Maternal Nutrition - Eldc

8/14/2019 Maternal Nutrition - Eldc

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Kilo-CaloriesKilo-Calories

N 75 Kcal /10 ml (average) = caloricN 75 Kcal /10 ml (average) = caloric

content of HM in well nourished womancontent of HM in well nourished woman

Fat -Fat - chief sourcechief source

LactoseLactose contribute tocontribute to

ProteinProtein totaltotal

Body FatBody Fat During PregnancyDuring Pregnancy (change fat cell size)(change fat cell size)

During LactationDuring Lactation



Energy in BreastmilkEnergy in Breastmilk

800 ml milk per day contains 560 kcal

Add 25% energy to make milk = 700kcal

200 kcal from pregnancy stores

500 kcal from diet





Example of extra food needed each day

by a breastfeeding woman

60 g rice (1 fistful) 240 kcal,protein,B vit60 g rice (1 fistful) 240 kcal,protein,B vit

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

calciumcalcium

Vegetables (1 fistful) protein,Cal,Vit A, folicVegetables (1 fistful) protein,Cal,Vit A, folic

acidacidHalf banana 90 kcal,ironHalf banana 90 kcal,iron

5 ml oil (1 tsp)5 ml oil (1 tsp) 50 kcal50 kcal

UNICEF



DIETDIET

DIETDIET Maintenance & ActivityMaintenance & Activity

++ MilkMilk

STORESSTORES Losses in Milk ProductionLosses in Milk Production

BODYBODY

STORESSTORES

ENERGY UTILIZATION IN LACTATIONENERGY UTILIZATION IN LACTATION





ProteinProtein

Normal 0.8 – 0.9 g/ 100 mlNormal 0.8 – 0.9 g/ 100 ml







LactoseLactose

Least affected by maternal diet Least affected by maternal diet

Water Water

Drink to relieve thirst only Drink to relieve thirst only

Excessive fluid intake ≠ Excessive fluid intake ≠

increase milk productionincrease milk production(water intoxication)(water intoxication)



Alcoholic beverages – metabolized inAlcoholic beverages – metabolized in2 hrs – limit intake2 hrs – limit intake

Caffeine – limit to two 8oz servingsCaffeine – limit to two 8oz servings300mg caffeine = 18 oz regular 300mg caffeine = 18 oz regular

coffee/daycoffee/day

8 oz expresso /day8 oz expresso /day48 oz of tea / day48 oz of tea / day

Chocolate/ soda = 10g / 1.5bar Chocolate/ soda = 10g / 1.5bar

50 g / 12 oz can50 g / 12 oz can

Water Water



VitaminsVitamins

Fat solubleFat soluble (Vit A / D / E / K )(Vit A / D / E / K )

Transported into milk via fat thereforeTransported into milk via fat thereforelevel level less affected less affected by dietary changeby dietary change

Milk levels do not changeMilk levels do not changeuntil a certain level isuntil a certain level isachieved in the storesachieved in the stores



Fat Soluble vitamins

Vitamin A & DVitamin A & D = stored in tissues= stored in tissues

vitamin A malnourished womanvitamin A malnourished woman

== level in HMlevel in HM



Vitamin D = SunlightVitamin D = Sunlight

30 min. of sunlight /wk30 min. of sunlight /wk conc.conc.

(with diaper)(with diaper) aboveabove

lower lower limitslimits

2 hours /week2 hours /week of of

(fully clothed)(fully clothed) NORMALNORMALvaluevalue



Vitamin EVitamin E

Sunflower oil Sunflower oil in HM by direct in HM by direct

maternal absorptionmaternal absorption

Tocopherol LevelsTocopherol Levels

Highest in colostrumHighest in colostrum

Uses in Neonates: - as anti-oxidant Uses in Neonates: - as anti-oxidant for prevention of hemolytic for prevention of hemolytic

anemia due to vitamin E deficiency anemia due to vitamin E deficiency



Vitamin KVitamin K

Maternal dietary intake isMaternal dietary intake is

most critical during end of most critical during end of gestationgestation

Critical - 1Critical - 1stst few daysfew days

- risk of ICH- risk of ICH



Water Soluble VitaminsWater Soluble Vitamins

Moves freely with ease from serumMoves freely with ease from serum

to milk to milk

- daily dietary fluctuationsdaily dietary fluctuations- levels affected by maternal dietslevels affected by maternal diets

Supplementation level onceSupplementation level once

reached = not affect reached = not affect

breast milk.breast milk.



