Maternal nutrition

Proph. Dr. Hadi. J . Suhail

10. 3. 24

The nutrition of mother is important for mother

health, fetal built& body structure, lactation & to
avoid certain deficiencies causing congenital
anomalies.
Maternal malnutrition is an important cause of low
birth weight, each year about 20 million babies born
with low birth body weight(birth weight less than
2.5kg) of these about 90% are born in developing
countries.
Nutrition during pregnancy
Many physiological, biochemical& hormonal changes
occur during pregnancy that influences the needs of
different nutrients, they also influence the efficiency
with which the body utilizes these nutrients.
These changes could be summarizing as:
1-increase blood volume by about 50% this will decrease Hb
concentration & serum levels of albumin& level of other
serum of protein& of water soluble vitamins.
Decrease serum albumin lead to increase tendency of
extracellular fluid accumulation & so causing subclinical
oedema.
2-increase cardiac output& pulse rate.
3-increase O2 demand & decrease in threshold for
CO2, this make pregnant feel dyspnea & this
exaggerated with progress of pregnancy because of
growing uterus pushes the diaphragm upwards.
4-increase serum concentration of fat soluble
vitamins& other lipid fractions like triglyceride,
cholesterol& free fatty acids.
5-early in pregnancy nausea ,vomiting& change of
appetite which may affect nutrient intake.
6-due to hormonal factors decrease gastrointestinal
mobility ,so constipation is a problem in pregnancy.

Also relaxation of lower esophageal sphincter

causing regurgitation of fluid & heart burn feeling.

7-increase GFR & greater amount of amino acids,

glucose& water soluble vitamins may appear in
urine.
Poor pregnancy outcome as low birth weight,
stillbirth, prenatal mortality are associated with
inadequate maternal nutrition.

In addition to some congenital defects as an

encephaly& spina bifida are associated with maternal
deficiency of folic acid.

Nutritional need of pregnant woman is affected by

age, parity, spacing between pregnancy,
preconception nutritional status& by individual
variation.
Weight gain during pregnancy:
This depend on pregnant weight, whether she's
underweight ,normal weight, or overweight.
Optimum wt gain during pregnancy as follows:
-underweight woman 12---16 kg
-normal weight woman 11---14 kg (mean=12.5 kg)
-overweight woman 9----10 kg.
Studies found +ve correlation between pre-
pregnancy wt, wt gain during pregnancy& birth wt.

Average of normal wt gain( 12.5 kg) has been found

to be 3.5 kg wt. gain by end of the first 20 weeks of
pregnancy& there after 0.5 kg/week until term.
Higher wt gain is usually advice for adolescent
pregnant woman& for woman with multiple
pregnancy.

Wt. reduction should never be done during

pregnancy,
abnormal sudden wt. gain after 20 weeks which
may signal for abnormal fluid retention that
should monitor closely especially if increased
blood pressure & proteinuria ( called pre-
eclampsia).
In order to supply optimum wt gain, sufficient energy
must be consumed, thus if physical activity remains
the same additional 300 kcal/ day .
Protein requirement increased as pregnancy
proceeds& the greatest demand occur in the 2nd& 3rd
trimesters.

Recommended intake: is 10g additional protein daily

more than that of non pregnant woman.
The requirement of absorb iron is relatively small
during first trimester is 2.4 mg/day,

but this requirement is increased in second trimester

about 4mg/day, & further increase in requirement in
3rd trimester to reach 6.3 mg/day.

Because of difficulty to obtain iron from food alone, so

iron supplement in range of 30—60mg/day is
recommended for prophylactic during pregnancy.
Some possible outcomes of maternal malnutrition:

1-low birth weight & prematurity,

2-fetal and neonatal morbidity & mortality,

3-pre-eclampsia & eclampsia,

4- anaemia: which occur due to many causes are:

a-increase iron requirements due to uterus, fetal & placental
growth,
b-interference with iron metabolism due to nausea &
vomiting,
c-short spacing between pregnancies,
d-insufficient dietary intake of iron,
e-blood loss due to some parasites such as ancylostoma &
plasmodium,
f-anaemia could be due to folic acid & B12 deficiency, also
due to protein insufficiency may lead to anaemia because
haeme molecule will not attach to a normal globins unit.
Nutritional requirement during lactation:
Lactation is the final phase of human reproduction; biologically
failure to lactate can be an important cause of failure to
reproduce; like failure to ovulate.

Therefore the mother will if necessary produce milk at expense

of her own body tissues, only in severe maternal malnutrition
the mother will be unable to produce milk.
The daily milk production is 850 ml. which means the loss of
nearly 1000 kcal/day.

If this amount is not balanced by energy intake, it will be

taken from body store.

Well fed woman lay down considerable amount of body fat

during the earlier phase of pregnancy, which will be used for
fetal growth during late pregnancy &later to subsidize
lactation.
Nutritional requirement during lactation:

1-energy requirement: the recommended intake

(R. I) of energy include 500 kcal/day additional from
non lactating woman.
2-protein: the R.I intake is 15gm/day additional to
non lactating woman.

3-vitamins: increase requirement of all vitamins

during lactation especially vit C,B & A.
4-minerals: the quantity required during lactation especially
Ca& iron is nearly the same as that during pregnancy.
(Ca=1200mg/day, Fe= 4—6.3mg/day).

5-fluid: increase intake necessary for lactating woman.

6-lipid: increase intake of polyunsaturated fatty acid is

advised during lactation is necessary for mother & her baby.