Promoting Nutrition for Pregnant and Breastfeeding Women

Use these illustrations when helping educate Central American communities. You can download and print full-size versions by clicking on the thumbnail-size versions below. 
Progression Illustration Progression Illustration

Illustration depicting healthy eating during prenatal, perinatal and postnatal periods

Proper nutrition during pregnancy and while breastfeeding is not only important for mothers, it is also crucial to the health of their infants. Women with poor nutrition put themselves and their growing fetuses at a greater risk of disease and death.

Malnutrition is a major concern for women who are pregnant or who may become pregnant in developing areas of Central America. Insufficient energy intake during pregnancy can cause low infant birth weight. Low birth weight affects 20 million children in underdeveloped countries and accounts for most of the deaths in the first week of life. Those who survive beyond the first week can be affected by irreversible consequences such as cognitive impairments, short stature and a higher risk of disease.

Other fetal or infant health consequences of malnutrition include birth defects and brain damage. Consequences of maternal malnutrition include increased risk of infection, anemia and weakness. Monthly weight monitoring supported by simple health education for pregnancy can be very effective for producing positive maternal and infant outcomes.

Encouraging Breastfeeding and Adequate Nutrition for Pregnant Women in Central America

To encourage adequate calorie, protein and micronutrient intake among pregnant and breastfeeding women, advise them to consume three meals a day with one or two snacks between meals. Consuming adequate amounts of food as well as a variety of foods daily helps ensure the mother and infant are obtaining proper nutrition needed for growth and development. Health educators can show expectant mothers nutrient-dense foods that should be included in the diet during pregnancy to promote maternal and infant health.

Methods for obtaining key nutrients such as iron, calcium, vitamin A, folic acid and protein should be emphasized during nutrition education for pregnant and breastfeeding women. Realistic strategies such as soaking beans and consuming vitamin C-rich foods with meals to increase iron bioavailability and using calcium salts to add calcium to homemade tortillas should be included in the lesson, emphasizing local foods. Dairy foods are an excellent source of calcium if available.

Below you can learn more about proper nutrition during each trimester for expectant mothers.

Nutrition during the First Trimester

The World Health Organization recommends pregnant women consume an additional 90 calories and 1 gram of protein during the first trimester of pregnancy. Some additional nutrient requirements, particularly iron, folic acid and vitamin A, are difficult to achieve through food sources alone during pregnancy. For this reason, supplements or fortified foods should be promoted throughout the entire pregnancy. Adequate micronutrient consumption decreases the risk of maternal and fetal complications that could inevitably lead to death.

Nutrition during the Second Trimester

During the second trimester, an extra 290 calories and 10 grams of protein are required. Extra calories should come from nutrient-dense foods including fruits, vegetables, beans and grains. Extra protein should come from meat, seafood, beans and eggs. Inadequate weight gain during this time can lead to low birth weight which may increase the infant's risk of death.

Nutrition during the Third Trimester

During the third trimester, an extra 470 calories and 31 grams of protein should be added to the diet. Processed foods containing added sugars and fats should be kept to a minimum, while fruits, vegetables, grains and protein-rich foods should be consumed for extra calories and protein.

The WHO found that a total gestational weight gain of 10 to 14 kilograms (22 to 31 pounds) was associated with optimal infant birth weights. Undernourished women may need to gain as much as 18 kilograms (40 pounds) during pregnancy. The Institute of Medicine recommends a weekly weight gain of one pound per week during the second and third trimesters for women with normal pre-pregnancy body mass indices.

Adolescent Pregnancy

Most of the world's births that take place during adolescence occur in low- and middle-income countries. Eighteen percent of all births in Latin America and the Caribbean are from women 15 – 19 years old. Pregnant adolescents in Latin America have a higher risk of maternal death, infant death, anemia, low birth weight and pre-term delivery.

Because pregnant adolescents are supporting their own growth as well as the fetus', they need to consume extra protein – up to 101 grams at term, or 1.5 grams per kilogram of pregnant body weight. The Institute of Medicine encourages adolescents to follow general pregnancy weight gain guidelines until more research is available to determine if specific guidelines are needed for this population.

