Nutrition during Pregnancy and Lactation

DR. ABDULAZIZ ALJOHANY CONSULTANT FAMILY MEDICINE 2009

nutrition during pregnancy and lactaion

The mothers diet influences the health of the baby in the short-term and perhaps even in the long-term.
Eating well during pregnancy and lactation requires a few adjustments to general good health dietary guidelines. A woman's need for calories, protein, vitamins, minerals and water all increase. Each woman will require different amounts of foods providing key nutrients to achieve the desired pregnancy weight gain and pregnancy support. Age, weight, activity level, and metabolism all influence how much you will need to eat for optimum weight gain, health, and fetal development or breastmilk production.

nutrition during pregnancy and lactaion>>

Breast-feeding is the best method of feeding for babies, A varied diet is important whilst breast-feeding to ensure a sufficient intake of all nutrients needed by both the mother and the baby.
It has been found that pre-pregnancy preparation has reduced the incidence of congenital malformation, pre-term birth, and intrauterine growth retardation. For the mother, optimum nutrition before and during pregnancy ensures a healthier pregnancy with fewer complications, resulting in a healthier and heavier baby.

A varied diet containing adequate amounts of energy and nutrients is essential both before a woman becomes pregnant ,during pregnancy and lactation.

nutrition during pregnancy and lactaion>>

When breastfeeding a single baby 300-500 calories per day should be added to the diet. When feeding twins an extra 600-1000 calories per day should be added to your diet.
Total caloric intake when lactating is 2300-2500 calories for singleton and 2600-3000 calories for twins

Be assured that the composition of nutrients in human milk is consistent. A nutrition shortage for mom is more like to reduce the quantity of milk than the quality of the milk for baby.

nutrition during pregnancy and lactaion>>

good fluid and nutrient intake is essential for successful nursing and thus to the growth and development of the baby.

In fact, if something is lacking in mom's current diet, mom's body will dip into her reserves of nutrients to keep breast milk nutrient-dense Obviously calcium for milk production comes from the mother. When calcium levels in mom's blood are not adequate for her needs and those of her child, calcium deposited in her bones is withdrawn for milk production.

Nutrition During Pregnancy >>

The nutrient program shown in the next table gives the range of values from the minimum requirements to the optimum amounts for the needs of lactation. Chloride, fluoride, phosphorus, potassium, and sodium are not usually supplemented unless shown by testing to be needed.
Water is the main ingredient of mothers milk, so adequate fluid intake is essential. At least three quarts of liquid are recommended daily, including water, juices, and milk.

Your supplement programme should include 200 mcg of folic acid, 20mcg of vitamin B12, 200mg of Vitamin B6, 15mg of zinc, 500mg of calcium, 250mg of magnesium and 30mg of iron. usually stop even the worst cases of pregnancy sickness.

Nutrition During Pregnancy >>

Nutrient
*Energy (kilocalories per day) Vitamin A (mcg RE) *Vitamin D (mcg) Vitamin E (mg) Vitamin C (mg) Thiamin (mg) Riboflavin (mg) Niacin (mg) Vitamin B6 (mg) Vitamin B12 (mg) Folate (mcg) *Calcium (mg) *Phosphorus (mg) Magnesium (mg) Iron (mg) Zinc (mg) Iodine (mcg) Selenium (mcg)

Non-Pregnant
adequate 800 5 8 60 1.1 1.1 14 1.3 2.4 400 1000 700 310-320 15 12 150 55

Pregnant
+300 800 5 10 70 1.4 1.4 18 1.9 2.6 600
19-50 yrs.=1000 <19yrs.=1300 19-50 yrs.=700<19 yrs.=1250

19-50 yrs=350-360 <19yrs.=400

30 15 175 65

Nutrition During Pregnancy >>

Folic acid A healthy, varied diet that contains adequate amounts of all the nutrients needed by a mother and her growing fetus (including sufficient iron, calcium and folate) is essential for a healthy pregnancy.

All women of child-bearing age who may become pregnant are advised to take daily supplements (400 micrograms) of folic acid, as this can help to reduce the risk of the baby suffering from a neural tube defect. A woman who has already had a baby with a neural tube defect may be advised to take a larger supplement (for example 5 mg/day). It is also important to consume foods that are naturally good sources of folate e.g. green vegetables, oranges, and foods that have been fortified with folic acid e.g. some breads and breakfast cereals.

