Nutrition During Lactation

Breast Feeding – From Nature to Nurture

Mother’s milk, time tested for millions of years, is the BEST NUTRIENT FOR BABIES because it is nature’s perfect food. – Robert S. Mendelsohn

The word nutrition is derived from “nutricus” which means to ‘suckle at the breast’. Breast milk is the natural food for the infant. Successful breast feeding is an important child rearing skill to be learnt and practiced. As growth during infancy is very rapid, dietary adaptation is required. During early infancy, much of the nutrient requirements are met by breast feeding and the RDA (recommended dietary allowance) of an infant is based on the composition of breast milk.

Breast milk should be fed to the infant within 30 minutes of birth; in case of a C-section, this time duration can be stretched to 4 hours. The mother being on IV or sedation is not a hindrance to breast feeding.

Colostrum

The first couple of days after delivery, colostrum is produced by the mammary glands. Colostrum differs in appearance from breast milk – it is slightly thicker in consistency and has a slightly yellow colour. Colostrum is protein rich with extra fat, vitamin A, vitamin K and zinc. The amount of colostrum produced varies between 10-40 ml.

Composition of Colostrum

Colostrum can be considered as the infant’s first brush with immunization as it has antibodies and also helps in the infant’s gastrointestinal tract growth.

Colostrum helps a baby pass first stool.

Transition Milk

In the 2 weeks that follow, the milk changes once again to what is called transition milk. Transition milk’s protein content is lower than colostrum but the fat and sugar present is more. Both colostrum and transition milk play an important role in controlling infection and preventing new-born death.

Foremilk

The milk at the beginning of the feed is thin as the fat content is low. However, it is rich in lactose sugar, protein, vitamins, minerals and water.

Hindmilk

The milk after foremilk has more fat content. As a result, it takes care of the baby’s appetite and energy requirements. Make sure to feed the hindmilk as it helps babies sleep soundly.

Nutrient Composition

Breast milk contains all the nutrients the baby needs. Through breastfeeding, these nutrients are given to the baby in a form that is easily digestible.

Comparison of Human Milk with Cow and Buffalo Milk

(Value per 100 g)

Nutritional Requirements for Lactation

Energy

The DRI (daily recommended intake) for energy during lactation is 330 kcal greater during the first 6 months of lactation and 400 kcal greater during the second 6 months of lactation over that for a non-pregnant woman. However, considering milk production usually drops to an average of 600 ml/day (approximately 20 oz/day) after other foods are introduced into the infant’s diet, ingested calorie levels may have to be adjusted for the individual woman who wishes to avoid weight gain. A mother is able to draw approximately 100 to 150 kcal/day from pregnancy fat stores.

Protein

The DRI suggests an additional 25 g of protein a day for lactation, based on an RDA of 1.1 gm/kg/day of a woman’s body weight. Clinical judgment is necessary with protein recommendations based on BMI. Women with surgical delivery and women who enter pregnancy with poor nutritional status may need additional protein. Breastmilk has a whey to casein ratio of 90:10 early in lactation, which changes to 80:20 as an average and to 60:40 as the baby gets older. It is speculated that this ratio makes breastmilk more digestible. In contrast, the whey casein ratio of cow’s milk protein is 18:82. Cow’s milk–based infant formula varies among commercial manufacturers, ranging from 18:82 whey to casein, to 52:48 whey to casein, and even up to 100% whey.

Carbohydrates

The RDA for carbohydrate is designed to provide enough calories in the diet for adequate volumes of milk and to maintain an adequate energy level during lactation. This may have to be adjusted depending on activity of the mother and the amount of breastfeeding. Women with poor gestational weight gain may require more carbohydrates. The principal carbohydrate in human milk is lactose; however, there is no evidence that maternal intake of carbohydrates affects the level of lactose in her milk.

Fat

There is no DRI for total lipids during lactation because it depends on the amount of energy required by the mother to maintain milk production. The recommended amounts of specific omega-6 and omega-3 during lactation vary little from pregnancy; they are crucial for foetal and infant brain development. Mothers should avoid eating predatory fish to prevent excessive levels of dietary mercury (pike, marlin, mackerel and swordfish) (AAP, 2012). Intake of trans fats should be kept to a minimum by the nursing mother so that the potential for their appearance in her breastmilk is reduced.

