PREGNANCY

AND LACTATION
Pregnancy or Gestation
 Pregnancy or Gestation
- The period when the fertilized ovum implants itself
in the uterus, undergoes differentiation and
grows until it can support extra-uterine life
- The whole pregnancy period 266 to 280 days
(37-40 weeks)
- Consist of 3 trimester (1st, 2nd, 3rd)
- Phases: implantation, organogenesis and
growth
 Nutritional Objectives
• Ensure optimum nutrition before, during and after
pregnancy and during lactation
• Provide adequate nutrition to meet increased
maternal and fetal nutrient demands
 Nutrition in Pregnancy
• Calorie allowances
• Weight gain
• Maternal weight
• Protein allowances
• Calcium allowances
• Iron allowances
• Iodine allowances
• Vitamin allowances
 Calorie allowances

- 80,000 kcal – the total energy cost of storage +

maintenance (work for maternal heart and
uterus and a steady rise in basal metabolism)
- 300 kcal/day - energy cost of pregnancy
- 36 kcal/kg – energy intake per kg/day
 Weight gain
* 1st trimester – small wt. gain
*2nd trimester – rapid wt. gain
* 3rd trimester – slower wt. gain
* 24 lbs – average wt. gain during
pregnancy
- * 1.5lbs to 3.0lbs wt. gain during 1st trimester
then a gain of 0.8lb per week thereafter
* sudden wt. gain after 20th week – indicate
water retention and possible onset of
pre-eclampsia.
• (refer to page 198, table 50 for maternal wt. gain)
 Maternal Weight
1. Underweight
2. Overweight and obese
 Maternal Weight
Underweight
- high risk of having low-birth wt. infants
- higher rates of pre-term deaths and infant
deaths
 Maternal Weight
Overweight and obese
a. High risk of complications like hypertension,
gestational diabetes, and postpartum infections
b. Complications of labor and delivery
c. Increases likelihood of a difficult labor and
delivery, birth trauma and cesarean
section for large babies
d. Doubled risk of neural tube defects
(refer to page 199, table 51 for recommended wt. gain during pregnancy)
 Protein Allowances
- 9.5g/day or 900 to 950 g – recommended protein
needs for a normal pregnant for the 9 mos.
gestation period
- pregnant adolescent – should receive:
59g for ages 16-19 (non pregnant)
14g/day (pregnant)
73g - total
 Protein Allowances
Reason for additional protein:
1. To provide for the storage of nitrogen,
2. To protect the other against many of the
complications of pregnancy,
3. For the growth of the woman’s uterus,
placenta and associated tissues,
4. To meet the needs for the fetal growth and
repair,
5. For the growth of the mammary tissues,
6. For the hormonal preparation for lactation.
 Protein Allowances
Sources:
- meat - eggs
- milk - cheese
- poultry - fish
 Nutritional needs during
pregnancy:
- The normal requirements of the mother
- Those of the developing fetus (including the uterus
and placenta)
- Building up reserves in the preparation for
the and lactation
Nutritional needs during
pregnancy:
 Nutritional needs during
pregnancy:
• Calcium Allowances
- calcium and phosphorus are deposited early in
pregnancy in small amount.
- adequate supply of vitamin D is essential in
the use of calcium and phosphorus to
calcify the fetal bones and teeth.
- inadequate calcium – calcium stored for
mother’s used will be provided to the
baby
 Nutritional needs during
pregnancy:
• Calcium Allowances
- fetus on the 1st trimester (2mos.) retain calcium
and phosphorus for about 65%
- full term fetus – 64%
- daily intake of calcium 0.5 (non-
pregnant) to 0.9 (pregnant)
 Nutritional needs during
pregnancy:
Iron allowances
- 700 to 1,000 mg of iron must be absorbed and
utilized by the mother throughout her
pregnancy
- 3rd trimester increases the need for iron
for the fetus
 Nutritional needs during
pregnancy:
Iodine Allowances
- important during pregnancy
- inadequate intake may result in goiter for the
mother or the child.
- advise regular use of iodized salt in food
 Nutritional needs during
pregnancy:
Vitamin Allowances
- thiamine, niacin, riboflavin, Vitamin D, calcium
and phosphorus, ascorbic acid, vitamin A,
vitamin B6 are needed for the developing
fetus.
 Nutritional needs during
pregnancy:
Food Allowances
- 1oz or 30g 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 and
yellow vegetables; and fresh and dried
fruits
- Liver at least once a week
- Fortified milk with vitamin D or fish liver oil
- Six to 8 glasses of water daily
 COMPLICATIONS OF
PREGNANCY AND POSSIBLE
DIETARY MODIFICATIONS
 COMPLICATIONS OF PREGNANCY AND
POSSIBLE DIETARY MODIFICATIONS

