Nutrition Disease & Health Promotion 2014 David Smith L00090777

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Nutritional needs of a pregnant woman and also a lactating woman

TABLE OF CONTENTS:..1.

1.0 INTRODUCTION2.
2.0 NUTRITIONAL NEEDS FOR PREGNANT WOMAN...2.
2.1 Energy Intake during Pregnancy..2.
2.2 Total Dietary Fat Intake during Pregnancy..3.
2.3 Vitamin D Intake during Pregnancy..3.
2.4 Calcium Intake during Pregnancy3.
2.5 Iron Intakes during Pregnancy..3.
2.6 Vitamin A Intake during Pregnancy..4.
2.7 Fibre intake during Pregnancy..4.
2.8 Folate Intake during Pregnancy4.
2.9 Tabulated Dietary Reference Intakes for pregnant and lactating women
in comparison with those of adult, non-reproducing women.5.
3.0 NUTRITIONAL NEEDS FOR LACTATING WOMAN6.
3.1 Energy intake during lactation..6.
3.2 Fat intake during lactation.6.
3.3 Iron intake during lactation6.
3.4 Calcium intake during lactation.6.
3.5 Vitamin D intake during lactation..7.
4.0 CONCLUSION7.
5.0 REFERNECES...8.

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1.0 INTRODUCTION:

During pregnancy, maternal nutrition is a critical factor which can impact the infants health
directly during development, as well as having an influence on health in later years. The
mothers diet during pregnancy is also important to protect her own health and to preserve her
nutrient stores, and so help her care for her infant after the birth. Generally, healthy eating
guidelines are largely the same as for women of childbearing age, however, the requirements
for key nutrients such as iron and folate, as well as certain LC omega-3 fatty acids increases
during pregnancy. It is important that these and other essential nutrients such as calcium and
vitamin D, are present in the diet in adequate amounts to ensure optimal growth and
development of the foetus, as well as protecting the health of the mother. Maintenance of a
healthy body weight, in addition to the avoidance of harmful lifestyle factors such as alcohol
and smoking, also contributes to a good pregnancy outcome. (FSAI, 2011)

During lactation, from the twenty-fourth week of pregnancy (the second and third trimesters),
a woman's body produces hormones that stimulate the growth of the milk duct system in the
breasts. Nutrient needs during lactation depend primarily on the volume and composition of
milk produced and on the mother's initial nutrient needs and nutritional status. Among women
exclusively breastfeeding their infants, the energy demands of lactation exceed pre-pregnancy
demands by approximately 640 kcal/day during the first 6 months post-partum compared with
300 kcal/day during the last two trimesters of pregnancy . In contrast, the demand for some
nutrients, such as iron, is considerably less during lactation than during pregnancy.(IOM,
1991)

2.0 NUTRITIONAL NEEDS FOR PREGNANT WOMAN
2.1 Energy Intake during Pregnancy
Energy needs during pregnancy are currently estimated to be the sum of total energy
expenditure of a non-pregnant woman plus the median change in total energy expenditure of
8 kcal/gestational week plus the energy deposition during pregnancy of 180 kcal/d. Because
total energy expenditure does not change greatly and weight gain is minimal in the first
trimester, additional energy intake is recommended only in the second and third trimesters.
Approximately an additional 340 and 450 kcal are recommended during the second and third
trimesters, respectively. (Picciano, 2003)
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2.2 Total Dietary Fat Intake during Pregnancy
As well as being an important energy source, fats in the diet also deliver several fat soluble
vitamins including vitamin A, D, E, and K. There is no official recommendation for fat intake
during pregnancy, but it is known that an adequate intake of long n-3 polyunsaturated fatty
acids (PUFAs) is necessary to ensure optimum neutral growth and development of the foetus.
High fat diets are generally not suitable during pregnancy as they can increase the potential
to gain excessive amounts of weight, which may negatively affect pregnancy outcomes. Small
amounts of certain fats are required in pregnancy and at all life stages and are necessary for
good health.
2.3 Vitamin D Intake during Pregnancy
Vitamin D is particularly important for healthy bones. Vitamin D status during pregnancy will
affect the bone development of babies. Human skin produces vitamin D when it is exposed to
sunlight, but the sun in the Ireland is only strong enough in the summer months (April to
September). So in the winter months, the main source of vitamin D is through food. However,
food sources are limited; sources include oily fish, spreads and eggs. It is recommended in
order to receive enough vitamin D, pregnant woman should take a daily supplement containing
10 g of vitamin D. (B.N.F, 2013)
2.4 Calcium Intake during Pregnancy
A baby at birth contains 25-30g of calcium, most of which is laid down in the last 10 weeks of
pregnancy. There is a consensus that the concentration of maternal free (biologically active)
1,25 dihydroxy vitamin D3

