- •
Maternal nutrient requirements are heightened during lactation.
- •
Some nutrients including vitamins A, D, B1, B2, B6, and B12, fatty acids, and iodine are required in the maternal diet to ensure optimal levels in breast milk and, thus, the goal for infant dietary intake.
- •
Complementary foods should begin by 6 months of age in exclusively breastfed infants with a focus on zinc-rich and iron-rich food sources.
Nutritional Management of the Breastfeeding Dyad
Section snippets
Key points
Nutrients Affected by Maternal Diet
Experimental studies indicate that vitamins A, B1 (riboflavin), B2 (thiamin), B3 (niacin) or the precursor tryptophan, B6 (pyridoxine), B12 (cobalamin), and D are necessary in the maternal diet to ensure adequate concentrations in breast milk.9, 10 These nutrients do not affect lactogenesis per se but are transferred into milk by transport from the peripheral blood of the mother across the mammary epithelium.11
Nutrient requirements during lactation
Nutritional demands are higher for the mother while nursing. These metabolic demands translate into the requirements for an additional 300 calories and a total of 71 g of protein per day.60 Table 1 shows the recommendations for nutrients during lactation. Nutrient intakes for the average woman are best achieved by a diet consisting of a variety of foods.
Exclusive Breastfeeding
The WHO recommends exclusive feeding on human milk for the first 6 months of life.2 With this recommendation comes the responsibility to also ensure that the mother’s diet is adequate, as described earlier. The assumed intake of 750 mL of breast milk per day at an average energy and protein content of approximately 67 kcal and 1 g of protein per deciliter60 provides breastfed infants with adequate intake for growth and development (Table 2).60
Iron Deficiency
Approximately 50% of the anemia diagnosed in the
Summary
Lactation is adequately sustained almost regardless of maternal nutrition, but attention to maternal nutrition during lactation can improve human milk composition in relation to some vitamins, fatty-acid constituents, and iodine. A varied and healthy diet can satisfy most nutritional needs of a nursing mother, and provide adequate milk for her infant. However, as maternal diet may not always be adequate, continued use of multivitamins is recommended. Vitamin K is needed for the breastfed infant
References (91)
- et al.
Bone mineral content, serum vitamin D metabolite concentrations, and ultraviolet B light exposure in infants fed human milk with and without vitamin D2 supplements
J Pediatr
(1989) B vitamins in breast milk: relative importance of maternal status and intake, and effects on infant status and function
Adv Nutr
(2012)- et al.
Vitamin B-6 status of breast-fed neonates: influence of pyridoxine supplementation on mothers and neonates
Am J Clin Nutr
(1992) - et al.
Vitamin A supplementation of women postpartum and of their infants at immunization alters breast milk retinol and infant vitamin A status
J Nutr
(2002) - et al.
High prevalence of Vitamin A deficiency is detected by the modified relative dose-response test in six-month-old Senegalese breast-fed infants
J Nutr
(2012) - et al.
Increased urinary methylmalonic acid excretion in breast-fed infants of vegetarian mothers and identification of an acceptable dietary source of vitamin B-12
Am J Clin Nutr
(1988) - et al.
Breast milk vitamin B-12 concentrations in Guatemalan women are correlated with maternal but not infant vitamin B-12 status at 12 months postpartum
J Nutr
(2012) - et al.
Influence of mineral intake and use of oral contraceptives before pregnancy on the mineral content of human colostrum and of more mature milk
Am J Clin Nutr
(1979) - et al.
