Maternal Nutrition During Lactation Lecture 5 PDF

Maternal Nutrition during Lactation (Part 2) Lecture 5 1/10/2024 Nutritional recommendations for lactating women Nutritional Recommendations for Lactating Women Energy Protei...

Maternal Nutrition during Lactation (Part 2) Lecture 5 1/10/2024 Nutritional recommendations for lactating women Nutritional Recommendations for Lactating Women Energy Protein Vitamins & Minerals 9/30/2024 Dr.Reham Shawky Metwally 4  Calorie Requirements during Lactation  The caloric requirement depends on................................................  Energy — The estimated energy requirement (EER) during lactation is based on maternal age, weight, height, and physical activity level (PAL), as outlined in table 1 ,plus the following additional energy requirements for milk synthesis: From 0 through six months From 7 through 12 postpartum – 330 kcal per months of postpartum – day more than nonlactating 400 kcal per day more women. than nonlactating women. 9/30/2024 Dr.Reham Shawky Metwally 5  Protein  The recommended dietary allowance (RDA) for protein for the first six months of lactation is:  71 grams per day, which is 25 grams more than the requirement for nonlactating women.  Based on 1.3 gm/kg/day of a woman’s body weight. Dr.Reham Shawky Metwally 9/30/2 6 024  Carbohydrates  The RDA is designed to provide enough calories in the diet :  For adequate volumes of milk  To maintain an adequate energy level during lactation.  Nursing mothers need additional carbohydrate (why?)  To replace the glucose used to make the lactose in breast milk. The fiber recommendation is 1 gram higher simply because it is based on calorie intake, which increases during lactation.  The woman with poor gestational weight gain may require more carbohydrates.  The USDA’s Dietary Guidelines for Americans suggest that dietary fiber intake is recommended at 14 grams per 1,000 calories of food. Dr.Reham Shawky Metwally 9/30/2 7 024  Lipids  Dietary fat choices by the mother can increase or decrease specific fatty acids in her milk, but not the total amount of fat in the milk ( Explain???)  Research suggests that the type of dietary fat consumed by the mother can affect the fatty acid profile of breast milk  For example, consuming fish oil supplements or eating fish can increase the levels of omega-3 fatty acids in breast milk. Similarly, consuming foods rich in linoleic acid, such as vegetable oils, can increase the levels of this fatty acid in breast milk. Dr.Reham Shawky Metwally 9/30/2 8 024  Fish intake  Fish and shellfish contribute high-quality protein and other essential nutrients to the diet.  Fish consumption by breastfeeding mothers has been suggested to be beneficial to the infant ( Why? )  Because fish contain large amounts of omega-3 long- chain polyunsaturated fatty acids (n-3 LCPUFA), including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), which are important in brain development. Dr.Reham Shawky Metwally 9/30/2 9 024  Fat-soluble vitamins  The RDAs for vitamins A and E represent an increase requirement during lactation compared with nonlactating women, to compensate for the vitamins secreted into milk. After six months of lactation, the requirement reverts to that of nonlactating women.  The maternal requirements for vitamins D and K are not increased during lactation. However, breast milk does not supply sufficient D and K to meet the infant's needs, and infants require supplementation.  Vitamin K supplementation is routinely given to the infant at birth Dr.Reham Shawky Metwally 9/30/2 11 024  Water-soluble vitamins  The RDAs for vitamin C and the B vitamins for lactating women exceed those of nonlactating women.  These requirements account for nutrient secreted into milk and allow for metabolic efficiencies and individual variation. Dr.Reham Shawky Metwally 9/30/2 13 024  Vitamin B12 and the lactating Vegan For lactating mothers who follow a strict vegan diet without any animal products, a vitamin B12 supplement is recommended strongly. The milk of a vegan mother can be severely deficient in vitamin B12, leading to a deficiency in her infant which, if not treated, can lead to growth failure and permanent damage to the nervous system. Nursing mothers who follow a strict vegetarian diet should have their infant’s B12 levels monitored. Dr.Reham Shawky Metwally 9/30/2 14 024  Calcium, phosphorus and magnesium  The RDA for calcium during lactation is 1000 mg daily for women 19 years and older, and 1300 mg daily for adolescents.  These requirements are the same as for nonlactating women, although about 200 mg per day of calcium is secreted in milk.  The RDA for calcium is not increased during lactation because lactation-induced loss in bone mass is not prevented by increased calcium intake, and this is recovered after weaning.  Increased bone resorption and decreased urinary excretion of phosphorus and magnesium are also independent of dietary intake during lactation.  