Chapter: Nutrition and Diet Therapy: Diet During Pregnancy and Lactation


A woman needs to decide whether to breastfeed before her infant is born.



A woman needs to decide whether to breastfeed before her infant is born. Almost all women can breastfeed; breast size is no barrier. Lactation, the pro-duction and secretion of breast milk for the purpose of nourishing an infant, is facilitated by an interplay of various hormones after delivery of the infant. Oxytocin and prolactin instigate the lactation process. Prolactin is responsible for milk production, and oxytocin is involved in milk ejection from the breast. The infant’s sucking initiates the release of oxytocin, which causes the ejec-tion of milk into the infant’s mouth. This is called the let-down reflex. It is a supply-and-demand mechanism. The more an infant nurses, the more milk the mother produces.


It will take 2 to 3 weeks to fully establish a feeding routine; therefore, it is recommended that no supplemental feedings be given during this time. Human milk is formulated to meet the nutrient needs of infants for the first 6 months of life. Iron content in breast milk is very low, but it is very well absorbed; there-fore, no iron supplement is needed for breastfed babies.

Lactation Specialist


A lactation specialist is an expert on breastfeeding and helps new mothers who may be having problems such as the baby not latching on properly. This could cause the breast to become sore and could be discouraging to first-timemothers. Since the best first food for babies is breast milk, a lactation specialist can teach the proper techniques for successful breastfeeding.


Benefits of Breastfeeding


There are many positive reasons to breastfeed. The primary benefit of breast milk is nutritional. Breast milk contains just the right amount of lactose; water; essential fatty acids; and amino acids for brain development, growth, and di-gestion. No babies are allergic to their mother’s milk, although they may have reactions to something their mother eats. Human milk contains at least 100 ingredients not found in formula.


Breastfed babies have a lower incidence of ear infections, diarrhea, aller-gies, and hospital admissions. Breastfed babies receive immunities from their mothers for the diseases that the mother has had or has been exposed to. When a baby becomes ill, the bacteria causing the illness is transmitted to the mother while the baby is breastfeeding; the mother’s immune system will start making antibodies for the baby.


Sucking at the breast promotes good jaw development because it is harder work to get milk out of a breast than a bottle, and the exercise strengthens the jaws and encourages the growth of straight, healthy teeth. Breastfeeding facili-tates bonding between mother and child. The skin-to-skin contact helps a baby feel safe, secure, and loved. Pediatricians encourage mothers of premature ba-bies to hold their babies on their chests—skin to skin. This is called “kangaroo care,” which has been shown to soothe and calm a baby and help maintain the baby’s temperature. Fathers too can participate in kangaroo care by placing their infants against their bare chests.


Benefits for mother include help in losing the pounds gained during pregnancy and stimulating the uterus to contract to its original size. Resting is important for a new mother, and breastfeeding gives her that opportunity. Breastfeeding is economical, always the right temperature, and readily available—especially in the middle of the night.


There is no need to stop breastfeeding when returning to work; a breast pump can be used to express milk for feedings when the mother is not available. Breast milk will keep 8 to 10 hours at room temperature (66°–72°F), 8 days in the refrigerator, 3 to 4 months in the refrigerator freezer, and 12 months in a deep freezer. Previously frozen milk must be used within 24 hours after defrosting in the refrigerator. Breast milk should not be heated in the micro-wave or directly on the stove. Those methods of heating breast milk will kill its immune-enhancing ability.


Calorie Requirements during Lactation


The mother’s calorie requirement increases during lactation. The caloric requirement depends on the amount of milk produced. Approximately 85 calories are required to produce 100 ml (31⁄3 ounces) of milk. During the first 6 months, average daily milk production is 750 ml (25 ounces), and for this the mother requires approximately an extra 640 calories a day. During the second 6 months, when the baby begins to eat food in addition to breast milk, averagedaily milk production slows to 600 ml (20 ounces), and the caloric requirement is reduced to approximately 510 extra calories a day.


The Food and Nutrition Board suggests an increase of 500 calories a day during lactation. This is less than the actual need because it is assumed that some fat has been stored during pregnancy and can be used for milk produc-tion. The precise number of calories the mother needs depends on the size of the infant and its appetite and on the size and activities of the mother. Each ounce of human milk contains 20 calories.


If the mother’s diet contains insufficient calories the quantity of milk can be reduced, as seen in many third world countries. Thus, lactation is not a good time to go on a strict weight loss diet. There will be some natural weight loss caused by the burning of the stored fat for milk production.


Nutrient Requirements during Lactation


In general, most nutrient requirements are increased during lactation. The amounts depend on the age of the mother (see Table 11-2). Protein is of par-ticular importance because it is estimated that 10 grams of protein are secreted in the milk each day.


MyPyramid will be helpful in meal planning for the lactating mother. She should be sure to include sufficient fruits and vegetables, especially those rich in vitamin C. Extra fat-free milk will provide many of the additional nutrients and calories required during lactation. Chips, sodas, candies, and desserts provide little more than calories.


Vegetarians will need to be especially careful to be sure they have suf-ficient calories, iron, zinc, copper, protein, calcium, and vitamin D. A vitamin B12 supplement can be prescribed for them.


It is important that the nursing mother have sufficient fluids to replace those lost in the infant’s milk. Water and real fruit juice are the best choices.


The mother should be made aware that she must reduce her caloric in-take at the end of the nursing period to avoid adding unwanted weight.

Medicines, Caffeine, Alcohol, and Tobacco

Most chemicals enter the mother’s milk, so it is essential that the mother check with her obstetrician before using any medicines or nutritional supplements. Caffeine can cause the infant to be irritable. Alcohol in excess, tobacco, and illegal drugs can be very harmful. Both illegal drugs, such as marijuana or heroin, and prescription medication, such as methadone and oxycodone, can cause the baby to be excessively drowsy and to feed poorly. Stimulant drugs can cause the baby to be irritable. The biggest concern is addiction of the mother and baby.

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