Alcohol, Caffeine, Nicotine

Smoking during pregnancy lowers the mean birth weight and increases the risk of
perinatal mortality. Smoking seems to affect the conversion of dietary calories into weight gain.
It is postulated that smoking increases the mother’s level of carboxyhemoglobin and nicotine
causing a decrease in the oxygenation of the fetus. Increasing the food intake of pregnant
smokers can compensate for some of the effects of smoking.
Excessive maternal alcohol ingestion is linked to fetal alcohol syndrome (FAS). Its major
features are CNS disorders, mental retardation, growth deficiencies, and facial deformities.
Caffeine crosses the placenta to the fetus very rapidly. The drug-metabolizing ability of a
fetus is extremely limited. The fetus can metabolize alcohol to a limited extent but not caffeine.
Alcohol, caffeine, and nicotine dramatically increase the circulating levels of
catecholamine.

MOTHER’S AGE AND ASSOCIATED HEALTH CONCERNS AND RISKS

Pregnancy in Adolescents (1 out of 20)

a. Iron deficiency anemia
b. Prolonged labor
c. Higher rates of stillbirths, pre-term births, and low-birth weight infants

Pregnancy in Older Women

a. Hypertension and diabetes
b. Higher rates of premature births and low birth weight
c. Birth defects
d. Fetal death

Daily food guide for a pregnant/lactating woman

Recommended amounts
Food Groups Pregnant Lactating
Woman Woman
Rice Rice and 5½-6 cups, cooked 6-7, cooked
alternatives others 1 cup rice, cooked = 4 pieces 1 cup rice cooked = 4 pieces
pan de sal (17 g each) pan de sal (17 g each)
4 slices of loaf bread 4 slices of loaf bread
1 pack of 60 g instant noodles 1 pack of 60 g instant noodles
1 cup cooked macaroni or 1 cup cooked macaroni or
spaghetti spaghetti
1 small root crop, cooked (3 1 small root crop, cooked (3
times a week) times a week)
Meat and Fish/meat/ At least 3½ servings At least 3½ servings
 alternatives poultry/ 1 serving cooked meat = 30 g 1 serving cooked meat = 30 g
Dried beans/ Fish = 2 pcs medium sized Fish = 2 pcs medium sized
nuts (50-60 g each) (50-60 g each)
1 cup cooked dried beans/ 1 cup cooked dried beans/ nuts
nuts preferably taken 3 times preferably taken 3 times a
a week week

egg 1 piece 1 piece

3-4 times a week 3-4 times a week

milk 1 glass whole milk, (240 mL) 1 glass whole milk, (240 mL)
equivalent to 4 tbsp powdered equivalent to 4 tbsp powdered
whole milk or ½ cup whole milk or ½ cup
evaporated milk diluted to 1 evaporated milk diluted to 1
glass water glass water
Vegetables Green leafy/ ¾ cup, cooked ¾ cup, cooked
Yellow

Others 1 cup, cooked 1 cup, cooked

Fruits Vitamin C- 1 medium-sized fruit or 1 medium-sized fruit or
rich 1slice of a big fruit 1slice of a big fruit

Others 1 medium-sized fruit or 1 medium-sized fruit or

1 slice of a big fruit 1 slice of a big fruit
Fats and oils 7 teaspoons 7 teaspoons

Sugar 6 teaspoons 6 teaspoons

Repeated Pregnancies
As parity increases, the tendency toward lower nutrient intake also increases. 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.

LACTATION
The preparation for assuring an adequate supply of good quality breast milk must begin at
the onset of pregnancy. Most of the dietary essentials are increased over and above the
requirements during pregnancy to meet the demands of milk production, namely;
a. Calories e. Thiamin
b. Proteins f. Riboflavin
c. Calcium g. Niacin
d. Vitamin A h. Ascorbic acid

NUTRITION IN LACTATION
Calorie Allowances

The chief concern during lactation is the loss of the food material in the milk and the
storage of a certain amount of food which cannot be entirely accounted for by the chemical
composition of the milk. Also, extra calories may be needed for additional activity necessitated
by the care of the infant.
The extra energy required for lactation depends on the amount of milk produced. The
food requirements are not uniform during the entire period of lactation, they depend on the
demands of the infant. 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. 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.

Protein Allowances

An adequate protein intake of HBV foods during pregnancy is essential in preparation of

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.
Lactation makes large demands on the human stores. The food intake of a nursing mother
must contain sufficient proteins to supply both the maternal needs and the essential amino acid to
be transferred through her breast for the baby’s growth. Additional protein in the diet tends to
increase the yield of breast milk while a decrease of protein lowers the amount of milk secreted.
If the amount of protein in the mother’s diet does not meet the body maintenance needs and the
necessary protein content of the milk secreted, a loss of maternal body tissues will result.
The average protein allowance for the lactating mother is an additional 20.2 g protein to
her normal requirement. In such a case, a 20 g factor may be used.

Calcium, Phosphorus, and Vitamin D Allowances

During lactation, the demand for calcium and phosphorus is increased above the
requirement of the pregnant woman. The calcium allowance is 1.0 g daily for good milk
production. If the protein requirement and other essentials of the diet are fulfilled, the increased
need for phosphorus will be met. The vitamin D requirement of 400 IU remains the same as
during pregnancy.

Iron Allowances

Some lactating women tend to be anemic unless the iron allowance n 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. Since milk is not a good source of
iron, a good allowance of iron in the mother’s diet during lactation does not convey additional
iron to the infant. Nevertheless, iron-rich foods are essential for the mother’s own health while
supplements are included early in the infant’s diet.

Vitamin Allowances

There is an increase demand for vitamin A, niacin, riboflavin, thiamine, and ascorbic acid
above the requirements of pregnancy during lactation.

FOOD NEEDS IN LACTATION

Nutritional Requirements

The nutritional requirements in lactation are greater than in pregnancy to ensure enough
supply of milk for the baby.
1. Calories – An addition of 1000 calories above the normal allowance needed. An
approximate amount of 120 calories is required to produce 100 mL of milk. Thus, the
daily production of 850 mL of milk will require an additional 1000 calories in the
diet. Energy-giving foods are good sources of calories.