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During Pregnancy
Improving Nutrition throughout the Life Cycle References Maternal Nutrition and Lactation
Pregnancy and lactation are times of By the time the pregnancy is detected, permanent damage is done. For 1. Institute of Medicine (IOM). Nutrition During Pregnancy: Re- 5. WHO. Postpartum Care of the Mother and Newborn: A Practi-
heightened nutritional vulnerability. How- these reasons, maternal malnutrition cannot be addressed during preg- port of the Committee on Nutritional Status During Pregnancy cal Guide. WHO/RHT/MSM.98.3 Geneva: World Health Organiza-
ever, the threat of malnutrition begins in nancy alone. The periods before and between pregnancies provide an and Lactation. Washington: National Academy Press, 1990. tion, 1998. Health workers often lack adequate information to counsel pregnant and lactat-
ing women on how to meet increased nutrient requirements through dietary
the womb and continues throughout the opportunity for women of reproductive age to prepare for pregnancy by 2. WHO. Safe Vitamin A Dosage during Pregnancy and Lactation. 6. Food and Nutrition Board, Institute of Medicine. Dietary Refer- and behavioral changes and other health practices. They are uncertain how to
life cycle. A mother who was malnour- consuming an adequate balanced diet, including supplements and forti- WHO/NUT/98.4. Geneva: World Health Organization, 1998. ence Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Dietary Guide translate general requirements into individual recommendations. This docu-
ished as a fetus, young child, or adolescent fied foods where available, and by achieving a desirable weight. Cholesterol, Protein, and Amino Acids (Macronutrients). Wash- ment attempts to fill this information gap and to help programs develop appro-
is more likely to enter pregnancy stunted 3. UNICEF/UNU/WHO. Iron Deficiency Anaemia: Assessment, ington: National Academies Press, pre-publication date 2002, fi-
and malnourished. Her compromised nu- Overweight and obesity at all ages, even in poor communities, present Prevention, and Control. WHO/NHD/01.3. Geneva: World Health nal version forthcoming. priate protocols and counseling materials on maternal nutrition.
tritional status affects the health and nu- a difficult challenge for maternal and child health programs. Under- Organization, 2001.
weight and overweight often occur in the same communities and even 7. Food and Nutrition Board, Institute of Medicine. Dietary Refer-
trition of her own children. 4. Stoltzfus RJ, Dreyfuss ML. Guidelines for the Use of Iron Sup- ence Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chro- Women’s nutrient needs increase during pregnancy and lactation, as Table 1 Weight Gain Recommenda-
the same households. Maternal overweight and obesity increase the plements to Prevent and Treat Iron Deficiency Anemia, Wash- mium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, shown in tables 1-3 inside this folder. Some of the increased nutrient tions for Pregnancy is based on pre-
Growth faltering earlier in life leaves risk of perinatal mortality, premature delivery, major birth defects, and ington, DC: The International Nutritional Anemia Consultative Silicon, Vanadium, and Zinc. Washington: National Academies requirements protect maternal health while others affect birth out-
women permanently at risk of obstetric maternal obstetric complications, including hypertension and gesta- Group, 1998. Press, 2002. come and infant health. If the requirements are not met, the conse- pregnancy weight. Individual energy
complications and delivering low birth tional diabetes. Maternal and child health programs should alert wom- quences can be serious for women and their infants. requirements vary according to pre-
weight babies. Deficiencies of some micro- en at all stages of the life cycle to the need to adjust diet and physical pregnancy height and weight, meta-
nutrients, such as folic acid and iodine, activity levels to achieve and maintain a desirable weight for their own Maternal Nutrition Resources During pregnancy all women need more food, a varied diet, bolic rate, and activity level. Energy
affect the fetus shortly after conception. health as well as for better birth outcomes. and micronutrient supplements. When energy and other nutrient requirements will increase in special
Food composition tables available in many countries can help field workers identify good, local sources of nutrient- intake does not increase, the body’s own reserves are used, leaving circumstances such as adolescence,
rich foods. The Food and Agriculture Organization’s website (www.fao.org/infoods) lists countries or regions with a pregnant woman weakened. Energy needs increase in the second multiple pregnancies, and HIV infec-
food composition tables. The nutrient content of specific quantities of most foods can be calculated using the nutrient and particularly the third trimester of pregnancy. Inadequate weight tion. Health workers should assess
database on the United States Department of Agriculture website (www.nal.usda.gov/fnic/foodcomp). Additional re- gain during pregnancy often results in low birth weight, which in- the nutritional situation of women of
sources on maternal nutrition are available from the LINKAGES Project and members of the CORE Group. creases an infant’s risk of dying. Pregnant women also require more reproductive age and tailor antenatal
protein, iron, iodine, vitamin A, folate, and other nutrients. Deficien- care messages about dietary intake,
cies of certain nutrients are associated with maternal complications healthy levels of weight gain during
LINKAGES Publications CORE Members’ Publications and death, fetal and newborn death, birth defects, and decreased pregnancy, and gradual weight loss
Frequently Asked Questions on Breastfeeding and Ma- CARE. Promoting Quality Maternal and Newborn Care: physical and mental potential of the child. during lactation according to pre-preg-
Supporting Interventions ternal Nutrition. Updated 2004. A Reference Guide for Program Managers. 1998. Lactation places high demands on maternal stores of energy, nancy body mass index (BMI).
