Micronutrient Malnutrition During Lactation

Introduction

Deficiencies in micronutrients and malnutrition are global health problems. Approximately two billion people in the world are estimated to be deficient in important vitamins and minerals, particularly vitamin A, zinc, and iron. According to the World Health Organization (WHO), globally, around 1.6 billion people are affected by anemia. People living in low-income countries are known to be typically deficient in one or more micronutrients. Pregnant females, lactating women, infants, and young children are most vulnerable to micronutrient deficiencies because of their greater requirements due to their physiological state.

What Are Micronutrients?

Micronutrients are mainly the vitamins and minerals required by the body in small amounts for normal growth, development, prevention of diseases, and overall well-being. They are present in a variety of plant-based and animal-based foods. Some of the essential micronutrients include iron, iodine, folate, zinc, and vitamins A, B, C, and D. Except for vitamin D, all other micronutrients must be acquired from the diet as they are not produced in the body.

Why Are Micronutrients Essential for Lactating Mothers?

Micronutrients are required for several vital functions in the body and contribute to the general health of an individual. Micronutrients are essential for pregnant women to prevent complications during childbirth and deliver a healthy baby. The nutritive demands are considerably higher in lactating women than in pregnancy, as the infants double their birth weight during the first four to six months. Studies have demonstrated that a restrictive diet during pregnancy and lactation may lead to malnutrition, which in turn affects the quality of breast milk. In nursing mothers, the nutrient status or the intake of vitamins and minerals strongly affects the amount of these nutrients secreted in breast milk. Hence, a balanced diet is essential for lactating mothers for their own health and the normal growth and development of the infant.

Micronutrients are divided into two priority groups according to the maternal status or intake of each nutrient, its concentration in breast milk, and the efficacy of the supplementation of nutrients.

• Group I: This includes water-soluble vitamins such as vitamins B1, B2, B6, and B12, as well as vitamin A, iodine, and selenium. Breast milk is a vital source of these micronutrients, and the amount varies depending on the maternal intake.

• Group II: This group includes vitamin D, calcium, folic acid, iron, copper, and zinc. Maternal status or dietary intake has relatively little effect on the concentration of these nutrients in breast milk.

However, usually, the infant is well protected from maternal deficiency, and the mother may be at risk during lactation if the dietary intake does not meet the requirements.

What Are the Deficiencies of Micronutrients?

Nutritional deficiencies occur when people do not consume enough healthy or nutrient-rich foods, such as fresh vegetables, fruits, animal products, and fortified foods. This can be due to the unaffordability (too expensive) or unavailability of resources in the local areas. The deficiency of micronutrients leads to an increased risk of infections and mortality due to conditions such as malaria, measles, pneumonia, etc.

• Iron deficiency in nursing mothers can occur due to poor iron status during pregnancy, improper diet, frequent pregnancies or abortions, low socioeconomic status, and increased bleeding during or after delivery. This can lead to generalized weakness and fatigue, which can, in turn, affect breastfeeding.

• Vitamin B1 deficiency, known as beriberi, is relatively common, and maternal deficiency of this vitamin can cause a depletion in breast milk. However, it can be improved through supplementation.

• Lactating mothers who are vegetarians or follow a vegan diet may be deficient in vitamin B12. This can result in a risk of vitamin B12 deficiency in infants, which may cause neurological damage.

• Vitamin C deficiency leads to scurvy, and supplementation may be required in some lactating women.

How Can Micronutrients Be Included in the Diet During Lactation?

American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for the initial six months and continued complementary feeding up to two years postpartum or more, as decided. A nutritious diet that provides appropriate calories is necessary to support the health of the lactating mother and the infant. Additional calories are recommended (approximately 2000 to 2800 kilocalories per day) for nursing mothers in comparison to other women.

• Iodine concentration in breast milk varies depending on maternal dietary intake. There is an increased need for iodine and choline during lactation, and it is recommended that lactating mothers must consume iodine and choline up to one-year post delivery. Iodine can be found in seafood, iodized table salt, eggs, dairy products, etc. Choline is found in beans, peas, lentils, meat, etc.

• During lactation, the recommended intake of iron is around 9 to 10 mg per day. Iron is present in breast milk in low concentrations and is not influenced by a change in maternal status or supplementary intake.

• Fish can be included in the diet as it is rich in proteins and also contains essential vitamins and minerals required for breastfeeding women. However, care must be taken in deciding the quantity and type of seafood to be consumed.

• Vitamin A supplementation of 200,000 international units (IU) is recommended following childbirth for vitamin A-deficient mothers.

• WHO recommends an extra 25 mg of vitamin C for nursing mothers due to a daily secretion of 20 mg and an absorption efficiency of 85 percent.

• Multivitamin supplements can be taken by lactating mothers (especially those who follow a vegetarian or vegan diet) after consultation with their healthcare provider.

• Daily oral supplementation of vitamin B12 up to 50 micrograms per day can significantly increase maternal plasma and breast milk concentrations.

• Calcium uptake is dependent on adequate vitamin D levels, and vitamin D is required to prevent rickets in children. AAP recommends vitamin D supplementation (400 IU/day) to all breastfed and partially breastfed infants.

Conclusion

Breast milk is an ideal source of nutrition for infants. The micronutrient status of the lactating mother determines the health and development of the baby, specifically during the first six months of life. Supplementation of multiple micronutrients can be an option to prevent malnutrition. However, high-quality studies must be undertaken to assess the safety and effectiveness of multiple micronutrient supplementation for lactating women in improving the health of both the mother and the infant.