Pregnancy and lactation: Meeting nutritional needs

A balanced diet is the foundation from which all other increased food needs are built.

As pregnant and lactating women require additional nutrients are required to meet the special demands of the body. This article deals with the major nutrients that a pregnant/lactating woman’s diet should comprise based on the recommendations of Indian Council of Medical Research’s (ICMR) Recommended Daily Allowances (RDA).

Energy (expressed in kilo calories)

A  woman weighing 50 kg will need 1875 cals (sedentary); 2225 cals (moderate work); and 2925 cals (hard work). To this, the extra 300 cals  suggested for pregnancy and extra 550 cals for the first 6 months of lactation should be added. The next 6 months of lactation needs 400 cals extra, due to solids being introduced in the infant’s diet which might reduce the milk production and feeds.

Protein
The protein requirement is based on 1g protein for body weight of 1 kg. So a woman weighing 50 kg would need 50g of protein. The increased needs of pregnancy are 15g protein and for the first 6 months of lactation, it is 25g and or the second half, it is 18g.

Fat
This stage definitely requires stepping up the fat quantity in the diet to meet the increased energy needs and for milk production. The normal requirement is 20g, while for pregnancy it is stepped up to 80g and for lactation it is 45g.

Calcium
The calcium needs are 400mg and are stepped up to 1000mg for both stages.

Iron
Iron is very essential for the growth of new tissue, for fetal growth and reserves, and for blood loss during delivery. Hence, the normal daily requirement of 30mg is raised to 38mg in pregnancy and brought down to the normal 30mg in lactation. This is because, milk is not a source of iron and therefore an increase is not required in the mother’s diet.

Ascorbic acid, Vitamin C
The Vitamin C requirement of 40mg need not be increased during pregnancy. But, it needs to be raised to 80mg during lactation. An increase in fruits and vegetables would meet this need but as the vitamin losses can be heavy, a little extra would be useful.

B-complex vitamins
All B-complex vitamins are required in excess and as most Indians and Indian diets are deficient, B-complex is prescribed as a supplement. It must be remembered that the water soluble vitamins C and B are easily lost in poor cooking methods and exposure to sunlight. Folic acid is very important to women at every stage – normal and growth stages of puberty, pregnancy and lactation.

Vitamins A and D
Their need is also increased. Since both these vitamins are generally occurring together in foods, if vitamin A requirements are met with vitamin D would be sufficient. However, recent studies have shown that there is a great prevalence of vitamin D deficiency among Indians.

How to meet increased the nutrient requirement
Assuming that a pregnant woman is consuming a balanced diet as per her daily requirements, the foods that provide the recommended increased allowances will be discussed here. For the above assumption to be correct, the knowledge of a balanced diet and what it includes is to be understood and is to be practically followed.
Given below is a balanced diet providing 1800 Kcals (approximate) – though it resembles any ordinary meal, what is important is the quantity eaten or portions.
Breakfast: Coffee 1cup, egg 1, bread, lightly buttered 2sl., fruit 1portion
Mid morning: Fruit juice 1 glass
Lunch: Phulkas 2, pulse preparation with green leafy vegetable 1cup, vegetable preparation 100g portion, rice ½ katori, curd ½ cup, ½ fruit
Evening: Sundal ½ cup, small banana, tea/coffee 1 cup
Dinner: Similar to lunch and the pulse can be replaced with a small piece of meat, fish or chicken for non- vegetarians in both the meals.

Increasing the calories: Use the table below for 100 calorie portions and step up by 300, 550 0r 400 calories as suggested above.

List of foods providing 100 calories each

Food Stuff Weight or measure Food stuff Weight or measure
Phulkas 2 small Bread 2 slices
Pulses, cooked ½ katori Potato 1 medium
Vegetables, cooked 1 katori Fruits 160g
Banana 1 long Egg 1 big or 1 ¼ small
Fish, chicken 1 small, 1 leg Meat 1 small piece
Milk 1 small cup Biscuits 3 small
Ice cream 1 med. cup Soft drink bottled 1 glass
Cooked rice 2/3rd katori Potato fry 25g, about 10 pcs
Upma ½ katori Oothappam 1 small
Plain masala dosa ½ dosa Idly 2 small
Poori 1 medium Coffee 1 cup


Now let’s look at what foods should be chosen

Energy: The 300 calorie increase for pregnancy can be met easily by an increase in pulses, milk, nuts with just the addition of an extra chapathi or a katori of rice. A teaspoon of ghee or oil can also be added if necessary.

Protein: The protein increase is met with pulses, nuts, milk, skimmed milk, paneer or cheese, one egg or an extra piece of meat, fish or chicken

Fat: Fats need not be increased as the nuts, milk, paneer or cheese, and extra non-vegetarian foods will take care of this need.

Minerals and vitamins: These go hand-in-hand with fruits and vegetables.

Calcium: An increase in calcium will also be met by the above fat-rich foods. In addition, green leafy vegetables, green masala and herbs like coriander leaves, curry leaves, mint, salad leaves and herbs like parsely, celery, fennel, dill and others are high in calcium, iron, vitamin A,C, B complex.

Folic acid: This is got from wheat germ, whole cereals and grains and oranges. It is also a component of all green leafy vegetables. Vitamin B12 is found only in animal products, hence vegetarians and non vegetarians who eat meat rarely need B12 supplementation. Spirulina is a single cell plant rich in B12 and can be used as a natural supplement by vegetarians but the strong smell may be a deterrent especially during spells of nausea in pregnancy.

Keeping in mind the foods and their quantities, the diet during pregnancy and lactation, can be prepared hygienically as per the comfort of the individual.

Malathi Mohan

The author is a retired professor of WCC, Chennai; retired Dean, Academy of Fitness Management, Chennai and Past President, Indian Dietetic Association

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Image: Thinkstockphotos.com

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