Vitamins and Minerals

Zinc

Breastmilk provides the only dietary source of zinc for exclusively breastfed infants, and it remains a potentially important source of zinc for children beyond infancy who continue to breastfeed. In the process of normal lactation, the zinc content of breastmilk drops dramatically during the first few months from 2 to 3 mg/day to 1 mg/day by the third month after birth. Zinc supplementation has not been found to affect concentrations in the breastmilk of women in developed countries but may increase the zinc content of the milk of women in developing countries with suboptimal zinc status.

Calcium

Although breastfeeding mothers should be encouraged to meet their DRI for calcium from their diet, the calcium content of breastmilk is not related to maternal intake, and there is no convincing evidence that maternal change in bone mineral density is influenced by calcium intake across a broad range of intakes up to 1600 mg/day.

Vitamin D

The lactating mother requires a significant amount of vitamin D daily from food or UV exposure. Maternal circulation allows transfer of the parent compound, vitamin D3 itself, and not circulating 25(OH)D, into human milk. Recent studies have shown that a daily maternal intake of 6400 IU of vitamin D is safe, and allows a mother to produce milk that will provide adequate amounts of vitamin D to her exclusively breastfed nursling, without additional supplementation directly to the infant (Hollis, 2015).

Vitamin B12 and Vegan Mothers

For lactating mothers who follow a strict vegan diet without any animal products, a vitamin B12 supplement is recommended strongly. The milk of a vegan mother can be severely deficient in vitamin B12, leading to a deficiency in her infant which, if not treated, can lead to growth failure and permanent damage to the nervous system. Nursing mothers who follow a strict vegetarian diet should have their infant’s B12 levels monitored.

Sodium

Sodium intake during lactation should be controlled with the inclusion of a diet composed of foods high in nutritional value, which are naturally lower in sodium. Although there is no specific recommendation or restriction for sodium in the diet of breastfeeding mothers, a relationship has been established between the sodium intake of mothers and breastfeeding success.

Benefits of Breast Feeding

For Infant

Decreases Incidence and Severity of Infectious Diseases

• Bacterial meningitis
• Diarrhoea
• Infant botulism
• Necrotizing enterocolitis
• Respiratory tract infection
• Urinary tract infection

Decreases Rates of Other Diseases

• Asthma
• Celiac disease
• Crohn’s disease
• Food allergies
• Hodgkin disease
• Hypercholesterolemia
• Leukaemia
• Lymphoma
• Overweight and obesity
• Sudden infant death syndrome
• Types 1 and 2 diabetes

Other Benefits

• Promotes enhanced performance on cognitive development tests; promotes mother-child bonding
• Promotes ready acceptance of solid foods

For Mother

• Decreases menstrual blood loss; decreases postpartum bleeding; decreases risk of hormonal (breast and ovarian) cancers
• Promotes earlier return to pre-pregnancy weight
• Increases child spacing
• Promotes rapid uterine involution
• Decreases need for insulin in mothers with diabetes
• Decreases risk of postmenopausal hip fracture and osteoporosis

For Society

• Reduces health care costs
• Decreases costs to public programs (i.e., WIC)
• Prevents excess lost wages resulting from employee absenteeism for sick children
• Supports greener environment

Diet During Breast Feeding

• Food that is heavily processed should be avoided – natural food is best.
• Include protein foods such as milk and other dairy products, meat, fish, eggs, nuts and seeds as additional proteins are recommended.
• The mother should make sure the diet has enough polyunsaturated fatty acids (omega 3 fatty acids).
• Include sufficient amounts of fruits and vegetables as it helps the body replenish the nutrients.
• Calcium is also encouraged which can be obtained through dairy as well as vegetables.
• Folates are needed and it would be best to get them from natural food sources instead of supplements.
• Breastfeeding requires the provision of iron, i.e., mainly after the resumption of menstruation.
• Liberal intake of fluids is needed.
• Foods containing preservatives, artificial additives and trans-fatty acids should be avoided.
• The consumption of products with high sugar content is not recommended.
• Moderate the consumption of coffee, tea, caffeinated sodas.
• Avoid consumption of alcohol.