Understanding the Essential Nutrient Requirements for a Healthy Pregnancy and Lactation
Nutrient Requirements during Pregnancy and Lactation
During pregnancy, women undergo several physiological changes to achieve the normal development and health of the fetus. These changes also prepare the mother and baby for delivery.
The first change observed during pregnancy is weight gain.
Following recommendations, for a woman with a normal weight (body mass index (BMI) between 19 and 24 kg/m2), gestational weight gain (GWG) should be between 11 and 16 kg
Hormonal changes are crucial throughout pregnancy.
On the one hand, there is an increase in the production of pre-existing hormones—mainly estrogens, progesterone, and prolactin—and the main producing tissues also change (the secretion becomes placental).
On the other hand, specific hormones are synthesized by the placenta, like human chorionic gonadotropin (hCG).
These hormones play a fundamental role in ensuring the proper course of pregnancy and their concentration evolves throughout pregnancy.
Oxygen demand in pregnant women increases dramatically by 20 to 30%. Increased progesterone levels lead to an increased respiratory rate and increased ventilation.
This hyperventilation is accompanied by some anatomic changes, such as diaphragmatic elevation supported by the gravid uterus or the extension of the lower ribs. This explains why many pregnant women feel short of breath.
A breastfeeding mother provides all the hydration and nutrients that a growing baby needs for the first 4–6 months of life.
During pregnancy, the body prepares for lactation by stimulating the growth and development of branched lactiferous ducts and lactocyte-lined alveoli that secrete milk by creating colostrum. These functions are due to the actions of estrogen, growth hormone, cortisol, and prolactin.
In Summary- The nutritional needs of women increase during pregnancy and breastfeeding to support all of these changes, prepare the body for delivery and for breastfeeding, and ensure the normal development of the fetus/baby.
Let's discuss the Role of Minerals, Vitamins, and Omega-3 Fatty Acids in Pregnancy—
Nutrient | RDA, Adult Non-Pregnant Women | EAR, Pregnancy | RDA, Pregnancy | UL, Pregnancy(tolerable upper intake level) | Justifications |
Vitamin A (μg/day) | 700 | 550 | 770 | 3000 | Regulation of genome expression and in cell differentiation |
Vitamin D (μg/day) | 15 | 10 | 15 | 100 | Mineralization of the fetal skeleton and decreased risk of hypocalcemia accidents and symptomatic osteomalacia |
Vitamin E (mg/day) | 15 | 12 | 15 | 1000 | – |
Vitamin K (μg/day) | 90 | – | 90 | none | – |
Vitamin B1 (mg/day) | 1.1 | 1.2 | 1.4 | none | – |
Vitamin B2 (mg/day) | 1.1 | 1.2 | 1.4 | none | – |
Vitamin B3 (mg/day) | 14 | 14 | 18 | 35 | – |
Vitamin B6 (mg/day) | 1.3 | 1.6 | 1.9 | 100 | Relieve nausea in early pregnancy |
Vitamin B9 (μg/day) | 400 | 520 | 600 | 1000 | Decreases the risk of spina bifida and other neural tube defects |
Vitamin B12 (mg/day) | 2.4 | 2.2 | 2.6 | none | – |
Vitamin C (mg/day) | 75 | 70 | 85 | 2000 | – |
Calcium (mg/day) | 1000 | 800 | 1000 | 2500 | Mineralization of the fetal skeleton Prevents pre-eclampsia |
Iodine (μg/day) | 150 | 160 | 220 | 1100 | Maintenance of thyroid homeostasis |
Iron (mg/day) | 18 | 22 | 27 | 45 | Decreases the risk of having a low birth weight or a premature baby |
Magnesium (mg/day) | 320 | 290 | 350 | 350 | Involvement in the occurrence of hypertensive disorders, gestational diabetes mellitus, preterm labor, or intrauterine growth retardation |
Phosphorus (mg/day) | 700 | 580 | 700 | 3500 | – |
Selenium (μg/day) | 55 | 49 | 60 | 400 | – |
Zinc (mg/day) | 8 | 9.5 | 11 | 40 | Involvement in cell division, protein synthesis and growth, nucleic acid metabolism |
Iron and Vitamin B9
Iron plays an important role in the production of hemoglobin and for the transport of oxygen; therefore, in the face of increased blood mass, fetal growth, and the development of appendages, including the placenta, the iron requirements of pregnant women are markedly increased (22–27 mg/day)
Calcium
Calcium participates in the mineralization of the fetal skeleton, especially during the third trimester. The skeleton of a full-term baby contains approximately 30 g of calcium, and three-quarters of this mineral content is deposited during the last trimester of pregnancy. As a result, maternal calcium needs to increase, especially from the third trimester (the need for calcium varies from 1000 to 1200 mg/day)
Magnesium
During pregnancy, serum magnesium levels gradually decrease, reaching low values during the last trimester and increasing after childbirth (variations compared to physiological hemodilution) .