Essential Health Sector Actions to Improve Maternal CARE. The Healthy Newborn: A Reference Manual for protein, and other nutrients. These stores need to be established, Table 2 Micronutrient Supplemen-
The following interventions can improve maternal nutrition and com- Health workers should mobilize sup- conserved, and replenished. Virtually all mothers, unless extremely tation during Pregnancy and Lac-
plement food-based approaches and micronutrient supplementation: port for maternal nutrition at all levels Nutrition in Africa. 2001. Program Managers. 2002. malnourished, can produce adequate amounts of breastmilk. The en-
through the following actions: ergy, protein, and other nutrients in breastmilk come from a moth- tation shows the dosage and timing
Reduction of malaria infection in pregnant women in endemic Maternal Nutrition: Issues and Interventions. (comput- Freedom from Hunger. Women’s Health: Healthy Wom- er’s diet or her own body stores. Women who do not get enough en- for vitamin A, iron/folate, and iodine
areas. Malaria causes anemia in several ways, primarily by destroy- •Initiate or strengthen health service er based slide presentation) Updated 2004. en, Healthy Families. (10 learning sessions for group- ergy and nutrients in their diets risk maternal depletion. To prevent supplementation. Appropriate regi-
ing red blood cells and suppressing production of new red blood cells. systems for timely provision of micronu- based education programs) 2003. this, extra food must be made available to the mother. Breastfeeding mens for micronutrient supplemen-
Over the past decade, new approaches to controlling malaria in preg- trient supplements, deworming, and ma- Recommended Feeding and Dietary Practices to Im- tation vary with the prevalence and
nancy that emerged in Africa proved highly effective. These approach- laria treatment. prove Infant and Maternal Nutrition. 1999. also increases the mother’s need for water, so it is important that she epidemiology of deficiencies and with
es include insecticide-treated materials (ITMs) and intermittent •Involve community leaders and other in- drink enough to satisfy her thirst. existing policies and programs. Health
preventive treatment after the first trimester (i.e., after quickening), fluential people in discussing increased The Case for Promoting Multiple Vitamin/Mineral Sup- workers should consult local protocols.
plements for Women of Reproductive Age in Developing Maternal deficiencies of some micronutrients can affect the quality of
a strategy that is gaining recognition as more effective than prophy- nutritional demands during pregnancy Countries. 1998. breastmilk. These deficiencies can be avoided if the mother improves
laxis. Pregnant women in malaria endemic areas should be given in- and lactation and the need for more rest her diet before, during, and between cycles of pregnancy and lacta- Table 3 Summary of Increased
termittent preventive treatment according to national protocols and and a decreased workload. Using the Essential Nutrition Actions to Improve the tion, or takes supplements. For example, studies have shown that Nutritional Needs during Preg-
protected from further infection by using bednets and other ITMs. •Disseminate messages to women and Nutrition of Women and Children: A Four-Day Training appropriate supplementation improves vitamin A levels in the moth- nancy and Lactation gives examples
Reduction of hookworm infection in pregnant women in en- their families through varied channels Course for Program Managers and Pre-service Instruc- er, in her breastmilk, and in the infant. of common foods in various parts of the
demic areas. Hookworm is an important cause of anemia in many and contact points. tors. 2004. world and lists actions health workers
situations. In areas where hookworm is considered a public health •Counsel not only women, but also their Meeting Nutrient Requirements can take to promote improved nutrient
problem, WHO recommends deworming pregnant women after the husbands and elders. intake. The examples show nutrient
first trimester (i.e., after quickening). Wearing footwear and carefully •Promote dietary diversification, coupled Visit the LINKAGES website at www.linkagesproject.org Adequate energy intake and a diversified diet that includes fruit, variations in comparable quantities
disposing of feces can prevent hookworm infection. with food production or income-genera- and the CORE website at www.coregroup.org vegetables, and animal products throughout the life cycle help en- of food, underlining the necessity of
tion activities, to make more diverse sure that women enter pregnancy and lactation without deficiencies tailoring messages to local foods. For
Birth spacing of three years or longer. Adequate spacing between foods available at the family level. Pro- and obtain adequate nutrients during periods of heightened demand. example, because an extra serving of
mote fortified foods where available and Maternal Nutrition During Pregnancy and Lactation is a joint publication of LINKAGES: Breastfeeding, Some nutrient requirements, particularly iron, folic acid, and vita- potatoes or tortilla does not provide
pregnancies gives a woman’s body time to recover and replenish nu- LAM, Related Complementary Feeding, and Maternal Nutrition Program and the Child Survival min A, are more difficult to achieve than others through food sources.