• Conditions that complicate the pregnancy:

- nausea
- vomiting
- improper body weight
- toxemia
- may influence the following:
* intake
* digestion
* absorption and utilization
- more serious on adolescents
 COMPLICATIONS OF PREGNANCY AND
POSSIBLE DIETARY MODIFICATIONS

- Rapid weight gain or loss

- Toxemia
- Anemia
- Diabetes
- Constipation
- Socio-economic and Cultural Factors
- Alcohol, Caffeine, Nicotine
 COMPLICATIONS OF PREGNANCY AND
POSSIBLE DIETARY MODIFICATIONS

• Rapid weight gain or loss

- eating for two – may lead to overweight,
toxemia, difficult labor, large sickly baby
- sudden increase in weight after 20th
week may suspect fld. retention that
serves as a warning sign for impending
eclampsia.
 COMPLICATIONS OF PREGNANCY AND
POSSIBLE DIETARY MODIFICATIONS

• Toxemia
clinical manifestations
- rapid wt. gain
- edema
- high blood pressure
- excretion of albumin in the urine
- convulsions
 COMPLICATIONS OF PREGNANCY AND
POSSIBLE DIETARY MODIFICATIONS

Classifications
1. Acute toxemia: onset after 24th week
- pre-eclampsia – hypertension with
proteinuria and/or edema
- eclampsia – convulsions or coma; usually
both when associated with
hypertension, proteinuria and edema
 COMPLICATIONS OF PREGNANCY AND
POSSIBLE DIETARY MODIFICATIONS

Classifications
2. Chronic hypertensive (vascular) disease
- without superimposed acute toxemia
- with superimposed acute toxemia
 COMPLICATIONS OF PREGNANCY AND
POSSIBLE DIETARY MODIFICATIONS

• Anemia
- combined deficiency of iron and folic
acid
- increases chances of premature birth
- can no longer be corrected during this
period
- enhance absorption thru ascorbic acid
rich foods and foods rich in iron
 COMPLICATIONS OF PREGNANCY AND
POSSIBLE DIETARY MODIFICATIONS

• Diabetes
- prone to develop:
- pre-eclampsia
- pyelonephritis - inflammation of the
kidney, typically due to a bacterial
infection
- polyhydramios - presence of excess
amniotic fluid in the uterus
- higher risk of the baby to die in the
uterus or at birth
 COMPLICATIONS OF PREGNANCY AND
POSSIBLE DIETARY MODIFICATIONS

• Constipation
- caused by:
- pressure exerted in the developing
fetus on the digestive tract
- lack of exercise
- insufficient bulk in the diet
- intervention: - fresh fruits,
- vegetables,
- fluids and regular exercise
 COMPLICATIONS OF PREGNANCY AND
POSSIBLE DIETARY MODIFICATIONS

• Socio-economic and Cultural Factors

- big families with low economic status
may have difficulty in complying with
nutritional needs of a pregnant mother.

- eating habit is also affected as well as the

choice of food to eat.
 COMPLICATIONS OF PREGNANCY AND
POSSIBLE DIETARY MODIFICATIONS

• Alcohol, Caffeine, Nicotine

- smoking – can lower the mean birth weight
of the baby
- increases the risk of perinatal
mortality
- alcohol ingestion may lead to Fetal Alcohol
Syndrome (FAS)
- may develop: CNS disorders, mental
retardation, growth deficiencies,
and facial deformities.
Mother’s age and
associated
health concerns
and risks
 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
 Mother’s age and associated health
concerns and risks

• Pregnancy in older women

a. Hypertension and diabetes
b. Higher rates of premature births and low birth
weight
c. Birth defects
d. Fetal death
 Mother’s age and associated health
concerns and risks

• Repeated pregnancies
- close interval depletes the maternal reserves
of nutrients

