NUTRITION DURING

PREGNANCY, &
LACTATION

D. Ekhlass Saleh Ebead

Introduction
 Good nutrition during the 38 to 40 weeks of a normal
pregnancy is essential for both mother and child.
 The pregnant woman must provide nutrients and calories
for the fetus, the amniotic fluid, the placenta, and the
increased blood volume and breast, uterine, and fat tissue.
 woman who consumed a nutritious diet before pregnancy
is more apt to bear a healthy infant than one who did not.
 Malnutrition of the mother is believed to cause decreased
growth and mental retardation in the fetus.
 Low-birth-weight infants (less than 2.3kg ) have a higher
mortality (death) rate than those of normal birth weight.
WEIGHT GAIN DURING
PREGNANCY
 Weight gain during pregnancy is natural and necessary
for the infant to develop normally and the mother to
retain her health.
 The average weight gain during pregnancy is 5 to 7 kg.
 A pregnant adolescent who is still growing should gain
more weight than a mature woman of the same size.
 Women of average weight should avoid excessive
weight gain
 Underweight women should gain 6 to 8 kg.
NUTRITIONAL NEEDS DURING
PREGNANCY
 Some specific nutrient requirements are increased
dramatically during pregnancy, based on the client’s
nutritional status, age, and activities.
- protein requirement is increased. Proteins are
essential for tissue building, and protein-rich foods
are excellent sources of many other essential
nutrients, especially iron, copper, zinc, and the B
vitamins.
NUTRITIONAL NEEDS DURING
PREGNANCY………
- no need for increased vitamin A during pregnancy.
Excess vitamin A has been known to cause birth
defects such as hydrocephaly (enlargement of the
fluid-filled spaces of the brain), microcephaly (small
head), mental retardation, ear and eye abnormalities,
cleft lip and palate, and heart defects.
- The required amount of vitamin D is 10 g, vitamin E is
15 mg, vitamin K is 75 to 90 g depending upon age.
- water-soluble vitamins are increased during pregnancy.
- Additional vitamin C is needed to develop collagen and
to increase the absorption of iron.
 The B vitamins are needed in greater amounts because
of their roles in metabolism and the development of red
blood cells.
NUTRITIONAL NEEDS DURING
PREGNANCY…………
- Need for minerals calcium, iron, zinc, iodine, and
selenium are all increased
- Calcium is essential for the development of the
infant’s bones and teeth as well as for blood clotting
and muscle action.
- If the mother is not consuming adequate calcium in
her diet, the baby will get its calcium from her bones.
FULFILLMENT OF NUTRITIONAL
NEEDS DURING PREGNANCY
 To meet the nutritional requirements of pregnancy, the
woman should base her diet on healthy plan
 One of the best ways of providing these nutrients is by :
- drinking additional milk each day or using appropriate
substitutes.
- To be sure that the vitamin requirements of pregnancy
are met, vitamin supplement in addition to an iron
supplement should be prescribed.
 The unusual cravings for certain foods during
pregnancy do no harm unless eating them interferes
with the normal balanced diet or causes excessive
weight gain.
CONCERNS DURING
PREGNANCY
Nausea
 occurs during the first trimester of pregnancy. This
type of nausea is commonly known as morning
sickness, but it can occur at any time.
 Suggestions can help relieve
- Eat dry crackers or dry toast before rising.
- Eat small, frequent meals.
- Avoid foods with offensive odors.
- Avoid liquids at mealtime.
 If persists and becomes so severe is called
hyperemesis gravidarum. The mother may be
hospitalized and given parenteral nutrition.
CONCERNS DURING
PREGNANCY…
Constipation and hemorrhoids
- can be relieved by eating high-fiber foods,
- getting daily exercise,
- drinking at least 8 glasses of liquid each day, and
- responding immediately to the urge to defecate.
Heartburn
- result from relaxation of the cardiac sphincter and smooth muscles related to
progesterone.
- is a common complaint during pregnancy.
- As the fetus grows, it pushes on the mother’s stomach, which may cause
stomach acid to move into the lower esophagus and create a burning sensation
there.
Relieved by:
- eating small, frequent meals; avoiding spicy or greasy foods;
- avoiding liquids with meals;
- waiting at least an hour after eating before lying down; and waiting at least 2
hours before exercising.
CONCERNS DURING
PREGNANCY…
 Excessive Weight Gain
 the pregnant woman should reevaluate her diet and
eliminate foods (except for the extra pint of milk) that
cause weight gain
- drink fat-free milk
- substitute calcium pills in some cases
- vegetables such as broccoli or cauliflower tips, carrots,
celery, cucumber.
- Fruits and custards made with fat-free milk make
nutritious, satisfying desserts that are not high in
calories.
- Broiling, baking, or boiling foods instead of frying can
further reduce the caloric intake.
CONCERNS DURING
PREGNANCY…
 Pregnancy-induced hypertension (PIH)
- was formerly called toxemia or preeclampsia
- characterized by high blood pressure, the presence
of albumin in the urine (proteinuria), and edema.
- occurs more frequently in first-time pregnancies, in
multifetal pregnancies, in those women with morbid
obesity, and among pregnant women on inadequate
diets, especially protein-deficient diets.
- Pregnant adolescents have a higher rate of PIH than
do pregnant adults.
CONCERNS DURING
PREGNANCY…
 Pica
- is the craving for nonfood substances such as starch,
clay (soil), or ice.
- is most common among pregnant women.
- The consumption of soil should be highly discouraged.
Soil contains bacteria that would contaminate both
mother and fetus.
- Ingesting soil can lead to an intestinal blockage, and
substances in the soil would bind with minerals,
preventing absorption by the body and thus leading to
nutrient deficiencies.
- Eating laundry starch, in addition to a regular diet, will
add unneeded calories and carbohydrates.
CONCERNS DURING
PREGNANCY…
Anemia
- is a condition caused by an insufficiency of red blood cells, hemoglobin, or
blood volume.
- The patient receive insufficient oxygen from the blood and consequently
feels weak and tired, has a poor appetite, and appears pale.
- Iron deficiency is its most common form. During pregnancy, the increased
volume of blood creates the need for additional iron.
- When this need is not met by the diet or by the iron stores in the mother’s
body, iron deficiency anemia develops.
- This may be treated with a daily iron supplement.
- Folate deficiency can result in a form of megaloblastic anemia that can
occur during pregnancy.
- It is characterized by too few red blood cells and by large immature red blood
cells.
- The body’s requirement for folic acid increases dramatically when new red
blood cells are being formed. Consequently, the obstetrician might prescribe
a folate supplement of 400 to 600 g a day during pregnancy.
CONCERNS DURING
PREGNANCY…
 Caffeine is known to cross the placenta, and it enters
the fetal bloodstream.
- Birth defects if large doses consumed
- it is suggested that pregnant women limit their
caffeine intake to 2 cups of caffeine-containing
beverages each day, or less than 300 mg/day.
CONCERNS DURING
PREGNANCY…
 Tobacco risks include:
- Reduced birth weight. The more the mother smokes,
the smaller her baby will be because smoking
reduces the oxygen and nutrients carried by the
blood.
- SIDS (sudden infant death syndrome), fetal death,
spontaneous abortion, and complications at birth.
- affect the intellectual and behavioral development of
the baby as it grows up.
- it is advisable that pregnant women avoid them.
DIET FOR THE PREGNANT
WOMAN
WITH DIABETES
Diabetes mellitus is a group of diseases in which one cannot use or
store glucose normally because of inadequate production or use of
insulin. This impaired metabolism causes glucose to accumulate in the
blood, where it causes numerous problems if not controlled.
Some women have diabetes when they become pregnant. Others may
develop gestational diabetes during pregnancy. In most cases, this
latter type disappears after the infant is born; however, there is a 40%
increased risk of developing type 2 diabetes later in life
Either type increases the risks of physical or mental defects in the
infant, stillbirth, and macrosomia (birth weight over 9 pounds unless
blood glucose levels are carefully monitored and maintained within
normal limits.
Every pregnant woman should be tested for diabetes between 16 and
28 weeks of gestation. Those found to have the disease must learn to
monitor their diets to maintain normal blood glucose levels and to avoid
both hypoglycemia and hyperglycemia.
DIET FOR THE PREGNANT
WOMAN
WITH DIABETES….
 In general, the nutrient requirements of the pregnant
woman with diabetes are the same as for the normal
pregnant woman. The diet should be planned with a
registered dietitian or a certified diabetes educator
because it will depend on the type of insulin and the
time and number of injections.
 Clients with gestational diabetes and diabetic clients
who do not normally require insulin to control their
diabetes may require insulin during pregnancy to
control blood glucose levels.
LACTATION

