Image Credits: UNICEF India Stories
"Breastfeeding is a natural "safety net" against the worst effects of poverty. If the child survives the first month of life (the most dangerous period of childhood) then for the next four months or so, exclusive breastfeeding goes a long way toward canceling out the health difference between being born into poverty and being born into affluence." - James P. Grant
Maternal undernutrition does not affect the quality & quantity of breast milk significantly, as long as it’s not severe. However, it will deteriorate the mother’s health further.
But on the other hand, it must be understood that the undernutrition of the mother at any stage in the reproductive age affects the child as well as the health status of the mother. Maternal nutrition affects both fetal programming and genomic imprinting.
Fetal programming refers to the concept that the conditions and experiences a foetus is exposed to, during the initial stages of pregnancy, can have a lasting impact on the child's growth. This could occur during the initial stage of pregnancy when tissues and organs are created. Undernutrition, infection and stress of the mother during this period create long time/permanent effects on the infant’s life.
Genomic imprinting is a condition that refers to the expression of a specific gene inherited from only one parent i.e., either the mother or father, in the baby. This leads to several problems such as unusual growth and diseases throughout life.
This is why it is to be remembered that, “Mother and child dyad” is one unit.
In India, there are no cultural barriers that hinder or discourage the practice of breastfeeding and it is widely embraced. As per the National Health Family Survey-5 (NHFS-5) conducted between 2019-21, 63.7% of the infants are exclusively breastfed until 6 months.
Latching:
Lactation is a normal physiological process of production and secretion of milk in mammary glands, enabled by hormone changes. During lactation, there are no specific food restrictions.
Latching refers to the mechanism by which newborns attach to the breast. Baby must latch properly, by taking the nipple and major parts of the areola in the mouth while the baby’s lips are curled outward without leaving any gap. A baby must be made to latch properly in order to maximize sucking and gain nutrition.
Proper latching takes some time for most newborns
Tickling the baby’s mouth with nipple is a good way to make the baby open its mouth
Proper latching makes the belly button of the baby less visible
Proper latching lets the mother move her hands and converse easily
Why the health mandates for women are high during breastfeeding?
The stored nutrition in the body could have depleted due to pregnancy or loss of blood during labour
They need to recover and feel strong and healthy
They have to produce breastmilk
At every postnatal visit, the diet of the mother should be discussed. The fat content of breast milk can vary, but the levels of carbohydrates, protein, iron, and calcium are generally unaffected by the mother's diet. However, a deficiency in vitamins A, B, D, and iodine can impact the composition of the mother's milk. Any cultural and social influences might be respected while dispelling myths.
All lactating mothers simply need to eat a good diet.
Key points to be known by all breastfeeding women:
Women should include a variety of foods
Drinking water should be as per thirst, excessive consumption is not required
Food should be consumed only when feeling hungry
Commonly extra consumption of 500 Calories/Day is recommended during the first 6 months
Calories stored in the body as fat during pregnancy, also help in lactation
By and large, breastfeeding mothers should include
At least 4 servings of milk, meat, legumes and pulses
4-5 servings of fruits and vegetables
Carbohydrates are seldom a concern, yet 4-6 servings should include some whole grains
Protein:
The average requirement of Protein is 65 g/day in the first 6 months. After that, it is 62 g/day while breastfeeding
Adequate protein intake is important as it helps to support immune function, maintain muscle mass, and promote tissue repair
Sources of Protein:
Lean meat, Poultry, Dals, Legumes, Dairy etc.,are important sources of protein
Fats:
Maternal undernutrition is associated with a lower volume of lipids in the milk
Adequate consumption of fats is about 20-35% of total calories
Fat plays a crucial role in the composition and quality of breast milk
Sources of fat:
Avocados, Cheese, Dark chocolate, Ghee, and Oil are important sources of good fats
Essential Nutrients:
1.3g of Docosahexaenoic acid(DHA) is recommended for women every day
Omega 3 acid intake is important for the growth of the brain, ears and retina
Vitamins and minerals:
An increase in intake of Thiamine, riboflavin, pyridoxine, cobalamine, vitamin A and Vitamin D is recommended during pregnancy
The deficiency of vitamins and minerals in the mother affects the composition of vitamins and minerals in breast milk
Vitamin A:
Vitamin A is a crucial and determinant factor of an infant’s health and photochemical reactions of the retina. Therefore, Vitamin A supplementation is essential for the mother to improve the health status of an infant. Maternal supplements enhance the quality of breast milk. In developing countries, women are recommended to take 2,00,000 IU of Vitamin A, as soon as possible, after delivery. Vitamin A is antioxidant and has anti-microbial properties.
