PREGNANCY AND LACTATION

PREPARED BY: JULIE C. PUGIES, RN

 NUTRITIONAL OBJECTIVES

1. Ensure optimum nutrition before,

during, and after pregnancy and
during lactation.
2. Provide adequate nutrition to
meet increased maternal and
fetal nutrient demands.
“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”.
PREGNANCY
 CHANGES DURING PREGNANCY
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.
 IMP O R T ANC E O F GO O D
NU T R I TIO N DU R I NG P R E GNANC Y
• 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.
 IMP O R T ANC E O F GO O D
NU T R I TIO N DU R I NG P R E GNANC Y
• 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.
DIET FOR PREGNANCY
Description of the Diet
• Dietary intake should be increased for optimal
pregnancy outcome.

Characteristics of the Diet

• Diet for pregnant women varies according to
nutritional status of the mother pre- and during
conception; as well as which trimester both mother
and child are in.
NU T R I T I O NA L NE E DS D U R I NG
P R E G NA NC Y

• 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.
Weight gain in pregnancy

There are three components to maternal weight

gain:
1. The maternal body composition whose changes
include increased blood and extracellular fluid
volume.
2. The maternal support tissues such as increased size
of the uterus and breasts, and
3. The products of conception, including the fetus
and placenta.
• An average gain in weight during pregnancy is
24lbs.
• A gain of 1.5 to 3.0 lb during the first trimester and a
gain of 0.8 lb per week during the remainder of the
pregnancy is a guideline.
• The pattern of weight gain is more important than
the total amount gained.
• Poor weight gain may then lead to intrauterine
growth retardation in the infant.
 DIET PRINCIPLES

• Caloric intake should be

increased by an average of 300
kcal/day to achieve an
appropriate weight gain.
ENE R G Y R E Q U I R E ME NT D U R I NG
P R E G NA NC Y
• A level of 8g/day of protein in excess of the RNI for
the non-pregnant state is advised to provide the
amino acids needed for fetal and placental
growth, for expansion of blood volume, and for
increase in size of breasts and uterus(NDAP Manual,
2010).

• Protein builds muscles, tissues, enzymes, hormones,

and antibodies for both the mother and the baby.
As pregnancy progresses, the more protein is
needed.
 FATS DURING PREGNANCY
• Fat (omega-3 fatty acid) requirement
during pregnancy:
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.
 PROTEIN

• Two-thirds of the proteins should be of animal origin

of the highest biologic value such as meat, milk,
eggs, cheese, poultry and fish.
• Nutritional needs during pregnancy include:
1. the normal requirements of the mother
2. those of developing fetus (including also the
uterus and placenta
3. building up reserves in preparation for labor and
lactation
 IODINE

• An additional allowance of 50mg/day is

recommended so as not to compromise the
development of the fetus.
• Iodine helps in the development of the
baby’s brain and nervous system.
• Serious iodine deficiency during pregnancy
may lead to miscarriage, stillbirth, preterm
delivery, cognitive abnormalities, and
mental retardation.
 ZINC

• An additional 5 milligrams of zinc

which the increase in protein helps to
provide is recommended during
pregnancy.
 CALCIUM

• 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
 IRON

• The RNI for iron during pregnancy is

27mg for the first trimester, 34 mg for
the second trimester and 38mg for the
third trimester for expansion of
maternal blood volume and for
synthesis of fetal and placental tissues.
 FOLIC ACID

• Dietary sources of folic acid are

inadequate to achieve, thus, a daily
supplement of 400µg should be
provided to protect the fetus and to
maintain maternal stores.
 VITAMIN REQUIREMENT DURING
PREGNANCY

• Vitamins 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
infantsm hemorrhages.
• Vitamin B12 (1.2 µg/d) : Vitamin B12
supplementation during pregnancy helps in brain
& nervous system development of the fetus.
 VITAMIN REQUIREMENT DURING
PREGNANCY
• Vitamin C (60mg/d): It increase iron
absorption and also helps in fetal growth.
Deficiency of vitamin C increases the
chances of preterm delivery.
• Vitamin B6 (2.5mg/d): It is required for
normal fetal development & positive
pregnancy outcomes.
• Vitamin 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.
 CONSIDERATIONS DURING
PREGNANCY
• Caffeine: 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.
• 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 labor, operative
delivery and other perinatal problems.
 CONSIDERATIONS DURING
PREGNANCY

• To meet the increased nutrients need during

pregnancy mother should increase her
feeding.
• Pregnant woman should consume 5-6 meals a
day and snacks in between the main meals.
• To meet the increased protein demand good
quality protein rich foods like milk, meat, eggs,
fish should be included.
• Nutrient rich foods specially iron, calcium, folic
acid , calcium & DHA rich foods should be
included in the diet during pregnancy.
LACTATION
 ENERGY REQUIREMENT
• Lactating mothers need additional energy for
production of milk.
• During pregnancy approximately 600-850 ml milk is
secreted daily.
• Energy content of mother’s milk and efficacy of
conversion of food energy into milk energy
determines the energy requirement of a lactating
woman.
• During first 6 months of lactation – additional 500
kcal/d energy is required
• 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
 CALCIUM

• 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

• 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
 VITAMINS AND MINERALS

• Vitamin A (950µg/d):
- Breast milk is rich in vitamin 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.
 VITAMINS AND MINERALS
• 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.
 DIET AND FEEDING PATTERNS
• Lactating mother requires larger quantities of body
building and protective foods & additional energy
yielding foods to facilitate the formation & secretion of
breast milk.
• Fluid intake should be increased as fluids are essential
for adequate quantity of milk production.
• No food should be restricted except highly spiced &
strongly flavored food, as they impart flavor to milk
which may be repulsive to the baby.
• 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.
COMPLICATIONS OF PREGNANCY AND
POSSIBLE DIETARY MODIFICATIONS

• Morning sickness
• small frequent feedings instead of three
large meals
• high carbohydrate-low fat foods such as
crackers and jelly
• Liquids are better taken between meals
rather than at mealtime.
COMPLICATIONS OF PREGNANCY AND
POSSIBLE DIETARY MODIFICATIONS

• Rapid weight gain or loss

• Excessive weight gain during pregnancy is
defined as an increase of three kilograms
or more per month in second and third
trimesters.
• Moderate calorie restriction with limited
weight loss for obese pregnant clients.
COMPLICATIONS OF PREGNANCY AND
POSSIBLE DIETARY MODIFICATIONS

• Toxemia
• Rapid weight gain, edema, high blood
pressure, excretion of albumin in the urine,
and convulsions are clinical manifestations
of toxemia.
• Intake of protein foods of high biologic
value and sources of iron, calcium, and
minerals.
• 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.
• Once anemia is established, 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 in the same meal containing rich
sources of iron.
COMPLICATIONS OF PREGNANCY AND
POSSIBLE DIETARY MODIFICATIONS

Diabetes
• A pregnant woman with diabetes is more
prone to develop pre-eclampsia,
pyelonephritis, and polyhydramnios and her
baby has higher risk of dying in utero or at
birth.
• Rigid control of maternal blood glucose
concentration
COMPLICATIONS OF PREGNANCY AND
POSSIBLE DIETARY MODIFICATIONS

• Constipation
• Pressure exerted by the developing fetus on
the digestive tract, lack of exercise and
insufficient bulk in the diet cause
constipation, which if chronic or habitual,
gives rise to headaches and much
discomfort.
• Take lots of fresh fruits, vegetables, fluid and
regular exercise