 Lactation, the production and secretion of breast milk for

the purpose of nourishing an infant, is facilitated
Oxytocin and prolactin. Prolactin is responsible for milk
production, and oxytocin is involved in milk ejection from
the breast.
 It will take 2 to 3 weeks to fully establish a feeding
routine; therefore, it is recommended that no
supplemental feedings be given during this time.
 Human milk is formulated to meet the nutrient needs of
infants for the first 6 months of life. Iron content in breast
milk is very low, but it is very well absorbed; there fore ,
no iron supplement is needed for breastfed babies.
Calorie Requirements during
Lactation
- The mother’s calorie requirement increases during
lactation.
- The caloric requirement depends on the amount of milk
produced.
- Approximately 85 calories are required to produce 100
mlof milk.
- During the first 6 months, average daily milk production is
750 ml, and for this the mother requires approximately an
extra 640 calories a day.
 During the second 6 months, when the baby begins to eat
food in addition to breast milk, average daily milk
production slows to 600 ml, and the caloric requirement
is reduced to approximately 510 extra calories a day.
Lactation

 In general, most nutrient requirements are increased during

lactation. The amounts depend on the age of the mother.
 Protein is of particular importance because it is estimated that
10 grams of protein are secreted in the milk each day.
 sufficient fruits and vegetables, especially those rich in vitamin
C.
 Extra fat-free milk will provide many of the additional nutrients
and calories required during lactation. Chips, sodas, candies,
and desserts provide little more than calories.
 sufficient fluids to replace those lost in the infant’s milk. Water
and real fruit juice are the best choices.
 The mother must reduce her caloric intake at the end of the
nursing period to avoid adding unwanted weight
Medicines, Caffeine, Alcohol,
and Tobacco
- Most chemicals enter the mother’s milk, so it is
essential that the mother check with her obstetrician
before using any medicines or nutritional
supplements.
- Caffeine can cause the infant to be irritable.
- Alcohol in excess, tobacco, and illegal drugs can be
very harmful.
- The biggest concern is addiction of the mother and
baby.