MANAGEMENT OF NUTRITION PROBLEMS IN

PREGNANCY AND LACTATIONProf. Sudha Salhan

NUTRITIONAL REQUIREMENTS OF PREGNANCY AND LACTATION

Cherished occasion for all women Anatomical and physiological changes occur

in the body Nutrients essential for the growth of the

foetus Al parts of the foetus synthesized from

nutrients in the mother’s diet The baby’s growth similarly determined by

maternal nutrition during lactation

NUTRITIONAL REQUIREMENTS OF PREGNANCY AND LACTATION

Extra calories during pregnancy to build tissues: enlarged uterus, placenta, breast development, foetal growth

Similarly increased nutritional needs during lactation

Gut absorbs nutrients better The body used them more efficiently If maternal intake of nutrients insufficient, foetal

malnutrition manifesting as intrauterine growth restriction, premature delivery, still birth.

Adequate quantity and quality of nutrition assures an adequate supply of good quality breast milk

NUTRITIONAL REQUIREMENTS OF PREGNANCY AND LACTATION IN A 50KG

WOMAN

Net energy (kcal)

Protein (gm/day)

Fat

Sedentary work

1850 50 20

Moderate work

2225 50 20

Heavy work 2925 50 20

Pregnant woman

+300 65 30

Lactation (0-6 mo)

+550 75 45

Lactation (6-12 mo)

+400 68 45

NUTRITIONAL REQUIREMENTS OF PREGNANCY AND LACTATION

Vitamin A, β-carotene, thiamine, riboflavin, nicotinic acid, pyridoxine, ascorbic acid, folic acid and vitamin B 12 requirements also increase

However, pregnant women don’t have to eat for two.

Foods like whole-grain bread, cereals, legumes, dark green vegetables, citrus fruit, non-fat milk and milk products and lean meats, fish, poultry and eggs.

Around 100 gm of extra carbohydrate Fat content of food 30%

NUTRITIONAL REQUIREMENTS OF PREGNANCY AND LACTATION

Calcium for bone formation of the foetus. Milk and milk products and calcium supplementation ~ 600 mg/day

Fibres in cereals, vegetables, fruit Iodized salt Fluid intake to be increased by about 30

ml/day. Baseline requirement: 100 ml/kg for the 1st 10kg, 50 ml/kg for the next 10 kg and 20ml/kg for every kg beyond that.

COMMON NUTRITIONAL PROBLEMS OF PREGNANCY AND LACTATION

Hyperemesis gravidarum Anemia Malnutrition Constipation

HYPEREMESIS GRAVIDARUM

Slight nausea is felt by most pregnant women due to high levels of hormones.

About 60-70% women experience nausea with onset at 4-7 weeks and lasting till 14 weeks of gestation. Harmless in them

However, it is termed hyperemesis gravidarum when there is persistent viomiting with loss of 5% weight.compromised fluid.electrolyte &nutritional status with ketoneuria.

HYPEREMESIS GRAVIDARUM: GENERAL MANAGEMENT

Frequent small semisolid food Foods causing vomiting to be avoided Foods of the pregnant woman’s choice (do

not be strict about caloric intake or about protein/carbohydrate/fat content)

Avoidance of oily or spicy foods Drinking ginger tea If bothersome, an obstetrician needs to be

consulted

ANEMIA

A condition of low hemoglobin (Hb < 11 gm/dl, hematocrit <33%)

Common finding in Indian women. The incidence is 68.8-96.8%

The most common type of anemia is nutritional deficiency anemia, due to deficiency of iron, folic acid, vitamin B12

Causes pre-eclampsia, preterm labour, PPH, cardiac failure, puerperal sepsis, subinvolution, etc in the mother

In the foetus it causes low birth weight, intrauterine death, iron deficiency during infancy (as the inadequate iron stores are rapidly used up during growth), cognitive and affective dysfunction

PREVENTION OF ANEMIA

Pre-pregnancy raising of hemoglobin levels by dietary modification is helpful

Consumption of iron-rich food such as green leafy vegetables (spinach, mustard leaves), jaggery, sprouted pulses

Cooking foods in iron utensils Avoidance of excessive tea and coffee and

overcooked foods Do not use calcium with iron rich foods. It will

prevent absorption High protein diet as hemoglobin includes

globin (protein) and heme (iron)

PREVENTION OF ANEMIA

Cereals, milk and milk products Two eggs per day with fish, poultry or meat if

non-vegetarian Ingestion of citrus fruit such as orange

enhances the absorption of iron

CONSTIPATION

Constipation is due to progesterone-induce relaxation of the intestinal smooth muscles and slow peristalsis

Troublesome in some patients It can be overcome by:

Adequate fluid intake High fibre diet e.g. cucumber, papaya, apple,

beans

HEMORRHOIDS

Avoid constipation with a high fibre diet with plenty of fluids