Breastfeeding nutrition

A woman’s total energy and nutrient needs during breastfeeding are greater than at any other time in her adult life, greater even than the nutrient demands of pregnancy, with the exception of iron. Setting nutrient recommendations for breastfeeding women is challenging as women may combine breastfeeding with infant formula feeding. The NRV recommendations and Australian Dietary Guidelines are based on exclusive breastfeeding for the first 6 months of a baby’s life^(1,2).

Nutrient needs

Energy needs while breastfeeding

The recommendations for additional energy intakes for women while breastfeeding are based on consideration of the utilisation of fat deposits laid down during pregnancy. Therefore, although breastfeeding is known to require approximately 3000kJ/day energy, the energy intake recommendation during lactation is an additional 2000-2100kJ/day (~500kcal/day), with the additional energy coming from stored fat deposits. This energy recommendation is based on the production of 780ml breastmilk/day.

Weight loss and exercise during breastfeeding

Modest weight loss of around 2kg/month is not associated with any decrease in infant growth⁽¹⁸⁾, indicating that weight reduction of this magnitude is unlikely to impact breastmilk production negatively. There is no robust evidence to suggest that moderate exercise during breastfeeding adversely effects either milk production or the baby’s liking for breastmilk. Thus, moderate exercise and weight reduction can be recommended for women who are breastfeeding.

Increased protein needs during 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 which will ensure adequate protein intake.

Protein requirements during breastfeeding

*Nutrient Reference Values⁽¹⁾
#Mean intakes from non-pregnant adult women in the National Nutrition Survey 1995⁽⁶⁾

Fibre and fluid needs during breastfeeding

Avoiding constipation and remaining hydrated is very important for the breastfeeding mother. The fluid recommendations for a lactating mother increase from 1.6-2.1L/day for women to 2.9-3.5L/day during breastfeeding. The Australia Dietary Guidelines recommend drinking plenty of water. Fibre needs also increase to between 27-30g/day. The increased recommendations for fruit, vegetable and cereal (grain) product intakes will meet this increased fibre need.

Vitamin needs during breastfeeding

Vitamin needs are increased for breastfeeding women, due to transfer of these nutrients to the baby in the breastmilk and increased energy use in the body.

Vitamin requirements during breastfeeding

*Nutrient Reference Values⁽¹⁾
#Mean intakes from non-pregnant adult women in the National Nutrition Survey 1995⁽⁶⁾

Mineral needs during breastfeeding

The increased requirement for minerals while breastfeeding is due to the amount secreted daily in breastmilk.

Mineral requirements during breastfeeding

*Nutrient Reference Values⁽¹⁾
#Mean intakes from non-pregnant adult women in the National Nutrition Survey 1995⁽⁶⁾

Iodine

The recommendation for iodine is greater than during pregnancy and is difficult to achieve through dietary intake. Therefore, the NHMRC recommend daily iodine supplement of 150µg during lactation.

Iron

The previous nutrient recommendation for iron was that the same amount of iron was needed daily during breastfeeding as for non-lactating adult women. However, in the 2006 release of the NRV, the recommendation for iron lowered to 9mg/day, because although during lactation there is a small maternal iron loss each day in the milk, this is offset by the lack of menstrual loss during much of the period of breastfeeding. If a women resumes menstruation while breastfeeding then her recommended intake of iron should be 18mg/day.

Calcium

There is no increase in the recommendation for calcium during breastfeeding as there is no evidence that dietary calcium intake influences the amount of calcium in breastmilk. Bone resorption appears to be the primary source of calcium for breastmilk and the bone lost during the breastfeeding period is replaced following the end of breastfeeding.

Zinc

The increased zinc needs during breastfeeding are modest compared with current intake levels and increasing consumption of grain and legumes should help to meet these higher needs.

Food requirements during breastfeeding

The table below outlines 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 require increased food intake to maintain appropriate levels of body weight while breast feeding.

Recommended dietary patterns for adult and breastfeeding women aged 19-50 years

Australian Dietary Guidelines⁽²⁾

Advantages of breastfeeding – the mother’s perspective

Breastfeeding promotes physiological recovery from pregnancy, acts as a natural contraceptive, promotes the psychological attachment between mother and child and saves time and money spent on the preparation of infant formula and sterilisation of equipment. Women who have breastfed during their lifetime have been shown to have a lower incidence of hypertension, diabetes and lower lipid levels compared with women who have never breast fed⁽¹⁹⁾. In addition, in a large European study into cancer prevention, women who breastfed had a lower rate of death from cancer, circulatory diseases and other causes than women who had not breast fed⁽²⁰⁾.

Nutritional concerns during breastfeeding

Fatigue

The energy and nutrient needs during breastfeeding are greater than any other time in a women’s lifespan. This increase 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. If available, supermarket delivery services may be useful to help ensure healthy foods are available in the home and appropriate support from family and friends can help the mother through this intensive period. Maternal support networks in the form of mothers groups have been shown to be associated with continuation of breastfeeding⁽²¹⁾.

Vitamin D

Infants born to vitamin D deficient mothers are more likely to be vitamin D deficient themselves. Thus, ensuring adequate vitamin D nutrition during breastfeeding is an important step to ensuring infants receive sufficient vitamin D via breastmilk, but the breastfed baby will still need to receive sufficient casual exposure to sunlight for his/her vitamin D. In doing so via casual walks etc., sensible sun protection strategies need to be followed including always avoiding high ultraviolet (UV) light times. Sun protection recommendations vary with latitude and UV index but as a general rule, if the UV index is less than three, sun protection is not needed unless in alpine regions or outside for extended periods or one is near a highly reflective surface, such as snow or water.

Dark skinned women, heavily veiled women or house bound women are at greatest risk of not getting enough sunlight exposure to ensure appropriate vitamin D status.

Special considerations

The NHMRC in their Infant Feeding Guidelines⁽²²⁾ recognise that there are few contraindications for breastfeeding. However, they do recommend that when a mother is known to be HIV positive, specialist advice for each individual case is a requirement. 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. Not drinking 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 healthcare professional to determine if their use is compatible with breastfeeding.