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).
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.
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.
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.
Recommended Dietary Intakes for protein while breastfeeding
| Age group | Women 19-50 years | Breastfeeding women 19-50 years | Food sources |
|---|---|---|---|
| Protein | 0.75gm/kg body weight | 1.1gm/kg body weight | Wide spread in most foods. Recommended increased serves of grain (cereal foods) and lean meats and alternatives |
*Nutrient Reference Values(1)
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 are increased for breastfeeding women, due to transfer of these nutrients to the baby in the breastmilk and increased energy use in the body.
Recommended Dietary Intakes for vitamins while breastfeeding
| Age group | Women 19-50 years | Breastfeeding women 19-50 years | Food sources |
|---|---|---|---|
| Vitamin B6 | 1.3mg/day | 2mg/day | Meat, fish, poultry, wholegrains |
| Vitamin B12 | 2.4μg/day | 2.8μg/day | Meat, seafood, poultry and dairy products |
| Folate | 400μg/day | 500μg/day | Vegetables, legumes, fruit, wholegrains, fortified foods |
| Vitamin C | 45mg/day | 85mg/day | Fruit, vegetables |
| Vitamin A | 700μg/day | 1100μg/day | Red, yellow vegetables, dairy products, vegetable oils |
| Vitamin D | 5μg/day | 5μg/day | Small amounts in limited foods. Produced in the body following sunlight. |
*Nutrient Reference Values(1)
The increased requirement for minerals while breastfeeding is due to the amount secreted daily in breastmilk.
Recommended Dietary Intakes for minerals while breastfeeding
| Age group | Women 19-50 years | Breastfeeding women 19-50 years | Food sources |
|---|---|---|---|
| Calcium | 1000mg/day | 1000mg/day | Milk, dairy products and calcium fortified alternatives such as soy milk |
| Iodine | 150μg/day | 270μg/day | Milk, dairy products, fortified bread, shellfish, iodised salt |
| Iron | 18mg/day | 9mg/day | Vegetables, legumes, fruit, wholegrains, fortified foods |
| Zinc | 8mg/day | 12mg/day | Milk, meat, wholegrain, legumes |
*Nutrient Reference Values(1)
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.
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.
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.
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.
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 number of serves of food groups for women while breastfeeding
| Vegetables and legumes | Fruit | Grain (cereal) foods, mostly wholegrain | Lean meats, poultry, fish, eggs, tofu, nuts and seeds, legumes | Milk, yoghurt, cheese and/or alternatives | Extra foods | |
|---|---|---|---|---|---|---|
| Adult women | 5 | 2 | 6 | 2.5 | 2.5 | 0-2.5 |
| Breastfeeding women | 7.5 | 2 | 9 | 2.5 | 2.5 | 0-2.5 |
Australian Dietary Guidelines(2)
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).
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).
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.
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.
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