Students

1. Maternal Nutrition
SHAFAAT ULLAH
Khyber Medical University
Peshawer,Pakistan
Applied Nutrition Unit-I

2. Objectives
By the end of this unit, the students will be able to:
• Define key terms
• Identify nutritional need in pregnancy and Lactation
• Identify pre-pregnancy diet
• Discuss the nutritional need in pregnancy and
adolescents
• Identify nutritional risk factors of pregnancy
• Discuss concerns during pregnancy / weight
gain/feeding twins/DM in pregnancy.
• Identify prevalence of Iron deficiency anemia in
Pakistani women.

3. Introduction to Applied Nutrition
• Nutrition at optimal levels is fundamental in the
maintenance of positive health. Maternal nutrition is very
important for the course and outcome of pregnancy.
• Lactation represents a stage where health and nutritional
status of the infant are dependent on the mother.
• Successful pregnancy and lactation require adjustments
in maternal body composition, metabolism and function
of various physiological systems.

4. Cont…
• Thus improving the nutrition and health of girls
and younger women and of mothers during
pregnancy and lactation will derive benefits in
terms of improved health of their children
throughout their lives.

5. Pregnancy
• Pregnancy is a period of great physiological stress
for women as they nurture a growing fetus in their
body.
• Some changes occur in mother’s body which
influence the need for nutrients and their use as:
• A. Increased Basal metabolic rate (BMR): Fetal
growth and development increases the BMR by 5 %
during 1st trimester and 12 % during 2nd & 3rd
trimester. This increases the total energy
requirement of mother.

6. Pregnancy Cont…
• B. Changes in Body fluid: Mother’s blood volume
increases so as to carry the appropriate amount of
nutrients to the fetus and metabolic wastes away
from the fetus. Increased blood volume decreases
the concentration ratio of plasma protein,
hemoglobin and other blood constituents.
• C. Gastrointestinal Changes: Alteration in GI
functions includes nausea, vomiting and
constipation. In the later trimester the absorption
of vit B12, iron and calcium increases in order to
meet the increased needs of mother and fetus.

7. Importance of Good Nutrition During Pregnancy
• Good health of fetus and newborn depends upon the
nutritional status of the mother during and prior to
conception.
• A well nourished woman prior to conception enters
pregnancy with nutrients reserve to meet the nutritional
needs of the fetus without affecting her own tissue s and
health.
• A well nourished mother minimizes complications during
pregnancy and premature delivery.
• Poor mother nutrition put the fetus on the risk of developing
complications , congenital defects and even death.
• Low nourished mother results in the delay of baby’s
milestones.

8. Nutritional Needs During Pregnancy
Nutrients need increases:
• To develop maternal organs like uterus, placenta,
and breast tissues.
• To build up body nutrients reserve.
• During 1st trimester qualitative improvement of
nutrients is needed.
• During 2nd and 3rd trimester both qualitative and
quantitative improvement of nutrients is needed.

9. Energy Requirement During Pregnancy
• Additional energy is required during pregnancy.
• Additional 300 Kcal is required
Group Energy requirement (Kcal)
Sedentary
worker
1875 + 300 = 2175
Moderate
worker
2225 + 300 = 2525
Heavy worker 2925 + 300 = 3225

10. Weight Gain During Pregnancy
• It is natural and necessary to gain weight during
pregnancy as uterus, placenta, breast, blood
volume, body fluids and fat increases.
• Average weight gain is 25—35 lbs
• Teen pregnant gains more weight than a
mature woman.

11. Nutritional Demands
• Energy Needs
• Mothers need more Kcal for two reasons:
• To supply the increased fuel demanded by the
increased BMR
• To spare protein for the newly added tissues

12. Protein Requirement during Pregnancy
Protein is a primary need during pregnancy
Additional 15 g protein is required for:
• Enlargement of maternal tissues
• Growth of placenta
• Growth of fetus
• Increased maternal blood volume
• Formation of amniotic fluid
• Preparation for labour and lactation

13. Calcium Requirement During Pregnancy
• Fetal bone, teeth development and growth.
• Decreases the risk of low birth weight and
maternal hypertension and pre-eclampsia.
• Helps in muscle contraction.
• Helps in blood clotting.
RDA during pregnancy is 1g.

14. Iron during Pregnancy
• Fetal growth
• Increases RBC production in mothers
• Building iron stores in fetal liver
• RDA: 3 g/day

15. Folic Acid
• Folic acid (RDA 400 mcg/d)
• Needed for maternal blood formation
• Prevents fetal neural tube defects and improves
birth weight.
• Pregnant women: 600 mcg (RDA)Breastfeeding
women: 500 mcg (RDA)

16. Other considerations during Pregnancy
• Avoid caffeine as it crosses placenta and enters
fetal blood circulation and increases the risk of
premature delivery.
• Avoid smoking as it results in placental
abnormalities and low birth weight (LBW).
• Avoid Alcohol as it causes LBW, growth
retardation, and mental retardation

17. Importance of Nutrition during
Lactation
• Mother needs extra nutrition to baby’s
nutritional needs.
• Inadequate maternal nutrition affects the
normal growth of the baby and ultimately
mother herself.

