Topic: Nutrition in pregnancy & lactation

Subject: midwifery 

(Basic, Post-Basic & Diploma )

Introduction:

Nutrition challenges continue through the life cycle. Poor nutrition often starts in utero and extends, particularly for girls & women, well into adolescent and adult life. It is also spans generations. Under nutrition that occurs during childhood adolescent and pregnancy has an additive negative impact on the birth weight of infants.

Human life cycle:

*Ovum                       : 0-14 days after fertilization

*Embryo                    : 14th day to 9 week

*Fetus                                    : 9th week to birth

*Neonate                   : 0-28th day after birth

*Infant                        : 0-1 year

*Toddler                     : 1-3 years

*Preschool children  : 5-15 years

*Adolescence            : 10-19 year

* Youth                       : 15-24 years

*Adult                                    : 25-60 year

*Elderly                      : 60 year +

Importance of maternal nutrition

  • Adequate nutrition during pregnancy ensures healthy pregnancy outcome: healthy mother with healthy baby with optimal birth weight and birth length.
  • Adequate nutrition during lactation results in successful lactation and maintenance of good maternal heath.

Effects of maternal malnutrition

  • Energy & protein deficiency in pregnancy may lead to reduction in birth weight.
  • High infant mortality & morbidity.
  • Increase risk of long term adverse health outcomes- CHD, hypertension, stroke, diabetes, obesity.
  • High maternal mortality & morbidity.
  • Obesity in pregnancy associated with LBW, prematurity & malformations.
  • Maternal D deficiency in pregnancy linked to reduced birth wt., neonatal hypocalcaemia, tetany& maternal osteomalacia.
  • Vitamin K deficiency in pregnancy is associated with the hemorrhagic disease of the new born.
  • Vitamin A deficiencies during pregnancy weaken the immune system; increase the risk of infection, night blindness, premature delivery, IUGR& premature births.
  • Folate deficiency in pregnancy causes megaloblastic anaemia& is linked with high rates of spontaneous abortion, premature delivery & IUGR, fetal malformation& ante partum hemorrhage.
  • Inadequate maternal B6 status is linked to toxema, LBW& poor general condition of the infant.
  • Calcium supplementation in pregnancy may reduce the incident of PPH, preterm delivery and possibly preeclampsia.
  • Iron deficient risk greater complication from the post partum blood loss also associated with increased rates of prematurity & LBW.
  • Iodine deficiency is related to mental impairment and cretinism.

Effects of under nutrition in pregnancy:

  • Reduction in mean birth weight and birth length.
  • Increase incident of LBW.
  • Increased incident of: miscarriage, abortion, still births, neonatal birth & malformations like neural tube defects e.g. spina bifida, anencephaly.

Effects of mother s nutrition on Breast milk production:

  • Nutritional quality of breast milk is not usually affected by mild or moderate malnutrition.
  • In severe malnutrition, the quality & the quantity of breast milk is affected.
  • The nutrients which are stored in the body enlarge amounts will be deficient in the milk if the diet is sufficient.

 Nutritional requirement in pregnancy& lactation:

  • Requirements of energy & almost all nutrients increase during pregnancy & lactation.
  • Energy requirement during lactation is more compared to pregnancy.
  • Requirements of some nutrients are met at cost of mother.
  • For some nutrients mother and child suffer.

Causes of increase requirements during pregnancy & lactation:

  • Pregnancy: growth of fetus, synthesis of maternal body tissue and storage of fat.
  • Lactation: production of milk& maintenance of maternal health.

Energy cost of pregnancy: The total energy requirements for pregnancy:

  • Fat store :36000 Kcal
  • Maintenance(metabolism and tissue synthesis) :36000 Kcal
  • Allowance for efficiency of conversion(90%) :8000   Kcal
  • Total cost :80,000 Kcal

 Dietary energy in pregnancy:

  • 1st trimester allowance(150 Kcal/day) :14000 Kcal
  • 2nd & 3rd trimester allowance(350 Kcal/ day) :65350 Kcal
  • Total cost :79350 Kcal

 Energy needs in lactation:

  • Daily 850ml milk for six months: : 135000 Kcal
  • Energy from fat(90% efficiency) (-)        :    36000 Kcal
  • ————————————————————————————-
  • Add requirement :100000 Kcal (approx.)

Dietary protein in pregnancy:

  • Add 5gm/day in 2nd & 3rd trimester——UK (DHSS)
  • Add 6gm/day throughout pregnancy—-FAO/WHO/UNU
  • Add 30gm/day throughout pregnancy—NRC,USA

Dietary protein in Lactation:

  • Daily 850 ml milk production
  • Protein content-1.2 gm/100ml
  • Add 24 gm/ day – FAO/WHO,20gm/day –NRC, USA

Extra Daily Nutrient Allowance for Pregnancy & Lactation

Nutrient                                 Non pregnant            Pregnant                    Lactating

Energy (Kcal)                          2100                           300                             500

Protein (g)                              44                                30                                20

Retinol (μg)                            800                             200                             400

Vitamin D (μg)                       7.5                               5                                  5

Vitamin E (mg)                      8                                  2                                  3

Vitamin C (mg)                      60                                20                                40

Riboflavin (mg)                      1.3                               0.3                               0.5

Nicotinic acid (mg)                14                                2                                  5

Vitamin B6 (mg)                     2.0                               0.6                               0.5

Folate (μg)                              400                             400                             400

Thiamine (mg)                       1.1                               0.4                               0.5

Calcium (mg)                         800                             400                             400

Iron (mg)                                18                                8                                  8

Zinc (mg)                                15                                5                                  10

(From NRC)

Dietary guideline for pregnant & lactating mothers:

  • Protein rich high calorie diet
  • Ensure adequate calorie
  • Calcium rich food- milk& milk products
  • Plenty of green leafy & colored vegetables
  • Fresh food
  • Plenty of fluid
  • Iodized salt.

Dietary advice for Extra calorie requirement in pregnancy:

  • 1 fistful (60gm) of rice.
  • 3tea spoon (15gm) of dal.
  • 1/2tea spoon (2.5) of oil
  • ½ cup of vegetables
  • (240cal+60cal+22 cal+30cal=352 cal).

Dietary advice for Extra calorie requirement in lactation:

  • 1 fistful (60gm) of rice.
  • 1/2fistful (30gm) of dal
  • 1tsp (5ml) of oil
  • ½ cup of vegetable
  • ½ banana
  • (240cal+120cal+45cal+30cal+90cal=525 cal).

Monitoring of nutritional status during pregnancy by weight gain:

  • 1st trimester 5—2Kg
  • 2nd trimester 3—4.5Kg
  • 3rd trimester 5—6Kg
  • Total (average) 5 Kg
  • *3-3.5 Kg laid down as fat for energy store to be used in lactation.
  • BINP recommended minimum weigh gain of 7 Kg during pregnancy.

Total weight gain of 12 Kg at Term Pregnancy

  • Reproductive weight gain—6Kg:

Fetus (3.3Kg); placenta (0.6 Kg); liquor (0.8 Kg); uterus (0.9 Kg); & breasts (0.4).

  • Net maternal weight gain—6 Kg:

Increase in blood volume (1.3Kg; increase in extra cellular fluid (1.2 Kg) & accumulation of fat (mainly) & protein (3.5Kg).

Risk factors for maternal malnutrition:

  • Maternal age
  • Pregnancy<2 years after onset of menarche
  • Low pre pregnancy weight
  • Sex determination
  • Low status of women
  • Low education & lack of knowledge about nutrition
  • Poor economic status
  • Socio-cultural and religious norms.

 

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