trients. Pregnant and lactating women and their partners can be affordable. Collaborations and Resources (CORE) Nutrition Working Group. The CORE Group is a membership nearly as many additional calories as
counseled on child spacing. •Negotiate with women and their families association of more than 35 U.S. nongovernmental organizations working together to promote and improve pri- For this reason, supplements with these nutrients are recommended a serving of cassava, a generic mes-
to take small steps to improve maternal mary health care programs for women and children and the communities in which they live. Support for LINK- in addition to improved diets. Fortified foods should be promoted
AGES was provided to the Academy for Educational Development (AED) by the Bureau for Global Health of through counseling and social marketing in countries where foods sage to eat an additional serving of the
Decreased work load or rest during pregnancy. Minimizing diet and to increase opportunities for the United States Agency for International Development (USAID), under the terms of Cooperative Agreement staple food may not be appropriate.
heavy work and reducing work hours enable energy-deficient women resting. No. HRN-A-00-97-00007-00. The opinions expressed herein are those of the authors and do not necessarily re- fortified with iron, iodine, folic acid, or vitamin A are available and
to conserve energy needed for pregnancy and lactation. flect the views of USAID or AED. August 2004 affordable.
LINKAGES Academy for Educational Development 1825 Connecticut Avenue, NW, Washington, DC 20009
Phone (202) 884-8221 Fax (202) 884-8977 E-mail linkages@aed.org Website www.linkagesproject.org
Table 1. Weight Gain Consequences of
1
Recommendations for Pregnancy Maternal Malnutrition
Pre-pregnancy Weight Recommended Total Gain Consequences for maternal health
Category Kilograms Pounds • Increased risk of maternal complications and death
• Increased infection
BMI < 19.8 12.5 – 18.0 28 – 40 • Anemia
• Lethargy and weakness, lower productivity
BMI 19.8 to 26.0 11.5 – 16.0 25 – 35 Consequences for fetal and infant health
• Increased risk of fetal, neonatal, and infant death
• Intrauterine growth retardation, low birth weight, prematurity
BMI > 26.0 to 29.0 7.0 – 11.5 15 – 25 • Birth defects
• Cretinism
• Brain damage
1. Institute of Medicine. Nutrition During Pregnancy, 1990. • Increased risk of infection
2
BMI = body mass index (weight in kg divided by height in meters squared, or kg/m )
Table 2. Micronutrient Supplementation during Pregnancy and Lactation
Supplement Timing Dosage
2,a During pregnancy: After the first trimester 10,000 IU daily or a maximum of 25,000 IU weekly
Vitamin A
(in vitamin A-deficient During lactation (after delivery): As soon as possible, but not later than 8 weeks after delivery Single dose of 200,000 IU
populations)
3-4,b Prevention of anemia
Iron/Folate Anemia prevalence >40%: 6 months during pregnancy through 3 months postpartum 60 mg iron and 400 µg folic acid daily
Anemia prevalence ≤40%: 6 months during pregnancy
Treatment of anemia
Until resolved or a minimum of 3 months, then continue with prevention regimen 120 mg iron and 800 µg folic acid daily
5 Before conception or as early in pregnancy as possible in high risk areas where iodized salt Single dose of 400–600 mg (2 or 3 capsules)
Iodine is not available
2. WHO. Safe Vitamin A Dosage during Pregnancy and Lactation, 1998.
3. UNICEF/UNU/WHO. Iron Deficiency Anaemia: Assessment, Prevention, and Control, 2001.
4. Stoltzfus RJ, Dreyfuss ML. Guidelines for the Use of Iron Supplements to Prevent and Treat Iron Deficiency Anemia, 1998.
