Maternal Nutrition

in Lactation
 Diet and Dietary Supplements
for Mother and Infant

Lactation - physiologic completion of

reproductive cycle

Body Preparation
 Breast development  produce
milk
 Store more nutrients and energy
 General Rule

Diet of lactating woman

should supply somewhat
more of each nutrient than the
recommended for the non-
pregnant woman
Kilo-Calories

 N 75 Kcal /10 ml (average) = caloric

content of HM in well nourished woman
 Fat - chief source
 Lactose contribute to
 Protein total

Body Fat  During Pregnancy

(change fat cell size)
During Lactation
 Energy in Breastmilk

800 ml milk per day contains 560 kcal

Add 25% energy to make milk = 700
kcal

200 kcal from pregnancy stores

500 kcal from diet
 Sufficient caloric intake -

Eat many different foods to get the

calories,vitamins and minerals you
need to remain healthy.

Minimal caloric intake of 2000 cal/ day

an optimal intake of 500 cal above non-
pregnant caloric intake

It is equivalent to a PEANUT BUTTER

sandwich and a glass of milk.
 Example of extra food needed each day
by a breastfeeding woman

60 g rice (1 fistful) 240 kcal,protein,B vit

30g beans (1/2 fistful) 120 Kcal,protein,iron,
calcium
Vegetables (1 fistful) protein,Cal,Vit A, folic
acid
Half banana 90 kcal,iron
5 ml oil (1 tsp) 50 kcal
UNICEF
 DIET

DIET Maintenance & Activity

+ Milk
STORES Losses in Milk Production

BODY
STORES

ENERGY UTILIZATION IN LACTATION

Volume

Volume Produced Varies

Decreased  10% dehydrated

 malnutrition
 famine  supply
dwindles  ceases
Protein

Normal 0.8 – 0.9 g/ 100 ml

Fat and Cholesterol

 FAT  main source of calories in

HM
 Triglycerides (98%) – affected by
maternal diets

Low cholesterol diets = maternal

blood cholesterol but not the
triglyceride levels in HM
Lactose
Least affected by maternal diet

Water
Drink to relieve thirst only
Excessive fluid intake ≠
increase milk production
(water intoxication)
 Water

Alcoholic beverages – metabolized in

2 hrs – limit intake

Caffeine – limit to two 8oz servings

300mg caffeine = 18 oz regular
coffee/day
8 oz expresso /day
48 oz of tea / day
Chocolate/ soda = 10g / 1.5bar
50 g / 12 oz can
Vitamins

Fat soluble (Vit A / D / E / K )

Transported into milk via fat therefore

level less affected by dietary change

Milk levels do not change

until a certain level is
achieved in the stores
 Fat Soluble vitamins

Vitamin A & D = stored in tissues

 vitamin A malnourished woman

= level in HM
Vitamin D = Sunlight

30 min. of sunlight /wk conc.

(with diaper) above
lower
limits
2 hours /week of
(fully clothed) NORMAL
value
Vitamin E

Sunflower oil in HM by direct

maternal absorption

Tocopherol Levels

Highest in colostrum
Uses in Neonates: - as anti-oxidant
for prevention of hemolytic
anemia due to vitamin E deficiency
Vitamin K

Maternal dietary intake is

most critical during end of
gestation

Critical - 1st few days

- risk of ICH
Water Soluble Vitamins

Moves freely with ease from serum

to milk

- daily dietary fluctuations

- levels affected by maternal diets

Supplementation level once

reached = not affect
breast milk.
Vitamin C

stress
 Body requirements lactation

 No effect on milk volume

 Level in HM 2x that
recommended for infant formula
Vitamin B

Acutely affected by maternal diet

B1 (Thiamine) infantile beriberi

B12 (Strict vegetarian)

- megaloblastic anemia
- methylmalonic aciduria
- homocystinuria
 General Recommendations for
Lactating Vegetarians

• Supplement with soy flour,

molasses, nuts
• Use complementary protein
combinations
• Avoid excessive phytates and bran
• Watch protein, iron, calcium, vit. D,
vit. B12, and Riboflavin to assure
adequate intake
Sodium