Effects of different levels of vitamin C intake on the vitamin C concentration in human milk and the vitamin C intakes of breast-fed infants
Am J Clin Nutr
(1985) Vitamin D and the immune system: new perspectives on an old theme
Endocrinol Metab Clin North Am
(2010)
Effects of maternal docosahexaenoic acid intake on visual function and neurodevelopment in breastfed term infants
Am J Clin Nutr
(2005)
The influence of dietary docosahexaenoic acid and arachidonic acid on central nervous system polyunsaturated fatty acid composition
Prostaglandins Leukot Essent Fatty Acids
(2007)
Docosahexaenoic and arachidonic acid concentrations in human breast milk worldwide
Am J Clin Nutr
(2007)
Effects of early maternal docosahexaenoic acid intake on neuropsychological status and visual acuity at five years of age of breast-fed term infants
J Pediatr
(2010)
Docosahexaenoic acid and amino acid contents in pasteurized donor milk are low for preterm infants
J Pediatr
(2010)
Docosahexaenoic acid supplementation in pregnancy and lactation
Am J Clin Nutr
(2009)
Lactation in lean and obese rats: effect of cafeteria feeding and of dietary obesity on milk composition
Physiol Behav
(1986)
Effect of dietary macronutrient composition under moderate hypocaloric intake on maternal adaptation during lactation
Am J Clin Nutr
(2009)
Effects of maternal caloric restriction and exercise during lactation
J Nutr
(1998)
Vitamin E and fatty acid composition of human milk
Am J Clin Nutr
(1981)
Vitamin A and E content of human milk at early stages of lactation
Early Hum Dev
(1985)
Enriched eggs as a source of N-3 polyunsaturated fatty acids for humans
Poult Sci
(2000)
Iron retention in preterm infants fed low iron intakes: a metabolic balance study
Early Hum Dev
(2010)
The role of iron in learning and memory
Adv Nutr
(2011)
Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial
Lancet
(2006)
Iron supplementation affects growth and morbidity of breast-fed infants: results of a randomized trial in Sweden and Honduras
J Nutr
(2002)
Nutritional effect of including egg yolk in the weaning diet of breast-fed and formula-fed infants: a randomized controlled trial
Am J Clin Nutr
(2002)
Dietary zinc and iron sources, physical growth and cognitive development of breastfed infants
J Nutr
(2000)
Composition of breast milk obtained from mothers of premature infants as compared to breast milk obtained from donors
J Pediatr
(1980)
Zinc requirements and zinc intakes of breast-fed infants
Am J Clin Nutr
(1986)
Breastfeeding and the use of human milk
Pediatrics
(2012)
Guiding principles for complementary feeding of the breastfed child
(2003)
Effect of maternal diet and body composition on lactational performance
Am J Clin Nutr
(1984)
Prevention of rickets and vitamin D deficiency in infants, children, and adolescents
Pediatrics
(2008)
Vitamin K in breast milk: no influence of maternal dietary intake
Eur J Clin Nutr
(1993)
Vitamin K status of lactating mothers, human milk, and breast-feeding infants
Pediatrics
(1991)
Vitamin K1 (phylloquinone) and vitamin K2 (menaquinone) status in newborns during the first week of life
Pediatrics
(1988)
The influence of maternal nutrition on lactation
Annu Rev Nutr
(1992)
The importance of beta-carotene as a source of vitamin A with special regard to pregnant and breastfeeding women
Eur J Nutr
(2007)
Breast-milk vitamin A as an indicator of the vitamin A status of women and infants
Bull World Health Organ
(1995)
Breast feeding and vitamin A deficiency among children attending a diarrhoea treatment centre in Bangladesh: a case-control study
BMJ
(1991)
Vitamin A supplementation for postpartum women
Cochrane Database Syst Rev
(2010)
Nutritional vitamin B12 deficiency in a breastfed infant following maternal gastric bypass
Pediatr Hematol Oncol
(1994)
Ascorbic acid levels in maternal milk: differences with respect to ascorbic acid status during the third trimester of pregnancy
Br J Nutr
(1998)
Effect of maternal dietary vitamin C intake on the level of vitamin C in breastmilk among nursing mothers in Baghdad, Iraq
Food Nutr Bull
(2002)
Cited by (0)
Copyright © 2013 Published by Elsevier Inc.