Manual of Clinical Nutrition

Nutrition Management During Pregnancy and Lactation

Manual of Clinical Nutrition Management A- 20 Copyright © 2013 Compass Group, Inc.

Specific Nutrient Requirements During Lactation
It is the position of the Academy of Nutrition and Dietetics that exclusive breastfeeding provides optimal
nutrition and health protection for the first 6 months of life and breastfeeding with complementary foods from 6
months until at least 12 months of age is the ideal feeding pattern for infants (32). Breastfeeding is associated
with a reduced risk of otitis media, gastroenteritis, respiratory illness, sudden infant death syndrome,
necrotizing enterocolitis, obesity, and hypertension. Breastfeeding is also associated with improved maternal
outcomes, including a reduced risk of breast and ovarian cancer, type 2 diabetes, and postpartum depression
(32).

Energy: The average energy costs of lactation are 500 kcal/day ( 6 ) in the first 6 months and 400 kcal/day in the
second 6 months ( 6 ). Excessive restriction of energy (< 1 ,800 kcal/day) may cause decreased milk production.

Fluids: Daily intake of adequate fluid is encouraged. Current evidence does not support that increasing or
decreasing fluid intake by 25 to 50 percent impacts breast milk production (Grade II)* (32).

Alcohol: A lactating woman should avoid alcohol consumption, unless it is permitted by her physician.

Caffeine: Lactating women should limit their daily consumption of caffeine to two 5-oz cups of coffee (<200
mg) (16).

Fiber: The 2002 DRI for adequate intake of total fiber is 29 g/day for all age groups during lactation ( 6 ).

Fish: The same guidelines provided for pregnancy should be applied while breastfeeding. Refer to Other
Substances in the section above.

Omega-3 Fatty Acids: Consistent results from randomized control trials have shown that omega- 3 - fatty acid
supplementation (fish oil, cod, liver oil, or docosahexaenoic acid [DHA]- rich oil) taken by pregnant women or
breastfeeding mothers can increase omega- 3 - fatty acid levels in both breast milk and infants’ plasma
phospholipids (Grade II) (32). There is a dose-response relationship between doses of DHA supplementation and
breast milk DHA levels, but the saturation remains unclear (32). These positive changes in breast milk omega-
3 - fatty acid compositions, however, do not always show a positive affect on children’s visual acuity and
cognitive development at long term follow-up (Grade I) (32).

*The Academy of Nutrition and Dietetics has assigned grades, ranging from Grade I (good/strong) to Grade V (insufficient evidence), to
evidence and conclusion statements. The grading system is described in Section III: Clinical Nutrition Management A Reference Guide,
page III-1.

References

1. Institute of Medicine of the National Academies. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The
   National Academies Press; 2009. Available at http://www.iom.edu/~/media/Files/Report%20Files/2009/Weight-Gain-During-
   Pregnancy-Reexamining-the-Guidelines/Report%20Brief%20-%20Weight%20Gain%20During%20Pregnancy.pdf. Accessed
   January 23, 2013..


2. Food Guide Pyramid: A Guide to Daily Food Choices. Washington, DC: US Dept of Agriculture, Human Nutrition Information Service.
   Home and Garden Bulletin No. 252.


3. Position of the American Dietetic Association: nutrition and lifestyle for a healthy pregnancy outcome. J Am Diet Assoc.
   2008 ;10 8 : 553 - 561.


4. Brown JE, Carlson M. Nutrition and multifetal pregnancy. J Am Diet Assoc. 2000;100:343-348.


5. Oken E, Taveras EM, Kleinman KP, Rich-Edwards JW, Gillman MW. Gestational weight gain and child adiposity at age 3 years. Am J
   Obstet Gynecol. 2007;196:322.e1- 322 .e8.


6. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids,
   Cholesterol, Protein, and Amino Acids. National Academy of Sciences; 2002:265-334. Preprint available at:
   http://www.nap.edu.books/0309085373/html/index.html. Accessed September 16, 2002.


7. Yates AA, Schlicker SA, Suitor CW. Dietary Reference Intakes: the new basis for recommendations for calcium and related nutrients,
   B vitamins, and choline. J Am Diet Assoc. 1998;98:699-706.


8. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin
   B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press; 1998.


9. MRC Research Group. Prevention of neural tube defects: results of the Medical Research Council vitamin study. Lancet.
   1991;338:131-137.


10. Department of Health and Human Services, Public Health Service. Recommendations for the use of folic acid to reduce the number
    of cases of spina bifida and other neural tube defects. MMWR Morb Mortal Wkly Rep. 1992;41(RR- 14 ):1-7.


11. American College of Obstetricians and Gynecologists. Folic acid for the prevention of recurrent neural tube defects. Washington, DC:
    American College of Obstetricians and Gynecologists; 1993 (Level III). ACOG Committee Opinion 120.


12. American College of Obstetricians and Gynecologists. Nutrition and Women. Washington, DC: American College of Obstetricians and
    Gynecologists; 1996. Technical Bulletin No. 229.


13. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and