5. WHO. Postpartum Care of the Mother and Newborn: A Practical Guide, 1998.
Notes:
a
Recommendations for vitamin A supplementation are currently under review and may be increased, pending the results of ongoing research.
(See: IVACG. The Annecy Accords to Assess and Control Vitamin A Deficiency: Summary of Recommendations and Clarifications, 2002.)
b Neural tube defects are caused by folate deficiency during the first few weeks of pregnancy. To prevent these and to ensure that mothers enter
pregnancy with sufficient iron stores, women should also take iron/folate supplements routinely if there is a possibility they could become pregnant.
a 6-7
Table 3. Summary of Increased Nutritional Needs during Pregnancy and Lactation
tation
Increase in pregnancy Increase in lac
Non-
pregnant,
non- st nd rd
lactating 1 2 3 o-6 7-12 Food sources (with nutrient
woman trimester trimester trimester months months c
Nutrient value of cooked portions) Health actions
All oily, starchy, and protein foods contribute Advise families that pregnant women need
+452 +500b significant calories extra food each day (one or more servings
kcal +400 1 cup rice =267 kcal of the staple food) and that lactating women
+240 kcal kcal 1 corn tortilla =66 kcal need an extra meal.
Energy 2200 +0 kcal 1 cup cassava =204 kcal Counsel families that reducing the
kcal kcal 1 white bun (bread) (35g) =90 kcal woman’s workload and ensuring opportun-
1 cup potatoes =135 kcal ity for rest will help her conserve energy.
1 Tbsp oil or fat =90 kcal Monitor weight gain during pregnancy.
Animal source foods, fish, pulses/legumes Promote favorable intra-family food distri-
70 g chicken, stewed =19 g bution by educating men and older women.
+25 1 egg(raw or cooked) =6 g Improve food and economic security and,
46 1 cup cow’s milk =9.6 g in rural areas, promote small livestock prod-
Protein grams 1 cup dried beans, peas, lentils =16-18 g uction.
grams 100 g tempeh or tofu =18 g Counsel pregnant women and their fam-
ilies on the need for protein and identify
local foods rich in protein.
Liver, eggs, dark orange and yellow fruits and Promote increased consumption and
+600 vegetables, dark green vegetables, red palm oil, production of fresh or dried fruits and
fortified oils or other fortified products vegetables.
RAE 1 chicken liver (20g) =983 RAE
+70 1 whole egg =229 RAE Initiate or strengthen systems for prenatal
Vitamin A 700 RAE 1 whole carrot =1010 RAE and postpartum supplementation.
d
RAE =150 RAE
1 cup cooked greens
1 cup cooked pumpkin =1325 RAE
1 medium mango =321 RAE
Animal source foods such as red meats, red organ Promote supplements during pregnancy
meats, poultry, fish; fortified foods; beans and some and consumption of iron-fortified foods where
green leafy vegetables available.
Counsel on coping with side effects of
+9 3.5 oz/100g red meat =2.5 mg supplements.
mg 3.5 oz/100g liver =4.3 mg Promote consumption of iron-rich foods and
Iron 18 +0 1 cup black beans =3.6 mg* foods that enhance absorption (meat, fish,
mg mg 1 cup lentils =6.6 mg* e
poultry, and vitamin C-rich foods).
1 cup spinach =2.7 mg* Suggest alternatives to tea or coffee with
meals.
*(when eaten with foods high in vitamin C) Prevent and treat malaria in endemic areas
per WHO protocols for pregnant women.
Implement deworming programs.
+200 Dark green leafy vegetables, legumes, nuts, liver Counsel women to increase consumption of
g +100 3.5 oz/100g liver =217 g folate-rich foods.
Folate 400 g 1/2 cup peanuts =106 g Provide supplements (combination of iron-
g folic acid), particularly during first weeks of
pregnancy.