is raised during pregnancy, increasing net calcium absorption.
Hence the increased requirement for calcium during pregnancy may or may not be met entirely
from increase absorption. No additional increment is made to the current RNI for calcium for
adult women (700mg/day for women aged 19-50 years and 800 mg/day for those aged 15-18
years). (Ross, Taylor, Yaktine, & Del Valle, 2011)
2.5 Iron Intakes during Pregnancy
Iron is essential during pregnancy to support the growth of the foetus. In addition to other
adaptations which occur in iron absorption during pregnancy, the increased requirement for
iron is offset by the absence of menstrual losses, resulting in a net iron requirement of
15g/day during pregnancy. In women who being pregnancy with adequate amounts of iron,
these adaptions will be satisfactory but if a women has low levels of iron at the beginning they
can develop anaemia. Anaemia is associated with adverse pregnancy outcomes which
include pre-term birth and low birth weight, as well as maternal mortality and morbidity (WHO,
2001). Doctors may advise some women to take extra iron in the form of a prescribed
supplement.
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2.6 Vitamin A Intake during Pregnancy
Vitamin A belongs to a group of fat soluble vitamins provided by the diet and is an essential
micronutrient which plays a role in many biological processes. The recommended daily
allowance (RDA) for vitamin A during pregnancy in Ireland is 700g/day retinol activity
equivalent. High doses (>5000 IU/day) have not been associated with increased risk of
malformations. Vitamin A supplementation has been shown to improve birth weight and growth
among infants born to HIV-infected pregnant women, possibly due to the enhancement of
immunity. Vitamin A supplementation may thus be beneficial in high-risk pregnancies, but
otherwise pregnant women should avoid excess supplementation with vitamin A. Considering
this, pregnant women should be advised to avoid very rich sources food sources of vitamin A
such as liver and liver products. Due to the risk of vitamin A toxicity. (Hovdenak & Haram,
2012)
2.7 Fibre intake during Pregnancy
Fibre is important during pregnancy and can help to prevent constipation, as well as helping
to maintain a healthy body weight. Pregnant women should be advised to consume whole
grains, in addition to five servings of fruit and vegetables daily, in line with healthy eating
guidelines for women in Ireland. (F.S.A.I, 2011)
2.8 Folate Intake during Pregnancy
Folate is a water-soluble B vitamin that plays a major co-enzymatic role in carbon metabolism
and in the synthesis of DNA, RNA and certain amino acids. Deficiency may lead to congenital
malformations (neural tube damage, orofacial clefts, cardial anomalies), anaemia and certain
complications during pregnancy (spontaneous abortions, bleeding, pre-eclampsia, IUGR and
abruptio placentae) (Black, 2001). Low folate status may also cause hyperhomocystemia,
hypercoagulability and venous thrombosis.
To reduce risk of congenital malformations and pregnancy complications a daily supplemental
dose of 400 g/day of folate is recommended when planning pregnancy. Increased risk of fetal
neural tube defects is seen in several conditions: obesity, personal or family history of neural
tube defects, pregestational diabetes, and epilepsy. A higher dose (5 mg) is recommended in
these situations (Talaulikar & Arulkumaran, 2011).



