FAQ_ Sheet Frequently Asked Questions on : Breastfeeding and Maternal Nutrition
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FAQ_ Sheet Frequently Asked Questions on :
Breastfeeding and Maternal Nutrition - extracted text
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SDA-RF-CH-1.45
FAQ SHEET 4
CH I
June 2000
From the LINKAGES Project
FAQ_ Sheet is a series of publications of Frequently Asked Questions on topics addressed by the
LINKAGES Project. This issue focuses on the impact of maternal nutrition on breastmilk quantity and
quality, the nutritional requirements of lactating women, the impact of breastfeeding on maternal
health, and implications of this information for programs.
Effect of
Breastfeeding on
Maternal nutrition
£ :
Does breastfeeding affect
the mother's nutritional
status?
woman’s appetite generally in
Summary of Main Points
creases. The resulting increase in
food intake helps meet the addi
1.
Unless extremely malnourished,
virtually all mothers can produce
adequate amounts of breastmilk.
When the breastfeeding mother
is undernourished, it is safer,
easier, and less expensive to give
her more food than to expose the
infant to the risks associated
with breastmilk substitutes.
2.
Maternal deficiencies of some
micronutrients can affect the
quality of breastmilk. These defi
ciencies shouldje avolded by im
tional demands of pregnancy and
lactation. Extra food, therefore,
must be made available to the
mother.
Community and household mem
bers should be informed of the
It can, depending on the
importance of making additional
mother's diet. The energy, pro
food available to women before
tein, and other nutrients in
breastmilk come from the
they become pregnant, during
pregnancy and lactation, and dur
mother’s diet or from her own
ing the recuperative interval ythen
body stores. When women do not
the mother is neither pregnant
get enough energy and nutrients
nor lactating. Making more food
in their diets, repeated, closely-
available to mothers is even more
spaced cycles of pregnancy and
important in societies with cul
lactation can reduce their energy
tural restrictions on women’s di
and nutrient reserves, a process
ets. Efforts to increase the amount
known as maternal depletion. How
of food available to adolescent,
ever, there are also adaptations
pregnant, and lactating women
that help protect the mother from
can b;e the most effective way of
these effects. The most important
improving their health and that
is appetite. During pregnancy and
of their infants.
proving the dict or providing
supplements to the mother.
3.
Lactation places high demands
on maternal stores of energy and
protein. These stores need to be
established, conserved, and re
plenished.
Delay of the first birth and ad
equate birth spacing help ensure
—Chat maternal stores are suffi
cient for healthy pregnancy and
lactation.
4.
5.
Breastfeeding provides health
benefits to the mother as well as
to the infant.
particularly during lactation, a
LINKAGES i Academy for Educational Development n 1825 Connecticut Avenue, NW Washington, DC 20009
Phone (202) 884-8700 a fax (202) 884-8977 s E-mail linkages^' aed.org u Website www.linkagcsproject.org
XX‘
Ii...' ■
^How much extra food
does a breastfeeding
mother need?
To support lactation and maintain
maternal reserves, most mothers
in developing countries will need
to eat about 650 additional kilo
Effect of Maternal
Nutrition on
Breastfeeding
nourished, it is safer, easier, and
less expensive to give her more
food than to expose an infant un
der six months of age to (he risks-
associated with feeding breastmilk
Can malnourished moth
ers produce enough milk
to breastfeed success
fully?
calories (the equivalent of one
extra meal) every da)’. Well-nour
Yes. In all but the most extreme
ished mothers who gain enough
weight during pregnancy need
cases, malnourished mothers can
follow the same recommenda
less because they can use body fat
tions for breastfeeding as mothers
and other stores accumulated dur
who are not malnourished. These
ing pregnancy. Lactation also in
recommendations include exclu
creases the mother's need for
sive breastfeeding' foi about six
water, so it is important that she
months followed bv on-demand
drink enough to satisfy her thirst.
breastfeeding and the introduc
tion of complementary foods.
-I Should certain foods be
eaten or avoided by
breastfeeding mothers?
