NUTRITION IN PREGNANCY AND

LACTIATION
BY
B. SWETHA
DIETETICS DEPARTMENT
Pregnancy obstetrics INTRODUCTION
 Pregnancy is also known as gestation is the time during which one or more
offspring develops inside a woman.
 A multiple pregnancy involves more than one off spring such as twins.
 A pregnancy may end in a live birth, a spontaneous miscarriage , an induced
abortion or a still birth.
 Pregnancy is divided into three timesters of 3 months each. During the first
trimester possibility of miscarriage is at its highest.
 Around the middle of second trimester, Movement of the Foetus may be felt.
 Prenatal care improves pregnancy outcomes It include taking extra folic acid,
avoiding drugs, tobacco, smoking, alcohol, taking regular exercise , blood test,
physical examinations.
 Complications include disorders of high blood pressure, gestational diabetes,
iron deficiency anaemia, severe nausea and vomiting, bleeding, miscarriage,
ectopic pregnancy, post partum, depression, Post partum psychosis,
thromboembolec disorders, pulmonary embolism, plaques of pregnancy,
thyroid disease, help syndrome.
 • A proper education should be given in
pregnancy on diet.
Babies born before 37 weeks are
preterm and at higher risk of health • Some may need special diets according to
the medical conditions, food allergies or
problems such as cerebral palsy. some religious/ethical beliefs.
Babies born between weeks 37 and • Folic acid (vitamin B9) is essential as it
39 are considered early term and decreases the risk of fetal neural tube
those born between 39 and 41 are defects such as spinabifida the neural tube
considered full term. develops during first 28 days of pregnancy.
Babies born between weeks 41 and Eg: GLVs, legumes, citrus foods before
pregnancy we need 400mcg/day, during
42 weeks are Considered late term
600mcg/day is needed.
while after 43 are Considered Post
term.
Nutrition during pregnancy is
important to ensure healthy growth
of the foetus. There are increased
energy requirements & Specific
nutrient requirements.
Omega 3 fatty acids are The amount of healthy weight gain Several micronutrients are
during pregnancy varies weight gain is important for the health of the
also important to
related to the weight of the body, the developing fetus especially in
support her well being
placenta, extra circulatory fluid, larger areas where insufficient
and health of her infant.
tissues, fat, and protein stores. nutrition is common.
Developing infants
The institute of medicine Women living in low and
cannot produce DHA middle income countries are
recommends an overall
efficiently and must suggested to take multiple
pregnancy weight gain
receive this nutrients micronutrient supplements
Categories BMI Weight
from woman through (kg/m2) gain (kgs) containing iron and folic acid
placenta and in breast Normal wt. 18.5- 11.3-15.9 these supplements have

milk after birth 24.24.9 been shown to improve birth

Eg: flaxseed, navy Under wt. Less than 12.7-18 outcomes and do not have an

beans, walnuts, olive oil,

18.5 effect on perinatal mortality

GLVs, kidney beans, Over wt. 25-29.9 6.8-11

Broccoli, fish, egg Obese Greater 5-9
than 30
 1 2 3

During pregnancy insufficient or excessive weight gain
can comprise the health of mother and fetus. Becoming
or being over weight in pregnancy increases the risk of
complications of mother and fetus like ceaserian
section, gestational hypertension, pre eclampsia. Hence
diet modification is the most effective way to reduce
weight gain and associated risks in pregnancy
Regular aerobic exercises during
prepregnancy appears to improve/ maintain
physical fitness it also decrease the need of C
section. Hydration is another special
nutritional concern during pregnancy, to stay
hydrated and support life inside it is
important to drink enough fluids every day.
Sleep is also important in pregnancy shift work and exposure
to bright light at height should be avoided during last
trimester to decrease risk of psychological and behavioural
problems in newborn.
During pregnancy avoided foods are alcohol, refrigerated
meat products, unpasteurised foods, caffeine, carbonated
Beverages.