Concentration most variable

Fluctuates ten folds during

lactation and diurnally
Iron

 Not readily affected by diet

 If added to HM  interfere
with function of lactoferrin
Iodine

 NOT depend on dietary intake

 Breast able to raise iodine level

above blood concentration
( NO Radioactive iodine to
lactating woman)
 Iodine

Iodized salt AND Bread dough

conditioners would increase risk
for excessive iodine intake

BM Iodine 29 – 490 mg /L

178 mg /L ABOVE the RDA for
infants
Calcium

 For bone growth

 Total calcium level in BM is low
 Lactating woman mobilizes 2%
skeletal calcium (100 days) 
BM
 Requirements for lactating
woman  400 mg /day over the
Normal
 Some Sources of Calcium in Foods
Julian Huang md, Jan 2003

Dairy foods – milk, yogurt

Leafy green veg – brocolli, spinach
Fruit – orange
Beans & peas – tofu, peanut, baked beans
Fish – salmon , sardines
Misc – sesame seed, almond, brown sugar

VIT D is necessary to allow the body to absorb

the calcium
 Some Sources of Calcium in Foods
Julian Huang md, Jan 2003

Non-dairy Calcium rich foods

Total cereal (3/4 cup) 250mg

Cal fortified orange juice (8oz) 250mg
Tofu raw (1/2cup) 130mg
Seedless raisin (2/3 cup) 53mg
Broccolli boiled (1 cup) 72mg
Carrots raw (1 med) – 19mg
 Other diet considerations:
considerations

Smoking/ tobacco affects women’s

appetite and tastes of many food…
limit to <10 cigarette (1/2 pack) per day
maybe compatible to breastfeeding

TOBACCO INTERFERE with milk let-

down and reduce amount of milk
produced.
 •Other diet considerations:

Caffeine -300g/day
Equivalent to :
–18 oz of regular coke
–8 oz of expresso DAY
–48 oz of tea

Alcohol does enter breastmilk and is

metabolized at about the same rate as
from blood stream – 1 ½ to 2 hrs / oz
Exercise While Breastfeeding ??

No contraindication

Use firm brassiere

Cause breast sagging ??

Diet while Breastfeeding

Avoid junk foods

No reduction diet should

be recommended
 Foods to Watch out for

Gassy foods Garlic

Onion
Acidic foods
Cabbage
Essential oils Colic in some
Turnips infants
(garlic, spices) Brocolli (24 hours after
 infants Beans ingestion)
object their Rubbarb
presence
Apricot
Prunes
 Foods to Watch out for

Heavy diet of melons

peaches 
colic freshfruits
diarrhea

Chocolates ≠ colic, diarrhea,

constipation
Color of Milk and Maternal Diet

Mature milk  bluish white

Colostrum  yellowish to yellowish orange
Sunkist orange soda  pink to pink orange
(due to food dyes)
Green beverages
Seaweeds in tablet forms  green milk
Natural vit. from health food
sources

Minocycline Hydrochloride  black milk (due

to hemosiderin)
Malunggay (leaves, pods, seeds, flowers)
Moringa Oleifera

An ounce of Malunggay leaves/seeds

is equal to :

4 glasses of milk (calcium)

7 oranges (vitamin C)
3 bananas
3x spinach (iron)
better than olive oil
 Summary : Diet of Lactating Woman

General Rule:
Eat more of each nutrient than the
recommended for the non-pregnant
woman.

Malnutrition
10% dehydrated = volume
Protein = volume
Lactose = least affected
Sodium = fluctuates 10 folds
Calcium
Iron = not readily affected but …
Vitamins
Maternal Nutrition and Milk Composition

Women are able to produce

milk with an adequate
content of fat, carbohydrate,
and most minerals, even
when their supply of
nutrients is limited.
2. Nutrients most likely to be
present in lower than normal
concentrations in response to
chronically low maternal
intakes are the vitamins
(especially B6, B12, A, and D).
• Nutrients maintained at the expense
of maternal stores or tissues
include the macronutrients, most
minerals, and folate.

4. Use the national guidelines to assist

the mother in achieving and
adequate diet.
Breastfed is BEST
FED