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An educational Intervention for WIC nutrition professionals: Nutritional Requirements in Breastfeeding Women

Thesis Project
by

Danielle Saltalamachia

on 29 April 2013

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Transcript of An educational Intervention for WIC nutrition professionals: Nutritional Requirements in Breastfeeding Women

Maternal Dietary Status Majority of current studies look at the effect of maternal nutritional status on composition of breast milk.

In general, a healthy women's breast milk content should stay relatively constant due to the ability of homeostasis to preserve nutrients and compensate for moderate increases and decreases in micronutrients.

For many micronutrients, there is a point at which maternal dietary insufficiency will have consequences in terms of maternal status and supply of nutrients to the infant via breast milk. (cite) Health Benefits Benefits for Mothers Breast Milk Content Recommendations Foods will change the flavor of your breast milk and the Mayo Clinic suggests by eating a variety of foods while breastfeeding, your baby may accept more varieties when they are ready to begin eating solid foods. By Danielle Saltalamachia Nutritional Requirements in Breastfeeding Women "Breastfeeding is an instinctual and natural act,
but it is also an art that is learned day by day.
It is almost always simply a matter of practical knowledge
and not a question of good luck".
- La Leche League "To eat is a necessity, but to eat intelligently is an art." ~ La Rochefoucauld What do we know about breastfeeding? Maternal Health benefits Caloric Intake Recommendations Breast Milk Content Recommendations Counseling Case Studies Vitamin A Vitamin E Nutritional needs for Vitamin A during lactation increase 90% to 1.5 mg/day.
The fetal liver is only able to store a small amount of Vit A during pregnancy so it is common for many newborns to have marginal vitamin A deficiency.
However, Colostrum from the mother contains extremely high levels of vitamin A and is usually able to correct the deficiency quickly.
Maternal intake of Vit A and b-carotene(pro vitamin A) strongly effect the micronutrients secreted into breast milk. Bioavailability The only relevant preformed dietary source of Vitamin A is liver- followed by meat, butter, eggs and milk which only contribute <20% vitamin A.
B- carotene absorption is strongly dependent on the source of food, manner (form) it is served and fats in the diet. In a study conducted with exclusively breastfeeding women, milk Tocopherol levels of breast milk at first, third and sixth months post partum have been associated with only mothers total fat and saturated fat dietary intake.
This study included Greek women who consumed a typical mediterranean diet which is low in PUFA and high in monounsaturated and saturated fats.
(olive oils, meats, vegetables, nuts and butters) Vitamin D Vitamin B The transfer of vitamin D across the placenta and into breast milk is small and unlikely compromise Vitamin D status of the mother, however if the mother is not exposed to regular sunlight they may be at risk. It is recommended that lactating women consume at least 600IU of vitamin D daily through dietary sources & sunlight exposure, or supplementation.

