Nutrition in Pregnancy and Lactation

Question 1

Why do mothers need more energy?

Answer 1

To supply the increased fuel demand by the enlarged metabolic workload for mother and fetus.
Spare protein for added tissue-building requirements.

Question 2

How many extra calories per day are needed in pregnancy?

Answer 2

200 kcal per day from 3rd trimester.
Increased complex carbohydrates and protein in the diet are the preferred energy sources.

Question 3

Protein needs facts

Answer 3

Protein serves as the building block for the growth of body tissues during pregnancy.
Rapid growth of the fetus.
Development of the placenta. Growth of maternal tissues.
Increased maternal blood volume.
Amniotic fluid.
Storage reserves.

Question 4

What is the protein intake recommended per day (pregnancy)?

Answer 4

Protein should increase by 25g per day.
Protein-rich foods contribute calcium, iron, B vitamins.

Question 5

What are the essential minerals?

Answer 5

• Calcium is essential for the fetal development of bones and teeth.
• Iron is essential for increased haemoglobin synthesis.
• Iodine is essential to produce more thyroxine.
• Folate builds mature red blood cells during pregnancy.

Question 6

Facts about Folate

Answer 6

Needed during the early periconceptional period.
DRIs recommend daily folate intake of 600 mcg during pregnancy and 400 mcg per day for non-pregnant women during childbearing years.
May require folate supplements

Question 7

What are the essential vitamins (pregnancy)?

Answer 7

Vitamin D. Ensures absorption and utilization of calcium and phosphorus for fetal bone growth. Daily intake of 3 to 4 cups of fortified milk. Exposure to sunlight increases the endogenous synthesis of vitamin D.

Question 8

Which diseases is the low birth weight associated with?

Answer 8

(Low birth weight is under 2.5kg for a term infant at 9 months)
Hypertension
Obesity
Heart disease
Type 2 diabetes
Cancer

Question 9

Weight gain during pregnancy

Answer 9

Underweight women: 28 to 40 lbs.
Normal-weight women: 25 to 35 lbs.
Overweight women: 15 to 24 lbs. Obese women: approx 15 lbs.
Teenage girls: 35 to 40 lbs.
Women carrying twins: 35 to 45 lbs.

Question 10

What is the average weight gain during the first trimester?

Answer 10

2 to 4 lbs

Question 11

What is the average weight gain after the first trimester?

Answer 11

1lb per week

Question 12

Sodium intake

Answer 12

2 to 3 g per day

Question 13

What are the functional gastrointestinal problems during pregnancy?

Answer 13

Nausea and vomiting are caused by hormonal adaptations.
Constipation may occur in the latter part of pregnancy and is the result of increased pressure of an enlarging uterus and reduced normal peristalsis.
Hemorrhoids, caused by the increased weight of the baby.
Heartburn, caused by pressure of enlarging uterus crowding the stomach.

Question 14

What are the effects of iron supplements?

Answer 14

Grey or black stool, nausea, constipation, diarrhoea. (take iron supplements 1hr before or 2 hrs after a meal with water or orange juice)

Question 15

What are some complications of pregnancy?

Answer 15

Anaemia: deficiency of iron or folate in mother’s diet.
Neural tube defect: caused by low folate intake.
Intrauterine growth failure: caused by low pregnancy weight, inadequate weight gain, and smoking.
Preexisting disease.
Pregnancy-induced hypertension: related to diets low in protein, kcal, calcium, and salt.
Gestational diabetes: results from increased metabolic workload.

Question 16

What is the physiological process of lactation?

Answer 16

Throughout pregnancy, mammary glands prepare for lactation.
Mammary glands extract nutrients from maternal blood and synthesize other compounds.
Stimulation of the nipple from infant suckling stimulates milk production.

Question 17

Which hormone stimulates the production of milk?

Answer 17

Prolactin

Question 18

Which hormone is responsible for the let-down reflex (milk ejection)?

Answer 18

Oxytocin

Question 19

What are the 3 essential reflexes?

Answer 19

Sucking
Moro (or rooting)
Swallowing

Question 20

What is the breastmilk composition?

Answer 20

It contains all the nutrients that an infant needs in the first 6 months of life, including fat, carbohydrates, proteins, vitamins, minerals and water.
It is easily digested and efficiently used.
it also contains bioactive factors that augment the infant’s immature immune system, providing protection against infection.

Question 21

What is the fat content of breast milk?

Answer 21

About 3.5g of fat per 100ml. Which provides about one-half of the energy content of the milk.
Breast milk fat contains polyunsaturated fatty acids (Docosahexaenoic acid DHA, and arachidonic acid ARA) that are unavailable in other milks.

