Maternal Nutrition - Eldc

Maternal Nutrition in Lactation

Diet and Dietary Supplements for Mother and Infant Lactation - physiologic completion of reproductive cycle Body Preparation  Breast development  produce milk  Store more nutrients and energy

General Rule Diet of lactating woman should supply somewhat more of each nutrient than the recommended for the nonpregnant woman

Kilo-Calories

 N 75 Kcal /10 ml (average) = caloric content of HM in well nourished woman  Fat chief source  Lactose contribute to  Protein total Body Fat  During Pregnancy (change fat cell size)

During Lactation

Energy in Breastmilk 800 ml milk per day contains 560 kcal Add 25% energy to make milk = 700 kcal 200 kcal from pregnancy stores 500 kcal from diet

Sufficient caloric intake Eat many different foods to get the calories,vitamins and minerals you need to remain healthy. Minimal caloric intake of 2000 cal/ day an optimal intake of 500 cal above nonpregnant caloric intake It is equivalent to a PEANUT BUTTER sandwich and a glass of milk.

Example of extra food needed each day by a breastfeeding woman 60 g rice (1 fistful)

240 kcal,protein,B vit

30g beans (1/2 fistful) 120 Kcal,protein,iron, calcium Vegetables (1 fistful)

protein,Cal,Vit A, folic acid

Half banana

90 kcal,iron

5 ml oil (1 tsp)

50 kcal UNICEF

DIET

DIET

+ STORES

Maintenance & Activity Milk Losses in Milk Production

BODY STORES

ENERGY UTILIZATION IN LACTATION

Volume Volume Produced Varies Decreased  10% dehydrated  malnutrition  famine  supply dwindles  ceases

Protein Normal 0.8 – 0.9 g/ 100 ml

Fat and Cholesterol  FAT  main source of calories in HM  Triglycerides (98%) – affected by maternal diets Low cholesterol diets = maternal blood cholesterol but not the triglyceride levels in HM

Lactose Least affected by maternal diet Water Drink to relieve thirst only Excessive fluid intake ≠ increase milk production (water intoxication)

Water

Alcoholic beverages – metabolized in 2 hrs – limit intake Caffeine – limit to two 8oz servings 300mg caffeine = 18 oz regular coffee/day 8 oz expresso /day 48 oz of tea / day Chocolate/ soda = 10g / 1.5bar 50 g / 12 oz can

Vitamins

Fat soluble (Vit A / D / E / K ) Transported into milk via fat therefore level less affected by dietary change

Milk levels do not change until a certain level is achieved in the stores

Fat Soluble vitamins

Vitamin A & D = stored in tissues  vitamin A malnourished woman = level in HM

Vitamin D = Sunlight 30 min. of sunlight /wk (with diaper)

2 hours /week (fully clothed)

conc. above lower limits of NORMAL value

Vitamin E Sunflower oil in HM by direct maternal absorption Tocopherol Levels Highest in colostrum Uses in Neonates: - as anti-oxidant for prevention of hemolytic anemia due to vitamin E deficiency

Vitamin K Maternal dietary intake is most critical during end of gestation Critical - 1st few days - risk of ICH

Water Soluble Vitamins Moves freely with ease from serum to milk -

daily dietary fluctuations levels affected by maternal diets

Supplementation level once reached = not affect breast milk.

Vitamin C

 Body requirements

stress lactation

 No effect on milk volume  Level in HM 2x that recommended for infant formula

Vitamin B Acutely affected by maternal diet B1 (Thiamine)

infantile beriberi

B12 (Strict vegetarian) - megaloblastic anemia - methylmalonic aciduria - homocystinuria

General Recommendations for Lactating Vegetarians • Supplement with soy flour, molasses, nuts • Use complementary protein combinations • Avoid excessive phytates and bran • Watch protein, iron, calcium, vit. D, vit. B12, and Riboflavin to assure adequate intake

Sodium Concentration most variable Fluctuates ten folds during lactation and diurnally

Iron  Not readily affected by diet  If added to HM  interfere with function of lactoferrin

Iodine  NOT depend on dietary intake  Breast able to raise iodine level above blood concentration ( NO Radioactive iodine to lactating woman)

Iodine

Iodized salt AND Bread dough conditioners would increase risk for excessive iodine intake BM Iodine 29 – 490 mg /L 178 mg /L ABOVE the RDA for infants

Calcium  For bone growth  Total calcium level in BM is low  Lactating woman mobilizes 2% skeletal calcium (100 days)  BM  Requirements for lactating woman  400 mg /day over the Normal

Some Sources of Calcium in Foods Julian Huang md, Jan 2003 Dairy foods – milk, yogurt Leafy green veg – brocolli, spinach Fruit – orange Beans & peas – tofu, peanut, baked beans Fish – salmon , sardines Misc – sesame seed, almond, brown sugar VIT D is necessary to allow the body to absorb the calcium

Some Sources of Calcium in Foods Julian Huang md, Jan 2003

Non-dairy Calcium rich foods Total cereal (3/4 cup) 250mg Cal fortified orange juice (8oz) 250mg Tofu raw (1/2cup) 130mg Seedless raisin (2/3 cup) 53mg Broccolli boiled (1 cup) 72mg Carrots raw (1 med) – 19mg

Other diet considerations: considerations Smoking/ tobacco affects women’s appetite and tastes of many food… limit to <10 cigarette (1/2 pack) per day maybe compatible to breastfeeding TOBACCO INTERFERE with milk letdown and reduce amount of milk produced.

•Other diet considerations:

Caffeine -300g/day Equivalent to : –18 oz of regular coke –8 oz of expresso –48 oz of tea

DAY

Alcohol does enter breastmilk and is metabolized at about the same rate as from blood stream – 1 ½ to 2 hrs / oz

Exercise While Breastfeeding ?? No contraindication Use firm brassiere Cause breast sagging ??

Diet while Breastfeeding Avoid junk foods No reduction diet should be recommended

Foods to Watch out for Gassy foods Acidic foods Essential oils (garlic, spices)  infants object their presence

Garlic Onion Cabbage Turnips Brocolli Beans Rubbarb Apricot Prunes

Colic in some infants (24 hours after ingestion)

Foods to Watch out for

Heavy diet of melons peaches  colic freshfruits diarrhea Chocolates ≠ colic, diarrhea, constipation

Color of Milk and Maternal Diet Mature milk  bluish white Colostrum  yellowish to yellowish orange Sunkist orange soda  pink to pink orange (due to food dyes) Green beverages Seaweeds in tablet forms  green milk Natural vit. from health food sources Minocycline Hydrochloride  black milk (due to hemosiderin)

Malunggay (leaves, pods, seeds, flowers) Moringa Oleifera

An ounce of Malunggay leaves/seeds is equal to :

4 glasses of milk (calcium) 7 oranges (vitamin C) 3 bananas 3x spinach (iron) better than olive oil

Summary : Diet of Lactating Woman

General Rule: Eat more of each nutrient than the recommended for the non-pregnant woman. Malnutrition 10% dehydrated = volume Protein = volume Lactose = least affected Sodium = fluctuates 10 folds Calcium Iron = not readily affected but … Vitamins

Maternal Nutrition and Milk Composition

Women are able to produce milk with an adequate content of fat, carbohydrate, and most minerals, even when their supply of nutrients is limited.

2. Nutrients most likely to be present in lower than normal concentrations in response to chronically low maternal intakes are the vitamins (especially B6, B12, A, and D).

• Nutrients maintained at the expense of maternal stores or tissues include the macronutrients, most minerals, and folate. 4. Use the national guidelines to assist the mother in achieving and adequate diet.

Breastfed is BEST FED