A woman’s total energy and nutrient needs are greater during breastfeeding than at any other time in her adult life, greater even than the nutrient demands of pregnancy (except for iron). Setting nutrient recommendations for breastfeeding women is challenging, because some women combine breastfeeding with infant formula feeding. The NRV recommendations and Australian Dietary Guidelines are based on exclusive breastfeeding for the first 6 months of the baby’s life(1, 2).
Food requirements during breastfeeding are outlined in Table 1(1), according to the Australian Dietary Guidelines for adult and breastfeeding women. Only very rarely will a woman require less than the minimum number of recommended serves from each food group. Women with very high activity levels may need more food to maintain appropriate levels of body weight while breast feeding.
|Vegetables & Legumes||Fruit||Grain (cereal) foods, mostly wholegrain||Lean meat, poultry, fish, eggs, tofu, nuts/ seeds & legumes||Milk, yoghurt, cheese &/or alternatives||Extra foods|
|Girl (14-18 yr.)||5||2||7||2½||3½||0-2½|
|Breastfeeding 14-18 yr.)||5½||2||9||2½||4||0-3|
Recommendations for additional energy during breastfeeding are based on using fat deposits laid down during pregnancy. Thus, although breastfeeding is known to require an extra ~3,000 kJ/day, only an additional 2000-2100 kJ/day (~500kcal) is recommended, with the additional energy coming from stored fat deposits. This recommendation is based on producing 780 mL breast milk/day.
Modest weight loss of around 2 kg/month is not associated with any decrease in infant growth(3), indicating that weight reduction of this magnitude is unlikely to negatively impact breast milk production. There is no robust evidence to suggest that moderate exercise during breastfeeding adversely affects either milk production or the baby’s liking for breast milk. As such, moderate exercise and weight reduction can be recommended for women who are breastfeeding.
Protein needs are greater during breastfeeding than during pregnancy. The Australian Dietary Guidelines recommend 2½ additional serves of vegetables and 3 additional serves of grain (cereal) products, to ensure adequate protein intake (Table 2)(2).
|Nutrient||RDI Woman (14-18 yr.)||RDI Lactation (14-18 yr.)||RDI Woman (19-50 yr.)||RDI Lactation (19-50 yr.)||Foods|
|Protein||0.77 g/kg/day||1.1 g/kg/day||0.75 g/kg/day||1.1 g/kg /day||Wide spread in foods. Recommended protein increases via grains & lean meats/alternatives|
Avoiding constipation and remaining hydrated is very important for the breastfeeding mother. Fluid recommendations increase from 1.6-2.1 L/day to 2.9-3.5 L/day during breastfeeding. The Australia Dietary Guidelines recommend drinking plenty of water.
Fibre needs also increase between 27-30 g/ day. Increased recommendation for fruit, vegetables and cereal (grain) products will meet this increased fibre need.
Vitamin needs are increased during breastfeeding, due to nutrient transfer to the baby via breast milk and increased energy use. Table 3(2) shows selected nutrient needs during lactation.
|Protein (g)||Fibre (g)||Folate (ug)||Vit A (ug)||Vit C (mg)||Vit D (ug)||Calcium (mg)||Zinch (mg)||Iron (mg)||Iodine (ug)||Selenium (ug)|
Minerals secreted daily in breast milk increase a woman’s mineral nutrient needs during breastfeeding.
The recommendation for iodine is greater during lactation than during pregnancy and is difficult to achieve through dietary intake alone: the NHMRC recommend daily iodine supplement of 150 µg(4).
Recommendations for iron during lactation is lower than during breastfeeding, at 9 mg/day. This is because, although there is a small maternal iron loss each day during lactation (in breastmilk), this is offset by no menstrual loss during much of the breastfeeding duration. If a women resumes menstruation while breastfeeding, then the recommended intake of iron is 18 mg/day.
There is no increase in the recommendation for calcium, as there is no evidence that dietary calcium intake influences the amount of calcium in breast milk. Bone resorption appears to be the primary source of calcium for breast milk, with lost bone replaced when breastfeeding ends.
Increased zinc needs during pregnancy are modest, and increasing consumption of grain and legumes should help meet these higher needs.
Ensuring adequate vitamin D nutrition during breastfeeding is an important step to ensuring infants are provided with sufficient vitamin D in breast milk. Infants born to vitamin D deficient mothers are more likely to be vitamin D deficient themselves. Dark skinned women, heavily veiled women or house bound women are at greatest risk of not getting enough sunlight to ensure appropriate vitamin D status.
Energy and nutrient needs during breastfeeding are greater than at any other time in a women’s life. This increased need coincides with a time when women may not have time or energy to shop for and prepare nutrient dense meals. It is important to look at ways of supporting women through the early months of breastfeeding, to ensure appropriate food is available to her. Maternal support networks (e.g. mothers groups) have been shown to be associated with continuation of breastfeeding(5).
The NHMRC in their Infant Feeding Guidelines(6) recognise that there are few contra-indications for breastfeeding. However, they do recommend that breastfeeding is contra-indicated when a mother is known to be HIV positive and recommend specialist advice for individual cases. It is also recommended that a breastfeeding woman and other household members around an infant stop or reduce smoking to limit the infant’s exposure to tobacco smoke. No alcohol is recognised as the safest option for a breastfeeding mother and mothers should be encouraged and supported to avoid illicit drug use. Prescription drugs should be assessed by a health professional to determine if their use is compatible with breastfeeding.