Nutrition During Pregnancy >>

It is recommended that all pregnant women in their second and third trimester take a daily iron supplement containing 30 mg of elemental iron. This is twice as much iron as you needed before you were pregnant.
For example, you need to eat about 15 servings of red meat or about 10 potatoes to get the recommended daily requirement. Daily supplementation with linoleic acid and calcium during the third trimester of pregnancy appears to significantly reduce the risk of preeclampsia in women at high risk for this complication. Researchers found that daily doses of 450 mg linoleic acid and 600 mg calcium raised prostaglandin E2 levels and decreased the ratio of thromboxane B2 to prostaglandin E2.

Nutrition During Pregnancy >>

Calcium helps growing baby's teeth and bones , prevent leg and muscle cramps in pregnant women.

You need at least 1,200 milligrams of calcium per day. This is 50% more than needed for awomen before pregnant.
You may need more than the recommended amount if you are under 25, because your bones need calcium too. You also need more calcium if you drink caffeine, because caffeine makes it harder for your body to absorb calcium.

Calcium deficiency in pregnant women cause increased blood pressure, myocyte contraction , arteriolar constriction and osteoporosis.

Nutrition During Pregnancy >>

calcium There is research that has found that bone density diminishes in the first three months of pregnancy to enable uptake of calcium by the developing baby.

In pregnancy calcium intake is increased 60-70%; therefore as long as you are taking the recommended amount of calcium further increase is not required. Calcium absorption is improved with the presence of vitamin D in the diet. The main source of vitamin D is from exposure to sunlight.

Nutrition During Pregnancy >>

Iron is required for the formation of red blood cells both for mother, as the blood volume expands dramatically in pregnancy, and for a developing baby.

Starting a pregnancy with anaemia can deprive the baby of oxygen which gets more marked during the second trimester. Unless this deficiency is corrected it may leave the mothers severely anaemic and any blood loss during pregnancy and after delivery may be dangerous to the mother and the baby.

Nutrition During Pregnancy >>

Zinc (15mg) Zinc deficiency cause congential malformations, neural tube defects and intrauterine growth retardation.
Magnesium (250mg) Magnesium deficiency includes hypomagnesaemia, hypomagnesuria and hypokalaemia.

Nutrition During Pregnancy >>

B Vitamins (An additional 2 mg of niacin a day, and 0.3 and 0.4 mg more of riboflavin and thiamine.)
B vitamins are required for the growth and development of unborn babies. B vitamins include: thiamine, riboflavin, niacin, pyridoxine, folic acid, cobalamin and choline. Essential for good digestion, energy production, certain enzymes invloved in amino-acid synthesis and maintenance of blood.

Nutrition During Pregnancy >>

Supplementation of the niacin form of vitamin B3 taken during the first trimester has been positively correlated with higher birth weights, longer length, and larger head circumference (all signs of healthier infants).
high-dosage B vitamin pills are best avoided during lactation. Specifically, high amounts of vitamin B6 can reduce milk production. Women who lack vitamin B in their diet are more likely to have a low birth weight baby.

Nutrition During Pregnancy >>

Vitamin A Vitamin A helps prevent infections and is needed for healthy tissue development.

Pregnant women should avoid supplements containing vitamin A.

Vitamin A in large quantities can cause congenital defects in children. However, it is not wise to eradicate vitamin A completely from your diet, as some vitamin A is required for a healthy pregnancy. Do not take more than 10,000iu of vitamin A, and have a hair mineral analysis to check for excesses of copper, lead or cadmium.

Nutrition During Pregnancy >>

Vitanmin C Needed for healthy collagen, helps wounds to heal, normal blood-clotting and healthy blood vessels, iron absorption, and strong, healthy bones.

Vitanmin C is occasionally recommended for pregnant women.

It has been reported that vitamin C may be effective for the treatment of leg cramps during pregnancy.

Nutrition During Pregnancy >>

Conservative doses are 500-2,000 mg daily. However,women who take more than 5,000 mg vitamin C daily throughout pregnancy must continue to supplement the infants afterward or the children are at risk of developing rebound scurvy. So, be aware and be safe. The National Academy of Sciences recommends vitamin C supplements of 50 mg per day for women carrying multiple fetuses, and for pregnant substance abusers.

