NUTRITION:

PREGNANCY
AND
LACTATION
Enriquez R. Cayaban, RN, LPT, MAN

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 OBJECTIVES
• Identify the nutritional requirements for pregnant and lactating mothers
• Plan a whole-day menu considering these nutritional requirements

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 PREGNANCY
• Or gestation is the period when the
fertilized ovum implants itself in the
uterus, undergoes differentiation, and
grows until it can support extra-uterine
life.
• Human pregnancy lasts for a period of
266 to 280 days (37-40 weeks).

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 NUTRITIONAL OBJECTIVES

• Ensure optimum nutrition before, during and

after pregnancy and during lactation
• Provide adequate nutrition to meet increased
maternal and fetal nutrient demands

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 Calorie Allowance

• During the course of pregnancy, the total energy

cost of storage plus maintenance (additional
work for maternal heart and uterus and a steady
rise in basal metabolism) amounts to
approximately 80,000 kcal. The energy cost of
pregnancy then is about 300 kcal per day. The
energy intake should be 36 kcal per kg of
pregnant weight per day.

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 Weight Gain
• The weight of the blood volume and the enlargement of the reproductive are fairly
constant.
• Although weight gain varies, it is generally agreed that the normal curve of weight
gain is sigmoid in shape.
• A small weight gain is observed during the first trimester. A more rapid weight
gain in the second trimester. A slower weight gain is recorded during the third
trimester.
• An average weight gain during pregnancy is 24 lbs which is commensurate with a
better-than-average course and outcome of pregnancy. A gain of 1.5 to 3.0 lbs
during the first trimester and a gain of 0.8 lbs per week during the remainder of
the pregnancy should be the guideline. The pattern of weight gain is more
important than the total amount gained. A sudden gain in weight after the 20th
week of pregnancy may indicate water retention and the possible onset of pre-
eclampsia.

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 Maternal Weight Gain
Tissue Weight (pounds)
Fetus 7.5
Uterus 2.0
Placenta 1.5
Amniotic Fluid 2.0
Blood Volume 3.0
Extracellular Fluid Accretion 2.0
Breast Tissue 1.0
Fat 9.0
TOTAL 28.0
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 MATERNAL WEIGHT GAIN

• High risk for having low-birth weight infants

Underweight
• Higher rates of preterm deaths and infant deaths

Overweight • High risk of complications like hypertension, gestational

diabetes and post-partum infections
• Complications of labor and delivery

and Obese • Increased likelihood of a difficult labor and delivery,

birth trauma and caesarean section for large babies
• Doubled risk of neural tube defects

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 Pre-Pregnancy Weight Recommended Weight Gain Patterns
Weight Gain First trimester Thereafter

Underweight BMI < 18.5 28-40 lbs 5 lbs 1 lb per week

Healthy BMI 18.5-24.9 25-35 lbs 3 ½ lbs 1 lb per week
weight
Overweight BMI 25.0-29.9 15-25 lbs 2 lbs 2/3 lb per week
Obese BMI ≥ 30 15 lbs

• During the total pregnancy period, the basal metabolic rate increase from 6% to
14% and the calorie requirements proportionately increase.
• Unless she is very active, the calories are increased only from 10% to 20%.
• The increase in the basal metabolic rate (BMR) during the second half of
pregnancy justifies a need for an increment in calories.

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 Protein Allowances

• The additional allowance of protein during pregnancy takes into

account the increased nitrogen content of the fetus and its
membranes, maternal tissues, and the added protection of the
mother against complications. It has been estimated that about 959
grams are deposited during the last 6 months of gestation
• The FAO/ WHO recommends an additional 9 grams of protein per
day for the latter part of pregnancy. Adjusting this for net protein
utilization (NPU) of 63, an additional allowance of a Filipino
pregnant woman becomes 14 g/ day or a total of 68 g/ day for the
adult pregnant woman. Pregnant adolescents should receive (59 g
for those aged 16-19) and additional 14 g/ day for the pregnancy
totalling 73 grams.

