NUTRTION SESSION-Slide Deck

. Nutrition in Pregnancy & Lactation.

. INTRODUCTION During pregnancy and lactation, what you eat has profound effect on your child's health. %rncy. Adapt—3 from: During pææncy and lactation, what you eat has profound effect 0k r child's health. "You are w pu eat'. gut dunno pregnamy You are what your m r ears",.

. DIETARY GOALS Ensuring adequate nutritional status for pregnant women and lactating mothers. Improvement of birth weights and promotion of growth of infants and children to achieve their full genetic potential. 6:00 National Institute of Nutrition. Dietary GOdeIineS for Indians - A Manual; 2011. Available from: httpWnihindiaorg dietarygu idelinesforninwebsite_pdt.

. NUTRIENT REQUIREMENT DURING PREGNANCY Nutrient requirements are increased during pregnancy to meet the high demands of the fetus and mother. National Institute ot Nutrition (2010). Nutrient reqerenvnts and reconvnended dietay allcwances for Indians - A report of ICMR Nutrient requirements are iru:teased to nvet the hi$' demands ot the fetus and rmther..

. WHAT IS REQUIRED FOR A HEALTHY PREGNANCY? Maintain a good nutrition status by increasing intake of energy, vitamins and minerals. ercwn LS Nutrition requirement during pregnancy. Ad»ted from: http:"su•nples.jbpubcorn meeting addtimal energy. vitamin and mirpral requirements.

. IMPACT OF MATERNAL WEIGHT STATUS Very low or very high maternal weight gain may lead to various gestational problems. 1, Ehrenberg HM. L Milluzzi C. etal, Low mnrnal failure to thrive in pregnancy. and adverse pregnancy outcornes. Am J Obstet Gynecol. 2003.1991726-1730 2, Paden M. Awry O, to prevent cornplications Of Of Medicine. 201290) 30-35. L_mv pregnano,' weight and maternal •eight gen ate risk 'actors for premature &livery. birth weOht ot the baby and canplications during pregnancy. Excessive weight gain durir»g pregnancy can lead to increased risk ot pregnancy related complkati•ms diabetes. hi$l PP. birth and caesMean &livery..

. NUTRIENTS REQUIREMENT DURING PREGNANCY Energy • Recommended intake: +350 Kcals/day Protein • Recommended intake: • +0.5 g/day - 1st trisemester • +6.9 g/day - 2nd trisemester • +22.7 g/day - 3rd trisemester Fats • Recommended intake of visible fat: 30 g/day National Institute of Nutrition (2010). requfenvnts and recommended dietay albuances tor Indians — A reput of ICMR Energy Fats Protein.

. NUTRIENTS REQUIREMENT DURING PREGNANCY Dietary Fiber • Recommended intake: around 25 g/lOOO Kcall Fluids • Recommended intake: 8-12 glasses of water/day2 Vitamin A • Recommended intake: 800 Qg/dayl National Institute of Nutrition (2010). Nutrient requirertvnts aru:å recomrnended dietay allowance s for Indians - A report of ICMR National Institute of Nutrition (2010). Dietary guidelines during pregnancy and Itxation. In: Dietary manual for Indians- A manual.2nd ed. p. 10-29. LDietary Fiber Fluids itamin.

. NUTRIENTS REQUIREMENT DURING PREGNANCY Vitamin D Helps to build and maintain strong bones and teeth; development of the babyl,2 Vitamin B12 • Promotes normal growth of the brain, production components (red blood National Institute of Nutrition (2010). Nutrient requirertvnts aru:å recomrnended dietay allowance s for Indians - A report of ICMR National Institute of Nutrition (2010). Dietary guidelines during pregnancy and Itxation. In: Dietary manual for Indians- A manual.2nd ed. p. 10-29. Vitamin Vitamin Vitamin B12.

. CRITICAL NUTRIENTS DURING PREGNANCY Folic acid • Extremely important nutrient during pregnancy Folic Expectant women should consume folate-rich foods like green leafy vegetables, legumes, nuts and liverl,2 • Daily intake of 500 Qg is advised throughout pregnancy2 National Institute of Nutrition (2010). Nutrient requirertvnts aru:å recomrnended dietay allowance s for Indians - A report of ICMR National Institute of Nutrition (2010). Dietary guidelines during pregnancy and location. In: Dietary manual for Indians- A manual.2nd ed. p. 10-29. acid Folic acid Folic acid.

