These are the slides that me, Madan Pandey & my friend, Deepak Kumar Mandal has presented in our class, B. Sc. (Nutrition & dietetics) 3rd year. We have slides here about physiological changes during pregnancy & lactation; complications at these stages and nutritional requirements according to ICMR, 2010. I hope it would be useful for the friends who are studying in field of food, nutrition, health & medicine. Madan Pandey Central Campus of Technology, Dharan Tribhuvan University Kathmandu, Nepal

1. NUTRITION FOR PREGNANT
AND LACTATING WOMAN
Presented by:
Deepak Kumar Mandal
Madan Pandey
B. Sc. Nutrition & Dietetics
Tribhuvan University
Central Campus of Technology
Dharan, Sunsari, Nepal 1

2. PREGNANT WOMAN
2

3. Contents
• Introduction
• Physiological changes
• Factors Affecting Pregnancy
• Complications
• Nutritional Requirement
• Balance diet
• Conclusion
3

4. Introduction
Pregnancy is a normal physiological phase where
rapid growth of fetus takes place in the mother’s
uterus along changes with in her body.
 The physiological and hormonal changes help to
better accommodate the fetus.
The blood sugar level, breathing & cardiac output
are also increased.
4

5. Cont……
Level of progesterone & estrogen rise
continuously.
5

6. Physiological changes
Energy metabolism
• Basal metabolism increases due to
development of fetus and other physiological
changes.
• The increase in BMR relative to pre-pregnancy
values are about 5.3%, 11.4% and 25.3%
during the first, second and the third trimester
respectively.
6

7. Cont……
Growth of maternal tissues
• Maternal tissues including breasts, uterus and
adipose tissues increase in size.
• Hormones promote growth and changes in
breast tissues.
7

8. Cont……
Alimentary Functions
• Reduced gastric tone, motility and secretion.
• Nausea and constipation are common.
• Efficiency of absorption of calcium, iron,
vitamin B12 and other nutrients increases.
8

9. Cont……
Renal Function
• Glomerular filtration rate increases to clear
substances such as creatinine, urea, uric acid
etc.
• Rate of excretion of water is higher in mid-
pregnancy, very low in advanced stage.
• Mild glycosuria is common.
• Increased loss of free amino acids and iodine
in urine.
• Decreased excretion of calcium & B-vitamins.
9

10. Cont……
Blood Composition
• Increase in plasma volume about 50% and RBC
mass by 20%.
• Increase in total haemoglobin but decrease in its
concentration.
• Fall in total serum protein.
• Decrease in concentration of vitamin A, ascorbic
acid and increase in concentration of carotene,
tocopherols, cholesterol and N-methyl
nicotinamide.
10

11. Cont……
Water Balance and Weight Gain
• Average weight gain is about 12 Kg but it may
range from 6 Kg to 18 Kg.
• Total body water increases by average 7 Kg.
• Kidney may have some difficulty in disposing
surplus water.
11

12. complications
Nausea & vomiting
• Due to nervous disturbance, placental protein
intoxication or derangement of carbohydrate
metabolism.
• Feeling of nausea may be higher if food is
eaten at too much hunger.
• Frequent and small meal should provided.
• Fat rich, fried, spicy foods should be restricted.
12

13. Cont……
Leg cramps
• Due to sudden contraction of muscles.
• Related with decline in serum calcium level.
Fatigue
• Caused by progesterone disturbances.
13

14. Cont……
Heart burn
• Due to increased progesterone levels which
decreases smooth muscle mobility of stomach
and pressure by growing uterus on stomach.
• Can be relieved by providing small & frequent
meals and drinking fluids between meals.
14

15. Cont……
Pre-eclampsia & eclampsia
• Disorder of pregnancy characterized by
hypertension and proteinuria.
• Symptoms may be swelling, convulsion
(shaking of body), nausea, vomiting,
headache, temporary loss of vision, or coma.
• Adequate amount of proteins, vitamins &
minerals should be provided.
15

16. Cont……
Constipation
• Due to pressure of enlarged uterus & effect of
placental hormones on GI tract.
• Increment of fluid intake & fibre in diet,
regular sleeping & exercise habit helps in
elimination.
16