Vitamin D deficiency in pregnant and lactating mothers can lead to lowered breast milk concentrations. (Seth et al. 2009) Vitamin B1(Thiamin) B2(Riboflavin), B3 (Niacin), B5 (Pantothenic Acid), B6 (Pyridoxine), B7 (Biotin), B9 (Folic Acid/Folate), B12 (Cobalamin) recommendations increase during Pregnancy. The most common nutritional deficits in breast milk are the results of maternal deficiencies of Thiamin, Riboflavin, B6 and B12.
Vitamins that are further increased during lactation are B2, B5, B6, B7, B12. Caloric Intake The energy required to produce 1 Liter of milk is estimated to be approximately 700Kcal. (cervera & Ngo 2001; Picciano 2003) Recommendations stand true that additional Energy need during exclusive breastfeeding is estimated to be 500kcal/day. (Dewey, 1997) Research estimates that exclusively breastfed infants consume a daily intake of 25 ounces, with a range of 19-30 ounces per day. (Bonyata, 2007) 1 Liter= 33.814 OZ Exclusive breastfeeding mothers are recommended to give infants 1ml or 400IU of vitamin D drops daily to prevent deficiency. (CPS, 2007) Specific concerns for B12 deficiency include breastfeeding women who follow a vegetarian or vegan diet which restricts women from consuming any animal proteins. Fatty Acids Vitamin E is important in newborns to prevent oxidative damage once born and exposed to higher oxygen levels than the intrauterine environment. Iodine Selenium Calcium Zinc Iron The brain is over 60% fat and very rich in both omega-3 and omega-6 EFA derivatives so the baby needs essential fatty acids (EFAs) for brain development and brain function. These are drawn from the mother's body during pregnancy and breastfeeding. ("Dha and breast," 2003)
Arachidonic acid (ARA) is a non essential omega-6 fatty acid. It has been observed in studies that low dietary intake of DHA or ARA in lactating women results in low DHA or ARA levels in milk. (xiang, Harbige & Zetterstrom, 2005) Docosahexaenoic acid (DHA) is a non essential omega-3 fatty acid. It is recommended that Iodine intake is increased from 220 micrograms/day in pregnancy to 290 micrograms/day during lactation. This increase is required to accommodate the changes in maternal thyroid metabolism to support lactation, supply sufficient iodine for milk to meet the needs of the infant and to ensure that lactating women do not suffer deficiency (WHO 2007). A few studies concluded that in an area of mild iodine deficiency, smoking was associated with decreased iodine content in breast milk and in the infant’s urine, 5 days after delivery. The institute for medicine suggests that adolescents who are still growing have an increased demand for Zinc during lactation. Studies have shown that meeting Zinc demands will depend on dietary supply, stage of lactation as well as genetic factors. Zinc transfer into milk declines from ~4mg/day during the first few days post-partum to ~1.75mg/day by one month. The RDA for Zinc increases from 8-9mg/d in non-pregnant non-lactating women to 12-13mg/day in lactating women. After delivery, hemoglobin
returns to pre-pregnancy levels, as long as pregnancy did not induce or worsen iron deficiency. The return to increased hemoglobin levels are often aided by lactational amenorrhea which conserves iron in breastfeeding women. VARIETY IS KEY Evidence from studies published so far suggests that dietary restrictions are in fact effective only in the treatment of specific food allergies, not in allergy prevention. An elimination diet of a breastfeeding mother entails a risk to normal nutrition and growth of the child. (Arvola & Holmberg-martila, 1999) Around 5 percent of your bone mass is lost in order to produce milk. However, once lactation ends any losses will be regained. Dr. Lawrence Gartner, chair of the American Academy of Pediatrics' task force on breastfeeding states that "breastfeeding may reduce your risk of osteoporosis"(Connolly, 2000). Iron Deficiency and Copper deficiency appear to increase the risk of selenium deficiency. The Academy of Nutrition and Dietetics recommends that breastfeeding women consume around 13 cups of fluids daily from water, juices and lowfat milk. Drinking more water according to thirst is also okay. Some women make a habit to drink a glass of fluid after every feed. Counseling case studies An exclusive breastfeeding women comes into the clinic, she is an African American Muslim and does not consume pork or any other meats.. her hemoglobin at this visit is 8.9, she wants to know if she may be deficient in any other vitamins or minerals because of her diet.
Which vitamins or minerals would we discuss and what foods sources can we recommend? Vitamin D deficiency impairs the absorption of calcium from the diet, and in this way can provoke calcium deficiency even when the diet contains adequate calcium- Populations at risk for Vit D deficiency are also at risk for Calcium deficiency. The amount of calcium the mother needs depends on the amount of breast milk produced and how long breastfeeding continues. Women also may lose bone mass during breastfeeding because they’re producing less estrogen, which is the hormone that protects bones. The National Academy of Sciences recommends that women who are pregnant or breastfeeding consume 1,000 mg (milligrams) of calcium each day. Pregnant or breastfeeding teenagers are recommended to consume 1,300 mg/day. However, for adults (including breastfeeding women), toxicity can occur at doses higher than 400 mcg of selenium per day so supplementation is not advised. Selenium in mothers breast milk is dependent on the intake in her diet and dietary components concentration depend on the soil concentration in the area. Regular exercise, especially weight-bearing exercise that forces you to work against gravity, helps build and maintain strong bones. Studies have shown that during lactation, "a daily loss of 13 micrograms of Selenium accompanies the secretion of 750 ml of milk. If a dietary absorption of 80% is assumed, an additional 20 micrograms is recommended to prevent depletion in the mother" (Zachara & Pilecki, 2000) Iron is also secreted in relatively low amounts in breast milk and recommendations are decreased from 15-18 mg in pregnancy to only 9-10 mg during lactation. An 18 year old girl is in her first week of breastfeeding but is hesitant to continue breastfeeding because she just returned to smoking cigarettes, she says she only smokes 3-4/day but is worried that she will hurt the baby. She is also a vegetarian but does enjoy dairy and eggs on occasions.
Which vitamins or minerals would you discuss? What recommendations would you make and what foods could you suggest to increase? References Antonakou, A., Chiou, A., Andrikopoulos, N. K., Bakoula, C., & Matalas, A.

(2011). Breast milk tocopherol content during the first six months in

exclusively breastfeeding greek women. European journal of nutrition, 50,

195-202.

Arvola, T., & Holmberg-martila, D. (1999). Benefits and risks

of elimination diets. Informa Healthcare, 31(4), 293-298.

Bonyata, K. (2007, October 28). How much expressed milk will my baby need?.

Retrieved from http://www.kellymom.com

Blumfield et al.: Disparities exist between National

food group recommendations and the dietary intakes of women. BMC

Women’s Health 2011 11:37.

Dha and breast milk: goodies for baby’s brain. (2003). Retrieved from http://www.007b.com

Durham, H. A., Lovelady, C. A., Brouwer, R. J. N., Krause, K. M., & Ostbye, T. (2011). Comparison of dietary intake of

overweight postpartem mothers practiceing breastfeeding or formula feeding. Journal of the american Dietetic

Association, 111(1), 67-74.

Moran, V. H., Lowe, N., Crossland, N., Berti, C., Cetin, I., Hermoso, M., Koletzko, B., & Dykes, F. (2010). Nutritional

requirements during lactation. towards european alignment of reference values: The eurreca network. Maternal and

Child Nutrition, 6(2), 39-54.

Zachara, B. A., & Pilecki, A. (2000). Selenium concentration in the milk of breast-feeding

mothers and its geographic distribution. Environmental health perspectives, 108(11),

1043-1046.

xiang, M., Harbige, L. S., & Zetterstrom, R.

(2005). Long-chain polyunsaturated fatty acids in chinese and swedish mothers:

Diet, breast milk and infant growth. Acta Paediatrica, (94), 1543-1549. Reduced risks of:
Breast cancer, type II diabetes, cardiovascular diseases, osteoporosis, some reproductive cancers, postpartum depression and rheumatoid arthritis. Maternal Dietary Status
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