This document discusses nutrition requirements during pregnancy and lactation. It notes that physiological changes during these periods increase demands for energy, protein, iron, vitamins and other nutrients. Recommended dietary allowances are provided for additional intake of calories, protein, iron, vitamin A, B vitamins and folic acid during pregnancy and lactation. The document recommends eating an extra meal per day to meet increased nutritional needs and emphasizes including foods like cereals, legumes, vegetables, fruits, meat and dairy. Proper nutrition during these critical life stages is important for both maternal and fetal health.

1. Nutrition in
pregnancy and
lactation
Dr P Raghavendra,
Post Graduate in the
Dept of Community Medicine,
Siddhartha Medical College, Vijayawada

2. • Human body changes and behaves differently
in different periods of its lifecycle.
• Changing age and physiological
status, changes the activity, BMR, growth
rate, etc.
• These variations change the nutritional
requirements too.

3. Why the dietetics change in pregnancy
Many physiological changes.
• Uterine hypertrophy and hyperplasia
• Increased vascularity
• HR, SV, CO increase, so do TV and oxygen
consumption.
Appetite changes  Cravings, Aversions for
certain foods.
Constipation sets in.

4. Contd..
• Above all, the growing demands of the
growing fetus.
• All these cause an increased demand and
requirements for energy and various other
nutrients.
• Also call for changes in lifestyle, including her
dietary habits.

5. Why in lactation?
• Lactation, biochemically, is a process of energy
conversion.
• Additional energy requirement is based on the
volume of milk secreted, its energy
content, and efficiency of energy conversion.
• The energy calculations are made at 850 ml
milk secretion per day and with 80%
conversion of food energy into milk energy.

6. Energy
Requirements

7. Energy Requirements
• Total energy equivalents for oxygen
consumption increased during pregnancy is
27,000 Kcal.
• Also needs energy for utilization of fats and
protein.
• 4 kg of fat is deposited.
• Total energy cost comes to about 73,000 Kcal.
• Most of this is needed in the last 2 trimesters.

8. Additional requirements
• Pregnancy  300 Kcal
• Lactation (1st 6 months)  550 Kcal
• Lactation (6-12 months)  400 kcal

9. Additional Energy requirements during motherhood (in KCals)
RDA (Sedentary woman) 1875
Add 300
Pregnancy
Total 2175
Add 550
Lactation
(1st 6 months) Total 2425
Add 400
Lactation
(6-12 months) Total 2275

10. Protein
Requirements

11. Protein requirements
• Demand for extra proteins:
– Rapid fetal growth
– Development of placenta, and other maternal
tissues
– Expanding fluids (Blood volume, Amniotic fluid)
– Storage reserves

12. Additional requirements
• Pregnancy  15 gm
• Lactation (1st 6 months)  25 gm
• Lactation (6-12 months)  18 gm

13. Additional Protein requirements during motherhood (in grams)
RDA (Sedentary woman) 50
Add 15
Pregnancy
Total 65
Add 25
Lactation
(1st 6 months) Total 75
Add 18
Lactation
(6-12 months) Total 68

14. Iron
Requirements

15. Additional iron is required for..
• Augmented demand for fetal growth
• Expansion of maternal tissues (including RBC
mass)
• Iron content in placenta
• Blood loss during parturition

16. Additional requirements
• 2nd trimester  3.3 mg
• 3rd trimester  5 mg
Poor absorption of iron makes RDA to be increased
by 8 mg per day throughout the pregnancy.
Lactational amenorrhoea saves some iron
loss, enough to cover losses in breast milk.

17. Additional Iron requirements during motherhood
(in mg)
RDA (Sedentary woman) 30
Add 8
Pregnancy
Total 38
Add 0
Lactation
(1st 6 months) Total 30
Add 0
Lactation
(6-12 months) Total 30

18. Vitamin
Requirements

19. Vitamin A (in Retinol Equivalents)
RDA (Sedentary woman) 600
Add 0
Pregnancy
Total 600
Add 350
Lactation
(1st 6 months) Total 950
Add 350
Lactation
(6-12 months) Total 950

20. (All values in mg) Thiamine Riboflavin Niacin pyridoxine
RDA (Sedentary
0.9 1.1 12 2
woman)
Add 0.2 0.2 2 0.5
Pregnancy
Total 1.1 1.3 14 2.5
Lactation Add 0.3 0.3 4 0.5
(1st 6
months) Total 1.2 1.4 16 2.5
Lactation Add 0.2 0.2 3 0.5
(6-12
months) Total 1.1 1.3 15 2.5

21. Folic acid
• Additional RDA: 300 g/day.
• Diet not enough. Supplementation through
medicinal folate is needed.
• Ideally should be started 3 months pre-
conceptionally.
• During lactation, RDA is increased by 50
g/day

22. Micronutrient
deficiency

23. • Fetus is very sensitive to micronutrient
deficiencies during organogenesis as well as
during growth.
• In deficiency, the meager maternal resources
are used off first.
• Even mother’s health can be compromised.

25. Diet during
pregnancy

26. • Food fads
• Vicious cycle of malnutrition
• Woman should be advised in their own
language as roti, chawal and not as proteins
and fats.

27. Dietary advices
• Eat one extra meal a day, to ensure adequacy
of all nutrients
• Try and eat with the whole family and not
alone
• Prefer high fibre cereals and legumes - include
sprouts
• Include ample amounts of vegetables and
fruits
• Take meat, milk and eggs regularly

28. Dietary advices
• If vegetarian, insist on at least ½ lit of milk, and
extra pulses
• Prefer nutritious foods like groundnuts and soya
beans
• No fad diets
• Take iron and folate supplements regularly
• No un-prescribed medicines, alcohol and tobacco
• Attend ANC clinic regularly and follow your
doctor’s advise

29. Balanced diet for a pregnant

30. Balanced diet for a lactating mother

31. References
1. Textbook of Public Health and Community Medicine, 1st edition, 2009.,
Dept of Community Medicine, AFMC.
2. K.Park, Textbook of Social and Preventive Medicine, 21/e, 2011,
Banarsidas Bhanot.
3. National Institute of Nutrition, Nutritional Requirements and
Recommended Dietary Allowances for Indians; A report of the ICMR,
2010
4. Venkatachalam PS, Rebello LM. Nutrition for Mother and Child. National
Institute of Nutrition (ICMR), Hyderabad. 5th edition, 2004
5. Gupta RK. Towards better nutrition of pregnant women in the
developing world. Indian J of PSM.
6. Geissler C, Powers H. Human Nutrition.11th ed. Elsevier Churchill
Livingstone London. 2005
7. Gopalan C, Ramasastri BV, Balasubramanium SC. Nutritive Value of
Indian foods, National Institute of Nutrition (ICMR), Hyderabad. 1999

32. Thank You