+140 Sea food, iodized salt Promote consumption of iodized salt.
g 3.5 oz/100g marine fish or shellfish =80 g Where iodine deficiency is endemic and
+70 iodized salt is not available, supplementation
Iodine 150 g may be needed.
g
Milk and milk products, whole fish (including bones), Promote consumption of calcium-rich foods
dark green leafy vegetables, legumes throughout the life cycle.
1000 +0 1 cup whole milk or yoghurt =306 mg
Calcium mg 1 cup dark leafy green vegetables =150-300
mg 1 cup white beans or chickpeas =95 mg mg
Organ meats, red meat, poultry, whole fish Promote small livestock production and
+4 3.5 oz/100g liver, kidney =4.2-6.1mg aquaculture for targeted feeding of children
+3 mg and pregnant and lactating women.
mg 3.5 oz/100g beef, pork =2.9-4.7 mg Promote germination and fermentation to
Zinc 8 3.5oz/100g seafood (fish, etc) =0.5-5.2 mg reduce phytate in cereal-based diets.
mg
6-7. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes, forthcoming and 2002.
Notes:
a “Needs” are the estimated average requirement for energy and the recommended dietary allowances for all other nutrients.
b
Caloric requirements during lactation assumes that the mother has no energy stores to contribute, so all the energy in breastmilk is derived from the mother’s diet.
c
All examples are for cooked foods unless otherwise stated. Protein, iron, iodine, and energy are unaffected by cooking, but signifi cant folate is lost. Iodine decreases
with storage and high humidity. Vitamin A (beta-carotene) is lost with high heat and with chopping leafy vegetables.
d RAE = retinol activity equivalent, equal to the activity of 1g of retinol (This is different from the older “retinol equivalent” which used different conversion factors for
provitamin A carotenoids in foods.)
e Iron from animal sources is more readily absorbed and utilized than iron from plant sources. Animal foods also enhance the absorption of iron from other sources.
Table 1. Weight Gain Consequences of
1
Recommendations for Pregnancy Maternal Malnutrition
Pre-pregnancy Weight Recommended Total Gain Consequences for maternal health
Category Kilograms Pounds • Increased risk of maternal complications and death
• Increased infection
BMI < 19.8 12.5 – 18.0 28 – 40 • Anemia
• Lethargy and weakness, lower productivity
BMI 19.8 to 26.0 11.5 – 16.0 25 – 35 Consequences for fetal and infant health
• Increased risk of fetal, neonatal, and infant death
• Intrauterine growth retardation, low birth weight, prematurity
BMI > 26.0 to 29.0 7.0 – 11.5 15 – 25 • Birth defects
• Cretinism
• Brain damage
1. Institute of Medicine. Nutrition During Pregnancy, 1990. • Increased risk of infection
2
BMI = body mass index (weight in kg divided by height in meters squared, or kg/m )
Table 2. Micronutrient Supplementation during Pregnancy and Lactation
Supplement Timing Dosage
2,a During pregnancy: After the first trimester 10,000 IU daily or a maximum of 25,000 IU weekly
Vitamin A
(in vitamin A-deficient During lactation (after delivery): As soon as possible, but not later than 8 weeks after delivery Single dose of 200,000 IU
populations)
3-4,b Prevention of anemia
Iron/Folate Anemia prevalence >40%: 6 months during pregnancy through 3 months postpartum 60 mg iron and 400 µg folic acid daily
Anemia prevalence ≤40%: 6 months during pregnancy
Treatment of anemia
Until resolved or a minimum of 3 months, then continue with prevention regimen 120 mg iron and 800 µg folic acid daily
5 Before conception or as early in pregnancy as possible in high risk areas where iodized salt Single dose of 400–600 mg (2 or 3 capsules)
Iodine is not available
2. WHO. Safe Vitamin A Dosage during Pregnancy and Lactation, 1998.
3. UNICEF/UNU/WHO. Iron Deficiency Anaemia: Assessment, Prevention, and Control, 2001.
4. Stoltzfus RJ, Dreyfuss ML. Guidelines for the Use of Iron Supplements to Prevent and Treat Iron Deficiency Anemia, 1998.
5. WHO. Postpartum Care of the Mother and Newborn: A Practical Guide, 1998.
Notes:
a
Recommendations for vitamin A supplementation are currently under review and may be increased, pending the results of ongoing research.