There is a common misconcep
No. There are no specific foods
that must be eaten or avoided by
nutrition may affect the quality of
milk, studies show that the
the breastfeeding mother, despite
amount of breastmilk produced
what many people think. Food
depends mainly on how often and
rules (eat this, avoid that) can
how effectively the baby sucks on
tion that malnutrition greatly re
duces the amount of milk a
mother produces Ab hough mal
substitutes or other foods.
Can breastmilk produc
tion be increased by giv
ing
o the mother
additional food?
Some evidence suggests it can.
Two randomized intervention tri
als, in Burma and Guatemala,
have sc far been conducted to an
swer this question. In both stud
ies. food supplementation of
malnourished lactating mothers
resulted in a small increase in in
fant milk intake. In another study
in Indonesia, maternal supple
mentation during pregnancy im-
piovcd infant growth rates,
possibly bv increasing breastmilk
production. Therefore, although
maternal malnutrition is not con
sidered an important constraint
to breastfeeding for most moth
ers, giving additional food to mal
cause harm by reducing the
the breast. If a mother tempo
mother's ability to choose a bal
anced diet or by discouraging her
rarily produces less milk than the
infant needs, the infant responds
pregnancy and/or lactation may
from breastfeeding Consumption
and will certainlv improve their
of a variety cf foods is the best di-
by suckling more vigorous!), more
frequentlv, or longer at each feed
etary advice.
ing. This stimulates greater milk
production. When the
breastfeeding mother is under
nourished mothers during
I elp increase milk prodiu lion
own nutritional status and pro
vide additional energy to care lor
themselves and then families.
' Exclusive breastfeeding means giving no otherfoods or liquids, not even water.
1 These substitutes are less nutritious than breastmilk, lack antibodies to fight infections, and often carry contaminants
Frequently Asked Questions on Breastfeeding and Maternal nutrition
weeks after deliver)1 (or later than
''‘^Should
■astfeeding
mothers lane extra vita
mins and minerals?
It depends on t:.■■ mother's diet.
Breastmilk is ri<. . in the vitamins
and minerals needed to protect
an infant’s health and promote
growth and dew iopmeni. If the
mother's diet is poor, the levels of
six weeks if the mother is not
breastfeeding) because too much
vitamin A mav cause damage to
the developing fetus. Although
high doses during pregnancy can
Effect of
Breastfeeding on
Maternal Health
'-dp.ocs breastfeeding ben
be dangerous, daily (<8,000 IU)
or weekly (<25,000 IU) low-dose
efit the mother’s health?
vitamin A supplements during
pregnancy can reduce maternal
night blindness and death.
Yes. Breastfeeding has many posi
tive effects on the mother’s
health. One of the most impor
micronutrients in breastmilk mav
The levels of thiamin, riboflavin.
be reduced or f:..- mother’s own
vitamin B-6, vitamin B-12, iodine,
1 he period of time after giving
health may bo . reeled. It is there
and selenium in breastmilk arc
birth that the mother docs not
..-.t the mother’s
also affected bv how much is in
become pregnant due to the hor
micronutrient intake is adequate.
the food the mother eats. In ar
monal effects of breastfeeding.
eas where deficiencies of these
Studies show that this effect is
greater when the infant suckles
fore important
A diverse diet containing animal
tant is lactational infertility. This is
products and fortified foods will .
micronutrients are common, in
help ensure ilt.it the mother con-'t
creasing the mother’s intakes
sumes enough. micronutrients for
both herself; i. 1 . >ei
through improved diets or supple
more frequently and is exclusively
breastfed. Increasing the interval
ments will primarily improve
between births has benefits for
.mt. If tfdivcrse
breastmilk'quality and infant nil-’
the mother and her children.
breastfeeding
diet is not aw-..Is le, .1 micronutri
tri lion.
ent supplement nay help.
For example, in .metis
.
where vi la
Fewer pregnancies reduce the
mother’s risk of maternal deple
Other micronutrients (such as
tion and maternal death. A re
folate, calcium, iron, copper, and
lated effect is lactational amenorrhea.
min A deficient is common, it is
zinc) remain at relatively high lev
the period of time after giving
currently recomi...ended diat all
els in breastmilk even when the
birth that the mother does not
mothers take a -I:ingle high-dose
mother’s reserves are low. This
menstruate due to the same hor
means that the breastfeeding
mother’s own reserves can be
This is the basis for the lactational
supplement o;
),00h interna-
tional units*45 (!U 1 >f vitamin A as
soon as possible ..tier
.
delivery.
