Nutrition in pregnancy

Pregnancy Nutrition Growth &
Development of fetus
Dr Nupur Gupta, Consultant & Unit Head

MOTHER’S MILK IS BEST FOR THE BABY

Pregnancy & Lactation: First 4 Trimesters of Growth
Pregnancy – importance of Nutrients
Maternal nutrition-Impact on Fetal health
Lactation – importance of Nutrients
Clinical evidences
Breastfeeding Benefits – Mother & Child
Overview

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Nutrition during pregnancy & lactation
• 2nd trimester to 6 months of lactation is a critical
period for an infant’s growth.
• 70% of brain development happens by birth & an
infant doubles its birth weight during 1st 6months
• Many mothers don’t get the extra nutrients they
need during this period

The human growth velocity - most rapid during 3rd
trimester & 4-5 months after birth
Nutrition during pregnancy & lactation
It is measured as gains in length,
skull circumference and weight

Pregnancy & Lactation: Physiology
• Nutrition demand increases
• For normal growth of infants in utero and
during early post-natal life
• The increased need for nutrients cannot always
be met from the maternal diet, however ample
it may be.

• Indian Mom* needs 31% extra energy & 41% extra protein
during lactation along with incr requirement of Calcium
(100%), Iron (19%), Vit B12 (50%) & Folic acid (50%)
Pregnancy & Lactation: Physiology

Dietary gaps in India: Birth Outcomes
30% Incidence of IUGR
26% prevalence of LBW
21% prevalence of pre-term

One of the most vulnerable segments of the
population for micronutrient deficiencies
Pregnant and lactating women

~27 million pregnancies/year
India contributes about 20% of births worldwide
India has the highest proportion of children < 5 years.
We need to improve maternal nutrition

Pregnancy- Recommended protein intake
Maximum during 3rd Trimester
For 10 kg gestational wt gain - 1, 7 and 23 g/day in 1st, 2nd,
and 3rd trimesters respectively.

Nutrients
FOLIC ACID
• Reduces the risk of congenital malformations and increases the birth weight
IRON
• Meet the high demands of erythropoiesis (RBC formation).
CALCIUM
• Proper formation of bones and teeth of the offspring, for secretion of breast-milk rich
in calcium and to prevent osteoporosis in the mother.
IODINE
• Ensures proper mental health of the growing foetus and infant.
VITAMINS
• Vitamin A is required during lactation to improve child survival. Besides these,
nutrients like vitamins B and C need to be taken by the lactating mother

Pregnancy– Nutrient deficiency
• Increased risk of premature birth and low birth
weight, neurodevelopmental problems and poor
growth outcomes in infants .
• Need in pregnancy
– Protein,
– Vitamin A, B12, C, D
– Folic acid, zinc, iron and choline

Maternal weight gain & fetal body weight
Gestational weight gain
of 10 to 14 kg,
average 12 kg
Birth weight of 3.1 - 3.6
kg with a desirable birth
weight of 3.3 kg
1kg = 20 to 25 gm
birthweight

• Energy + weight gain = protein, fat and water
• Protein - deposited in fetus (42%), uterus (17%),
blood (14%) placenta (10%) and breast (8%)
• Fat – mainly in fetus and maternal tissues &
contributes substantially to overall energy cost of
pregnancy

Tissue deposition max during 2nd & 3rd trimester

Lactation – importance of nutrients
There is growing evidence that optimal dietary
intake of important nutrients, like iodine, DHA,
choline, and folate, is necessary during pregnancy
and lactation
Ziessel et al. Am J Clin Nutr 2009;89(suppl):685S–7S

Lactation- Recommended protein intake

Nutrients affecting infant health
• The main nutrients include
– Vitamins A, C, and D
– B vitamins,
– Iodine, and
– Choline

ESPGHAN COMMITTEE ON NUTRITION
The provision of supplemental food is able to improve
milk production and the duration of exclusive
breastfeeding among undernourished women.

