This document discusses nutrition and health promotion during pregnancy and breastfeeding. It notes that breast milk provides sufficient nutrition for infants to double their birth weight by 6 months and contains over 200 substances that vary depending on the woman and stage of lactation. Breast milk from women who deliver premature infants contains higher levels of calories, fats, proteins, and immune factors. The document outlines nutritional guidelines and additional calorie and nutrient needs for lactating women, including calcium, iron, folic acid, vitamins, fluids, and snacks. It discusses factors that can influence breast milk composition and causes of low milk supply.

1. HEALTH PROMOTION IN
PREGNACY AND BREAST
FEEDING
BY
A.Pavithra

2. INTRODUCTION
 Breast milk provides sufficient calories and nutritive factor to allow an
infant to double its birth weight by six months of age
 Breast milk is a bio active, complex fluid containing more than 200
recognized substance varying in composition between women, and from
the same woman, depending upon her stage of lactation.
 Breast milk of women who deliver a premature infant is higher in calories,
fats, protein, immune factor, and anti-inflammatory agents compared to
full-term breast milk, therefore, adaptive to the additional nutritional
needs of the premature infant.

3. NUTRITION AND LACTATION
 It has been calculated that breast feeding carries a daily energy cost of
650kcal.
 However , some of this is obtained by using up fat stored during
pregnancy for this purpose.
 Women who exclusively breast feed for 3-4 months need an extra
500kcal/day , on average , which corresponds to an average milk output of
750ml/day
 This extra energy is obtained via consumption of a balanced and varied
diet, the additional needs for essential vitamins and minerals .

4. Normal range of values:
 Calcium
 Vitamin-A
 Vitamin-B12
 Vitamin-C
 Vitamin-D
 Vitamin-E
 Vitamin-K
 Sodium
 Iron
 1-2g/day
 2400-3000IU/day
 2-3g/day
 40mg/day
 400-500IU/day
 10-15mg/day
 50-80ug/day
 2-3g/day
 28-30mg/day

5. NUTRITION DURING LACTATION;
 Lactating mother’s produce normally about 750 ml of milk daily Protein
requirement:70% of food alter pr of milk
 For the production of the 100ml of milk-they need for extra protein is 2,4 g
 The increment of protein allowance:
RDA: 25 g/day extra protein for the first 6 month of full lactation
 To prevent dehydratation: at least 2-3 litre water is also need each day for milk
production
 Energy requirement: ~500 additional calories is required but about 150 kcal is
supplied by extra fat, accumulated during pregnancy
 In menu planning guidelines: fluids, dairy products, fruits and vegetables are
emphasized

6. NUTRITIONAL GUIDELINES ARE ;
 Calcium:
• Calcium is especially required during pregnant or breastfeeding because it shows
that calcium is drawn out of bones during pregnancy and lactation.
• The recommended daily allowance is 1,600mg daily;
 which is 2-4 servings of milk products.
• Some good sources of calcium include yogurt, milk, cheese, broccoli,
watercress, oranges, almonds, tofu and dark leafy greens.

7. Iron:
 Iron is important during pregnancy and postpartum. A lack of iron
in the blood can cause to feel weak, light headed, tired, have a
loss of appetite, or be more likely to get colds and flu.
 Continuing to take prenatal vitamins will help keep the iron levels
up but the best way to have enough iron in the blood is to eat
foods that are high in iron.
 Here is a list of foods- red meat, lamb, turkey, chicken, pork and
fish, kidney beans, dried beans and peas, whole grain breads and
iron fortified cereals, greens, broccoli, baked potato with skin,
raisins, and dried fruit.

*** High vitamin C foods/beverages along with high iron foods
help the body absorb iron easier, so drink a glass of 100% fruit
juice with the meal.

8. Folic Acid:
 Folic acid is very important for potentially become pregnant.
Folic acid is a B-vitamin, when taken one month before
conception and throughout the first trimester reduces the risk of
neural tube defects.
 The recommended amount of folic acid is 400 micrograms daily
which can be consumed in a vitamin supplement or by eating
foods high in folic acid.
 Breakfast cereal are especially high in folic acid, many contain
100% of the daily value, enriched pasta, rice, breads, flour and
other grains have been fortified with folic acid. Fruits, green leafy
vegetables, dried beans and legumes also contain folic acid.

9. Vitamins:
It is recommended that breastfeeding women continue to take
prenatal vitamins.
Eating lots of fruits and vegetables will also help to get all the
vitamins and mineral that the body needs.
Vitamin D is important to your baby's bone growth.
It is now recommended that ALL infants and children have a
minimum daily intake of 400 IU of Vitamin D beginning soon after
birth.
Vitamin D is found in fish, milk, eggs and butter.
Caffeine:
Caffeine should be limited to 2 servings or less daily. Caffeine is
found in coffee, soft drinks, tea, some medications and chocolate. If
the baby seems unusually fussy or wakeful you may want assess
how much caffeine you are consuming.

10. Fluids:
 Drinking plenty of fluids is very important when breastfeeding.
Eight to ten glasses of fluids are recommended daily.
 Water, 100% juice and low fat milk are good fluids to keep on hand.
 Try to always have some water available when you are
breastfeeding.
Snacks:
 One of the biggest problems mothers face when they have a new
baby is finding time for themselves.
 Make it a priority to take care of them self and find time to eat. It
is not only important for mother but also for the baby.

11. SUPPLEMENT AND HERBS;
The FDA does not regulate supplements and herbs and therefore
are not recommended when breastfeeding without consulting
health care provider.
Artificial Sweeteners;
 There is not evidence that artificial sweeteners are harmful when
breastfeeding.
 Of course there is one exception to this rule for mothers of infants
with Phenylketonuria (PKU) as aspartame contains phenylalanine.
 In general it is always a good idea to keep food additives to a
minimum.

12. BREAST MILK COMPOSITION AND DIET
• DHA levels of breast milk vary with diet. Increased amounts of DHA
have been found in the breast milk of mothers consuming fish or fish
oil, and with supplementation.
• Water soluble vitamins may vary with diet. Diets inadequate in B12
or thiamin have been associated with case reports of deficiency in
infants. High intakes of Vitamin C, however, does not appear to
change the content of breast milk.
• Supplementation of fat soluble vitamins do not appear to alter
the content of breast milk
• Iron supplementation does not appear to alter the iron
content of breast milk

13. INFLUENCE OF DIET ON MILK
COMPOSITION:
 Protein-energy malnutrition impacts milk volume.
 Composition remains relatively unaffected
 Water soluble vitamins move readily from serum to milk thus dietary
fluctuations are more apparent
Fat soluble vitamin content not improved with supplementation
 Fatty acid composition altered by maternal diet and
supplementation

14. CAUSES OF LOW MILK SUPPLY:
 Various factors can cause a low milk supply during breast-feeding, such as
waiting too long to start breast-feeding, not breast- feeding often enough,
and use of certain medications.
 Sometimes previous breast surgery affects milk production. Factors such
as premature birth, maternal obesity and insulin- dependent diabetes
can also affect milk production.
 In fact, most women make one-third more breast milk than their babies
typically drink.

15. Foods to avoid during breast feeding:
There are no specific foods should avoid when
breastfeeding. If you notice your baby is fussy often you
may want to consider what you ate 4-6 hours previously.
Some foods that babies can be sensitive to are cabbage,
beans, broccoli and some times peanuts, cow's milk,
eggs, wheat, fish, citrus foods and other nuts if there is a
strong family history of allergies to these foods.