Vitamin CVitamin C

stressstress

Body requirementsBody requirements lactationlactation

No effect on milk volumeNo effect on milk volume

Level in HM 2x thatLevel in HM 2x that

recommended for infant formularecommended for infant formula



Vitamin BVitamin B

Acutely affected by maternal dietAcutely affected by maternal diet

B1 (Thiamine)B1 (Thiamine) infantile beriberiinfantile beriberi

B12 (Strict vegetarian)B12 (Strict vegetarian)

- megaloblastic anemia- megaloblastic anemia

- methylmalonic aciduria- methylmalonic aciduria

- homocystinuria- homocystinuria







SodiumSodium

Concentration most variableConcentration most variable

Fluctuates ten folds duringFluctuates ten folds during

lactation and diurnallylactation and diurnally



IronIron

Not readily affected by dietNot readily affected by diet

If added to HMIf added to HM interfereinterfere

with function of lactoferrinwith function of lactoferrin



IodineIodine

NOTNOT depend on dietary intakedepend on dietary intake

Breast able toBreast able to raiseraise iodine leveliodine levelabove blood concentrationabove blood concentration

( NO( NO Radioactive iodine toRadioactive iodine to

lactating woman)lactating woman)



Iodine

Iodized saltIodized salt AND Bread doughAND Bread dough

conditionersconditioners would increase riskwould increase risk

for excessive iodine intakefor excessive iodine intake

BM Iodine 29 – 490 mg /LBM Iodine 29 – 490 mg /L

178 mg /L178 mg /L ABOVEABOVE the RDA for the RDA for infantsinfants



CalciumCalcium

For bone growthFor bone growth

Total calcium level in BM is lowTotal calcium level in BM is low

Lactating woman mobilizes 2%Lactating woman mobilizes 2%

skeletal calcium (100 days)skeletal calcium (100 days)

BMBM

Requirements for lactatingRequirements for lactating

womanwoman 400 mg /day over the400 mg /day over the

NormalNormal



Some Sources of Calcium in FoodsSome Sources of Calcium in Foods

Julian Huang md, Jan 2003Julian Huang md, Jan 2003

Dairy foods – milk, yogurtDairy foods – milk, yogurt

Leafy green veg – brocolli, spinachLeafy green veg – brocolli, spinach

Fruit – orangeFruit – orangeBeans & peas – tofu, peanut, baked beansBeans & peas – tofu, peanut, baked beans

Fish – salmon , sardinesFish – salmon , sardines

Misc – sesame seed, almond, brown sugar Misc – sesame seed, almond, brown sugar

VIT D is necessary to allow the body to absorbVIT D is necessary to allow the body to absorb

the calciumthe calcium



Some Sources of Calcium in Foods

Julian Huang md, Jan 2003

Non-dairy Calcium rich foodsNon-dairy Calcium rich foods

Total cereal (3/4 cup) 250mgTotal cereal (3/4 cup) 250mg

Cal fortified orange juice (8oz)Cal fortified orange juice (8oz) 250mg250mg

Tofu raw (1/2cup) 130mgTofu raw (1/2cup) 130mg

Seedless raisin (2/3 cup) 53mgSeedless raisin (2/3 cup) 53mg

Broccolli boiled (1 cup) 72mgBroccolli boiled (1 cup) 72mg

Carrots raw (1 med) – 19mgCarrots raw (1 med) – 19mg



Other diet considerationsOther diet considerations:

Smoking/ tobaccoSmoking/ tobacco affects women’saffects women’s

appetite and tastes of many food…appetite and tastes of many food…

limit to <10 cigarette (1/2 pack) per daylimit to <10 cigarette (1/2 pack) per daymaybe compatible to breastfeedingmaybe compatible to breastfeeding

TOBACCO INTERFERETOBACCO INTERFERE with milk let-with milk let-down and reduce amount of milkdown and reduce amount of milk

produced.produced.