(refer to page 208, table 52 for the dietary guide for a pregnant/lactating
woman)
Lactation
Lactation
• Lactation
- the preparation for assuring adequate supply
of good quality breast milk – begins during
pregnancy
- increase dietary essentials such as:
- calories, protein, calcium, vitamin A,
thiamin, roboflavin, niacin and
ascorbic acid
Nutrition in
lactation
Nutrition in lactation
• Calorie Allowances
• Protein Allowances
• Calcium, Phosphorus, and Vitamin D Allowances
• Iron Allowances
• Vitamin Allowances
Nutrition in lactation
• Calorie Allowances
- no accurate food requirement – it depends on
the demands of the infant.
- suggested – 700 to 1,500 calories of food
for 500 to 1,000 ml of milk
- FNRI – an increase by 1,000 calories above
the normal requirement in an average milk
production of 850ml – energy value (600
calories)
- human milk – 0.70 calories/ml or 20 calories
/oz – contains 1.2 g protein per 100ml
Nutrition in lactation
• Protein Allowances
- an additional of 20.2 g protein for lactating
mother
Nutrition in lactation
• Calcium, Phosphorus, and Vitamin D Allowances
- calcium allowance – 1.0g daily for good milk
production
- phosphorus – adequate intake of protein
- vitamin D – 400 IU
Nutrition in lactation
• Iron Allowances
- during lactation the loss of iron is similar to the
loss during menstrual flow
- baby when born have adequate reserve of
iron
Nutrition in lactation
• Vitamin Allowances
- increase demand on: vitamin A, niacin,
riboflavin, thiamin, ascorbic acid
Food needs in
lactation
Food needs in lactation
• Mother’s milk
- the best food for the baby
- easily digested
- economical
- has the right temperature
- free from harmful bacteria
- contains colostrum (has high protein content,
acts as laxative, contains antibodies that help resist
infection)
Food needs in lactation
Nutritional Requirements
• Calories
• Protein
• Calcium and Phosphorus
• Iron
• Vitamin A
• Vitamin B1
• Riboflavin, Vitamin C
• Fluids
Food needs in lactation
• Calories
- an additional of 1,000 calories from the normal
(300-400 bf, 700 lunch, 700 dinner)
- 120 calories is required to produce 100ml of
milk thus if daily milk production of
850 it requires 1000 calories in the
diet.
- energy giving food are good source of calories.
Food needs in lactation
• Protein
- additional of 20g to the normal allowance
- 2g of food protein required to produce 1g of milk
protein (conversion of milk to protein is only
50% efficient)
- sources: milk, eggs, animal proteins and
legumes
Food needs in lactation
• Calcium and Phosphorus
- an increase of 0.5mg needed to prevent severe
depletion of maternal calcium reserve being
used for milk production
- sources: milk and milk products, eggs,
etc.
Food needs in lactation
• Iron
- additional iron intake is recommended due to
blood loss during parturition (childbirth), milk
iron and basal losses.
Food needs in lactation
• Vitamin A
- an additional of 2,000 IU to provide
adequate amount for milk production
- sources: green leafy and yellow
vegetables, milk, eggs, etc.
Food needs in lactation
• Vitamin B1
- additional allowance is needed
- diet with very low thiamin may secrete toxic
substance called glyoxaline – it is
associated with infantile beriberi
- sources: unpolished rice, legumes,
vegetables, milk, etc.
Food needs in lactation
• Riboflavin, Vitamin C
- an additional allowance is needed for milk
production
Food needs in lactation
• Fluids
- take 8 glasses or more to increase milk
production
Food needs in lactation
Food to avoid for a lactating mother
- Too much fried foods
- Pickles
- Highly seasoned food
- Stimulants (drugs, nicotine, caffeine, theobromine,
morphine and alcohol)
a bitter, volatile
compound obtained
from cacao seeds
(Refer to page 213 for dietary allowance for lactating mother’s)
Breast Feeding
Misconception
Breast Feeding Misconception

• A mother with TB 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.
Advantages of
Breastfeeding
Advantages of Breastfeeding

• Provides passive antibody (immunity of the baby to

some children’s diseases)
• Higher in lactose than in cow’s milk
• Easy regulation of calcium and phosphorus
• Prevents dental defects/malformation
• Protects from allergies
• Beneficial to the mother
- prevent breast cancer
- less incidence of thrombophlebitis
- rapid return of uterus to its original size
Factors Affecting
Milk Secretion
 Factors Affecting Milk
Secretion
• Diet
• Nutritional State of mothers
• Emotional and physical state
• Suckling
• Use of Contraceptives and drugs
 Factors Affecting Milk
Secretion
• Diet
- galactagogues(a food or drug that promotes or
increases the flow of a mother's milk.)
- meat and vegetable soups (tahong, tulya, malunggay),
milk and fruit juices
- drink water regularly and occasionally (do
not wait to feel thirsty to drink water, it
suppresses milk secretion)
 Factors Affecting Milk
Secretion
• Nutritional State of mothers
- sufficient nutrients must be provided to the
mother
- quality and quantity of milk flow is affected
due to these diseases:
- malnutrition
- cardiac and kidney diseases
- anemia - beriberi
- TB - infections
 Factors Affecting Milk
Secretion
• Emotional and physical state
- worries can affect milk production
- to enhance milk secretion, surrounding must be:
- pleasant
- relax
- conducive to rest
- conducive to good sleep
 Factors Affecting Milk
Secretion
• Suckling
- stimulate milk production
- supply of milk increases if babies are feed for
longer period
 Factors Affecting Milk
Secretion
• Use of Contraceptives and drugs
- using contraceptives can decrease milk flow and
may lead to osteria (cessation of lactation)
- alcohol and nicotine from smoking can
affects the quality of milk