1st trimester

2nd trimester

3rd trimester

Vitamin A (retinol) I.U. * Vitamin B1 (Thiamine hcl) Vitamin B2 (riboflavine) Vitamin B6 (pyridoxine hcl) Vitamin B12 Vitamin C (ascorbic acid) Vitamin D Vitamin E Vitamin B5 Biotin Folic acid Calcium Iron Magnesium Manganese Copper Phosphorus Zinc Choline

800 mg 200mg 200mg 200mg 20mcg 50-60 mg 5 mg 10 mg 10.0mg 0.2mg 400 mg 500 mg 30 mg 250mg 1.0mg 1.0mg 125.0mg 15 mg

4000 1.6mg 1.8mg 2.6mg 4.0mcg 100 mg 500 I.U. ** 15 I.U. *** 10.0mg 0.2mg 0.8mg 1200 mg 60 mg 100 mg 1.0mg 1.0mg 125.0mg 7.5mg 450 mg

4000 1.6mg 1.8mg 2.6mg 4.0mcg 70 mg 500 I.U. ** 15 I.U. *** 10.0mg 0.2mg 0.8mg 600 mg 30 mg 350 mg 1.0mg 1.0mg 125.0mg 7.5mg 450 mg

Nutrient Program for Lactation(Range RDAs to Optimum)

Nutrient Program for Lactation(Range RDAs to Optimum)

Calories Fiber Protein Vitamin A Calcium Beta-carotene Chloride Vitamin D Chromium Vitamin E Copper Vitamin K Fluoride Thiamine (B1) Iodine Riboflavin (B2) Iron Niacin (B3) Magnesium

*2,6003,500 1530 g. *6590 g. *7,00010,000IUs *1,2001,600 mg. 5,00015,000 IUs +24 g. 400600 IUs 200400 mcg. *60400 IUs 23 mg. 100400 mcg. +1.53.5 mg. 1.625.0 mg. *200400 mcg. 1.725.0 mg. *50100 mg. 18100 mg. *4501,000 mg

Pantothenic acid(B5)

Manganese Pyridoxine (B6) Molybdenum Cobalamin (B12) Phosphorus Folic acid Potassium Biotin. Selenium Choline Sodium Inositol Zinc PABA Vitamin C Bioflavonoids

7250 mg. 2.515 mg. 2.5100 mg. 150500 mcg. 4200 mcg.
*+1,2001,600 mg.

*6001,000 mcg. +25 g. 200500 mcg 150300 mcg. 100250 mg. +2.54.0 g. 100250 mg. *2540 mg. 25100 mg. *1002,000 mg. 125250 mg.

nutrition during pregnancy and lactaion>>

For vegetarian women, it is wise to eat the recommended amount of the dairy products and eggs to meet protein and calcium needs, as well as to eat more whole grains and legumes.
If milk consumption is minimized, more tofu, legumes, nuts and seeds, and leafy greens and some calcium supplement are recommended.

More care in balancing the diet is usually necessary whenever the diet limits specific food groups.
Additional protein powder or supplemental amino acids (free form), as powder or capsules (7501,500 mg. daily) may be useful if the protein intake is not sufficient.

nutrition during pregnancy and lactaion>>

Vitamin D-If mother/infant not exposed to sunlight or diet low in Vitamin D should be added to supplement.
Vitamin B12-If mother is a vegan, infant will be B12 deficient,even if mother shows no sign of deficiency. Vitamin K If women have problems with hemorrhaging, you might want to consider taking a low dose of vitamin K at the end of pregnancy. A single intramuscular (IM) dose of 1 to 5mg IM can be given to the mother 12 to 24 hours before delivery,

nutrition during pregnancy and lactaion>>

Maternal intake does not seem to predict the milk content, but low maternal vitamin D plasma levels may limit transfer into breast milk.
Mothers who have restricted intake of foods rich in vitamin D, such as strict vegetarians, and those who are exposed to limited sunlight may have critically low plasma levels.

Breast-feeding

mums are also advised to take supplements containing 10 mcg of vitamin D each day.

nutrition during pregnancy and lactaion>>

Vitamin E concentration in breast milk is responsive to maternal intake; supplementing the infant is usually not necessary, provided the mother has adequate intake.

Vitamin C is usually found in adequate concentrations of about 100mg/L of breast milk in well-nourished mothers.