Caffeine -300g/dayCaffeine -300g/dayEquivalent to :Equivalent to :

–18 oz of regular coke18 oz of regular coke

–8 oz of expresso DAY8 oz of expresso DAY –48 oz of tea48 oz of tea

Alcohol does enter breastmilk and isAlcohol does enter breastmilk and ismetabolized at about the same rate asmetabolized at about the same rate as

from blood stream – 1 ½ to 2 hrs / ozfrom blood stream – 1 ½ to 2 hrs / oz

•Other diet considerations:



Exercise While Breastfeeding ??Exercise While Breastfeeding ??

No contraindicationNo contraindication

Use firm brassiereUse firm brassiere

Cause breast sagging ??Cause breast sagging ??



Diet while BreastfeedingDiet while Breastfeeding

Avoid junk foodsAvoid junk foods

No reduction diet shouldNo reduction diet shouldbe recommendedbe recommended







Color of Milk and Maternal DietColor of Milk and Maternal Diet

Mature milkMature milk bluish whitebluish white

ColostrumColostrum yellowish to yellowish orangeyellowish to yellowish orange

Sunkist orange sodaSunkist orange soda pink to pink orangepink to pink orange

(due to food dyes)(due to food dyes)Green beveragesGreen beverages

Seaweeds in tablet formsSeaweeds in tablet forms green milkgreen milk

Natural vit. from health foodNatural vit. from health food

sourcessources

Minocycline HydrochlorideMinocycline Hydrochloride black milk (dueblack milk (due

to hemosiderin)to hemosiderin)











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

Moringa OleiferaMoringa Oleifera

An ounce of Malunggay leaves/seedsAn ounce of Malunggay leaves/seeds

is equal to :is equal to :

4 glasses of milk (calcium)4 glasses of milk (calcium)

7 oranges (vitamin C)7 oranges (vitamin C)

3 bananas3 bananas3x spinach (iron)3x spinach (iron)

better than olive oilbetter than olive oil



Summary : Diet of Lactating Woman

General Rule:General Rule:

Eat more of each nutrient than theEat more of each nutrient than therecommended for the non-pregnantrecommended for the non-pregnantwoman.woman.

MalnutritionMalnutrition

10% dehydrated =10% dehydrated = volumevolume

ProteinProtein == volumevolume

Lactose = least affectedLactose = least affectedSodium = fluctuates 10 foldsSodium = fluctuates 10 folds

CalciumCalcium

Iron = not readily affected but …Iron = not readily affected but …

VitaminsVitamins



Maternal Nutrition and Milk CompositionMaternal Nutrition and Milk Composition

Women are able to produce

milk with an adequatecontent of fat, carbohydrate,

and most minerals, evenwhen their supply of

nutrients is limited.



2. Nutrients most likely to be2. Nutrients most likely to bepresent inpresent in lower than normallower than normal

concentrations in response toconcentrations in response to

chronically low maternalchronically low maternal

intakes are theintakes are the vitaminsvitamins

(especially B6, B12, A, and D).(especially B6, B12, A, and D).



• NutrientsNutrients maintained at the expensemaintained at the expense of maternal stores or tissuesof maternal stores or tissues

include the macronutrients, mostinclude the macronutrients, most

minerals, and folate.minerals, and folate.

4. Use the national guidelines to assist4. Use the national guidelines to assist

the mother in achieving andthe mother in achieving andadequate diet.adequate diet.



BreastfedBreastfed is BESTis BEST

FEDFED

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Maternal Nutrition - Eldc