PREGNANCY AND LACTATION
(under 3rd trimester)
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
demand
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.
Maternal Weight
1. Underweight
2. Overweight and obese
Underweight - high risk of having low-birth
wt. infants - higher rates of pre-term deaths
and infant deaths
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
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
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
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.
• 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 phosphorusto
calcify the fetal bones and teeth.
- inadequate calcium – calcium stored for
mother’s used will be provided to the baby
- fetus on the 1st trimester (2mos.) retain
calcium and phosphorus for about 65%
- full term fetus – 64%
- daily intake of calcium 0.5 (nonpregnant)
to 0.9 (pregnant
• 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
• 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
• Vitamin Allowances
- thiamine, niacin, riboflavin, Vitamin D,
calcium and phosphorus, ascorbic acid,
vitamin A, vitamin B6 are needed for the
developing fetus.
• 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
• Conditions that complicate the pregnancy:
- nausea
- vomiting
- improper body weight
- toxemia
- may influence the following:
* intake
* digestion
* absorption and utilization
- more serious on adolescents
- Rapid weight gain or loss
- Toxemia
- Anemia
- Diabetes
- Constipation
- Socio-economic and Cultural Factors
- Alcohol, Caffeine, Nicotine
• 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.
• Toxemia clinical manifestations
- rapid wt. gain
- edema
- high blood pressure
- excretion of albumin in the urine
- convulsions
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
2. Chronic hypertensive (vascular)
disease
- without superimposed acute toxemia
- with superimposed acute toxemia
• 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
• Diabetes
- prone to develop:
- pre-eclampsia
- pyelonephritis- inflammation of the kidney,
typically due to a bacterial infection
- polyhydramnios - presence of excess
amniotic fluid in the uterus
- higher risk of the baby to die in the uterus
or at birth
• 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
• 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.
• 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
• 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
• Repeated pregnancies - close interval
depletes the maternal reserves of nutrients •
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
• Calorie Allowances
• Protein Allowances
• Calcium, Phosphorus, and Vitamin D
Allowances
• Iron Allowances
• Vitamin Allowances
• 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
• Protein Allowances - an additional of
20.2 g protein for lactating mother
• Calcium, Phosphorus, and Vitamin D
Allowances
- calcium allowance – 1.0g daily for good
milk production
- phosphorus – adequate intake of protein
- vitamin D – 400 IU
• Iron Allowances
- during lactation the loss of iron is similar to
the loss during menstrual flow
- baby when born have adequate reserve of
iron
• Vitamin Allowances - increase demand
on: vitamin A, niacin, riboflavin, thiamin,
ascorbic acid
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)
Nutritional Requirements
• Calories
• Protein
• Calcium and Phosphorus
• Iron
• Vitamin A
• Vitamin B1
• Riboflavin, Vitamin C
• Fluids
• 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.
• 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
• 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
• Iron
- additional iron intake is recommended due
to blood loss during parturition (childbirth),
milk iron and basal losses.
• Vitamin A
- an additional of 2,000 IU to provide
adequate amount for milk production
- sources: green leafy and yellow
vegetables, milk, eggs, etc.
• 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.
• Riboflavin, Vitamin C - an additional
allowance is needed for milk production
• Fluids - take 8 glasses or more to
increase milk production
Food to avoid for a lactating mother
- Too much fried foods
- Pickles
- Highly seasoned food
- Stimulants (drugs, nicotine, caffeine,
theobromine, morphine and alcohol)
theobromine- a bitter, volatile compound
obtained from cacao seeds
Breastfeeding 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
• 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 - using contraceptives can decrease milk
• Beneficial to the mother flow and may lead to osteria (cessation of
- prevent breast cancer lactation)
- less incidence of thrombophlebitis - alcohol and nicotine from smoking can
- rapid return of uterus to its original size affect the quality of milk.
Factors Affecting Milk Secretion
• Diet
• Nutritional State of mothers
• Emotional and physical state
• Suckling
• Use of Contraceptives and drugs
• 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)
• 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
• 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
• Suckling
- stimulate milk production
- supply of milk increases if babies are feed
for longer period
• Use of Contraceptives and drugs