Maternal nutritional risk factors for SGA
babies in a developed country.
This study has shown that eating more fish and
carbohydrate rich foods and taking folate
supplements around the time of conception is
associated with a reduced risk of having an SGA
baby.
Methods:
Case-control study of 844 cases (SGA) and 870 controls (appropriate size for
gestational age (AGA)). Only term (37+ completed weeks of gestation)
infants were included. Retrospective food frequency questionnaires were
completed at birth on the diet at the time of conception and in the last
month of pregnancy.

preterm birth (A), low birth weight (B)
Preconception dietary patterns Preterm
Delivery

The Barker theory (Fetal origin of adult diesase)
Fetal Malnutrition & Adult Metabolic Diseases

Consequences Of Maternal
Anemia
Foetal
Outcomes
Reduced
Cognitive
Development
LBW &
SGA
Prone to
Infection
after
birth
Maternal Outcomes
Abruptio
Placenta
Prolonged
labour &
PPH
Compro
mised
Physical
capacity
Clinicalevidence Iron supplementation

Balanced energy Supplementation
WHO & Cochrane review
• Balanced energy and protein supplementation
improves fetal growth, reduces risk of stillbirth, LBW,
SGA infants, especially among undernourished pregnant
women.
• Antenatal nutritional advice - to reduce risk of preterm
birth.

Benefits of Breastfeeding to Babies
Incidence and severity
of infections
Growth until one
year of age
Incidence of obesity
in adulthood
Improves mental
development

Not breastfeeding is associated with
health risks for babies
Increased incidence of
Infectious morbidity (otitis media, GE, pneumonia)
Elevated risks of
Childhood obesity,
Type 1 & type 2 diabetes,
Leukemia
Sudden infant death syndrome (SIDS).
Rev Obstet Gynecol. 2009;2(4):222-231

In India, preferred alternative to Human Milk is:
Bovine Milk
 American Academy of Pediatrics (AAP) states that:
Unmodified cow's milk is not recommended for
infants less than 12mo of age

g/dl Human milk Cow milk
Total proteins 0.89 3.30
Caseins 0.25 2.60
Whey proteins 0.70 0.67
 -Lactalbumin 0.26 0.12
 ß-Lactoglobulin - 0.30
 Lactoferrin 0.17 trace
 Serum albumin 0.05 0.03
 Lysozyme 0.05 trace
 Immunoglobulin 0.105 0.066
Protein composition of mature HM and cow milk
is very different
(Hambaeus Nutr Abstr Rev, Rev Clin Nutr 1984;54:219-236)

Psychological benefits
for mother, child
& father
LAM – Contraception
Benefits of Breastfeeding to mother
Weight loss
after
delivery

If mother is not breastfeeding
• Epidemiologic data suggest that women who do
not breastfeed face higher risk of
– Breast and ovarian cancer,
– Obesity,
– Type 2 diabetes,
– Metabolic syndrome, and
– Cardiovascular disease.
Rev Obstet Gynecol. 2009;2(4):222-231

Maternal Counseling
Reasons for early breastfeeding discontinuation:
– Lack of confidence in mothers' ability to breastfeed,
– Problems with the infant latching or suckling, breast
pain or soreness,
– Perceptions of insufficient milk supply, and
– Lack of individualized encouragement from their
clinicians in the early post discharge period.

Summary
 Maternal Nutrition is one of the indicators for
improving Maternal and Child Health Care.
 The last two trimesters of pregnancy and first two
trimesters of lactation are most critical periods for
Infants growth & development.
 The increased need for energy, protein, and
micronutrients cannot always be met from the
maternal diet, however ample it may be.

Summary
 Inadequate nutrition may affect and lead to adverse
outcomes both in mother as well as fetus.
 In addition to adequate nutrition, maternal counseling
for breastfeeding plays a very important role in
effective lactation.

Nutrition in pregnancy

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