NUTRITION DURING

LACTATION

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In-Hospital Breastfeeding Rates (US, 2001)

90
80
Healthy People 2010 Goal
70
60 40.7
23.2
Percent

50 Mixed
40 Exclusive
30
42.2 46.3
20
10
0
California National
 Breastfeeding Rates at 6 mo (2001)

Exclusive Mixed

100
90
80 Healthy People 2010 Goal
70
Percent

60
50
40
30 20.1
15.3
20
10 24.1 17.2
0
Pacific Region National
Breastfeeding : A Learned Behavior

 Physiological process  virtually all mothers

are capable of doing
 Is a learned behavior  not all mother
decide to do
 Mother’s partner also plays an important
role
Advantages

 Nutritionally superior to any alternatives

 Bacteriologically safe & always fresh
 Contains various antiinfectious factors &
immune cells
 The least allergenic to any infant food
 Breast-fed babies are less likely to be
overfed
 Promotes good jaw & tooth development
 Cost less
 Promotes close mother-child contact
 More convenient once the process is
established
American Academy of Pediatrics (AAP) &
American Dietetic Association (ADA)

Exclusive breastfeeding for 6 months,

and breastfeeding with
complementary foods for at least 12
months as an optimal feeding pattern
for infants
American Academy of Pediatrics (AAP)

Females infected with the human

immunodeficiency virus (HIV) should be
counseled not to beast-feed
Females who are at risk for being infected
with the virus should be educated about the
risk of infecting their infant with HIV
through breast milk
The Baby Friendly Hospital Initiative

 Global effort to  the incidence & duration

of breast-feeding
 To become ‘baby friendly’, a hospital must
agree to implement the “Ten steps to
Successful Breast-feeding”
Ten steps to successful breast-feeding

 Have a written breast-feeding policy that is

routinely communicated to all health care
staff
 Train all health care staff in the skills
necessary to implement this policy
 Inform all pregnant females about the
benefits and management of breast-feeding
 Help the mother initiate breast-feeding
within a half hour of birth
 Show mothers how to breast-feed and how
to maintain lactation, even if they are
separated from their infant
 Give new born infants no food or drink other
than breast milk unless medically indicated
 Practice rooming-in
 Encourage breast-feeding on demand
 Give no artificial teats or pacifiers
 Foster the establishment of breast feeding
support groups, and refer mothers to them
on discharge from the hospital or clinic
Nutritional requirements

 Lactation is nutritionally demanding

 Increased intake of most nutrient is advised
 Milk production is most affected by the
frequency of suckling
 Milk composition varies according to
mother’s diet, but in general the effect is to
reduce quantity, not quality
Energy

 Production 100 ml of milk  need 85 kcal

expenditure
 1st 6 mo of lactation  750 ml/day (550 –
1200 ml/day)
 RDA : + 330 kcal (1st 6 mo)
+ 400 kcal (2nd 6 mo)
 2nd 6 mo 
- production  600 ml/day  E req
- consuming solid food
 Energy intake at least 1800 kcal/day
 Inadeq maternal fluid intake affects milk
volume
 After birth  women are in a hurry to lose
weight
 In general  lose ½ - 1 kg / mo during the
1st 4 – 6 mo of lactation
 Exercise >>   lactic acid of breast milk 
influence milk taste
Breastfeeding and maternal weight loss
(Dewey et al. Am J Clin Nutr 1993;58:162-6)
Fat

 20 – 35% of total calories

 Presence of long-chain PUFA
(polyunsaturated fatty acid)  crucial for
fetal & infant retina & brain development
 AI n-6 PUFA : 13g/day
 AI n-3 PUFA : 1.3 g/day
 Human Milk Composition
 Influences of maternal diet
a. CHO, protein & minerals  not influenced by maternal diet
b. Fat and vitamins  influenced by maternal diet


 Human Milk Composition

Influences of maternal nutritional status

- milk composition remains relatively constant unless malnutrition

is severe
- the volume of milk produced may  with malnutrition
Water

Drink a glass of milk, juice or water at

each meal and each time the infant
nurses
Nutrient supplements

 Most women can obtain all the nutrients

from a well balanced diet
 Some may need iron  to refill their
depleted iron stores
 Particular foods

 Foods with strong or spicy flavors (e.g.

garlic) may alter the flavor of breast milk
 Infants who develop symptoms of food
allergy  more comfortable if the mother’s
diet exclude the most common offenders
(cow’s milk, eggs, peanuts)
Increased Requirements
Practices incompatible with lactation

 Alcohol
- easily enters breast milk
 Smoking
- transfer nicotine
 Medicinal drugs
 Environmental contaminants
 Caffeine
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