The concentration of magnesium in the blood of the umbilical cord is higher than maternal magnesium levels, which means that active transport occurs through the placenta, where 50% of the average amount of dietary magnesium is absorbed. In addition, to meet the needs of the fetus, magnesium requirements increase during pregnancy because renal magnesium excretion is enhanced by about 25%
Iodine
Thyroid homeostasis, especially in pregnant women and fetuses, is essential for the development of brain tissue, the acquisition of intelligence, and learning. The main sources of iodine in the diet come from foods that contain it (e.g., fish, seafood, and dairy products) and certain additives that are fortified or rich in iodine (e.g., cooking salt). However, health experts recommend that pregnant women avoid certain types of fish and seafood during pregnancy because they have a high risk of contamination with parasites, germs, or toxins.
Zinc
Zinc is essential for many biological processes including, for example, cell division, protein synthesis and growth, and nucleic acid metabolism. During pregnancy, zinc deficiencies may lead to congenital malformations, low birth weight, intrauterine growth retardation, and preterm delivery . The zinc requirements of pregnant women are slightly increased (11 mg/day)
Omega-3 Fatty Acids
Polyunsaturated fatty acids (PUFAs) are necessary for the optimal functioning of the brain. A food deficiency that modifies the membrane composition, particularly that of omega-3, is a source of dysfunction at the metabolic, physiological, and behavioural levels. Clinical studies have also established that low consumption of omega-3 or low plasma levels of docosahexaenoic acid (DHA) is associated with cognitive and behavioural disorders during development.
Micronutrients and Omega-3 Fatty Acid Requirements for Breastfeeding Women
Scientific evidence on which micronutrient intake recommendations for breastfeeding are based is sparse compared to that published about pregnancy. Lactation is considered successful when the breastfed baby gains an appropriate amount of weight .
Weight loss during breastfeeding generally does not affect the quantity or quality of breast milk, but maternal deficiencies of magnesium, vitamin B6, folate, calcium, and zinc have been reported during breastfeeding. The fat-soluble vitamins A, D, and K and the water-soluble vitamins C, B1, B6, B12, and folates are secreted in breast milk and their content is reduced in breast milk in the event of vitamin deficiency in the mother
Micronutrient requirements in lactating women.
Recommendations | Justifications for Breastfeeding | |
Calcium | 1000 mg/day | Maintenance and production of breast milk |
Magnesium | 390 mg/day | Muscle relaxant Prevention of constipation |
Zinc | 19 mg/day | Participation in postpartum healing |
Vitamin C | 130 mg/day | Stimulation of immune functions |
Vitamin D | 10 µg/day = 400 IU a/day | Important contribution to obtaining good quality milk |
Vitamin A | 10,000 IU/day or max 25,000 IU/week or a unique intake of 200,000 IU | Only in deficient populations, as soon as possible after childbirth, but not more than 8 weeks afterwards |
Iron | 60 mg/day | Prevention of maternal anemia For 3 months after postpartum |
Vitamin B9 | 400 µg/day | |
Omega–3 | 100 mg/day of DHA b during the 1st year of the newborn’s life | Newborn brain development |
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Reference
Jouanne M, Oddoux S, Noël A, Voisin-Chiret AS. Nutrient Requirements during Pregnancy and Lactation. Nutrients. 2021 Feb 21;13(2):692. doi: 10.3390/nu13020692. PMID: 33670026; PMCID: PMC7926714.
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