” Studies have sum-■■■ ■.i ih.it such a
monal effects of breastfeeding.
used up and that it is primarily
amenorrhea method (LAM)'1 of
the mother herself who will ben
contraception. Iractational amen
supplement imp ■ -ves die vitamin
efit if she eats more food high in
orrhea also reduces the amount
A levels in the hi .her. in
breastmilk, and 1 , tin infant.
these micronutrients Additional
of menstrual blood loss, which
calcium and iron, in particular,
helps to prevent anemia bv con
arc often needed to protect ma
serving the mother's iron stores.
High doses of vii ..mii; A are not.
recommended a : women during
ternal reserves.
pregnancy or lam•r than eight
1 This recommends'ion is currently under review and may be increased, pending the results of on-going research.
4 LAM is defined !■■■. three criteria: I) the woman's menstrual periods have not resumed, AND 2) the baby is fully or nearly
fully breastfed. .1 3) the baby is less than six months old.
frequently Asked Questions on Breastfeeding and Maternal nutrition
There are many oilier benefits of
ciencies, infections, parasites^and
^support she needs for
breastfeeding for the nioilier.-
heavy physical labor. Health ser
breastfeeding. Providing addi
Breastfeeding immediately after
vices and agricultural extension
tional foods and fluids to the
deliver}' stimulates contraction of
services, secondary schools,
mother helps both mother and
child.
the uterus. This may help reduce
women's groups, and other out
loss of blood and risk of hemor
reach networks proride opportu
rhage, a major cause of maternal
nities to promote better infant
feeding and maternal dietary
The.time for inter/ention should
mortality. There is good evidence
that breastfeeding reduces the
practices and to offer preventive
nancy and lactation. Adequate '
risk of cervical and breast cancer
care and counseling. Health care
nutrition is a cumulative process.
proriders can help improve ma
In fact, birth outcome is strongly
ternal nutrition by counseling
women about breastfeeding, in
creased food intake, dietar}' diver
influenced by the mother's nutri
tional status even before she be
comes pregnant. The
sification, workload reduction,
recuperative interval between lac
and helps prevent osteoporosis.
Program
Implications and
Guidelines
What can programs do
to support breastfeeding
and maternal nutrition?
and family planning (including
tation and the next pregnancy
delaying the first birth, birth spac
also offers an opportunity to re
ing, and options for limiting fam
plenish the mother’s reserves by
ily size). They can also assess a
offering extra food.
woman's need for antimalarials,
hookworm medication, and mi
cronutrient supplementation and
Information presented in this
not be limited to periods of preg
provide appropriate treatment.
The recommendations in die box
on page 5 are suggested to im
prove tile nutrition of adolescent
girls and women of reproducuvc
FAQ has implications for the dis
tribution of food in the house
For undernourished populations
age. These recommendations,
hold, the division of labor, and
and populations displaced by war
coupled with optimal
the delivery of services to women.
and natural disasters, the use of
breastfeeding and complemen
Women’s nutritional status is
breastmilk substitutes can be par
tary feeding practices, will con
threatened-by repeated, closely-
ticularly dangerous. The best solu
tribute to good health and
spaced pregnancies, inadequate
tion is to feed die mother, not the
nutrition throughout the life
infant, and to give her whatever
cycle.
energy intake, micronutrient defi
Frequently Asked Questions.on Breastfeeding and Maternal nutrition
4
Recommended Practices to Improve the nutrition of
Adolescent Girls (10-19 Years) and Women of Reproductive Age
*
♦
Recommended at all times
Increase food intake, if underweight, to protect adolescent girls’ and women’s health and establish
reserves for pregnancy and lactation.
♦
♦
•
Diversify the diet to improve the quality and micronutrient intake.
•
Increase daily consumption of fruits and vegetables.
•
Consume animal products, if feasible.
•
Use fortified foods, such as vitamin A-enriched sugar and other products and iron-enriched and
vitamio-enriched flour or other staples, when available.
Use iodized salt.
If micronutrient requirements cannot be met through available food sources, supplements contain
ing folic acid, iron, vitamin A, zinc, calcium, and other nutrients mav be needed to build stores and
improve women's nutritional status.