18. During Lactation
• Protein Requirement:
• Protein need increases in lactation as mother’s
milk contains 1.15g of protein/100 ml.
• During first 6 months of lactation 75. g/d is
required.
• During 6—12 months of lactation 65 g/d is
required.

19. During Lactation
• Calcium:
• Additional calcium is required for breast milk
secretion as 30—40 mg/100 ml is secreted per
day.
• Iron:
• Iron intake should be increased to 30 mg/d to
make up the iron secreted milk.
• Note: 1 mg of iron/d is lost during menstrual
period.

20. During Lactation
• Vit A (950mcg/d):
• Breast milk is rich in vit A.
• About 350 mcg /d of vit A is secreted in mother’s
milk.

22. Nutrients requirement
Nutrient Non-pregnant pregnant increase
Energy (kcal 2100 2400 300
Protein (g) 44 74 30
Retinol (μg) 800 1000 200
Vitamin D (μg) 7.5 12.5 5
Vitamin E (mg) 8 10 2
Vitamin C (mg) 60 80 20
Riboflavin (mg) 1.3 1.6 0.3
Nicotinic acid mg) 14 16 2
Vitamin B6 (mg) 2 2.6 0.6
Folic acid (μg) 400 800 400
Thiamin (mg) 1.1 1.5 0.4
Calcium (mg) 800 1200 400
Iron (mg) 18 -(S) -(S)
Zinc (mg) 15 20 5

23. Obstetrical History
• Past medical history (wt gained in pregnancy)
• Current dietary intake patterns
• Vitamin, mineral and herbal intake
• Caffeine and other fluids
• Nausea, vomiting, and heartburn
• Constipation

24. Obstetrical Physical Exam
• Low pre-pregnancy weight and low
maternal weight gain are risk factors for:
– Intrauterine growth retardation
– Low birth weight baby
– Increased incidence of perinatal death
• Need to asses:
– Pre-pregnancy weight (BMI)
– Current weight (BMI)
– Weight gain from previous visit

25. Recommended Weight Gain
<156.8
Obese
BMI > 30.0
15-256-11
Overweight
BMI 25-29.9
25-3511-15
Normal Weight
BMI 19-24.9
28-4012-18
Underweight
BMI < 18.5
Weight Gain
(lbs)
Weight Gain
(kg)
BMI Weight (kg)
Height (m2)

26. Concerns during Pregnancy
Nausea and Vomiting
 Strategies for managing morning sickness:
– Eat small, low-fat meals and snacks
– Drink fluids between meals, avoid caffeine
– Limit spicy and high-fat foods
– Avoid lying down after eating or drinking
– Take a walk after meals
– Wear loose-fitting clothes
Constipation:
– Increase fluid and fiber intake to reduce
constipation.

27. Iron Deficiency Anemia
• A pathological condition in which oxygen
carrying capacity of RBCs is insufficient to meet
the needs of the body.
• WHO recommends the HB %age should not fall
below 11 g/dl throughout pregnancy.
• CDC refers the value of 10.5 g/dl

28. Iron Deficiency Anemia
• Susceptible Population:
– Pregnant women who have not been taking iron
supplements
– Infants and children
– Menstruating females
– Teens
– Low income women

29. Iron Deficiency Anemia
• Weakness, fatigue, poor work performance, and
changes in behavior.
• Physical signs include pallor, fatigue, coldness and
paresthesia (a sensation of tingling, burning,or
numbness) of the extremities, greater susceptibility
to infections.
• Infants and young children with iron deficiency may
have low IQ levels, poor cognitive and motor
development, learning, and behavioral problems.

30. Iron Treatment Recommendations
• Iron-rich foods:
– Meat, fish, poultry, eggs
– Organ meats
– Peas and beans
– Dried fruit
– Whole grain and cereal

31. Prevalence of Anemia in Pregnancy in Pakistan
• The prevalence of anemia in pregnancy is 56 % in Pakistan
 Factors:
• Dietary and socioeconomic factors.
• Likes and dislikes in food
• Pica, tea consumption, and low intake of eggs and red meat
are associated with anemia.
Recommendations:
• Women of childbearing age should be provided nutritional
education regarding food sources of iron, especially prior to
becoming pregnant, and taught how food choices can
either enhance or interfere with iron absorption.