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2.9 Tabulated Dietary Reference Intakes for pregnant and lactating women in
comparison with those of adult, non-reproducing women

Nutrient
Dietary Reference Intakes (DRI)
Adult women Pregnancy Lactation


Energy, kcal

1950 y
340 kcal/d 2nd
trimester
452 kcal/d 3rd
trimester

500 kcal/d 06 mo 400
kcal/d 79 mo
Protein, g 46 71 71
Vitamin C, mg 75 85 120
Thiamin,

mg 1.1 1.4 1.4
Riboflavin,

mg 1.1 1.4 1.6
Niacin,

ng NE 14 18 17
Vitamin B-6,

mg 1.3 1.9 2
Folate, g DFE 400 600 500
Vitamin B-12, g 2.4 2.6 2.8
Pantothenic acid,
,
mg 5 6 7
Biotin,

g 30 30 35
Choline, mg 425 450 550
Vitamin A,

g RE 700 770 1300
Vitamin D,

g 5 5 5
Vitamin E, mg -TE 15 15 19
Vitamin K,

g 90 90 90
Calcium,

mg 1000 1000 1000
Phosphorus,

mg 700 700 700
Magnesium, mg 310 350 310
Iron,

mg 18 27 9
Zinc,

mg 8 11 12
Iodine,

g 150 220 290
Selenium,

g 55 60 70
Fluoride,

mg 3 3 3
(Picciano, 2003)




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3.0 NUTRITIONAL NEEDS FOR LACTATING WOMAN
3.1 Energy intake during lactation
The recommended energy intake during the first 6 months of lactation is an additional 500
kcal under the assumption that 170 kcal/d will be mobilized from energy stores accumulated
in pregnancy. The energy demands of comparable periods of full lactation (780 mL/d) greatly
exceed those of pregnancy. The recommended energy intake after 6 months is reduced to an
additional 400 kcal/d because milk production rates decrease to 600 mL/d. (Picciano, 2003)
3.2 Fat intake during lactation
Fats in human milk are of critical importance during infancy, and are a major energy source
present in breast milk, helping to support the rapid growth and development which is occurring
at this time. In recent years, the importance of long chain polyunsaturated fatty acids (PUFA),
particularly Docosahexaenoic acid (DHA), has been increasingly recognised. Long chain
omega-3 PUFA such as DHA are important to protect the health of the mother and may be
involved in the brain and eye development of infants. Mothers should eat 1 to 2 portions of oily
fish weekly whilst breastfeeding. It has been recommended that breastfeeding women should
aim to consume 200mg DHA per day (Koletzko, Cetin, & Brenna, 2007).
3.3 Iron intake during lactation
There is no additional requirement of iron during lactation. The baby is born with enough
reserves since milk is not a good source of this nutrient. The additional iron in the mother's
diet during lactation does not pass on to the infant but iron-rich foods are important for mother's
health and the recommendations are same as those for an adult woman. Unless there was
excessive blood loss at delivery, the total demand for iron during lactation is reduced while the
woman is still amenorrheic compared with the demand when the woman is nonpregnant and
nonlactating (IOM, 1991).
3.4 Calcium intake during lactation
Calcium is one of the important minerals required both during pregnancy and lactation. During
pregnancy, it is required for the fetal skeletal development and during lactation, calcium is very
essential for milk production. Breast milk contains about 30 mg calcium per 100 ml. Based on
the optimal output of 850ml of milk, the total calcium secreted through milk is 300 mg/day.
Therefore, an additional intake of calcium is essential to enable the secretion of 300 mg of
extra calcium daily. Considering the mothers own needs and the calcium required for milk
production, 1000mg per day calcium is required during this period.
At least 500 ml milk or milk products per day must be taken to meet the calcium requirement
and the remaining requirements should be met from other food stuffs (Medindia, 2014)
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3.5 Vitamin D intake during lactation
Breastfeeding women are advised to include vitamin D rich foods in their diet to meet normal
Daily Recommendations for Vitamin D. A supplement of vitamin D (5-10 g/d) is
recommended for women who avoid milk and other foods fortified with vitamin D.

