The importance of nutrition during the post-partum and breastfeeding period
Written by Charlotte Hales (BSc Nutrition student)
Instagram: @nutrichar_ / LinkedIn: https://www.linkedin.com/in/charlotte-hales/
For mum, a healthy diet during the post-partum period is important to help with recovery from birth, replenish nutrient stores following pregnancy, and provide energy to take on the demands of motherhood. For baby, breast milk is a complete source of nutrition, and its composition is determined by maternal nutrient stores and dietary intake, and baby´s requirements, which are constantly changing. Interestingly, dietary intake of some nutrients, including most vitamins and fatty acids, is likely to affect milk composition more than others, of which levels remain relatively stable. There is also evidence that some flavours from mum´s diet reach the breast milk and can be sensed by baby, potentially impacting their taste preferences. When breastfeeding, most mums will need to increase their intake of some nutrients, and this is influenced by how much baby is being breastfed and for how long.
What are the key nutrients that need to be considered?
Omega-3 fatty acids
Omega-3, especially DHA (docosahexaenoic acid), plays an important role in infant brain development, and there may be an association between the content of DHA in breast milk and a child´s IQ and immune function. The amount of different fatty acids in breast milk is largely dependent on maternal intake, however, genes may play a role in some cases.
Sources of omega 3: Animal sources (high in DHA) are mainly oily fish and seafood. Plant sources include flax, pumpkin and hemp seeds, walnuts, dark green leafy vegetables (such as kale and spinach), soya beans and seaweed.
Calcium
Calcium is important for baby´s skeletal health, growth and development, and 280-400mg are lost through breast milk each day. Absorption of dietary calcium and its release from stores in the mother´s bones provide most of that found in breast milk. Whilst concentrations are generally stable and do not appear to be impacted greatly by dietary intake, calcium requirements during breastfeeding are increased to almost double to meet the increased demand.
Calcium-rich foods: dairy and fortified alternatives, tofu, almonds, sardines, pulses, fortified breads and cereals, figs and dark green leafy vegetables.
B vitamins
B vitamins are involved in metabolism and energy production. Breast milk concentrations of B vitamins are mostly determined by maternal dietary intake, and low intake may lead to infant deficiency. Low intake of B vitamins may also contribute to low maternal energy levels, which is not ideal with a new baby to care for!
Food sources of some B vitamins: wheat germ (B1, B3, B6), fortified cereals (B1, B2, B3, B12), dark leafy greens (B2, B6, B9), meat (B1, B3, B6, B12), organ meats (B2, B5, B12), legumes and pulses (B1, B3, B6, B9), dairy and fortified alternatives (B3, B5, B12) and eggs (B2, B5, B12).
Vitamin A
Vitamin A is essential for infant development and cell and tissue growth, and plays an important role in supporting vision, with insufficiency being linked to visual impairment and blindness. It also has antioxidant properties, meaning it is important in protecting healthy cells from damage.
Food sources: organ meats, dairy, eggs, oily fish, fortified cereals, dark orange or green vegetables (such as squash and broccoli) and orange fruits (including apricots and mango).
Take note: Foods containing high levels of vitamin A, such as liver, are not advised to be avoided during lactation as they are during pregnancy.
Vitamin D
Vitamin D is involved in regulating calcium and phosphate absorption and is important for growth and bone development. Infants have high vitamin D needs as they are constantly growing, therefore it is vital that they receive enough of this nutrient. Breast milk contains little vitamin D; therefore, infant supplementation is recommended. There is also some evidence to support a link between low maternal vitamin D levels and post-partum depression, however, this is not yet clear.
Food sources of vitamin D are limited, but include: eggs, mushrooms, dairy and most dairy alternatives, cod, oily fish and liver.
Are any supplements needed?
Vitamin D
Government guidelines recommend supplementation of 10mcg (or 400IU) daily from September to March for everyone, including breastfeeding women who are at particular risk of vitamin D deficiency. Whether or not mum is supplementing with vitamin D, babies consuming less than 500ml daily of infant formula should receive supplementation of 8.5-10mcg/day.
As well as the above, vegetarian and vegan diets may be low in some nutrients including vitamin B12 and omega 3, as well as iodine, of which breast milk levels are also largely dependent on maternal intake, and individuals may consider supplementation. Omega 3 and iodine may also be considered for individuals who do not consume fish or seafood for other reasons.
In summary…
Post-partum is a challenging time and there is a wealth of information available, some contradictory and lacking evidence, and it can be hard to know what to do at a time when uncertainty and self-doubt are rife. Aiming to include a diverse range of foods, especially plant foods (meaning nuts and seeds, legumes and beans, herbs and spices and wholegrains, as well as fruits and vegetables!), into the diet is a great way to increase micronutrient, antioxidant and fibre intake, and make sure both mum and baby are getting the nutrients that they need each day.
References
Aghajafari, F., Letourneau, N., Mahinpey, N., Cosic, N. and Giesbrecht, G., 2018. Vitamin D deficiency and antenatal and postpartum depression: a systematic review. Nutrients, 10(4), p.478.
Moran, V. and Robinson, S., 2017. Pregnancy and lactation. In: C. Geissler and H. Powers, ed. 2017. Human Nutrition. Oxford: Oxford University Press. Ch.15.
Marshall, N.E., Abrams, B., Barbour, L.A., Catalano, P., Christian, P., Friedman, J.E., Hay Jr, W.W., Hernandez, T.L., Krebs, N.F., Oken, E. and Purnell, J.Q., 2022. The importance of nutrition in pregnancy and lactation: lifelong consequences. American Journal of Obstetrics and Gynecology, 226(5), pp.607-632.
NHS, 2021. Vitamins for children. [online] Available at: <https://www.nhs.uk/conditions/baby/weaning-and-feeding/vitamins-for-children/> [Accessed 20 May 2023].
NHS, 2022. Breastfeeding and diet. [online] Available at: <https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding-and-lifestyle/diet/> [Accessed 20 May 2023].
Spahn, J.M., Callahan, E.H., Spill, M.K., Wong, Y.P., Benjamin-Neelon, S.E., Birch, L., Black, M.M., Cook, J.T., Faith, M.S., Mennella, J.A. and Casavale, K.O., 2019. Influence of maternal diet on flavor transfer to amniotic fluid and breast milk and children's responses: a systematic review. The American Journal of Clinical Nutrition, 109(Supplement 1), pp.1003S-1026S.