Question 22

What is the carbohydrate content of breast milk?

Answer 22

About 7g lactose per 100ml.
The main carbohydrate is lactose, a disaccharide.
Oligosaccharides or sugar chains are present in milk, and provide important protection against infection.

Question 23

What is the protein content of breast milk?

Answer 23

0.9g per 100ml (is lower than in animal milks)
Breast milk contains less protein casein and has a different molecular structure, easily digested curds than other milks.
Contains more alpha-lactalbumin .

Question 24

Which protein from animal milk can cause intolerance in the infant?

Answer 24

Beta-lactoglobulin

Question 25

Which vitamin is not present in breast milk?

Answer 25

Vitamin D. The infant needs exposure to sunlight to generate endogenous vitamin D. If this is not possible, a supplement.

Question 26

Breast milk contains many factors that help to protect an infant against infection, including:

Answer 26

K immunoglobulin, principally secretory immunoglobulin A (sIgA), which coats the intestinal mucosa and prevents bacteria from entering the cells.
K white blood cells, which can kill micro-organisms.
K whey proteins (lysozyme and lactoferrin), which can kill bacteria, viruses and fungi.
K oligosaccharides which prevent bacteria from attaching to mucosal surfaces.
Bile-salt stimulated lipase facilitates the complete digestion of fat once the milk has reached the small intestine. Fat in artificial milk is less completely digested.
Epidermal growth factor stimulates maturation of the lining of the infant’s intestine, so that it is better able to digest and absorb nutrients, and is less easily infected or sensitised to foreign proteins.

Question 27

What is the colostrum?

Answer 27

The special milk that is secreted in the first 2-3 days after delivery.
It is produced in small amounts, 40-50ml on the first day.
It is rich in white cells and antibodies, especially sIgA, and contains a larger percentage of protein, minerals and fat-soluble vitamins (A, E and K). Vitamin A is important for eye protection and for the integrity of epithelial surfaces.

Question 28

What makes the colostrum yellowish in colour?

Answer 28

Vitamin A

Question 29

Why is colostrum important?

Answer 29

Because it provides immune protection to an infant when first exposed to the microorganisms in the environment, and the epidermal growth factor helps to prepare the lining of the gut to receive the nutrients in milk.

Question 30

What is the amount of breast milk taken by the infant on the 3rd day?

Answer 30

about 300-400 ml per 24 hrs

Question 31

What is the amount of breast milk taken by the infant on the 5th day?

Answer 31

about 500-800 ml per 24 hrs

Question 32

What is the name of the breast milk from day 7 to 14?

Answer 32

Transitional

Question 33

What is the name of the breast milk after 2 weeks?

Answer 33

Mature milk

Question 34

Explain the breast structure

Answer 34

Nipples, areola, mammary tissue, supporting connective tissue and fat, blood and lymphatic vessels, and nerves.

Question 35

Explain the mammary tissue

Answer 35

This tissue includes the alveoli, which are small sacs made of milk-secreting cells, and the ducts that carry the milk to the outside. Between feeds, milk collects in the lumen of the alveoli and ducts.

Question 36

How many milk ducts are in the nipple?

Answer 36

An average of 9

Question 37

Where the Montgomery’s glands are located?

Answer 37

In the areola

Question 38

What do the Montgomery’s glands secrete?

Answer 38

Oily fluids that protect the skin of the nipple and areola during lactation

Question 39

What are the 2 hormones that directly affect breastfeeding?

Answer 39

Prolactin and oxytocin

Question 40

Explain the hormonal control of milk

Answer 40

When a baby suckles at the breast, sensory impulses pass from the nipple to the brain. In response, the anterior lobe of the pituitary gland secretes prolactin, and the posterior lobe secretes oxytocin.

Question 41

Explain prolactin reflex

Answer 41

Sensory impulses from the nipple
Prolactin in blood
More prolactin is secreted at night
Secreted after feed to produce next feed
Suppresses ovulation

Question 42

What are the nutritional needs for lactation?

Answer 42

Milk production requires 500-700 kcals per day
25g extra of protein
3L per day of water, juices (fluids)

Question 43

What are the advantages of breastfeeding?

Answer 43

Fewer infections
Fewer allergies and intolerances
Ease of digestion
Convenience and economy
Improved cognitive development

Question 44

Macronutrients in breast milk

Answer 44

39% Carbohydrates
55% Fat
6% Protein

Question 45

What supplements are recommended for infants after 6 months?

Answer 45

Vitamin D, Iron and Fluoride