MANAGEMENT OF NUTRITION
PROBLEMS IN PREGNANCY AND
LACTATION
Prof. 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