Foods that are rich in Vitamin A:
carrots, pumpkins, dark orange vegetables, drumstick leaves/pod, papaya, mango, green leafy vegetables, milk/milk products, egg yolk and fish
Vitamin B:
Vitamin B supports the high energy demands of milk production and promotes the health and development of the infant.
Foods rich in Vitamin B:
Green leafy vegetables, milk, wholegrains, cashew nuts, almonds etc.,
The husk, or outer layer, of rice, contains a significant amount of Vitamin B1. Therefore, it is recommended to lightly wash rice before cooking to retain the valuable nutrients present in the husk
If the mother has a low amount of vitamin B12, then the child develops stunting, poor neurocognitive function, less ability to thrive and global development delays, which are irreversible. Fish, Meat, poultry and dairy products are some of the common vitamin B12-rich foods
As vitamin B12 is primarily found in animal-based foods, women who adhere to a strict vegan or vegetarian diet should consider taking a vitamin B12 supplement
Vitamin D:
It is essential for the formation of healthy bones and teeth.
Deficiency of Vitamin D is frequent in pregnant and lactating women
It is recommended that all infants receive a supplement of 400 IU/day of Vitamin D
They should expose themselves and their infants to sunlight(when safe and appropriate)
Food rich in Vitamin D:
Fatty fish, egg yolks, cheese, meat and fortified foods.
Iodine:
It plays a crucial role in the production of thyroid hormones, which are essential for proper growth and development of the infant's brain and nervous system.
The iodine requirement in lactating mothers is twice that of an adult woman because they are required to meet the iodine requirements of a baby to synthesise thyroid hormones
The iodine content in the milk depends on the mother’s diet
Foods rich in Iodine:
The Iodine requirement is fulfilled by including iodised salt, seafood, seaweed and dairy products
Iron:
Iron is important in the production of hemoglobin.
Sources of Iron:
Iron supplementation is required to fulfil the iron loss due to loss of blood during delivery
After delivery, women don't menstruate for 6 months if they exclusively breastfeed, therefore there is no loss of iron through blood loss
Supplementation of 60 mg/day is recommended for 3 to 6 months, along with an iron-rich diet
Non-vegetarian foods, leafy vegetables, jaggery, black currant & dates are rich sources of iron
Cooking food using iron utensils, increases iron consumption in the body
Consumption of lemon(Vitamin C) increases the bioavailability of Iron
Calcium:
Calcium is important for maintaining a mother's own bone health, as lactation can lead to a temporary loss of bone density.
Sources of Calcium:
Mothers should consume calcium-rich foods such as dairy products, green leafy vegetables, whole grains, broccoli, canned fish, cabbage, tofu, sesame seeds, almonds and other dry fruits
If there is low calcium in the diet, a supplement of 600 mg is recommended
Calcium tablets should be taken separately from the iron tablets
Can a malnourished mother breastfeed?
Malnourishment affects the mother much more, as the baby can draw its needs from the mother
To avoid this, mothers need to be renourished with a proper diet
It is better to renourish breastfeeding mothers than to provide artificial milk
Though a mother who does not have sufficient nutrition in her diet can breastfeed a child successfully, good nutrition helps a mother maintain her health
Food restrictions while breastfeeding:
Mothers should be allowed to eat whatever they want during breastfeeding and it is important to eat a variety of foods
There are no food restrictions during breastfeeding as all foods can be included, from hot to cold
The flavour of the food and spices in the mother’s diet remains in breastmilk, which helps babies to pick up taste when they start to eat solid foods
There are rare chances for a baby to develop an allergy to a specific food from a mother’s diet. In the occurrence of such allergies, that specific food item should be avoided
Caffeine and alcohol consumption should be limited
Practices for effective management:
In Postnatal medical visits, thorough diet history should be analysed with open-ended questions. Counselling and sufficient education should be provided. That includes:
Assessing a lactating mother's cooking abilities and providing appropriate resources to improve her skills is recommended
The whole family should be involved in the process of providing her with a healthy diet
Crucial nutritional practices are
Intake of foods rich in Iron, Folate, Vitamin A, B, Calcium and Iodine
Intake of a variety of foods that includes protein, energy, vitamin and mineral
Clean, safe drinking water, personal and environmental hygiene
Comments