Therefore, the dietary recommendations for phosphorus and magnesium are the same as for nonlactating women. Dr.Reham Shawky Metwally 9/30/2 16 024  Sodium Sodium intake during lactation should be controlled. There is no specific recommendation or restriction for sodium in the diet of breastfeeding mothers. Dr.Reham Shawky Metwally 9/30/2 17 024  Trace minerals Iron – The RDA for iron during lactation is 9 mg daily for women 19 years and older, and 10 mg daily for adolescents.  This recommendation is less than the RDA for nonlactating women (18 mg daily) ,during pregnancy ( 27mg/day) and adolescents (15 mg daily), because of lactation-induced amenorrhea, which reduces iron loss. Zinc, iodine and selenium – The RDAs for these minerals are moderately higher during lactation than for nonlactating nonpregnant women, to compensate for their secretion into the breastmilk. Dr.Reham Shawky Metwally 9/30/2 18 024  Fluids  It is important that the nursing mother have sufficient fluids to replace those lost in the infant’s milk.  Water and real fruit juice are the best choices. 9/30/2024 Dr.Reham Shawky Metwally 20 Practices Incompatible with Lactation  Medicines, Caffeine, Alcohol, and Tobacco  Most chemicals enter the mother’s milk, so it is essential that the mother check with her obstetrician before using any medicines or nutritional supplements.  Caffeine can cause the infant to be irritable.  Alcohol in excess, tobacco, and illegal drugs can be very harmful.  Both illegal drugs, such as marijuana or heroin, and prescription medication, such as methadone and oxycodone, can cause the baby to be excessively and to feed poorly. 9/30/2024 Dr.Reham Shawky Metwally 23  Caffeine  Most breastfeeding women can drink a moderate amount of caffeine (less than 300 mg daily), without significant effects on their infants.  The American Academy of Pediatrics defines a moderate intake of caffeine as two to three cups of a caffeinated beverage per day.  However, some young infants are sensitive to caffeine and become irritable or have difficulty sleeping, even with small amounts of caffeine. 9/30/2024 Dr.Reham Shawky Metwally 24  Food to Avoid during Lactation Consumption of certain fish and shellfish by breastfeeding If the mother or infant has a women may pose an increased metabolic disease such as A potential disadvantage of risk to the breastfed infant's phenylketonuria or glucose-6- fish intake is exposure to developing nervous system, phosphate dehydrogenase mercury. since both inorganic and deficiency, special dietary organic mercury are restrictions will apply. transferred from maternal serum to human milk. 9/30/2024 Dr.Reham Shawky Metwally 25 Common problems experienced while breastfeeding  Common problems Experienced while Breastfeeding (Mastitis)  Mastitis is a breast inflammation of tissue in one or both mammary glands inside the breast, usually caused by infection.  It can happen to any woman, it’s most common during the first 6 months of breast-feeding.  Symptoms: Breast pain , swelling, flu-like symptoms, headache, and fever.  Causes: Bacteria (from the skin or the infant's mouth ) that enter the breast through:  A break or crack in the skin of the areola.  The opening to the milk ducts. 9/30/2024 Dr.Reham Shawky Metwally 27  The risk of developing mastitis Feeding on Clogged one breast Wet breast milk ducts only pads Anemia Stress Cracked Wearing a Infrequent Fatigue nipples tight bra feeding 9/30/2024 Dr.Reham Shawky Metwally 28  Postpartum Depression  An estimated 10 to 15 percent of women experience postpartum depression.  Several dietary factors—including vitamin D, zinc, selenium, and omega-3 fatty acids—have been studied to find a nutritional link. A healthy, well-balanced diet supports a mother’s mental and physical health, which can influence her relationships with her children. Maternal depression and an unhealthy diet often go hand in hand, and together contribute to a child’s emotional and behavioral problems. 9/30/2024 Dr.Reham Shawky Metwally 29 Contraindication to breastfeeding  Contraindication of Breastfeeding  Infectious Disease Women with the following should not breastfeed their infants:  Active, untreated tuberculosis.  Typhoid.  Active herpes in the breast.  Rubella.  Mumps.  Women with cancer should avoid breast-feeding while on chemotherapy.  Human immunodeficiency virus (HIV ). 9/30/2024 Dr.Reham Shawky Metwally 31 Causes of Malnutrition during Pregnancy or Lactation  Malnutrition during pregnancy or lactation can be caused by: Being underweight and Lack of a nutritious diet not maintaining optimal Severe morning sickness in low-income families prenatal health Deficiency of Painful teeth or mouth Use of certain micronutrients such as conditions that may medications that may Zinc, Magnesium, Iron, affect the ability to interfere with nutrient Vitamin B12, Vitamin K, consume food absorption and Iodine Loss of appetite due to Following an unhealthy other health conditions diet due to lack of such as chronic knowledge infections, depression, etc. 9/30/2024 33