(See: IVACG. The Annecy Accords to Assess and Control Vitamin A Deficiency: Summary of Recommendations and Clarifications, 2002.)
b Neural tube defects are caused by folate deficiency during the first few weeks of pregnancy. To prevent these and to ensure that mothers enter
pregnancy with sufficient iron stores, women should also take iron/folate supplements routinely if there is a possibility they could become pregnant.
a 6-7
Table 3. Summary of Increased Nutritional Needs during Pregnancy and Lactation
tation
Increase in pregnancy Increase in lac
Non-
pregnant,
non- st nd rd
lactating 1 2 3 o-6 7-12 Food sources (with nutrient
woman trimester trimester trimester months months c
Nutrient value of cooked portions) Health actions
All oily, starchy, and protein foods contribute Advise families that pregnant women need
+452 +500b significant calories extra food each day (one or more servings
kcal +400 1 cup rice =267 kcal of the staple food) and that lactating women
+240 kcal kcal 1 corn tortilla =66 kcal need an extra meal.
Energy 2200 +0 kcal 1 cup cassava =204 kcal Counsel families that reducing the
kcal kcal 1 white bun (bread) (35g) =90 kcal woman’s workload and ensuring opportun-
1 cup potatoes =135 kcal ity for rest will help her conserve energy.
1 Tbsp oil or fat =90 kcal Monitor weight gain during pregnancy.
Animal source foods, fish, pulses/legumes Promote favorable intra-family food distri-
70 g chicken, stewed =19 g bution by educating men and older women.
+25 1 egg(raw or cooked) =6 g Improve food and economic security and,
46 1 cup cow’s milk =9.6 g in rural areas, promote small livestock prod-
Protein grams 1 cup dried beans, peas, lentils =16-18 g uction.
grams 100 g tempeh or tofu =18 g Counsel pregnant women and their fam-
ilies on the need for protein and identify
local foods rich in protein.
Liver, eggs, dark orange and yellow fruits and Promote increased consumption and
+600 vegetables, dark green vegetables, red palm oil, production of fresh or dried fruits and
fortified oils or other fortified products vegetables.
RAE 1 chicken liver (20g) =983 RAE
+70 1 whole egg =229 RAE Initiate or strengthen systems for prenatal
Vitamin A 700 RAE 1 whole carrot =1010 RAE and postpartum supplementation.
d
RAE =150 RAE
1 cup cooked greens
1 cup cooked pumpkin =1325 RAE
1 medium mango =321 RAE
Animal source foods such as red meats, red organ Promote supplements during pregnancy
meats, poultry, fish; fortified foods; beans and some and consumption of iron-fortified foods where
green leafy vegetables available.
Counsel on coping with side effects of
+9 3.5 oz/100g red meat =2.5 mg supplements.
mg 3.5 oz/100g liver =4.3 mg Promote consumption of iron-rich foods and
Iron 18 +0 1 cup black beans =3.6 mg* foods that enhance absorption (meat, fish,
mg mg 1 cup lentils =6.6 mg* e
poultry, and vitamin C-rich foods).
1 cup spinach =2.7 mg* Suggest alternatives to tea or coffee with
meals.
*(when eaten with foods high in vitamin C) Prevent and treat malaria in endemic areas
per WHO protocols for pregnant women.
Implement deworming programs.
+200 Dark green leafy vegetables, legumes, nuts, liver Counsel women to increase consumption of
g +100 3.5 oz/100g liver =217 g folate-rich foods.
Folate 400 g 1/2 cup peanuts =106 g Provide supplements (combination of iron-
g folic acid), particularly during first weeks of
pregnancy.
+140 Sea food, iodized salt Promote consumption of iodized salt.
g 3.5 oz/100g marine fish or shellfish =80 g Where iodine deficiency is endemic and
+70 iodized salt is not available, supplementation
Iodine 150 g may be needed.
g
Milk and milk products, whole fish (including bones), Promote consumption of calcium-rich foods
dark green leafy vegetables, legumes throughout the life cycle.
1000 +0 1 cup whole milk or yoghurt =306 mg
Calcium mg 1 cup dark leafy green vegetables =150-300
mg 1 cup white beans or chickpeas =95 mg mg
Organ meats, red meat, poultry, whole fish Promote small livestock production and
+4 3.5 oz/100g liver, kidney =4.2-6.1mg aquaculture for targeted feeding of children
+3 mg and pregnant and lactating women.
mg 3.5 oz/100g beef, pork =2.9-4.7 mg Promote germination and fermentation to
Zinc 8 3.5oz/100g seafood (fish, etc) =0.5-5.2 mg reduce phytate in cereal-based diets.
mg
6-7. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes, forthcoming and 2002.