Recommended during periods of special needs
At certain times, girls and women have heightened nutritional requirements. During these times, they
should follow the above recommendations plus those listed below.
During adolescence and before pregnancy
*
Increase food intake to accommodate the adolescent “growth spurt” and to establish energy reserves
for pregnancy and lactation.
■*
Delay the first pregnancy to help ensure full growth and nutrient stores.
During pregnancy
*
Increase food intake to permit adequate weight gain to support fetal growth and future lactation.
♦
Take iron/folic acid tablets daily.
During lactation
*
♦
Eat the equivalent of an additional, nutritionally-balanced meal per day.
In areas where vitamin A deficiency is common, take a high-dose; vitamin A. capsule (200,000 IU) as
soon after delivery as possible, but no later than S weeks postpartum to build stores, improve the vita, min A content of breastmilk, and reduce infant and maternal morbidity.
*
Use the Lactational Amenorrhea Method (LAM) and other appropriate family planning methods to
protect lactation, space births, and extend the recuperative period.
During the interval between stopping lactation and. the next pregnancy
*
Plan and ensure an adequate period (at least six months) between stopping lactation and the next
pregnancy to allow for the necessary build-up of energy and micronutrient reserves.
Frequently Asked Questions on Breastfeeding and Maternal nutrition
y
Further Reading
Krasovec K. Labbok MH.
Morbacher N, Stock J. The
Quecnan JT. (eds).
breastfeeding Answer booh (re
Allen LH. Maternal micronutrient
Breastfeeding and borderline
vised edition). Schaumburg.
malnutrition: Effects on
malnutrition in women, four-
IL: La Leche League Interna
breast milk and infant nutri
nal of Tropical Pediatrics 37
tional, 1997.
tion, and priorities for inter
(suppl 1). 1991.
Naing KM. Oo TT. Effect of di
vention. SCA'Aiws 11:21-27,
1994.
Institute of Medicine. Nutrition
Brown KH, Dewey KG. Relation
Academy Press: Washington,
undernourished Burmese
ships between maternal nutri- ’ tional status and milk energy -
DC, 1991.
mothers. Food and-Nutrition
output of women in develop
ing countries In: Mechanisms
Regulating Lactation and Infant
Nutrient Utilization (Picciano
MF and Lonnerdal B, eds.),
during Lactation. National
Lawrence RA. breastfeeding: ,1
Guide for the Medical Profession,
and Dietary Practices to Improve
Infant and Maternal Nutrition,
tion. Annual Review of Nutri
tion 17:19-36, 1997.
Gonzalez-Cossio T, Habicht J-P,
Rasmussen KM, Delgado HL.
Impact of food supplementa
tion during lactation on in
fant breast-milk intake and on
tire proportion of infants ex
clusively breast-fed. Journal of
Bulletin 9:59-61. 1987.
LINKAGES. Recommended heeding
pp. 77-95. Wiley-Liss: New
requirements during lacta
tation performance of
4lh edition. Mosby: St. Louis.
1994.
York, 1992.
Dewey KG. Energy and protein
etary supplementation on lac
.Academy for Educational De
velopment: Washington. DC,
1999.
Si
Merchant K. Martorell R, HaasJ.
Maternal and fetal responses
to the stresses of lactation
concurrent with pregnancy
and of short recuperative in
tervals. American Journal of
Clinical Nutrition 52:280-288,
1990.
Nutrition 128:1692-1702, 1998.
FAQ Sheet is a publication of LINKAGES Breastfeeding. LAM and Related
Complementary Feeding and Maternal Nutrition Program. LINKAGES is
supported by G/PHN/HN, t,he United States Agencv for International
Development (USAID) under rhe terms of Grant No. IlRN-A-00-97-()00(‘)7-0d and is
managed bv the Academy for Educational Development The opinions expressed
herein are those of the authors ami do not nccc«arjlv reflect the views of USAID.
AED
LINKAGES = Academy for Educational Development ■ 1825 Connecticut Avenue, NW Washington, DC 20009
Phone (202) 884-8000 e Fax (202) 884-8977 ■ E-mail linkages@aed.org n Website www.linkagesproject.org
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