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 • The protein needs of a normal woman are 1.1 g/kg BW; a normal
pregnant woman requires an additional 9.5 g/day or a total of 900-
950 g for the 9 months gestation period.
• Reasons for additional protein:
• To provide for the storage of nitrogen
• To protect the mother against many of the complications of pregnancy
• For the growth of the women’s uterus, placenta and associated tissues
• To meet the needs for the fetal growth and repair
• For the growth of the mammary tissues
• For hormonal preparation for lactation

• Two- thirds of the proteins should be of animal origin of the highest

biological value such as meat, milk, eggs, cheese, poultry and fish. A
factor of 10 g added to the normal protein allowance may be used
for simplicity.
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 Calcium Allowance
• Some calcium and phosphorus deposition takes place early in pregnancy, but the
amounts are small.
• During the latter half of pregnancy, the intake and retention of calcium are
considerably increased
• An adequate supply of Vitamin D is essential in the use of Calcium and
Phosphorus needed to calcify the fetal bones and teeth, if the diet of the pregnant
woman is inadequate in calcium she will have to sacrifice the calcium of her bones
in favour of the developing fetus.
• To satisfy these additional needs, the daily intake of calcium must be increased
from 0.5 to 0.9 to that of the non-pregnant adult’s daily allowance.

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 Iron Allowance
• At least 700 to 1000 mg of iron must be absorbed and utilized by the mother
throughout her pregnancy. Of this total, about 240 mg is spared by the cessation
of the menstrual flow.
• The remainder must be made available from the diet. The rate of absorption is
increased, therefore, in the third trimester when the needs of the fetus are
highest.

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 Vitamins Allowances
• Thiamine and niacin allowances are increased in proportion to the calorie
increase while the riboflavin allowances are increased according to the higher
protein level.
• The need for Vitamin D is increased during the pregnancy to make easier the
utilization of greater amounts of calcium and phosphorus.
• Ascorbic acid, vital tissue structure, is required in considerably increased
amounts.
• Vitamin A is important in the epithelial cells during organogenesis and is
necessary to ensure good vision.
• Folic Acid and Vitamin B12 are important in the synthesis of RBC.
• Vitamin B6 or pyridoxine requirement has been observed to be greater during
pregnancy

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 Vitamins Allowances
• Vitamin K may be given to the mother at 2mg to 5 mg parenterally before the
birth of the baby to stabilize the prothrombin level of the infant until synthesis
can t
• Otherwise 1 mg to 2 mg can be given to the infant after birth take place.
• The use of vitamin k supplement during the course of pregnancy is, therefore, not
necessary.

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 Food Allowances
• One ounce or 3o g of meat or its equivalent and an extra pint of milk to the
normal diet
• Daily consumption of whole-grain cereals; enriched bread; rice; leafy green
vegetables and fresh and dried fruits
• Liver at least once a week
• Egg in the daily diet
• Fortified milk with vitamin D or fish liver oil
• Six to 8 glasses of water daily

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 Complications of
PREGNANCY and
Possible DIETARY
MODIFICATIONS

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 Rapid Weight Gain or Loss

• The popular concept of “eating for two” is not valid among well-
nourished mothers.
• Excessive weight gain during pregnancy is defined as an increase of
three kilograms or more per month in the second and third
trimesters. A sudden increase in weight after about the 20th week of
gestation is a cause for suspecting that water is being retained at an
inordinate rate and should be regarded as warning sign of an
impending eclampsia.
• Proper management of obese pregnant patients is a matter of
controversy.

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 Rapid Weight Gain or Loss

• On the other hand, a gain of less than 500g/month during the first
trimester of pregnancy and 250 g during the second trimester is
considered a maternal risk factor. Those who are seriously
underweight entering pregnancy (<38kg), or showing inadequate
weight gain (<40 kg at the 20th week of pregnancy)
• Excessive weight gain of 3 kg or more per month in the second and
third trimesters can lead to eclampsia while weight gain of less than
500 g per month during the first trimester and 250 g during the
second trimester can lead to the delivery of low- birth weight or
premature infants and babies with brain and nerve damage.
Abortion may also occur.

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 Toxemia
• Rapid weight gain, edema, high blood pressure, excretion of albumin in the urine
and convulsions are clinical manifestations of Toxemia.
• Its classification are as follows:
• Acute Toxemia of pregnancy; onset after the 24th week
• Pre-eclampsis- hypertension with proteinuria and/or edema
• Eclampsia conculsions or coma; usually both when associated with hypertension,
proteinuria and edema

• Chronic hypertensive (vascular) disease

• Without superimposed acute toxaemia
• With superimposed acute toxaemia

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 Anemia

• The classic macrocytic anemia of pregnancy represents a combined

deficiency of iron and folic acid. It produces anemia in babies and
increases the chances of premature birth. Once anemia is
established, it is difficult to overcome the condition even by raising
the level of iron in the diet although its absorption can be enhanced
by the inclusion of ascorbic acid-rich foods in the same meal
containing rich sources of iron.