5
6
4
Protein in pregnancy provides the building blocks for your baby's
cells and help the baby's develop skin, hair, fingernails and
Iron is important for the baby's growth and Calorie requirement is also increased during pregnancy. In
muscles. During pregnancy 60-100 grams of protein is required
brain development. It increases during the 1st trimester we don't need extra calories, in 2nd
everyday, depending on your weight, physical activity level and
pregnancy 27 mg of Iron/day is required. trimester 340 extra calories/day, in 3rd trimester 450 extra
trimester. Eg: meat, Poultry, fish, eggs, milk, cheese, tofu and
Calcium can reduce the risk of pre-eclampsia calories/day.
beans. Weight gain, muscle fatigue, frequent infections, severe
builds up the baby's bones and teeth Sedentary - 1660k.cals
fluid retention are the signs of not taking enough protein in the
1000mg/day is required.vitamin D helps the Moderate - 2130k.cals
diet. Protein s help to digest food, fight infection and carry
calcium to buildup the baby's bones and teeth Heavy- 2720k.cals
nutrients throughout the body. The 3rd trimester is a time of
600IU/day.
rapid growth and brain development so the protein requirement
is high in third trimester extra 22gms of protein.
 PR
GESTATIONAL HYPERTENSION EGNANCY
C O M P L I C A• TGestational
I O N
diabetes is high blood sugar that starts during pregnancy.
• Gestational hypertension is a form of high blood pressure in
pregnancy. It occurs in about 6 percent of all pregnancies.
• Another type of high blood pressure is chronic hypertension
high blood pressure that is present before pregnancy.
• Gestational hypertension can develop into pre-eclampsia it occurs mostly
in second half of pregnancy after 20weeks of gestation.
• The signs of high blood pressure are headache, edema, sudden weight gain,
vision changes, pain in upper right side of the body or pain around the
stomach.
• High blood pressure can effect the blood vessels causing decrease blood flow
in liver, kidneys,brain, uterus and placenta.
• these issues can cause placental abruptness,poor fetal growth, still births,
seizures, death of the mother and baby.
• A balanced and healthy diet is the only solution to fight against high BP in
expectant mothers.
• Foods that are rich in essential fatty acids help to fight hypertension eg: nuts,
seeds,fruits, flaxseed and fresh water fish.
• Whole grains are rich in soluble fibre that controls HTN.
• Choose leanmeats, lentils,beans are good sources of protein.
• 2300mg of sodium that is 1 tsp of salt is needed.
• High salted products like pickles, pacpackaged foods, sauces, extra aadded
salt to be avoided
GESTATIONAL
DIABETES
S
• It is usually arises in the second half pregnancy
• The first step in treating gestational diabetes is to modify the diet to maintain the blood
sugar levels in normal range.
• To maintain the sugar levels in normal range,we need to monitor the carbohydrates in the
diet. Carbohydrates food digest and turn into blood glucose. Glucose in the blood is
necessary because it is the fuel for the body and nourishment for the body.
• Carbohydrates are found in foods like milk, yogurt,fruits, Juices,rice, grains,cereals, breads,
pulses,roots and tubers, sweets and dessert, soda, cookies, cakes
• It is important to focus on the quality of carbohydrates and encourage conconsumption of
vegetables, fruits, complex carbohydrates and high fibre foods.
• The combination of high pre pregnancy BMI and excessive weight gain during pregnancy
increases the risk of GDM, pre eclampsia, large for gestational age babies and
complications for both mother and new born at delivery.
• according to WHO report, high risk women who follow life style change interventions (diet
and exercise) reduce the riak of excessive gestational weight gain reducing the risk of
perinatal complications
• The do's and dont's of gestational diabetes
• Eat small meals
• never skip meals or avoid carbohydrates,
• include vegetables in adequate amounts, consume foods rich in protein, Re consider fat
