nutritional requirements during pregnancy and lactation

Nutrition is required During Pregnancy and Lactation Mother: Vitamins, Proteins, Minerals, Calcium, Zink Requirement.

A pregnant woman’s body undergoes several Physical and Mental changes to prepare her for upcoming motherhood. Her requirements for all the nutrients increase. Malnutrition in mothers has been found to be associated with adverse pregnancy outcomes, e.g. anaemia in pregnant women may compromise maternal and foetal health. During lactation nutrition of the baby is solely dependent on the mother. So, diet during lactation helps the mother to maintain sound health and also ensures a good milk supply for the baby.

PHYSIOLOGICAL CHANGES IN THE BODY DURING PREGNANCY-

• Changes in Uterus and Breasts
• Weight Gain
• Changes in Body Fluids

INCREASED NUTRITIONAL REQUIREMENTS DURING PREGNANCY

1. Calories – Additional energy is required during pregnancy to support the metabolic demands of pregnancy and foetal The average pregnant woman needs only an additional 150 kcal/day during the first trimester of pregnancy and 350 kcal/day during the second and third trimesters of pregnancy.
2. Proteins- To support the synthesis of maternal and foetal tissues, additional protein is required (up to 20 gm per day). This demand increases throughout gestation. It is maximised during the third Protein deficiency during pregnancy has adverse consequences, including poor foetal growth.
3. Micronutrients – All vitamins and minerals are needed for optimal pregnancy outcomes. In some instances requirements may be met through diet; for others, a supplement is often The requirement for most of the vitamins and minerals increases with pregnancy.

The following micronutrients such as minerals and vitamins are given in detail below:

Minerals Required During Pregnancy

1. Iron: Its requirement increases from 21 mg/day to 35 mg/day during This is due to –
   • expansion of maternal tissues including red cell mass,
   • the iron content of the placenta,
   • blood loss during
   • Total iron requirement during pregnancy is estimated to be approximately 1,000 This is distributed in the foetus and placenta (300 mg) and expanded red cell mass (400 mg).
2. Calcium: Its requirement for an adult woman is 600 mg/day/woman for good Growth of the baby. During pregnancy, there is an increase in the demand for calcium by the growing So the requirement increases up to 1200 mg/day.
3. Zinc: Deficiency of zinc adversely affects the outcome of Severe deficiency in the mother can lead to spontaneous abortions and congenital malformations. The requirement increases from 10 mg/ day (pre-pregnant) to 12 mg/day during pregnancy. Dietary sources of zinc are meat and fish. Wheat, pulses and nuts also provide zinc.

Vitamins Required During Pregnancy

Vitamin A: High levels of some forms of vitamin A can harm the foetus’s development if taken in too high amounts during pregnancy. Mothers should avoid vitamin A supplements and animal sources of vitamin A (e.g. Liver) throughout pregnancy.

Vitamin D: Its active forms (calcidiol and calcitriol) can pass through the placenta with ease and help in the calcium metabolism of the foetus.

Vitamin B complex: Requirement for Thiamine, Riboflavin and Niacin increase during pregnancy i.e. +0.2 mg, +0.3 mg and +2.0 mg respectively. Pyridoxine (vitamin B6) needs are increased during pregnancy. (2.5mg of vitamin B6 during pregnancy; vitamin B12 = 1.2 mg / day). Dietary sources of vitamin B are milk and orange juice are good sources.

Folic acid: Adult women require 200 µg of folic acid per day necessary. In pregnancy, it is 500 µg/day. It is an essential element for blood formation and synthesis of essential components of DNA/RNA which increase rapidly during the growth of a baby. It may also lead to congenital

malformations (spina bifida and anencephaly), cleft lip and congenital heart defects. Supplementation of folic acid before conception and during the first twelve weeks of pregnancy is therefore recommended. Dietary sources of folic acid are Liver, soybean and dark green leafy vegetables.

Vitamin C: Its daily requirement for an adult woman is 40 mg/day. Additional 20 mg are needed during pregnancy. Dietary sources are Fresh fruits, lemon, amla, tomato, orange, and fresh green leafy vegetables.

DIET DURING PREGNANCY –

Additional* Allowances during Pregnancy and Lactation

Meal Planning for a Pregnant Woman-

the pregnant woman should eat a variety of foods. There is no need to modify the usual diet if the quantity and frequency of usage of the different foods should be increased to and maximum.

• She can derive maximum energy (about 60%) from cereals like rice, wheat and (9 portions-30 g each)
• Cooking oil is a concentrated source of both energy and polyunsaturated fatty (Fats/Oils-6 portions-5 gm each)
• Good quality protein is derived from milk, fish, meat, poultry and eggs. However, a proper combination of cereals, pulses and nuts also provides adequate (2 portions of pulses and 1 portion of non-veg-30 gm each)
• (vegetables- 5 portions and fruits- 2 portions- 100 gm each)
• Bioavailability of iron in pulses can be improved by fermentation and sprouting and eating foods rich in vitamin C such as citrus •
• Milk and milk products are the best sources of biologically available (5 portions-100 gm each)

Model Menu during Pregnancy-

1. Before getting off the bed: Tea 1 cup with 1–2 teaspoons of sugar + milk rusk/biscuit
2. Breakfast: Milk 200 ml (1 glass) Porridge (1 bowl)/ Idli (2 medium)/ Chapati Parantha (2 medium) Cheese 30 gm (1 cube)/ egg-1/ sprouts 25 gm (1 bowl)
3. Mid Morning: Buttermilk 1 glass or fruit – 1 medium
4. Lunch: Fresh salad, Chapati – 4 medium sizes (100 gm), preferably made with a mix of wheat with Bengal gram/soya Or Rice (100 gm)- 4 servings Pulses (25 gm)- 1 Katori or meat or fish or chicken (90 gm), Curd 125 gm (1 bowl), Green vegetables 250 gm (2 bowls), Cooking oil 10 gm (2 teaspoons) Fruit: 1–2 servings any time during the day
5. Evening Snacks: Freshly prepared snacks, such as sandwiches, pav bhaji, noodles, dhokla, khandvi, dal Wada, medu Wada, Dahi Wada, and appams. Milk 200 ml (1 glass) Cheese sandwich (1 small) or Poha (1 bowl) or Upma (1 bowl) or Vada (1 large)
6. Dinner: Same as Lunch, Bed Time: Milk 200 ml (1 glass)

Iron Folic Acid Supplementation-

• Prophylactic dose: All pregnant women need to be given one tablet of IFA (100 mg elemental iron and 5 mg folic acid) every day for at least 100 days, starting after the first trimester, at 14–16 weeks of gestation to prevent the occurrence of anaemia (prophylactic dose).
• Therapeutic dose: If a woman is anaemic (haemoglobin less than 11 g/dl) or has pallor, give her two IFA tablets per day (one morning and one evening) for three months. This means that a pregnant woman with anaemia needs to take at least 200 tablets of IFA for correction of anaemia (therapeutic dose).