IMAM GUIDE

1. NUTRITION IN THE LIFE CYCLE

NUTRITION CARE DURING PREGNANCY AND LACTATION

PREGNANCY

Pregnancy is a critical period in the life cycle because of many body changes that occur in the
mother and the fetus. Good nutrition is important for a successful child delivery. Dietary advice
relating to pregnancy is one of the major factors in determining the future well-being of a child
conceived. Good nutrition during pregnancy reduces childhood morbidity and mortality, and
minimizes the risks of maternal death associated with pregnancy. Several studies have shown
that poor nutrition during pregnancy lead to physical, emotional and neurological disorders in
the infant.

HIGH RISK PREGNANCY FACTORS INCLUDE

Maternal weight: Both total weight gain and patterns of weight are important indicators of
pregnancy outcomes. Weight should be gained gradually. Excessive weight gain is gaining
more than one kilogram of body weight in a week (>1kg/week) while inadequate weight
gain is gaining less than one kilogram of body weight in one month (<1kg/month).

Pre-pregnancy BMI either < 19.8 or > 26.0: This may lead to nutrient deficiencies or toxicities
and eating disorders.

Previous pregnancies may put the mother at a nutritional risk
 Many previous pregnancies (3 or more to mothers under age 20, 4 or more to
mothers age 20 and older)
 Short intervals between pregnancies (< 1 year)
 Previous history of pregnancy-related problems
 Multiple pregnancies e.g. twins or triplets etc
 Low or high birth weight of infants

1.1. GENERAL NUTRITION REQUIREMENTS IN PREGNANCY AND LACTATION

Energy and Protein

Dietary intake during pregnancy should provide the energy that will ensure the full term
delivery of a healthy newborn baby of adequate size and appropriate body composition by a
woman whose weight and body composition are consistent with long-term good health and
well-being. The ideal situation is for a woman to enter pregnancy at a normal weight and good
nutritional status. The energy requirement of pregnant woman is determined by several factors.
These include the need to ensure adequate growth of the fetus, placenta and associated
maternal tissues; to provide for increased metabolic demands of pregnancy in addition to
maintaining adequate maternal weight, body composition and physical activity throughout
gestational period as well as sufficient stores of nutrients for lactation. Special consideration
must be made for women who are under or overweight when they enter pregnancy. A proper
dietary balance is necessary to ensure sufficient intake for adequate growth without drawing
from the mother’s own tissues to maintain her pregnancy.

The increased energy needs during lactation is imposed by additional demands and needs for
adequate milk production and secretion. The additional demands correspond to the energy cost
of milk production. Fat stores accumulated during pregnancy may cover part of the additional
energy needs in the first few months of lactation. The average energy requirement for normal
women is 2150kilocalories per day. Table 1 below shows recommended energy and protein
requirements for women during pregnancy and lactation.

1.2. DESIRABLE BIRTH WEIGHT AND GESTATIONAL WEIGHT GAIN

Poor maternal weight gain during pregnancy is associated with poor pregnancy and fetal outcomes such as pre-clampsia, eclampsia, postpartum hemorrhage, need for assisted delivery low birth weight, intra uterine growth retardation (IUGR) and preterm birth among others. Weight gain during pregnancy comprise of products of conception (fetus, placenta, and amniotic fluids), growth of various tissues (uterus, breasts) and increase in blood volume, extra cellular fluid and maternal fat stores. The desirable amount of weight is associated with optimal pregnancy outcomes such as reduced maternal mortality and pregnancy related complications during pregnancy, labour and delivery. It should also allow adequate postpartum body weight and lactation performance; as well as optimal outcome for the infant including adequate foetal growth and maturation, prevention of gestational and perinatal morbidity and mortality.

The WHO recommends that healthy, well-nourished women should gain 10 to 14 kg during pregnancy. That is an average of 12 kg during the 9 months, increases the probability of delivering full-term infants with an average birth weight of 3.3 kg. This also reduces the risk of foetal and maternal complications. Table 2 shows recommended weight gain in pregnancy.