Notes:
a “Needs” are the estimated average requirement for energy and the recommended dietary allowances for all other nutrients.
b
Caloric requirements during lactation assumes that the mother has no energy stores to contribute, so all the energy in breastmilk is derived from the mother’s diet.
c
All examples are for cooked foods unless otherwise stated. Protein, iron, iodine, and energy are unaffected by cooking, but signifi cant folate is lost. Iodine decreases
with storage and high humidity. Vitamin A (beta-carotene) is lost with high heat and with chopping leafy vegetables.
d RAE = retinol activity equivalent, equal to the activity of 1g of retinol (This is different from the older “retinol equivalent” which used different conversion factors for
provitamin A carotenoids in foods.)
e Iron from animal sources is more readily absorbed and utilized than iron from plant sources. Animal foods also enhance the absorption of iron from other sources.
Table 1. Weight Gain Consequences of
1
Recommendations for Pregnancy Maternal Malnutrition
Pre-pregnancy Weight Recommended Total Gain Consequences for maternal health
Category Kilograms Pounds • Increased risk of maternal complications and death
• Increased infection
BMI < 19.8 12.5 – 18.0 28 – 40 • Anemia
• Lethargy and weakness, lower productivity
BMI 19.8 to 26.0 11.5 – 16.0 25 – 35 Consequences for fetal and infant health
• Increased risk of fetal, neonatal, and infant death
• Intrauterine growth retardation, low birth weight, prematurity
BMI > 26.0 to 29.0 7.0 – 11.5 15 – 25 • Birth defects
• Cretinism
• Brain damage
1. Institute of Medicine. Nutrition During Pregnancy, 1990. • Increased risk of infection
2
BMI = body mass index (weight in kg divided by height in meters squared, or kg/m )
Table 2. Micronutrient Supplementation during Pregnancy and Lactation
Supplement Timing Dosage
2,a During pregnancy: After the first trimester 10,000 IU daily or a maximum of 25,000 IU weekly
Vitamin A
(in vitamin A-deficient During lactation (after delivery): As soon as possible, but not later than 8 weeks after delivery Single dose of 200,000 IU
populations)
3-4,b Prevention of anemia
Iron/Folate Anemia prevalence >40%: 6 months during pregnancy through 3 months postpartum 60 mg iron and 400 µg folic acid daily
Anemia prevalence ≤40%: 6 months during pregnancy
Treatment of anemia
Until resolved or a minimum of 3 months, then continue with prevention regimen 120 mg iron and 800 µg folic acid daily
5 Before conception or as early in pregnancy as possible in high risk areas where iodized salt Single dose of 400–600 mg (2 or 3 capsules)
Iodine is not available
2. WHO. Safe Vitamin A Dosage during Pregnancy and Lactation, 1998.
3. UNICEF/UNU/WHO. Iron Deficiency Anaemia: Assessment, Prevention, and Control, 2001.
4. Stoltzfus RJ, Dreyfuss ML. Guidelines for the Use of Iron Supplements to Prevent and Treat Iron Deficiency Anemia, 1998.
5. WHO. Postpartum Care of the Mother and Newborn: A Practical Guide, 1998.
Notes:
a
Recommendations for vitamin A supplementation are currently under review and may be increased, pending the results of ongoing research.
(See: IVACG. The Annecy Accords to Assess and Control Vitamin A Deficiency: Summary of Recommendations and Clarifications, 2002.)
b Neural tube defects are caused by folate deficiency during the first few weeks of pregnancy. To prevent these and to ensure that mothers enter
pregnancy with sufficient iron stores, women should also take iron/folate supplements routinely if there is a possibility they could become pregnant.
a 6-7
Table 3. Summary of Increased Nutritional Needs during Pregnancy and Lactation
tation
Increase in pregnancy Increase in lac
Non-
pregnant,
non- st nd rd
lactating 1 2 3 o-6 7-12 Food sources (with nutrient
woman trimester trimester trimester months months c
Nutrient value of cooked portions) Health actions
All oily, starchy, and protein foods contribute Advise families that pregnant women need
+452 +500b significant calories extra food each day (one or more servings
kcal +400 1 cup rice =267 kcal of the staple food) and that lactating women
+240 kcal kcal 1 corn tortilla =66 kcal need an extra meal.