. CRITICAL NUTRIENTS DURING PREGNANCY Iron Helps formation of red blood cells for you and your babyl,2 • Consume iron-rich foods like lean meats (kidney, liver), green leafy vegetables, cooked beans, peas2 • Take foods rich in vitamin C (citrus fruits, amla) along with iron-rich foods to enhance its absorption2 National Institute of Nutrition (2010). Nutrient requirertvnts aru:å recomrnended dietay allowance s for Indians - A report of ICMR National Institute of Nutrition (2010). Dietary guidelines during pregnancy and Itxation. In: Dietary manual for Indians- A manual.2nd ed. p. 10-29. Iron Iron Iron.

. CRITICAL NUTRIENTS DURING PREGNANCY Calcium Adequate calcium is neededl'2 Calcium • For healthy bones and teeth • For healthy development of baby's bones, heart, nerves and muscles To prevent osteoporosis in the mother later in life Good sources: • Milk and milk products are good sources of calcium; other alternatives are ragi, til, soyabeans2 National Institute ot Nutrition (2010). Dietary gu&lines during pregnancy and location. In: Dietary rnanual tor Indians- A manual,2nd p, 0-29. Kcwacs CS. Fulehan GE Calcium and bcre disorders during premancy lactation. Endccrirol Clin N Arn 2Cxh35_21-SL Good sources Calcium.

. ADDITIONAL FOOD DURING PREGNANCY AND LACTATION A lactating mother requires extra food to secrete adequate quantity / quality of milk and to safe guard her own health. Pægnæwy is physiologica•y and nutritionally a highly &manding pericd. Extra fcu3d is required to requirernents of the fetus. A Lactating requires extra food to secrete quantity/ quality ot milk and to sate guard own health..

. GET RIGHT AMOUNT OF CALORIES For most normal-weight pregnant women, the right amount of calories is: 1,800 calories 2,200 calories 2,400 calories per day during per day during per day during the first trimester the second trimester the third trimester Eating right during pregnancy. Avadable from: https://W&WN.nIrn.nihg„:x/rne31inepIw•ncy.'patientinstructions/OCR)S94.htm.

. GO FOR FIBRES TO AVOID CONSTIPATION > Choose foods rich in fibre like whole grain cereals, pulses and vegetables, along with 8-12 glasses of water daily rich in fibre (around 25 kcal) Whole grain cereals. to a'.n•id Of ary •A Manual: 2011. from: dietarygu idelinestor ninwebsite.

. HEALTHY DIET PYRAMID Fats, oil sail and sugar Use in small amounts Meat & alternatives 2-3 servings Fruit & vegetables 2 servings each Rice & alternatives 5-7 servings Image from: FAO 2017. Food-based dietarv guidelines - India. Available at httpffWWN.taoorWrMritiorVedo:ation/tcc„d-détary-guO- lines/regions/countries/india,7en./ Accessed on: Feb 28 2017 Food Groups.

. FOOD GROUPS Food group Bread, other cereals and potatoes Fruit and vegetables Milk and dairy foods Meat, fish and alternatives (such as beans, lentils, eggs, soya products) Foods and drinks containing high amounts of fat and/or sugar Advice Eat plenty, choosing wholegrain varieties if possible Eat a variety - at least five portions/- day. Remember that potatoes do not count and pure fruit juice can only count once towards the five a day Eat or drink recommended amounts and choose low-fat versions whenever you can Eat moderate amounts and choose lower fat meat products whenever you can Eat foods containing high amounts of fat sparingly and look out for the low-fat alternatives. Foods and drinks containing sugar should not be eaten too often. Available from:.

. FOOD GROUPS Balance your eating by choosing a variety of foods from each of the food groups. eatjng different+ages+and+stages+.