4.0 CONCLUSION
It is important for woman to follow the advice to follow all nutritional advice during pregnancy
and lactation for a healthy pregnancy and nutritional birth milk. Doctors may advise some
women to take extra nutrients in the form of a prescribed supplement. Pregnant women may
need more calories in the third trimester than usual. This is best provided by including just 1-
2 extra servings each day from either the fruit and vegetable or the dairy or the bread, potatoes
and cereal food groups.
Fish is an important source of many essential nutrients, and should be eaten as part of a
healthy, balanced diet. Oily fish, e.g. salmon, sardines, herring and mackerel, provide special
fatty acids (long chain omega-3 fatty acids) which are important during pregnancy for eye and
brain development in the baby. Women should try to include 2 servings of fish per week oily
if possible. However, certain types of fish need to be avoided because they contain
contaminants such as mercury which may be harmful to the developing baby. For this reason,
pregnant women should avoid eating large predatory fish such as marlin, shark and ray. Fresh
or tinned tuna may also be higher in mercury than other fish, and so pregnant women should
not consume more than 1 serving of fresh tuna weekly, and not greater than two cans (2
240g) of tinned tuna per week.
Caffeine in the mothers diet can reach the baby and may be harmful. High caffeine intakes
during pregnancy are not advisable, and mothers should aim to keep their caffeine intake
below 200mg of caffeine per day. Alcohol consumption as well as Smoking during pregnancy
is not recommended, as is advised to not be carried out.
Other nutritional recommendations to prevent potentially harmful foodborne illnesses include:
Avoid unpasteurised milk and any cheese or yoghurts made with unpasteurised milks
Avoid cheeses which have been ripened by mould, e.g. Camembert, Danish Blue
Avoid eating deli meats and deli salads, and pre-packed salads and coleslaws
Avoid smoked fish such as smoked salmon, pre-cooked ready-to-eat meats, cured and
smoked meats, e.g. salami
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It is important during breastfeeding that women have a good diet and to limit consumption of
alcohol and stimulants. A vitamin D supplement containing 5g per day, and a folic acid
supplement containing 400g per day should be taken. Breastfeeding mothers may also need
extra calories, and so, as for pregnancy, this is best provided as an extra 1-2 Recommended
Servings each day, in the form of extra bread or cereal or fruit or milk or yoghurt. Plenty of
water is needed as breastfeeding can make a woman very thirsty. (FSAI, 2011)

5.0 REFERENCES
B.N.F. (2013). Life Cycles: Pregnancy. British Nutrition Fountation, 1.
Black, R. E. (2001). Micronutrients in pregnancy. Br J Nutr, 85 Suppl 2, S193-197.
F.S.A.I. (2011). Scientific Recommendations for a National Infant Feeding Policy Food
Safety Authority of Ireland(2).
FSAI. (2011). Scientific Recommendations for Healthy Eating Guidelines in Ireland
(Vol. 1). Abbey Court, Lower Abbey Street, Dublin 1.
Hovdenak, N., & Haram, K. (2012). Influence of mineral and vitamin supplements on
pregnancy outcome. European Journal of Obstetrics & Gynecology and Reproductive
Biology, 164(2), 127-132.
IOM. (1991). Nutrition During Lactation. Institute of Medicine: National Academies
Press.
Koletzko, B., Cetin, I., & Brenna, J. T. (2007). Dietary fat intakes for pregnant and
lactating women. Br J Nutr, 98(5), 873-877.
Medindia (2014). Nutrient Needs in Lactation.
http://www.medindia.net/patients/lifestyleandwellness/nutrient-needs-in-lactation.htm
Picciano, M. F. (2003). Pregnancy and Lactation: Physiological Adjustments,
Nutritional Requirements and the Role of Dietary Supplements.
Ross, A. C., Taylor, C. L., Yaktine, A. L., & Del Valle, H. B. (2011). Dietary Reference
Intakes for Calcium and Vitamin D: National Academies Press.
Talaulikar, V. S., & Arulkumaran, S. (2011). Folic acid in obstetric practice: a review.
Obstet Gynecol Surv, 66(4), 240-247.
WHO. (2001). Iron Deficiency Anaemia: Assessment, Prevention and Control (1 ed.):
World Health Organisation.