may be given to mother at 2-5mg
parentally before the birth of the baby to
stabilize the prothrombin level of the infant
until synthesis can take place
 1-2mg can be given to the infant after birth
VITAMIN ALLOWANCES
 FOOD ALLOWANCES

 One ounce or 30gms of meat or its equivalent

and an extra pint of milk to the normal diet
 Daily consumption of whole grain cereals,
enriched bread, rice, leafy vegetables, fresh and
dried fruits
 Include liver is at least once a week
 Egg in the daily diet
 Fortified milk with Vit D or fish liver oil
 6-8 glasses of water daily
COMPLICATIONS OF PREGNANCY
AND POSSIBLE DIETARY
MODIFICATIONS

 Morning sickness
– Beads’ longitudinal study on pregnant women
reveals nausea to affect frequency of food
intake, resulting in decrease in calorie intake
and increase hormone secretion
– Must have small frequent feedings instead of
three large meals, and high CHO-low fat
foods such as crackers and jelly to overcome
the above complications. Liquids are better
taken between meals rather than at mealtime
COMPLICATIONS OF PREGNANCY
AND POSSIBLE DIETARY
MODIFICATIONS
 Rapid weight gain or loss
– “Eating for two” is not valid among well nourished
mothers
– Excessive weight gain during pregnancy is
increase of 3kgs or more per month in 2nd and 3rd
trimester. They should consciously avoid severe
calorie as well as prevention of excessive weight
gain
– Weight gain of <500gm/month during the 1st
trimester & 250gm during 2nd trimester can lead to
LBW or premature infants with brain and nerve
damage. Abortion may also occur.
COMPLICATIONS OF PREGNANCY
AND POSSIBLE DIETARY
MODIFICATIONS

 Toxemia
– Rapid weight gain, edema, high blood
pressure, excretion of albumin in the urine
and convulsions
– Classifications: Acute toxemia of pregnancy
and Chronic hypertensive disease
– Optimum nutrition is a fundamental aspect
of therapy.
– Salt intake is restricted for edema
COMPLICATIONS OF PREGNANCY
AND POSSIBLE DIETARY
MODIFICATIONS

 Anemia
– The classic macrocytic anemia of
pregnancy represents a combined
deficiency of iron and folic acid
– It is difficult to overcome by raising the
level of iron in the diet although its
absorption can be enhanced by the
inclusion of ascorbic acid-rich foods
COMPLICATIONS OF PREGNANCY
AND POSSIBLE DIETARY
MODIFICATIONS

Constipation
– Lots or fresh fruits, vegetables,
fluid and regular exercise will
correct this disorder.
COMPLICATIONS OF PREGNANCY
AND POSSIBLE DIETARY
MODIFICATIONS

Socio-economic and Cultural factors

- Low income groups tend to have
big families, one reason for the
decrease in kind and amount of
food available to the pregnant
women
COMPLICATIONS OF PREGNANCY
AND POSSIBLE DIETARY
MODIFICATIONS

 Alcohol, Caffeine, Nicotine

– Smoking during pregnancy lowers mean birth
weight and increases risk or perinatal mortality.
– Increasing the food intake of pregnant smokers
can compensate for some of the effects of
smoking.
– Caffeine crosses the placenta to the fetus
rapidly.
– Alcohol, caffeine, and nicotine dramatically
increase circulating levels of cathecolamine
LACTATION
 LACTATION

 Most of the dietary essentials are

increased over and above the
requirements during pregnancy to meet
the demands of milk production,
namely: calories, proteins, calcium, Vit
A, Thiamin, riboflavin, Niacin and
ascorbic acid.
 NUTRITION IN LACTATION

 Calorie Allowances
– The chief concern during lactation is the loss of
the food material in the milk and the large storage
of a certain amount of food which cannot be
entirely accounted for by the chemical
composition of the milk.
– It is generally suggested that the extra food
calories should be about twice those secreted in
the milk of approximately 700-1500 calories of
food for 500-1000ml of the milk.
CALORIE ALLOWANCES

 The FNRC recommends an increase by

1000 calories above the normal
requirement for an average production of
850ml of milk, with an energy value of
about 600 calories,
 Human milk is approximately 0.70 calories
per ml or approximately 20 calories per
ounce, and it contains 1.2g/100mm.
 NUTRITION IN LACTATION

 Protein Allowances
– The need for protein is greatest when
lactation has reached its maximum but it is
a need which should be anticipated and
planned for during pregnancy.
– Additional protein in the diet tends to
increase the yield of breast milk while a
decrease of protein lowers the amount of
milk secreted.
 PROTEIN ALLOWANCES

The average CHON allowance for

the lactating mother is an
additional 20.2g CHON to her
normal requirement.
A 20g factor may be used
 NUTRITION IN LACTATION

 Calcium, Phosphorus and Vit D allowances

– During lactation, the demand for calcium and
phosphorus is increased above the requirement
of the pregnant woman.
– The calcium allowance is 1.0g daily for good milk
production. If the CHON requirement and other
essentials of the diet are fulfilled., the increase
need for phosphorus ill be met
– The Vit D requirement of 400 I.U remains the
same as during pregnancy.
 NUTRITION IN LACTATION

 Iron allowances
– Iron rich foods are essential for the
mother’s own health, while
supplements are included early in the
infant’s diet.
– Additional intake is recommended for
blood lost in parturition, for milk iron,
and basal losses.
 NUTRITION IN LACTATION

 Vitamin Allowances
– There is an increased demand for Vitamin A,
Niacin, Riboflavin, Thiamine, and Ascorbic Acid
above the requirements of pregnancy during
lactation.
– Vit A – an additional of 2000 I.U to the normal
allowance
 BREASTFEEDING
MISCONCEPTIONS

 A mother is sick with TB cannot breastfeed.

 Breast milk is not good if the mother has
stayed long under the sun.
 A mother cannot breastfeed during pregnancy.
 A mother cannot breastfeed with only one
breast if the other breast is painful.
 A mother cannot breastfeed if she has cold, flu
or diarrhea.
 Breast milk is not good if the mother has been
caught in a sudden shower.
ADVANTAGES OF
BREASTFEEDING

 Breast milk provides antibody transfer to the

newborn.
 Breast milk is higher in lactose than cow’s
milk.
 Breastfed babies have no difficulty with the
regulation of calcium, phosphorus level, than
those who are bottle-fed.
 Bottle feeding affects the dental arch.
 Cow’s milk protein causes allergy.
ADVANTAGES OF
BREASTFEEDING

 For mothers
– Less incidence of breast cancer in women
who breastfed
– Less incidence of thrombophlebitis or
inflammation of a vein with formation of
blood clot, and
– It results to fast return of uterus to its
original size.
 FACTORS AFFECTING MILK
SECRETION

Diet
NutritionalState of Mothers
Emotional and Physical State
Suckling
Use of the contraceptive and drugs