NUTRITION DURING LACTATION zzt’07

In-Hospital Breastfeeding Rates (US, 2001) Healthy People 2010 Goal

Breastfeeding Rates at 6 mo (2001) Healthy People 2010 Goal

Breastfeeding : A Learned Behavior Physiological process  virtually all mothers are capable of doing Is a learned behavior  not all mother decide to do Mother’s partner also plays an important role

Advantages Nutritionally superior to any alternatives Bacteriologically safe & always fresh Contains various antiinfectious factors & immune cells The least allergenic to any infant food

Breast-fed babies are less likely to be overfed Promotes good jaw & tooth development Cost less Promotes close mother-child contact More convenient once the process is established

American Academy of Pediatrics (AAP) & American Dietetic Association (ADA) Exclusive breastfeeding for 6 months, and breastfeeding with complementary foods for at least 12 months as an optimal feeding pattern for infants

American Academy of Pediatrics (AAP) Females infected with the human immunodeficiency virus (HIV) should be counseled not to beast-feed Females who are at risk for being infected with the virus should be educated about the risk of infecting their infant with HIV through breast milk

The Baby Friendly Hospital Initiative Global effort to  the incidence & duration of breast-feeding To become ‘baby friendly’, a hospital must agree to implement the “Ten steps to Successful Breast-feeding”

Ten steps to successful breast-feeding Have a written breast-feeding policy that is routinely communicated to all health care staff Train all health care staff in the skills necessary to implement this policy Inform all pregnant females about the benefits and management of breast-feeding

Help the mother initiate breast-feeding within a half hour of birth Show mothers how to breast-feed and how to maintain lactation, even if they are separated from their infant Give new born infants no food or drink other than breast milk unless medically indicated

Practice rooming-in Encourage breast-feeding on demand Give no artificial teats or pacifiers Foster the establishment of breast feeding support groups, and refer mothers to them on discharge from the hospital or clinic

Nutritional requirements Lactation is nutritionally demanding Increased intake of most nutrient is advised Milk production is most affected by the frequency of suckling Milk composition varies according to mother’s diet, but in general the effect is to reduce quantity, not quality

Energy Production 100 ml of milk  need 85 kcal expenditure 1 st 6 mo of lactation  750 ml/day (550 – 1200 ml/day) RDA : kcal (1 st 6 mo) kcal (2 nd 6 mo)

2 nd 6 mo  - production  600 ml/day  E req - consuming solid food Energy intake at least 1800 kcal/day Inadeq maternal fluid intake affects milk volume

After birth  women are in a hurry to lose weight In general  lose ½ - 1 kg / mo during the 1 st 4 – 6 mo of lactation Exercise >>   lactic acid of breast milk  influence milk taste

Breastfeeding and maternal weight loss (Dewey et al. Am J Clin Nutr 1993;58:162-6)

Fat 20 – 35% of total calories Presence of long-chain PUFA  crucial for fetal & infant retina & brain development AI n-6 PUFA : 13g/day AI n-3 PUFA : 1.3 g/day

Human Milk Composition a. CHO, protein & minerals  not influenced by maternal diet b. Fat and vitamins  influenced by maternal diet  Influences of maternal diet  

Human Milk Composition  Influences of maternal nutritional status - milk composition remains relatively constant unless malnutrition is severe - the volume of milk produced may  with malnutrition

Water Drink a glass of milk, juice or water at each meal and each time the infant nurses

Nutrient supplements Most women can obtain all the nutrients from a well balanced diet Some may need iron  to refill their depleted iron stores

Particular foods Foods with strong or spicy flavors (e.g. garlic) may alter the flavor of breast milk Infants who develop symptoms of food allergy  more comfortable if the mother’s diet exclude the most common offenders (cow’s milk, eggs, peanuts)

Increased Requirements

Practices incompatible with lactation Alcohol - easily enters breast milk Smoking - transfer nicotine Medicinal drugs Environmental contaminants Caffeine

zzt’07