Intake less than 100mg/day may decrease milk content, but doses over 100mg/day will not increase it.

nutrition during pregnancy and lactaion>>

.Vitamin

B6 levels in breast milk increase with increased maternal intake, but may be reduced in women who have been using oral contraceptives for an extended period of time cases of women who were strict vegetarians, malnourished, or had hypothyroid-induced pernicious anemia. Infant supplementation would be recommended in such cases.

in

nutrition during pregnancy and lactaion>>

Minerals Unlike vitamins, minerals do not seem to correlate with maternal intake or maternal plasma levels. Copper, iron, and zinc concentrations seem to be strongly related to liver stores of the mother accumulated during the third trimester. Maternal intake has very little effect on them.

Both iron and zinc have a high bioavailability in breast milk, but the bioavailability of copper is unknown

Nutrition During Pregnancy >>

The Food Standards Agency has advised pregnant women and those women intending to become pregnant to limit their caffeine consumption . minimise their risk of suffering from food poisoning (e.g. by strict use of good food hygiene practices and avoidance of high risk foods).

Staying physically active during pregnancy is important to promote general health and well-being.

Nutrition During Pregnancy >>

The Food Standards Agency (FSA) advises women intending to become pregnant to avoid eating shark, swordfish and marlin and not to eat more than 4 medium-sized cans of tuna or 2 fresh tuna steak a week. This is because the mercury present in these fish can potentially harm an unborn childs nervous system. the levels of potential contaminants in these fish.

General Pregnancy Nutritional Plan

Nonpregnant
Milk foodslowfatmilk(avoidskim), cheese, yogurt, butter (1 serving = 1 cup milk or yogurt, orcheese 34 oz.) Cereal grains (1 serving = about 1 cup grain or 1 slice of bread) Vegetablesraw yellow or dark green (1 serving = 1 cup) Other vegetables (1 cup) Vitamin C foodscitrus, berries, peppers, tomato (1 serving = 1 cup) Eggs (1 serving = 1 egg) Meatsfish, poultry, or lean red (1 serving = 34 oz.) Legumes (1 serving = 6 oz.) 2

pregnant
3-4

Nursing
5-6

3
1

4-5
2

4-5
2

1 1
1 1 1

2 2
1-2 1-2 1-2

2 2
1-2 2-3 1-2

Weight Gain During Pregnancy

Weight Gain During Pregnancy >>

Weight Gain: Recommendations for the range of total weight gain and the pattern of weight gain should be based on the prepregnancy weight for height. Weight gain should be recorded on a chart that shows weight gain by gestational age. Normal Weight 25-35 pounds 1 pound per week Underweight 28-40 pounds more than 1 pound per week Overweight 15-25 pounds 2/3 pound per week Twins 30-35 pounds 1 1/2 pound per week

Weight Gain During Pregnancy >>

The weight gain for a woman of healthy body weight is recommended to be between 25-35 lbs.

this is how those pounds may add up: 7.5 pounds - average baby's weight 2 pounds - breast enlargement 7 pounds - your body's extra stored protein, fat, and other nutrients 1.5 pounds - the placenta 2 pounds - enlargement of your uterus 2 pounds - amniotic fluid surrounding your baby 4 pounds - your extra blood 4 pounds - your other extra body fluids

Weight Gain During Pregnancy >>

Being a healthy body weight is important before pregnancy.

Being underweight can affect fertility, making it more difficult to conceive.

An underweight woman who fails to gain adequately during pregnancy is most likely to give birth to a baby with dangerously low birthweight.

Weight Gain During Pregnancy >>

Infant birthweight is the single most potent indicator of a child's future nutrition and health status. It is advisable for an underweight woman to gain about 40 pounds during the course of her pregnancy. Teenage mothers seem to be at greater risk for this condition than adult women, therefore any teen pregnancy should be closely monitored.

Weight Gain During Pregnancy >>

Obese women too, are urged to attain healthy weights before pregnancy.

The infant of an obese mother may be larger than normal, and born late, or it may be large in size even if born prematurely.

Also increases the risk for neural tube defects in the infant, more often suffer gestational diabetes, hypertension, infections after the birth, than do women of healthy weight and intervention to induce labor,affect fertility.

Weight Gain During Pregnancy >>

A good idea for obese women who may become pregnant is to consume adequate amounts of essential nutrients from nutrient-dense foods and good-quality supplements, without consuming excess fat. The goal is to attain a body weight just low enough to lower the medical risks associated with obesity, before becoming pregnant. the minimum weight gain should be around thirteen pounds during the pregnancy.

Thank You