Nutrition inpregnancy and lactation Dr P Raghavendra, Post Graduate in the Dept of Community Medicine,Siddhartha Medical College, Vijayawada
• Human body changes and behaves differently in different periods of its lifecycle.• Changing age and physiological status, changes the activity, BMR, growth rate, etc.• These variations change the nutritional requirements too.
Why the dietetics change in pregnancyMany physiological changes.• Uterine hypertrophy and hyperplasia• Increased vascularity• HR, SV, CO increase, so do TV and oxygen consumption.Appetite changes Cravings, Aversions for certain foods.Constipation sets in.
Contd..• Above all, the growing demands of the growing fetus.• All these cause an increased demand and requirements for energy and various other nutrients.• Also call for changes in lifestyle, including her dietary habits.
Why in lactation?• Lactation, biochemically, is a process of energy conversion.• Additional energy requirement is based on the volume of milk secreted, its energy content, and efficiency of energy conversion.• The energy calculations are made at 850 ml milk secretion per day and with 80% conversion of food energy into milk energy.
Energy Requirements• Total energy equivalents for oxygen consumption increased during pregnancy is 27,000 Kcal.• Also needs energy for utilization of fats and protein.• 4 kg of fat is deposited.• Total energy cost comes to about 73,000 Kcal.• Most of this is needed in the last 2 trimesters.
Additional iron is required for..• Augmented demand for fetal growth• Expansion of maternal tissues (including RBC mass)• Iron content in placenta• Blood loss during parturition
Additional requirements• 2nd trimester 3.3 mg• 3rd trimester 5 mgPoor absorption of iron makes RDA to be increased by 8 mg per day throughout the pregnancy.Lactational amenorrhoea saves some iron loss, enough to cover losses in breast milk.
Additional Iron requirements during motherhood (in mg) RDA (Sedentary woman) 30 Add 8 Pregnancy Total 38 Add 0 Lactation(1st 6 months) Total 30 Add 0 Lactation(6-12 months) Total 30
Folic acid• Additional RDA: 300 g/day.• Diet not enough. Supplementation through medicinal folate is needed.• Ideally should be started 3 months pre- conceptionally.• During lactation, RDA is increased by 50 g/day
• Fetus is very sensitive to micronutrient deficiencies during organogenesis as well as during growth.• In deficiency, the meager maternal resources are used off first.• Even mother’s health can be compromised.
• Food fads• Vicious cycle of malnutrition• Woman should be advised in their own language as roti, chawal and not as proteins and fats.
Dietary advices• Eat one extra meal a day, to ensure adequacy of all nutrients• Try and eat with the whole family and not alone• Prefer high fibre cereals and legumes - include sprouts• Include ample amounts of vegetables and fruits• Take meat, milk and eggs regularly
Dietary advices• If vegetarian, insist on at least ½ lit of milk, and extra pulses• Prefer nutritious foods like groundnuts and soya beans• No fad diets• Take iron and folate supplements regularly• No un-prescribed medicines, alcohol and tobacco• Attend ANC clinic regularly and follow your doctor’s advise
References1. Textbook of Public Health and Community Medicine, 1st edition, 2009., Dept of Community Medicine, AFMC.2. K.Park, Textbook of Social and Preventive Medicine, 21/e, 2011, Banarsidas Bhanot.3. National Institute of Nutrition, Nutritional Requirements and Recommended Dietary Allowances for Indians; A report of the ICMR, 20104. Venkatachalam PS, Rebello LM. Nutrition for Mother and Child. National Institute of Nutrition (ICMR), Hyderabad. 5th edition, 20045. Gupta RK. Towards better nutrition of pregnant women in the developing world. Indian J of PSM.6. Geissler C, Powers H. Human Nutrition.11th ed. Elsevier Churchill Livingstone London. 20057. Gopalan C, Ramasastri BV, Balasubramanium SC. Nutritive Value of Indian foods, National Institute of Nutrition (ICMR), Hyderabad. 1999