. SAMPLE MEAL PLAN FOR ADULT WOMAN (SEDENTARY) Meal Time Breakfast Lunch Tea Dinner Food Group Milk Sugar Cereals Pulses Cereals Pulses Vegetables Vegetables Milk Cereals Milk Sugar Cereals Pulses Vegetables Milk (Curd) Vegetables Fruit Raw 100 ml 10 g 50 g 20 g 100 g 20 g 100 g 50 g 100 ml 50 g 50 ml 10 g 100 g 20 g 100 g 50 ml 50 g 100 g Cooked Recipe Milk or Tea or Coffee Breakfast Rice Phulkos Dhal Veg. curry Veg. salad Curd Snack Tea Rice Phulkos Dhal Veg. curry Seasonal Item Serving Amounts 1/2 cup 2 Cups I Cup 1 cup 2 Nos. 1/2 cup 1/2 cup 7-8 Slices 1/2 cup I Cup 1 Cup 2 Nos. 1/2 cup 1/2 cup 1 Medium 1 cup = 200 ml For Non-Vegetarians - Substitute one pulse portion with one portion Of egg/meat/chicken/fish.lJse 20 g visible fat and <5g salt during preparation Of meal per day. Breakfast Items: Idli - 3 Nos. / Dosa - 2 Nos. / Upma - 1 Cup / Bread - 3 Slices / Porridge - 1-1/2 Cups / Corn flakes with milk - 1-1/2 Cup. Snacks: Poha - 1 Cup/ Toast - 2 Slices. Dhokla -4 Nos l. Institute Of Nutrition. Dietary for • A from:.

. Approx. Calories Value of Some Mealsl Preparation 1. Cereal Rice Phulka Paratha Puri Bread Poha Upma Idli Dosa Khichidi Wheat porridge Semolina porridge Cereal flakes with milk (corn/wheat/rice) l. Institute Of Nutrition. Dietary for • A from: Quan6ty for one serving 1 cup 1 No. 1 No. I No. 2 slices 1 cup I cup 2 Nos. 1 No. I cup 1 cup 1 cup I cup Calories (Kcal) 170 150 80 170 270 270 150 125 200 220 220 220.

. Approx. Calories Value of Some Mealsl Preparation 2. Pulse Plain dhal Sambar 3. Vegetable With gravy Dry 4. Non-Vegetarian Boiled egg Ommelette Fried egg Mutton curry Ch icken curry Fish fried Fish cutlet Prawn Curry Keema kofta curry l. Institute Of Nutrition. Dietary for • A from: Quantity for one serving 1/2 cup 1 cup I cup 1 cup 1 No. 1 No. 1 No. 3/4 cup 3/4 cup 2 big pieces 2 Nos. 3/4 cup 3/4 cup (6 small koftas) Calories (Kcal) 110 170 150 160 160 260 240 190 190 220 240.

. Approx. Calories Value of Some Mealsl Preparation 5. Savoury snacks Bajji or pakora Besan ka pura Chat (Dahi-pakori) Cheese balls Dahi vada Vada Masala vada Masala dosa Pea-kachori Potato bonda Sago vada Samosa Sandwiches (butter- 2 tbsp) Vegetable puff Pizza (Cheese and tomato) l. Institute Of Nutrition. Dietary for • A 2011. from: Quantity for one serving 8 Nos. 1 No. 5 pieces 2 Nos. 2 Nos. 2 Nos. 2 Nos. 1 No. 2 Nos. 2 Nos. 2 Nos. 1 No. 2 Nos. 1 No. I slice Calories (Kcal) 280 220 220 250 180 150 200 380 200 210 200 200 200 200.

. Approx. Calories Value of Some Mealsl Preparation 6. Chutneys Coconut/groundnuts/til Tomato Tamarind (with jaggery) 7. Sweets and Desserts Besan barfi Chikki Fruit cake Rice puttu Sandesh Double ka meetha Halwa (kesari) Jelly/Jam Custard (caramel) Srikhand Milk chocolate Ice-cream l. Institute Of Nutrition. Dietary for • A from: Quantity for one serving 2 tbsp I tbsp 1 tbsp 2 small pieces 2 pieces 1 piece 1/2 cup 2 Nos. 1/2 cup 1/2 cup 1 tbsp 1/2 cup 1/2 cup 25 g 1/2 cup Calories 120 10 60 400 290 270 280 140 280 320 20 160 380 140.

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. FOODS TO AVOID Restrict your salt and caffeine intake Avoid smoking, tobacco and alcohol nt and+breastteeding Obacco.

