Postpartum Weight Retention

 1/3 of pregnant women gain more wt during pregnancy than is recommended, particularly overweight or obese women.  Wt loss among women postpartum is highly variable; most women will retain kg from their previous pregnancy  At 18 months postpartum, 20% of women will be more than 5 kg heavier than they were before pregnancy.  nonlactating women may be attributed to enhanced appetite due to increased prolactin levels and higher energy demands.

 The most consistent and strongest determinant of weight loss during lactation is pregnancy wt gain.  Other factors include pre-pregnancy wt, age, parity, race, smoking, exercise, return to work outside the home, and lactation.  Breastfeeding results in a faster rate of postpartum weight loss than formula feeding; 0.6–2.0 kg /12 months.  Breastfeeding facilitates changes in body composition; fat is mobilized from the trunk and thigh areas

Exercise And Lactation  Physical activity at any age is essential to minimize the risk of several morbidity and mortality; specifically in lactation, it improves cardiovascular fitness, plasma lipid levels, and insulin response. Besides, it promotes body wt regulation and optimizes bone health  Also it has the potential to benefit psychosocial well-being in lactation, such as improving self-esteem and reducing depression and anxiety.  Resuming physical activity gradually, and only when a woman’s body has healed substantially from pregnancy and delivery (usually 4–6 weeks postpartum). They must avoid fatigue, remain well hydrated, and watch for abnormal bleeding or pain.

Achieving a balance of diet and exercise for Mom And Baby  Table Maintaining a healthy diet during lactation is essential to ensures that macro- and micronutrient intake is adequate to support optimal maternal health and breastfeeding success.

A. Calcium  99% of total body ca is found in bones and teeth. Remainder plays a role in BP regulation, muscle contraction, nerve transmission, and  hormone secretion.  Calcium homeostasis is maintained by parathyroid hormone, hypercalcemia, and calcitonin, hypocalcium.  Secretion of ca into breast milk averages about 200 mg/day.  During pregnancy; increased maternal bone resorption and decreased renal ca excretion rates occur to meet the elevated calcium demands of lactation.

 The concentration of ca in breast milk decreases after 3–6 months; greatest loss of bone mineral content occurs within the first few months postpartum.  Ca adequate Intake during lactation is 1,000 mg/day for women (19–50 y), if < age of19;1,300 mg.  Loss of ca from maternal skeleton is not prevented by increased dietary intake, even among women with low baseline ca intakes.  The bone mineral changes occurring during and following lactation are a normal physiological response, and an increased requirement for calcium is not needed.  Sources of ca; milk and other dairy products, salmon with bones, some green leafy vegetables such as broccoli.  The absorption of supplemental calcium is greatest when ca is taken in doses of 500 mg or less

Vitamin D  The main function of vit D is to maintain normal blood ca & Ph; promoting bone health.  Provitamin is obtained from food, vit is synthesized in the skin by exposure to ultraviolet light.  Human milk contains low amounts of vitamin D; 4 to 40 IU/l. Infant formula is routinely fortified with 400 IU vitamin D per liter, while the breastfed infant is primarily dependent upon endogenous synthesis or supplemental sources of vitamin D.

 Breastfed infants are recommended to be given a 400 IU vitamin D supplement each day.  There is no evidence that lactation increases maternal requirements for vitamin D; similar to nonlactating adults 200 IU/day. Currently, an intake of 2,000 IU/day for lactating women to be the tolerable upper intake level. The tolerable upper limit for vitamin D consumption by adults should be set at10,000 IU/day.  Obesity is linked with poorer vitamin D status; obese subjects may have a greater requirement for vitamin D than their non- obese

 Sources of vit D in the diet include liver, fatty fish such as salmon, and eggs yolks. Milk may be fortified with vit D.  Supplemental vitamin D is available in  two distinct forms, vitamin D2 and  vitamin D3.

 Folate; a number of related compounds  that are involved in the metabolism of  nucleic and amino acids, and therefore  the synthesis of DNA, RNA, an  proteins.  Folic acid is a synthetic form of the vitamin, used in vitamin supplements  and food fortification. C. Folate

 The average amount of folate secreted into human milk is estimated to be 85 mcg/ liter/day. With the exception of severe maternal folate deficiency (i.e., megaloblastic anemia), the content of folate in human milk remains stable and appears to be conserved at the expense of the mother’s folate stores.  A folic acid supplement taken on an empty stomach is thought to be 100% bioavailable compared to about 50% for naturally occurring food folate.  The recommended dietary allowance for folate for breastfeeding women aged 14–50 years is 500 mcg per day.

 Lactating women who are planning a subsequent pregnancy, or who are not taking effective precautions to prevent one, should be encouraged to consume 400 mcg folic acid supplement daily for at least 4 weeks before and 12 weeks after conception to reduce the risk of having a subsequent child with NTD  Overzealous use of folic acid supplements is not risk free; may mask a vitamin B12 deficiency by correcting its characteristic symptom, megaloblastic anemia.

 Dietary Intake of Folate; without mandatory folic acid fortification, 98% of lactating women would not have met their requirements for folate from diet alone.  Sources of Folate; green leafy vegetables as well as citrus fruit juices, liver, and legumes

 D. Vitamin B12  Known as cobalamin, and required for RBCs formation & normal neurological function. Similar to folate, it is involved in DNA synthesis.  Vit B12 deficiency is associated with DNA production disruption; megalo-blastic anemia and neurological complications.  Vit B12 deficiency may result from  inadequate absorption rather than a dietary deficiency; chronic antacid use, atrophic gastritis, or pernicious anemia.

 High doses of synthetic folic acid (greater than 1,000 mcg) can mask vitamin B12 deficiency.  Megaloblastic anemia is the clinical  indicator of vitamin B12 deficiency.  Vitamin B12 is excreted in the bile and effectively reabsorbed it can take  up to 20 years for a vitamin B12  deficiency to develop due to low vitamin B12 intake. However, deficiency due to poor absorption can take only a few years to develop.  During lactation, the concentration of vit B12 in human milk varies widely, and reflects maternal vitamin B12 intake and status. Low maternal intake or poor absorption rapidly leads to a low level of vitamin B12 in human milk

 Severe deficiency can occur after approximately 4 months of age in exclusively breast-fed infants  of mothers with inadequate intake.  Symptoms of infantile vitamin  B12 deficiency include irritability,  abnormal reflexes, feeding  difficulties, reduced level of alertness  or consciousness leading to coma,  and permanent development  disabilities.

 The concentration of vit B12 in human milk changes very little after the first month postpartum; 0.33 mcg/day during the first 6 months of lactation, and 0.25 mcg/day during the second 6 months.  The RDA for lactating women age 14–50 years is 2.8 mcg/day; higher  than nonpregnant, nonlactating  women (2.4 mcg/day).  Low dietary vit B12 intakes during lactation typically occur when either the mother is a strict vegetarian or when usual consumption of animal products is low.  Sources of Vit B12; in the diet

 vit B12 is synthesized by bacteria and found primarily in meat, eggs, fish (including shellfish), and to a lesser extent dairy products. Plant sources, such as spirulina (algae طحالب ) and nori (seaweed), contain vitamin B12 analogues. Milk and milk products are a good source of vitamin B12 (0.9 mcg/250 ml), while vegans are recommended to consume a supplement (2.8 mcg/ day) and/or ensure their diet includes foods fortified with vitamin B12.

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