17. Cont……
Anaemia
• According to WHO, a pregnant woman is
anaemic if hemoglobin level is 11mg/dl or
haematocrit percent is below 33%.
• The concentration of haemoglobin in blood is
lowered due to increased plasma volume.
• May be due to iron deficiency, folate
deficiency (megaloblastic), less often due to
vitamin B12 deficiency.
17

18. Cont……
• Supplements of iron and folic acid should
provided.
• Regular consumption green leafy vegetables,
whole cereal grains & pulses, animal meat &
liver and vitamin C rich foods is to be
increased.
18

19. Cont……
Gestational Diabetes Mellitus
• Refers to carbohydrate intolerance during
pregnancy.
• Caused due to impaired insulin action.
• Insulin antagonism is probably due to
combined effect of placental hormones.
• Resolves after delivery.
19

20. Factors Affecting Pregnancy
Diet
• Diet is a main factor that influences in health
of mother.
• Consumption of ill-balanced and inadequate
diets leads to deterioration of physical and
mental strength, development of anaemia and
general weakness.
20

21. Cont......
Socio-economic Factor
• Still birth and neonatal death rates are
generally high among the pregnant women
belonging to low socio-economic status.
• The low standard of living, living in insanitary
surrounding and poor quality diets are
reasons for high still birth and neonatal death.
21

22. Cont……
Mother body size
• Generally tall women have babies with greater
body length and weight than those born to short
women.
• It has been found that:
a) Babies born to short women are 8% lighter than
those born to tall women.
b) Babies born to under weight women are 8%
lighter than those born to over weight women.
c) Babies born to tall and heavy women are about
14% heaver than those born to short and light
women.
22

23. Nutritional Requirements
Calories
• Approximately 77,000 Kcal energy is required per
pregnancy if weight gain is supposed to be 12Kg.
• More than 40,000 Kcal is accounted by protein &
fat storage.
• For this, ICMR (2010) has recommended additional
calorie intake as below:
23
Trimester Additional Requirement
First 85Kcal/day
Second 280Kcal/day
Third 470Kcal/day

24. Cont……
• Further allowance has to be made for
spontaneous decrease in physical activity
particularly occurs in third trimester.
24

25. Cont……
 Carbohydrate
• It is main source of extra calories during
pregnancy.
• A fiber rich diet is recommended to help
prevention of constipation and hemorrhoids.
25

26. Cont……
 Fat
• Dietary fats provide vital fuel for the mother and
development of fetus.
• Need of essential fatty acid is slightly higher than
those of non-pregnant women during pregnancy.
• Very low fat diets (which provide less than 10%
daily calories from fat) do not supply sufficient
essential fatty acid, fat-soluble vitamins or calories.
• Diet should contain at least 30 gm visible fat(ICMR,
2010)
26

27. Cont……
 Protein
• About 597 g of protein is deposited during
pregnancy in fetus and maternal tissues.
• To fulfill this requirement, ICMR(2010) has
recommended an extra allowance of dietary
protein as below:
27
Trimester Additional
requirement(gm/day)
First 0.6
Second 8.1
Third 27

28. Cont……
 Calcium
• About 30g of calcium is deposited in fetus during
pregnancy.
• Maternal reserves are in positive balance.
• Absorption is not less than 40% of calcium
available in diet during pregnancy.
• ICMR(2010) has recommended an extra 600mg
(total-1200mg) calcium per day.
28

29. Cont……
Iron
• Fetus and placenta contain about 230mg and
100mg of iron respectively.
• Increment of RBC mass increases about
296mg of iron.
• Since menstruation stops iron losses is
minimized to 234mg for period of pregnancy.
• The additional 860mg of iron is required
when above factors are considered.
29

30. Cont……
• This requirement is fulfilled by providing
additional 14mg (total 35mg) iron per day in
diet (recommended by ICMR,2010).
• Here, it is supposed only 8% of iron is
absorbed from diet.
30

31. Cont……
Vitamin A
• The liver of infant at birth contain about 5,400
µg to 7,200 µg of retinol.
• To fulfill this requirement ICMR (2010) has
recommended following additional dietary
allowances:
a. 200µg (800 µg total) as retinol
b. 1600 µg (6400µg total) as β-carotene
31