intake,avoid refined cereals and sweetened foods, don't encourage fasting and feasting,
include physical activity.
 C A R D I O VA S C U L A R P R O B L E M S
• Prevalence of heart disease in pregnancy vary from 0.3 to 3.5%. In presence of maternal heart
disease, the circulatory changes of pregnancy Result in decomposition or death of mother or
foetus.
• Pre existing conditions that can predispose pregnant women to CVD include HTN,DM & congenital
heart disease
• Cardiac disease of pregnancy is a significant cause of morbidity & mortality between 1 to 4 % of all
pregnancies
• Pre eclampsia and eclampsia could contribute to myocardial infarction
• Certain features which would lead to consideration of cardiac disease include fatigue, SOB,
Dyspnea, orthopaedics, increasededema, light headed news, chest pain, syncope, personal or
familial history of heart disease
• Complications related to cardiac disease in pregnancy include excessive weight gain during
pregnancy, pre eclampsia, preterm birth, intra uterine growth restrrestriction , hemorrhage,
placental abruption, gestational diabetes, progressive heart failure, maternal/foetal death.
• A heart healthy lifestyle ( healthy diet, exercise and weight management) is recommended)
 HELLP Syndrome
HELLP Syndrome (hemolysis,elevated liver enzymes and
low platelets) is a life threatening pregnancy complications
usually considered to be a variant of pre eclampsia. Both
conditions usually occur during the later stages of
pregnancy or soon after child birth. Hellp Syndrome can
cause major complications which include seizures, stroke,
liver rupture, placental abruption
• Risk factors include age greater than 35, Obesity, history
of pre eclampsia, diabetes, renal disease, multiple births
and high blood pressure.
• Symptoms are feeling tired, retaining fluid, headache,
nausea, upper right abdominal pain, blurry vision, nose
bleeds and seizures.
 LACTATION
Hormones signal the mammary glands in your
body to start producing milk to feed the baby
Lactation is divided into 4 phases
• Preparation of breast(mammogenesis)
• Synthesis and secretion from breast alveoli
(lactigenlactigenesis)
• Ejection of milk (galactokinesis)
• Maintenance of Lactation (galactopoiesis)
 • A healthy mother produces 500 to 800ml milk/day to feed her infant with
about 500kcal/day
• Colostrum is the milk secreted during first 3 days after delivery. It is yellow
and thick contains more antibodies and cells and higher amounts of vitamins
A, D, E and K.
• The breast feeding mother should give adequate attention to her diet,
personal hygiene and health ;should have sufficient rest.
• Like in pregnancy, adequate nutrition of the mother during lactation is of vital
importance since the infant derives all the nutrition from the mothers milk.
• As mother has to nourisha fully developed and rapidly growing baby, she
needs extra nutrients to meet infants requirements. Any inadequacy in her
diet influencesboth quantity and quality of milk secreted.
• therefore it is important for the lactating mother to take adequate nutrients
so that she can't only nourish her child but also mamaintain her own
nutritional status.
 NUTRITIONAL
REREQUIREME
NTS FATS
CALCIUM
An intake of
ENERGY additional Important mineral
PROTEIN essential fatty required for
The lactating An additional
Mother needs acids is skeletal and foetal
amount of recommended to development; milk
an additional
16.8g/d meet needs and production. breast
550k.cals/day proteins during
during first 6 are important for milk contains 30mg
0 to 6 months & visual and calcium per 100ml.
months; 12g during 6 to
400k.cals cognitive So 1200mg
12 months development in calcium required
during next 6
months infancy during lactation

• Pregnancy uses up the iron stores. During breast feed you need to rebuild your iron stores with foods such as legumes,
nuts, whole grains, GLVS and meats
• Breast feeding increases the need of folate and other vitamins (spinach, cabbage and Sprouts)
• Vitamins C - citrus, berries and capsicum
• Vitamin D - dark colored vegetables and fruits
THANK YOU