Discussing the necessity of weight gain and nutrient-dense foods to eat to support both mom's health, and baby's growth and development should be included in nutrition education for pregnant adolescents.

Nutrition while Breastfeeding

Nutrition while breastfeeding is just as important as nutrition during pregnancy. A breastfeeding mother needs to continue to eat to support her own as well as her baby's nutrition. A varied diet with a focus on nutrient-dense foods helps mom make nutritious breastmilk. A mother who is exclusively breastfeeding (only feeding her child breast milk) requires about 670 extra calories and 19 extra grams of protein a day; the WHO recommends exclusively breastfeeding for the first six months of a child's life. Fluid needs increase during breastfeeding and health educators should encourage ample safe water intake. This discussion should include safe drinking water and limiting sugar-sweetened beverage intake.

When a baby's diet includes more complementary foods and less breastmilk, the energy needs of the baby's mother will decrease as well.

Dietary Supplement Use While Pregnant or Breastfeeding

Nutrient needs are increased during periods of growth such as pregnancy. Because of this, dietary supplements may be recommended during this important period of the life cycle. Individual needs will vary, and should be assessed for each patient.

The Academy of Nutrition and Dietetics recommends any pregnant woman who is abusing alcohol or drugs, suffers from iron deficiency anemia, follows a vegan diet or generally has a poor-quality diet should take a multivitamin and multimineral supplement.

The WHO recommends a daily iron supplement of 60 milligrams per day for all pregnant women. However, researchers have found that supplemental micronutrients can reduce the risk of having an infant of low birth weight but may not have an effect on perinatal mortality in developing countries.

Along with pregnancy, breastfeeding is a time characterized by increased nutrient needs that may not be able to be fulfilled through diet alone. There is little evidence regarding supplement use during lactation and no consistent recommendations are available. Mothers who consume little dairy or other calcium-rich foods may be recommended to take a calcium supplement.

Health educators should learn about any governmental or aid organization efforts to provide supplements to community members. Supplement form and dosage can vary greatly depending on availability. Health educators should tailor their dietary supplement education to complement any supplement programs occurring in the community.

Assessing attitudes toward and beliefs of dietary supplements in the community will also help the health educator deliver an effective lesson including this topic. Appropriate usage and supplement safety, such as keeping these items out of reach of children, should also be discussed.

Tips for Teaching Nutrition for Pregnancy and Breastfeeding

Health educators should become familiar with the local food supply and include lessons on accessible nutrient-rich foods to consume while pregnant and breastfeeding. Emphasizing fruits and vegetables, protein-rich foods and foods that can satisfy nutrient requirements within the local food supply are key topics to discuss. Doing a cost comparison between high- and low-nutrient dense foods can be an effective strategy.

Discovering cultural beliefs surrounding appropriate foods to consume during and after pregnancy will help the health educator provide relevant and effective information.

Health educators should also emphasize that alcohol and tobacco products, as well as other drugs, should be avoided during pregnancy.

The Hesperian health guides contain information on good pregnancy care. The Special Supplemental Nutrition Program for Women Infants and Children provides free nutrition education materials in Spanish.

Additional Resources

  • Institute of Medicine. Weight Gain during Pregnancy: Reexamining the Guidelines. 2006. Accessed May 24, 2016.
  • Rush D. Nutrition and maternal mortality in the developing world. Am J Clin Nutr. 2000;72(1 Suppl):212S-240S.
  • United Nations International Children's Emergency Fund. Maternal Nutrition. Accessed May 27, 2016.
  • World Health Organization. Adolescent Pregnancy. Maternal, newborn, child and adolescent health. Accessed May 24, 2016.
  • World Health Organization. Exclusive Breastfeeding. 2016. Accessed May 27, 2016.
  • World Health Organization. Maternal Multiple Micronutrient Supplementation and Pregnancy Outcomes in Developing Countries: Meta-Analysis and Meta-regression. 2011. Accessed May 27, 2016.
  • World Health Organization. Protein and Amino Acid Requirements in Human Nutrition. 2007. Accessed May 24, 2016.