32. Cont……
Thiamine
• Small amounts of thiamine are stored in
tissue of new born infant.
• Extra calorie allowance requires extra
thiamine.
• Thus, ICMR(2010) has recommended an extra
allowance of 0.2 mg per day of thiamine.
32

33. Cont……
Riboflavin
• Small amounts of riboflavin are found in
tissues of new born infant.
• Extra calorie allowance requires extra
riboflavin.
• Thus, ICMR(2010) has recommended an extra
0.3mg per day of riboflavin.
33

34. Cont……
Niacin
• Nicotinic acid and coenzymes I & II containing
nicotinamide are found in tissues of new born
infants.
• Extra calorie allowance requires extra niacin.
• To fulfill this requirement, ICMR(2010) has
recommended extra allowance of 2mg per
day.
34

35. Cont……
Folic acid
• There is rapid growth of fetus.
• Total number of RBCs also increases.
• Folic acid is required for synthesis of DNAs &
RNAs.
• ICMR(2010) has recommended an extra
allowance of 300 µg (total 500 µg) of folic
acid per day.
35

36. Cont……
Vitamin B6: ICMR(2010) has recommended
additional 0.5 mg (total 2.5 mg) of vitamin B6
per day.
Vitamin B12: Extra 0.2 µg (total 1.2 µg) of this
vitamin has been recommended.
Ascorbic acid: 20mg extra requirement (total
60 mg) during pregnancy.
36

37. Items Quantity
Cereals 475gms
Pulses 55gms
Leafy vegetables 100gms
Other vegetables 40gms
Roots and tubers 50gms
Milk and milk products 250ml
Oils and fats 40gms
Fruits 60gms
Sugar and Jaggery 40gms
Composition of Balanced Diet during
Pregnancy
Source: ICMR- 1984 37

38. Conclusion
Pregnancy is stage of rapid growth of infant in
mother’s body.
Her body itself changes physiologically to help
growth of fetus & for preparation of lactation.
Thus, sufficient nutrients from diet, proper
health care & sanitary conditions should
maintained for safe delivery.
38

39. LACTATING WOMAN
39

40. contents
• Introduction
• Hormonal control of lactation
• Lactation and growth of infant
• Nutritional requirements
• Benefits of breast feeding
• Practices to avoid during lactation
40

41. Introduction
Lactation is a normal physiological process in
which there is production of milk by
mammary glands of mother after delivery of
her child.
Milk is only source of energy and nutrients for
the newly born baby.
It promotes optimal physical and mental
growth of infant.
41

42. Hormonal control of lactation
Sucking infant
Hypothalamus stimulated
causes release of milk
from alveolus
Pituitary stimulated
Prolactin produced by anterior
pituitary
Facilitates uterus to return
in normal size
Stimulates milk production in
alveolus
Oxytocin produced by posterior
pituitary
42

43. Lactation and growth of infant
Milk yield is 500ml in first month, & reaches
up to 1litre in fifth month and declines
steadily later.
Average milk production is about 650ml.
Doubling of weight in first six months indicates
infant is getting sufficient nutrient.
43

44. Cont……
Growth can be monitored by using growth
chart.
Along with age of infant, other factors such as
age, health and nutrition of mother influences
the volume of milk produced.
44

45. Cont……
The composition and output of milk are likely
to be affected by mother’s diet and state of
nutrition.
Studies have shown that:
• High fat diets slightly increase the fat content
of milk and its output.
• High protein diet slightly increase milk output.
45

46. Nutritional requirements
Lactating woman’s nutritional supplies should:
• Meet her own body needs.
• Provide enough nutrients in milk.
• Furnish energy for mechanism of milk
production.
46

47. Cont……
Calorie
• Nursing mother needs more than 1000kcal
extra energy for
a) metabolic work to produce milk and
b) calorie content in milk.
• It is partly fulfilled by mobilization of fat
stores in body and partly by dietary supply.
47

48. Cont…
• Thus, ICMR(2010) has recommended
additional:
a) 600Kcal energy for first 6 months
b) 520Kcal energy for next 6 months
48