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 Diabetes

• A pregnant woman with diabetes is more prone to develop pre-

eclampsia, pyelonephritis and polyhydramios (an excess of amniotic
fluid), and her baby has a higher risk of dying in utero or at birth.
Rigid control of maternal blood glucose concentration is considered
vital for a good prognosis of the fetus.

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 Constipation

• Pressure exerted by the developing fetus on the digestive tract, lack

of exercise and insufficient bulk in the diet cause constipation,
which if chronic or habitual, gives rise to headaches and much
discomfort . Lots of fresh fruits, vegetables, fluid and regular
exercise can correct this disorder.

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 Socio-economic and Cultural Factors
• Low income groups tend to have big families, one reason for the decrease in kind
and amount of food available to the pregnant mother. Unusual eating habits such
as frequent snacks rich in carbohydrates; irregular meals; special cravings such as
raw white rice and green mangoes; and odd eating habits like chewing cigarettes,
chicken manure, and soot of pots deprive the mother of wholesome foods.
• Fallacies (eg. That eating eggplant cause beriberi in the mother; dark food results
in dark complexion of babies; and eating crabs produce physical abnormalities)
should be ignored.

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 Alcohol, Caffeine, Nicotine
• Smoking during pregnancy lowers the mean birth weight and increases the risk of
perinatal mortality.
• Excessive maternal alcohol ingestion is linked to fetal alcohol syndrome (FAS).
• Caffeine crosses the placenta to the fetus very rapidly.

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 MOTHER’S AGE AND
ASSOCIATED HEALTH
CONCERNS AND RISKS

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 Socio-economic and Cultural Factors
Pregnancy in Adolescents (1 out of 20) Pregnancy in Older Women

• Iron deficiency anemia • Hypertension and diabetes

• Prolonged labor • Higher rates of premature births and
low birth weigh
• Higher rates of stillbirths, pre-term
babies, and low-birth weight infants • Birth defects
• Fetal death
Repeated Pregnancies
As parity increases, the tendency toward lower nutrient intake also increase. Moreover,
gestation in close interval depletes the maternal reserves of nutrients. Since replenishment
of reserves does not take place, the mother’s nutritional status, and consequently that of
the infant, are greatly affected.
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 Daily Food Guide for a Pregnant/ Lactating Woman

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 LACTATION
The preparation for assuring an
adequate supply of good quality
breast milk begin at the onset of
pregnancy.

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 Calorie Allowances
• The actual mechanisms involved in the production of milk does not demand a
great expenditures of energy.
• The extra energy required for lactation depends on the amount of milk produced.
• It is generally suggested that the extra food calories should be about twice those
secreted in the milk of approximately 700 to 1500 calories of food for 500 to 1000
ml of the milk.
• The FNRI recommends an increase by 1000 calories above the normal
requirement for an average production of 850 ml of milk, with an energy value of
about 600 calories.
• Human milk is approximately 0.70 calories per mL or approximately 20 calories
per ounce, and it contains 1.2 g protein per 100 ml.

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 Protein Allowances
• An adequate protein intake off HBV foods during pregnancy is essential in
preparation for lactation.
• The need for protein is greatest when lactation has reached its maximum, but it is
a need which should be anticipated and planned for during pregnancy.
• The average protein allowance for the lactating mother is an additional 20.2 g
protein to her normal requirement. In such case, 20 g factor may be used.

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 Calcium, Phosphorus, and Vitamin D Allowances

• During the lactation, the demand for calcium and phosphorus is

increased above requirement of the pregnant woman, the calcium
allowance is 1.0 g daily for good milk production. Of the protein
requirement and other essentials of the diet are fulfilled, the
increased remains the same as during the pregnancy.

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 Iron Allowances

• Some lactating women tend to be anemic unless the iron

allowance in the diet is increased to the same level as that
during pregnancy. During lactation, the loss of iron which
is considered on an annual basis is probably similar to
that which is lost in the menstrual flow.
• The baby is born with a relatively large reserve of iron.

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 Vitamins Allowances

• There is an increased demand for vitamin A, niacin, riboflavin,

thiamine, and ascorbic acid above the requirement of pregnancy
during lactation.

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 FOOD NEEDS IN
LACTATION

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 Nutritional Requirements
• Calorie- an addition of 100 calories above the normal allowance is needed. An
approximate amount of 120 calories is required to produce 100 ml of milk. Thus,
the daily production of 850ml of milk will require an additional 1000 calories in
the diet. Energy- giving foods are good sources of calories.
• Protein- an additional 20 g to the normal allowance is needed to compensate for
the protein lost in milk. The conversion of food into milk protein is only about
50% efficient; thus, 2g of food protein is required to produce 1 g of milk protein.
Sources are milk, eggs, animal proteins, and legumes.
• Calcium and Phosphorus-an increase of 0.5 mg to the normal allowance is needed
to prevent severe depletion of maternal calcium reserve since this is used for milk
production. Sources are milk and milk products, egg, etc.