Energy 2200 +0 kcal 1 cup cassava =204 kcal Counsel families that reducing the
kcal kcal 1 white bun (bread) (35g) =90 kcal woman’s workload and ensuring opportun-
1 cup potatoes =135 kcal ity for rest will help her conserve energy.
1 Tbsp oil or fat =90 kcal Monitor weight gain during pregnancy.
Animal source foods, fish, pulses/legumes Promote favorable intra-family food distri-
70 g chicken, stewed =19 g bution by educating men and older women.
+25 1 egg(raw or cooked) =6 g Improve food and economic security and,
46 1 cup cow’s milk =9.6 g in rural areas, promote small livestock prod-
Protein grams 1 cup dried beans, peas, lentils =16-18 g uction.
grams 100 g tempeh or tofu =18 g Counsel pregnant women and their fam-
ilies on the need for protein and identify
local foods rich in protein.
Liver, eggs, dark orange and yellow fruits and Promote increased consumption and
+600 vegetables, dark green vegetables, red palm oil, production of fresh or dried fruits and
fortified oils or other fortified products vegetables.
RAE 1 chicken liver (20g) =983 RAE
+70 1 whole egg =229 RAE Initiate or strengthen systems for prenatal
Vitamin A 700 RAE 1 whole carrot =1010 RAE and postpartum supplementation.
d
RAE =150 RAE
1 cup cooked greens
1 cup cooked pumpkin =1325 RAE
1 medium mango =321 RAE
Animal source foods such as red meats, red organ Promote supplements during pregnancy
meats, poultry, fish; fortified foods; beans and some and consumption of iron-fortified foods where
green leafy vegetables available.
Counsel on coping with side effects of
+9 3.5 oz/100g red meat =2.5 mg supplements.
mg 3.5 oz/100g liver =4.3 mg Promote consumption of iron-rich foods and
Iron 18 +0 1 cup black beans =3.6 mg* foods that enhance absorption (meat, fish,
mg mg 1 cup lentils =6.6 mg* e
poultry, and vitamin C-rich foods).
1 cup spinach =2.7 mg* Suggest alternatives to tea or coffee with
meals.
*(when eaten with foods high in vitamin C) Prevent and treat malaria in endemic areas
per WHO protocols for pregnant women.
Implement deworming programs.
+200 Dark green leafy vegetables, legumes, nuts, liver Counsel women to increase consumption of
g +100 3.5 oz/100g liver =217 g folate-rich foods.
Folate 400 g 1/2 cup peanuts =106 g Provide supplements (combination of iron-
g folic acid), particularly during first weeks of
pregnancy.
+140 Sea food, iodized salt Promote consumption of iodized salt.
g 3.5 oz/100g marine fish or shellfish =80 g Where iodine deficiency is endemic and
+70 iodized salt is not available, supplementation
Iodine 150 g may be needed.
g
Milk and milk products, whole fish (including bones), Promote consumption of calcium-rich foods
dark green leafy vegetables, legumes throughout the life cycle.
1000 +0 1 cup whole milk or yoghurt =306 mg
Calcium mg 1 cup dark leafy green vegetables =150-300
mg 1 cup white beans or chickpeas =95 mg mg
Organ meats, red meat, poultry, whole fish Promote small livestock production and
+4 3.5 oz/100g liver, kidney =4.2-6.1mg aquaculture for targeted feeding of children
+3 mg and pregnant and lactating women.
mg 3.5 oz/100g beef, pork =2.9-4.7 mg Promote germination and fermentation to
Zinc 8 3.5oz/100g seafood (fish, etc) =0.5-5.2 mg reduce phytate in cereal-based diets.
mg
6-7. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes, forthcoming and 2002.
Notes:
a “Needs” are the estimated average requirement for energy and the recommended dietary allowances for all other nutrients.
b
Caloric requirements during lactation assumes that the mother has no energy stores to contribute, so all the energy in breastmilk is derived from the mother’s diet.
c
All examples are for cooked foods unless otherwise stated. Protein, iron, iodine, and energy are unaffected by cooking, but signifi cant folate is lost. Iodine decreases
with storage and high humidity. Vitamin A (beta-carotene) is lost with high heat and with chopping leafy vegetables.
d RAE = retinol activity equivalent, equal to the activity of 1g of retinol (This is different from the older “retinol equivalent” which used different conversion factors for
provitamin A carotenoids in foods.)
e Iron from animal sources is more readily absorbed and utilized than iron from plant sources. Animal foods also enhance the absorption of iron from other sources.
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