. FOODS TO AVOID Avoid contaminated foods to prevent microbial food borne illness. Healthy eating from: http/,Wvov.sat•A31th.saw.'.N••wps.•wcrn/con- Stfeeding lance your eathg by chcos ng a groups..

. IMPORTANCE OF CALCIUM IN PREGNANCY AND LACTATION CALCIUM Ima* trom.

. IMPORTANCE OF CALCIUMI Recommends calcium supplementation for reducing adverse gestational outcomes including maternal death, preterm birth and early infant mortality. WHO. Icium in pre nt wonvn; 2013. Available from: htt%4'appswho.inViris.

. . . an617214 2017-03-08 10:45:32 -- Above reference is give to Ragi/ nuts but picture is of rajma/ kidney beans. Do not use a picture different from words becausethere are always some patients who will rely on pictures more than words if pictures are printed..

. CALCIUM-RICH FOODS Milk Orange Sesame Seeds Yogurt Lady's Finger Almonds Cheese Soya Beans TurnipGreens Cinnamon Source mik Lakshmi V, Calcium • A Vital a Body, IJSER_ 2014 Jarr2(l): 1—3, 2. National Institute of NLRrition (NIN). C•tary for Indians - A manual 2ndeditiom 2011. Adapted from: httpwninindiaorg.'dietatyguidehræsfc•rninvæbsiæ.pdf Accessed on Dec II. 2016. Image source scya Beans: Farrell VAet C&kiurn and Content ofSeIe:ted Foods. The University of Arizona Cooperative Extensiorc Available at: http'Æxtønsionarizonaedu,'sites.Oxt•nsion.arüona«fw•tiIes.'pubs.•az112A.pcf on: II, 2016. In-bage source Orange: Farrell VA et al. Calcium and Calorie Content of Selected Fcods. Uni•ærsin,' of Arizona Cooperative Extension. Available at: Accesæd on: Dec II. 2016. Irmge source ctvese_ National Institute of Nutrition Dietary fot Indians - A rnanual 2nd edition: from http'//ninindia.org/dietaryguidelinesfomirwebsite pdf Accessed on Dec II. 2016. Image source almoru%: Lakshmi V. Calcium - A Vital Foundation Mineral for a Healthy gcd,'. IJSER. 2014 Jan2(I): -3. 2 National Institute ot Nilrition (NIN). gui&lirvs tor Indians - A rnanuaL 2ndedition: 2011. Adapted from: Accessed on n, 2016. Irna* from: http•//ww.v.heaIthandbborn„:orrv'HeMthtips/wp-contenVupIoads/2014/02/caIcium2jpg.

. IMPROVING CALCIUM UPTAKEI Improve Calcium and Vit D uptake by Drink one glass of milk everyday Have one cup of curd everyday Take morning sunlight everyday Must take green leafy vegetables Take one cup ragi everyday MiniaolXIth and tarnity welfare. National gull* lines for calcium suppl—tim during pægnancy and Éctaion; 2014..

. CALCIUM AND IRON SUPPLEMENTS Iron and calcium supplements should preferably be administered several hours apart to avoid interaction. 9789241505376_e pdf.

. CALCIUM IN PREGNANCY Recommended dietary allowances for calcium in Indian women during pregnancy and lactation is 400 mg/day. and Lactaton, 52n-r7 J pwgnaryzy and.

. CALCIUM IN PREGNANCY Calcium supplementation is recommended after the 1st trimester till 6 months postpartum, for better maternal and fetal wellbeing. 'III CALCIUM Y Ik;etwrcvn: and lactation: 2014 from: http••4WWW.nrHnhpgov.in/sites/&tauIVfiWfiles/NG_calciurn.cxff.

. POINTS TO PONDERI Eat more food during pregnancy. Eat more whole grains, sprouted grams and fermented foods. Take milk/meat/eggs in adequate amounts. Eat plenty of vegetables and fruits. Avoid superstitions and food taboos. Do not use alcohol and tobacco. Take medicines only when prescribed. Take iron, folate and calcium supplements regularly, after 14-16 weeks of pregnancy and continue the same during lactation. Y Ik;etwrcvn: and lactation: 2014 from: http••4WWW.nrHnhpgov.in/sites/&tauIVfiWfiles/NG_calcium.pdf.

. . PM-IN-CCC-PPT-210001 Date of preparation: March 2021.