Nutrition in Pregnancy and Lactation

Pregnancy Power-Up - Energy & Weight Game

• Additional Energy Requirements (ICMR/NIN):
  • Pregnancy:
    • 1st Trimester: +0 kcal/day
    • 2nd Trimester: +350 kcal/day
    • 3rd Trimester: +450 kcal/day
  • Lactation:
    • 0-6 months: +600 kcal/day
    • 7-12 months: +520 kcal/day
• Recommended Gestational Weight Gain (GWG) - IOM:
  • Based on pre-pregnancy BMI ($kg/m^2$):
    • Underweight (<18.5): 12.5-18 kg
    • Normal (18.5-24.9): 11.5-16 kg
    • Overweight (25-29.9): 7-11.5 kg
    • Obese (≥30): 5-9 kg
  • Pattern: ~1-2 kg total in 1st trimester; then ~0.4-0.5 kg/week.

⭐ Inadequate GWG is linked to Low Birth Weight (LBW) and preterm birth; excessive GWG to macrosomia & C-section risks.

Pregnancy's Micronutrient Must-Haves - Building Blocks

• Iron:
  • RDA: 35 mg/day.
  • Supplement: 60 mg elemental Fe + 500 µg Folic Acid (IFA) daily for ≥100 days (from 2nd trimester).
  • Deficiency: Anemia, LBW, preterm birth.
• Folic Acid (B9):
  • RDA: 570 µg DFE/day.
  • Periconceptional: 400 µg/day (WHO) to prevent NTDs.
  • Previous NTD history: 4-5 mg/day.
• Calcium:
  • RDA: 1000 mg/day.
  • Supplement: 1 g/day if low intake. For fetal skeleton, maternal stores.
• Vitamin D:
  • RDA: 600 IU (15 µg)/day. Aids Calcium absorption.
• Iodine:
  • RDA: 250 µg/day. Fetal brain dev; Source: Iodized salt.
• Vitamin B12:
  • RDA: 2.75 µg/day. Neuro function.
• Zinc:
  • RDA: 14.5 mg/day. Cell growth, immunity.

⭐ Daily supplementation with 60 mg elemental iron and 500 µg folic acid for at least 100 days during pregnancy is a key component of India's Anemia Mukt Bharat strategy.

Pregnancy Plate Pointers - Smart Eating & Risks

• My Plate for Two: Prioritize whole grains, fruits, vegetables, lean protein, dairy.
• Caloric Intake: Gradual ↑, average +300 kcal/day. Hydrate well.
• ⚠️ Critical Food Safety:
  • Thoroughly cook: Meat, poultry, fish, eggs.
  • Avoid:
    • Unpasteurized milk/juices (Listeria risk).
    • High-mercury fish (e.g., shark, swordfish).
    • Raw sprouts.
    • Deli meats unless heated.
  • Limit: Caffeine < 200 mg/day. Liver (excess Vit A).
  • Wash: All fruits & vegetables.
• Alcohol: Complete avoidance (FAS risk).
• PICA: Report non-food cravings.

⭐ Listeria monocytogenes infection during pregnancy can lead to fetal loss, preterm birth, or neonatal sepsis. Avoid unpasteurized dairy and deli meats to minimize risk.

Lactation Fuel-Up - Milk-Making Magic

• Energy Needs:
  • 0-6 months: Additional +550 kcal/day.
  • 6-12 months: Additional +400 kcal/day.
• Protein Needs:
  • 0-6 months: Additional +15 g/day.
  • 6-12 months: Additional +12 g/day.
• Key Nutrients:
  • Calcium: 1200 mg/day.
  • Iron: IFA supplementation often continued (e.g., 100 mg elemental iron, 0.5 mg folic acid).
  • DHA (Omega-3): Crucial for infant neurodevelopment.
  • Vitamins: ↑ needs for Vit A, B-complex, C, D.
  • Iodine: 250 µg/day.
• Fluid Intake:
  • Essential for milk volume; drink to thirst (approx. 3-4 L/day).
• 📌 Mnemonic "MILC": M-ore Calories & Protein, I-ncreased Fluids, L-oad up on Vitamins, C-alcium & Iron.

⭐ Human milk composition changes: Colostrum (first 3-4 days) is rich in protein, Vitamin A, and antibodies (IgA); transitional milk (5-14 days); mature milk (after 14 days).

High‑Yield Points - ⚡ Biggest Takeaways

• Pregnancy: Additional 350 kcal/day (2nd/3rd tri); aim for 10-12 kg weight gain.
• Lactation: Additional 600 kcal/day (0-6 months), 520 kcal/day (6-12 months).
• IFA: 100 mg elemental iron + 500 µg folic acid daily for ≥100 days from 2nd trimester.
• Calcium: 1200 mg/day required during pregnancy and lactation.
• Exclusive breastfeeding: Crucial for first 6 months of life.
• Protein needs: Significantly ↑ during pregnancy and lactation.