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Maternal Nutrition/Minimum Meal Frequency for Pregnant and Lactating Women

This question was posted the Management of At Risk Mothers and Infants forum area and has 3 replies.

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Yara Sfeir

Global Nutrition Cluster Technical Alliance

Normal user

4 Mar 2021, 13:22

Dear colleagues, 

Do you know of any guidelines that include information on minimum meal frequency for pregnant and lactating women? 

I am also interested in recent guidelines on maternal nutrition.

Thank you very much, 

Yara

John NTABO SHEBENI

Heqlth &Nutrition Supervisor

Normal user

5 Mar 2021, 07:28

  • The "energy cost" of pregnancy is an additional 150 kcal per day during the first trimester and 350 kcal during the second and third trimesters. The size of the woman before pregnancy, her activity level during pregnancy and other individual factors should also be taken into account when examining the weight curve.

If the energy intake is less than 1500 kcal per day during the second half of pregnancy, there may be repercussions on the growth of the fetus.

  • The recommended protein intake is 70 g per day for pregnant women.
  • The metabolism (assimilation by the body) of carbohydrates is profoundly altered during pregnancy, and glucose is very important for fetal tissue . It is necessary to privilege the slow sugars and to distribute the carbohydrates well during the meals , especially at the breakfast because the risks of hypoglycemia are very important after the night fast. A carbohydrate breakfast should provide 40 to 50 g of starch, ie 80 g of bread or 6 rusks or 60 g of cereals.
  • In addition to the contribution of lipid intake in energy intake, care must be taken to ensure their content in essential fatty acids which are important for the fetus. Some fatty acids should not be overlooked. This is the case with DHA, a fatty acid from the omega 3 family. It contributes to the proper development of the baby's brain. According to many studies, consuming a lot of DHA during pregnancy is good for the cognitive and physical development of the child.

DHA is found in salmon, herring, mackerel, cod and even fish oils.

  • Calcium requirements increase by approximately 1,200 mg per day. Calcium is essential for building a baby's skeleton, especially during the third trimester. Do not panic, if you do not consume enough, the fetus will seek it in your own reserves. In addition to bone mineralization in the baby, the consumption of calcium protects the pregnant woman from the risk of high blood pressure and its serious complications, attacks of eclampsia . It enriches future breast milk with calcium and is believed to have a role in preventing the risk of postpartum depression . Dairy products (except those made from raw milk) are very rich in calcium. It is advisable to consume three dairy products a day : milk, yogurt, cottage cheese, cheese ... For those who do not like dairy products, there are mineral waters rich in calcium (Hepar).
  • Vitamin D deficiency, common in late pregnancy, promotes neonatal hypocalcemia . This is why in France it is recommended to systematically supplement pregnant women with vitamin D , at least during the 3rd trimester .
  • Iron requirements are increased especially during the last six months of pregnancy. Intakes vary from 30 to 50 mg per day . Iron deficiency anemia, a consequence of iron deficiency, increases the risk of prematurity and fetal hypotrophy . Due to low reserves before pregnancy, many women experience anemia and need to be given iron supplements during pregnancy. The women most at risk are adolescent girls, women with early or multiple pregnancies, vegetarians and women from disadvantaged backgrounds.
  • Vitamin requirements are all increased during pregnancy. The needs for vitamins A, C and group B are easily met by a sufficiently diversified diet. On the other hand, meeting the needs for folic acid (vitamin B9) can be problematic. Many women have a low rate early in pregnancy. However, folic acid deficiency increases the risk of prematurity and delayed fetal growth, and can lead to neural tube defects. All women are therefore advised to increase their dietary intake of folic acid, supplementation being indicated in groups at risk.
  • The needs for other micronutrients (magnesium, zinc, iodine) are well covered by the diet. There is no evidence that fluoride supplementation has an effect on the future dentition of the fetus.
  • Salt can be consumed normally during pregnancy, i.e. 10 to 12 g per day, unless medically contraindicated.
  • The number of meals to be consumed to supplement these contributions varies between 4-6 meals per day in pregnant and breastfeeding women.

Philip James

Senior Technical Associate, ENN

Technical expert

9 Mar 2021, 09:30

Dear Yara,

Just to let you know that over the next few months ENN is updating their 2013 technical brief on maternal nutrition. So hopefully there will be a new resource on this soon! It looks as though John has given some useful summary advice too.

In the meantime you may also find the following references interesting to read on latest thoughts on mutliple micronutrient supplementation

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004905.pub6/full

https://nyaspubs.onlinelibrary.wiley.com/toc/17496632/2019/1444/1

WHO collate their guidelines on nutrition and pregnancy here:

https://www.who.int/nutrition/publications/pregnant/en/

And some more general WHO guidance (although with a more European focus)

https://www.euro.who.int/__data/assets/pdf_file/0008/313667/Good-maternal-nutrition-The-best-start-in-life.pdf?ua=1

Hope to have more information to update you with over the coming months. 

Best wishes, Phil

Colleen Emary

World Vision International

Normal user

15 Mar 2021, 12:37

Hi Yara,

In terms of measuring MDD in Women of Reproductive age.  Here is a useful reference: http://www.fao.org/3/i5486e/i5486e.pdf 

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