49. Cont……
Protein
• Protein requirement of lactating mother is
calculated on the basis of milk output and
protein concentration in it.
• ICMR(2010) has recommended following
allowance of protein:
49
Lactation period Additional
Requirement
0-6 months 22.9g
6-12 months 15.2g

50. Cont……
Fat
• Quantity of fat in mother’s diet does not
influence the fat content of milk
• Composition of milk fat reflects composition
of fat in mother’s diet.
• Sufficient amount of fat should be consumed
in order to get sufficient unsaturated fatty
acids & fat soluble vitamins.
• Diet should contain at least 30 gm visible fat.
50

51. Cont……
Calcium
• Breast feeding is associated with transfer of
approximately 200mg calcium per day.
• Supposing the retention of dietary calcium
about 30% in pregnant mother, ICMR(2010)
has recommended additional 600mg (total-
1200mg) calcium per day.
51

52. Cont……
 Iron
• Mother’s milk is not a good source of iron.
• It contains about 0.78 mg/l iron, so loss iron
from milk is about 0.5mg a day.
• Loss of iron from body is 0.77mg/day.
• To compensate these loss, ICMR(2010) has
recommended total 25mg iron per day.
52

53. Cont……
Vitamin A
• The quantity of retinol in milk is about 50μg/dl;
total about 350μg.
• Thus, ICMR(2010) has recommended
additional vitamin A requirement as below:
53
Additional Requirement
Retinol 350μg (total 950μg)
β-carotene 2800μg (total 7600μg)

54. Cont……
B-vitamins
• Breast milk contains all types of B-vitamins.
• Increased energy need also increases need of
these vitamins.
• Content of these vitamins in milk depends
upon content in mother’s diet.
54

55. Cont……
Thiamine
• About 0.2mg thiamine per day is secreted via
milk.
• Additional recommendations are:
a. For 0-6 months of lactation: +0.3mg
b. For 6-12 months of lactation: +0.2mg
55

56. Cont……
Riboflavin
• About 0.3mg riboflavin is secreted in milk per
day.
• ICMR(2010) has recommended:
a. Additional 0.4mg for first six months
b. Additional 0.3mg for next six months
56

57. Cont……
Niacin
• Nicotinic acid secreted in milk per day is about
0.9 to 1.2mg.
• Allowance of niacin is:
a. Additional 4mg for first six months
b. Additional 3mg for next six months
57

58. Cont……
• Vitamin B6: Additional 0.5 mg pyridoxine has
been recommended.
• Vitamin B12 : Additional 0.5µg is recommended.
Ascorbic acid: About 3mg/dl ascorbic acid is
secreted in milk.
• Additional 40mg has been recommended,(with
consideration of cooking loss)
58

59. Benefits of breast feeding
Benefits to infant
• Protects from infections & illness including
diarrhea, pneumonia, asthma.
• Decreases risk of obesity.
• Reduced risk of diabetes & cardiovascular
diseases.
• Decreases health care costs.
59

60. Cont……
Benefits to mother
• Stimulates uterine contraction.
• Convenient because no requirement of
preparing, mixing & heating.
• Less expensive than formula feeding.
• Reduces risk of breast cancer, ovarian cancer,
osteoporosis.
60

61. Practices to Avoid
If mother drinks alcohol or use drugs they are
seen in milk.
So illicit drugs, alcohol, smoking should
avoided.
61

62. conclusion
Milk is exclusive source of nutrients and
energy for infant.
Proper nutritional care is required for both
infant and mother.
Breast feeding benefits both mother and
infant.
62

63. REFRENCES
• Essentials of Food and Nutrition(volume 1);Dr. M
swaminthan
• Dietetics; B. Srilakshami; New age International
• Discovering Nutrition; Paul Insel, Don Ross,
Kimberley McMahon, Melissa Bernstein; Jones &
Bartlett Learning
• NUTRIENT REQUIREMENTS AND RECOMMENDED
DIETARY ALLOWANCES FOR INDIANS, 2009 ;Indian
Council of Medical Research; Jamai-Osmania PO,
Hyderabad – 500 604
63

64. 64
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