The document discusses nutritional requirements during stressful conditions such as pregnancy, lactation, and for newborns. It notes that during pregnancy nutritional needs change and the health of the baby and mother's comfort can be affected by diet. It provides details on increased energy, protein, folate, iron, calcium, and iodine needs during pregnancy. Complications of malnutrition in pregnancy include emotional stress, complicated deliveries, and increased risk of miscarriages and infant mortality. Nutritional needs are also increased during lactation to support milk production and the infant. Breastfeeding is advocated as the best option for newborns for its health benefits though modified formula is also suitable for the first 4-6 months.

1. NUTRITIONAL
REQUIRMENTS in Stressful
Conditions
During
• Pregnancy
• Lactation
• New born
• Nutritional Diseases
Dr Shamim

2. NUTRITION IN PREGNANCY

3. Nutrition in Pregnancy
• Pregnancy is a time when appetite is altered and nutritional
needs change. What the expectant mother eats or drinks can
affect her baby’s health and her own comfort.
• They are entitled to advice from their doctors. The first advice
should ideally be communicated before pregnancy, when a
woman decides to try to have a baby.
• Pregnancies in women who are overweight, have anorexia
nervosa, or whose growth is not complete, need extra
nutritional care.

4. NUTRITION IN PREGNANCY
 The extra energy need for a pregnancy is about 80000 kcal. Thus the daily
additional intake of 300 kcal is needed. This includes:
 Energy stored in fetal fat and protein, and in maternal reproductive tissues
and adipose tissue.
 Mother’s increased basal metabolic rate and
 The energy needed to move a heavier body .
 Pregnant women seem to reduce their exercise if they can.
 Postprandial cholecystokinin concentrations increase, which enhances
nutrient absorption and the anabolic actions of insulin. So it is not true that
a pregnant woman has to eat calories for two, but a few nutrients should
be substantially increased. The women involved in agricultural labour,
food intake may—and should—increase in pregnancy.

6. NUTRITION IN PREGNANCY

7. NUTRITION IN PREGNANCY
 Folate and iron the only nutrient element whose requirements double in pregnancy.
 Extra folate is needed for the first month and again for the last trimester. Folate is
important in preventing neural tube defects and some other malformations in the fetus. The
supplement dose is 400 or 500 micro g/day.
 Iron concentration, transferrin saturation, and ferritin concentration all go down. These are
prevented by iron supplementation.
 With calcium, absorption becomes more efficient.
 Without any change of vitamin D intake or exposure to the sun, plasma concentrations of
calcitriol (the active form of the vitamin converted in the kidney) are increased. Some of this
extra conversion takes place in the placenta.
 The easiest way of obtaining the extra calcium needed for pregnancy and lactation is from
milk; 0.5 litre supplies about 600mg calcium.
 The increased need for iodine may be taken for granted in Britain, but in areas where goitre
is endemic there is a risk of cretinism. In such areas expectant mothers should be given an
injection of iodised oil, preferably before conception or iodine salt in routin use.

8. Complications of Malnutrition in Pregnancy
 Emotional Stress
 Complicated Deliveries
 Greater Incidence of Miscarriages, Stillbirths and Premature Deliveries
 Decreased Birth weight of newborn infants.
 Higher Infant Mortality
 Anemia and Osteomalacia are very common in ill-nourished mothers

9. NUTRITION DURING LACTATION

10. NUTRITION DURING LACTATION
Nutritional needs are increased during lactation:
For sufficient breast milk production.
For providing adequate nutrients to the infant.
To meet the mother’s daily needs.
Energy
The lactating mother needs an additional 550 kcal per day during the first six months an additional
400 kcal per day is needed from 6 to 12 months.
Protein
The lactating mother n additional amount of 16.8g per day during 0 to 6 months and 12g per day 6 to
12 months period of lactation . ( take more milk, cheese, paneer, curds, chicken, eggs, cereal pulse
combinations, nuts etc.
Calcium
850ml of milk, the total calcium secreted through milk is 300 mg/day. Therefore, an additional intake of
300 mg of extra calcium daily. Considering the mothers own needs and the calcium required for milk
production, 1000mg per day calcium is required during this.

11. NUTRITION FOR NEW BORN

12. NUTRITION FOR NEW BORN
Breast or bottle?
 For the first 4-6 months of life the infant can be fed either by
breast feeding or on a formula milk or on cows’ milk modified
to make its composition suitable for infants.
 The decision on which method to use should be made well
before delivery, and it should be made by the mother.So
mother”s councling, convincing her for breast feeding should
be done during antenatal visits.

13. Advantages of breast feeding
 Breast feeding is natural and may confer advantages that
science has not yet discovered.
 Breast milk is microbiologically clean.
 Breast milk’s nutrient composition is the standard against
which infant formulas for bottle feeding must be judged. Many
of the differences between cows’ and human milk have been
minimised in modern infant formulas, but by no means all and
some nutrients such as iron and zinc are known to be better
absorbed from human milk.
 .

14. Advantages of breast feeding
 Only breast milk provides a complex range of anti-infective
components: macrophages, lymphocytes, immunoglobulins
(especially IgA), lactoferrin, lysozyme, complement,
interferon, oligosaccharides (for example, bifidus factor), sialic
acid, xanthine oxidase, gangliosides, glycoconjugates, growth
factors, and enzymes.
 Breast feeding reduces the risk of gastrointestinal, respiratory
and other infections (otitis media, meningitis, urinary tract
infections), SIDS, childhood lymphomas, early allergic
diseases, and type 1 diabetes.
 For most women breast feeding is a satisfying, convenient
and enjoyable experience that is beneficial to the mother-child
relationship.