Nutritional Requirements of Pregnant and Lactating Women

NUTRITIONAL REQUIREMENTS OF PREGNANT AND LACTATING WOMEN

Nutrition requirements increase tremendously during pregnancy and lactation owing to the physiological changes.

Wholesome nourishment before pregnancy has a greater impact on the long term health on the mother and foetus. A well nourished foetus enters life with good physical and mental health.

Physiological Changes in Pregnancy

Foetal development is accompanied by many physiological, biochemical and hor-monal changes which influence the nutri-ent needs and the efficiency with which the body utilizes them. The changes include

i. Increased basal metabolic rate (BMR)

Due to foetal growth the BMR increases.

ii. Gastro intestinal changes

Gastro intestinal motility diminishes which may result in constipation.

iii. Hormonal changes

During pregnancy there is increased secretion of the following hormones: i) Aldosterone ii) Progesterone iii) Thyroxin iv) Parathormone.

iv. Changes in body fluid

The blood volume expands by 50 per-cent and this increased amount of blood is required to carry nutrients to the foe-tus and remove metabolic wastes from the foetus.

v.  Altered renal function

Increased blood volume and increased production of waste products like creati-nine, urea and other wastes due to foetal and maternal metabolism produces a high glomerular filtration rate (GFR).

vi. Weight Gain during Pregnancy

Less than half of total weight gain resides in the foetus, placenta and amniotic fluid. Women with desirable body weight is 12.5 kg ranging between 11-13 kg.

Nutritional Needs during Pregnancy

In addition to the RDA for an adult women the nutritional needs increase during pregnancy.

Energy

Energy requirement during pregnancy is increased because of the additional energy required for growth and activity of foetus, growth of placenta and maternal tissues, increase in maternal body size and steady rise in BMR.

Protein

An additional protein intake is essential for:

–  Growth of the foetus.

–  Development of placenta

– Enlargement of uterus, mammary glands

–  Increased maternal blood volume

–  Formation of amniotic fluid

Fat

ICMR expert committee has suggested an intake of 30g of visible fat/day during pregnancy.

Calcium

Additional calcium is needed for the growth and development of bones as well as teeth of the foetus and also for the pro-tection of calcium resources of the mother to meet the high demand of calcium dur-ing lactation.

Iron

The requirement of iron increases from 21mg/day to 35mg/day during pregnancy.

The increased requirement is due to

i.  expansion  of  maternal  tissues including red cell mass, iron con-tent  of  placenta  and  blood  loss during parturition.

ii. to build the iron store in foetal liver to last for at least 4-6 months after birth. This is because the baby’s first food milk is deficient in iron.

Iodine

Due to increase in BMR, iodine needs are also enhanced during pregnancy.

Zinc

Deficiency of zinc adversely affects the outcome of pregnancy. Zinc deficiency leads to foetal mortality, foetal malfor-mations and reduced intra uterine growth rate.

Sodium

Normal sodium intake without restric-tion is advised during pregnancy. Sodium is restricted when there is oedema or hypertension.

Vitamins

An additional allowance of Vitamin A is needed during pregnancy. Vitamin D is essential as it enhances maternal calcium absorption. Vitamin K is required for syn-thesis of prothrombin which is essential for normal coagulation of blood. A liberal vitamin K level in the mother’s blood is helpful in preventing neonatal haemor-rhage. Vitamin C, pyridoxine, and vitamin B12 needs are increased during pregnancy.

Folic acid

Folic acid is essential for increased blood formation i.e. haematopoiesis and for synthesis of essential components of DNA/RNA which increase rapidly during growth.

Problems during Pregnancy

·        Nausea and vomiting

·        Constipation

·        Heart burn

·        Oedema and leg cramps

·        Pica

·        Anemia

·        Pregnancy induced hypertension (PIH)

·        Gestational diabetes

Lactation

Adequate nutrition for the mother during lactation is also of vital importance as the infant is dependent on mother’s milk for its nutrition for the first few months of life. Inadequate nutrition during lactation is reflected on both the quality and quan-tity of milk secreted.

Physiology of lactation

The Table 13 below gives the summary of hormonal control of lactation.

Nutrient Needs during Lactation

ICMR nutrient recommendations for a lactating mother are based on the com-position of breast milk and the fact that 850 ml of milk is produced daily. However, the milk secretion continues to increase in the early periods of lactation up to six months and then gradually decreases. Therefore the nutrient requirements are given for the two periods in lactation i.e. 0-6 months and 6-12 months.

Energy

The lactating mother requires additional energy for the production of milk. Based on the optimal output of 850 ml/day, the additional allowance is recommended during first six months of lactation.

Protein

Due to production of milk, protein requirement also increases.

Fat

The total fat in breast milk is not influ-enced by the mother’s diet. The fat also provides energy density to meet the higher energy requirement during lactation.

Calcium

The requirement for calcium doubles dur-ing lactation.

Iron

Since most mothers have lactational amenorrhea, it results in saving of nearly 1mg iron per day which otherwise would have been lost due to menstruation. There is a marginal increase in the iron intake.

Vitamins

The additional need of vitamin A during lactation is based on the amount secreted in the mother’s milk. As the calorie and protein requirements increase during lac-tation, the requirements of B vitamins also increase correspondingly. Ascorbic acid content increases during lactation.

Galactogogues

Galactogogues are foods that help to pro-duce more milk. Garlic, milk and almonds are considered to increase milk pro-duction. Studies carried out on nursing mothers have revealed that extra amounts of body building foods like fish and mut-ton increase the secretion of breast milk. Lactating mothers are also given special preparations containing ajwain and fen-ugreek seeds, which supply iron, protein, calcium and B- complex vitamins.