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 • Iron-an additional intake of recommended for blood lost in
parturition, for milk iron and basal losses.
• Vitamin A-an additional 2000 IU to the normal allowance is needed
to provide the amount of vitamin A secreted in milk. Sources are
green leafy and yellow vegetables, milk, eggs, etc.
• Vitamin B1-an additional allowance is needed for thiamine secreted
in milk. A mother whose diet is very low in thiamine may secrete a
toxic substance called “glyoxaline” which accumulates in thiamine
deficiency. Its presence with the low thiamine content in milk is
associated with infantile beriberi. The sources of vitamin B1 include
unpolished rice, legumes, vegetables, milk, etc.
• Riboflavin, Vitamin C, etc.-an additional allowance is needed for
milk secretion
• Fluids- an intake of 8 glasses or more is recommended to increase
milk production.
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 MOTHER’S MILK
• is the best food for the baby.
• It is easily digested, economical, has the right temperature, and is free from
harmful bacteria.
• For the first 3 to 4 days, the milk contains the substance called colostrum.
Colostrum has high protein content, acts as a laxative and contains antibodies
which help resist infection. It should be given to all newborn infants.
• A mother who wants to breastfeed her baby should follow the basic food groups in
meal planning.
• Too much fried foods, pickles and highly seasoned foods and stimulants such as
drugs, nicotine, caffeine, theobromine, morphine and alcohol should be avoided.

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 Dietary Allowance for Lactating Mothers

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 Breastfeeding Misconceptions
• A mother sick with tuberculosis cannot breastfeed
• Breast milk is not good if the mother has stayed long under the sun
• A mother cannot breastfeed during pregnancy
• A mother cannot breastfeed with only one breast if the other breast is painful
• A mother cannot breastfeed if she has a cold, flu or diarrhea
• Breast milk is not good if the mother has been caught in a sudden shower

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 Advantages of Breastfeeding
• Breastmilk is the ideal food for infants.
• It is safe, clean and contains antibodies which help protect against many common
childhood illnesses.
• Breastmilk provides all the energy and nutrients that the infant needs for the first
months of life, and it continues to provide up to half or more of a child’s
nutritional needs during the second half of the first year, and up to one third
during the second year of life.
• Breastfed children perform better on intelligence tests, are less likely to be
overweight or obese and less prone to diabetes later in life.
• Women who breastfeed also have a reduced risk of breast and ovarian cancers.

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 Factors Affecting Milk Secretion
• Diet
• The volume of milk secreted is affected by the diet, but the protein and calcium compositions are not
• Meat and vegetables soups (tahong, tulya, malunggay) milk, and fruits juices have been referred to as
“galactagogues” (milk secretion stimulating)
• Water should not be drunk beyond the level of natural thirst because it suppresses milk secretion
through its action on the pituitary hormone that regulates milk production

• Nutritional State of Mother

• Energy-yielding constituents of human milk are maintained at expense of the maternal stores while the
water-soluble vitamins and vitamin A are low in poorly nourished mothers
• Sufficient nutrient reserves in the mother’s tissues before conception and during pregnancy influence
milk secretion.
• Malnutrition and illnesses such as cardiac and kidney diseases, anemia, beriberi, tuberculosis, and
infectious can lessen the quality and quantity of milk flow

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 Factors Affecting Milk Secretion
• Emotional and Physical States
• Attitudes affects milk secretion. When the mother worries or frets about the sufficiency of her milk, about her
breast contour and about being tied down in her home, the flow of milk steps
• A relaxed temperament, pleasant surroundings, lots of rest and good sleep enhance milk production

• Suckling
• The presence of the baby and suckling, immediately after delivery, stimulate the milk- producing gland
• As the baby feeds for longer periods of time, the supply of milk increases in proportion to the body’s demands
• Increased frequency of nursing is positively associated with infant weight and lactation period

• Use of Contraceptives and Drugs

• Women who use contraceptives like pills while breastfeeding depress that milk flow and the insufficiency of
milk triggers the cessation of lactation (osteria)
• Most drugs, including alcohol and nicotine from smoking, reach the milk sometimes in physiologically large
doses thus affecting the quality of milk secreted.

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 THANK YOU!

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