Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Maternal nutrition during lactation

INTRODUCTION

A mother's capacity to produce milk of sufficient quantity and quality to support infant growth is resilient and remarkably resistant to nutritional deprivation. However, milk production normally affects maternal body composition and nutritional status, and lactating women have increased nutrient demands.

The changes in maternal nutritional status during lactation, effect of maternal nutrition on milk volume and composition, and nutrient requirements of lactating women are reviewed here. Additional aspects of breastfeeding are discussed separately.

MATERNAL NUTRITIONAL STATUS

Lactation is supported partially by mobilization of tissue stores. This, in turn, affects maternal weight and nutritional status.

Body weight — Postpartum weight changes in lactating women are highly variable [1]. Mild, gradual weight loss typically occurs during the first six months postpartum. Average weight loss in this period is greater in affluent than poor populations (0.8 versus 0.1 kg per month). These differences are thought to depend upon differences in weight gain in pregnancy, cultural practices, level of physical activity, and availability of food.

Gestational weight gain is the most consistent and strongest predictor of postpartum weight change in most studies [1,2]. Other factors that contribute to weight loss after pregnancy include prepregnancy weight, age, parity, race, smoking, exercise, return to work outside the home, and lactation.

                       

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jul 2014. | This topic last updated: May 29, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Butte NF, Hopkinson JM. Body composition changes during lactation are highly variable among women. J Nutr 1998; 128:381S.
  2. Potter S, Hannum S, McFarlin B, et al. Does infant feeding method influence maternal postpartum weight loss? J Am Diet Assoc 1991; 91:441.
  3. Brewer MM, Bates MR, Vannoy LP. Postpartum changes in maternal weight and body fat depots in lactating vs nonlactating women. Am J Clin Nutr 1989; 49:259.
  4. Dugdale AE, Eaton-Evans J. The effect of lactation and other factors on post-partum changes in body-weight and triceps skinfold thickness. Br J Nutr 1989; 61:149.
  5. Ohlin A, Rössner S. Maternal body weight development after pregnancy. Int J Obes 1990; 14:159.
  6. Schauberger CW, Rooney BL, Brimer LM. Factors that influence weight loss in the puerperium. Obstet Gynecol 1992; 79:424.
  7. Parker JD, Abrams B. Differences in postpartum weight retention between black and white mothers. Obstet Gynecol 1993; 81:768.
  8. Greene GW, Smiciklas-Wright H, Scholl TO, Karp RJ. Postpartum weight change: how much of the weight gained in pregnancy will be lost after delivery? Obstet Gynecol 1988; 71:701.
  9. Prasad AS. Zinc deficiency in women, infants and children. J Am Coll Nutr 1996; 15:113.
  10. Neu J. Necrotizing enterocolitis: the search for a unifying pathogenic theory leading to prevention. Pediatr Clin North Am 1996; 43:409.
  11. Rookus MA, Rokebrand P, Burema J, Deurenberg P. The effect of pregnancy on the body mass index 9 months postpartum in 49 women. Int J Obes 1987; 11:609.
  12. DENNIS KJ, BYTHEWAY WR. CHANGES IN BODY WEIGHT AFTER DELIVERY. J Obstet Gynaecol Br Commonw 1965; 72:94.
  13. Kramer FM, Stunkard AJ, Marshall KA, et al. Breast-feeding reduces maternal lower-body fat. J Am Diet Assoc 1993; 93:429.
  14. Dewey KG, Heinig MJ, Nommsen LA. Maternal weight-loss patterns during prolonged lactation. Am J Clin Nutr 1993; 58:162.
  15. Baker JL, Gamborg M, Heitmann BL, et al. Breastfeeding reduces postpartum weight retention. Am J Clin Nutr 2008; 88:1543.
  16. Motil KJ, Sheng HP, Kertz BL, et al. Lean body mass of well-nourished women is preserved during lactation. Am J Clin Nutr 1998; 67:292.
  17. Motil KJ, Davis TA, Montandon CM, et al. Whole-body protein turnover in the fed state is reduced in response to dietary protein restriction in lactating women. Am J Clin Nutr 1996; 64:32.
  18. Kent GN, Price RI, Gutteridge DH, et al. Human lactation: forearm trabecular bone loss, increased bone turnover, and renal conservation of calcium and inorganic phosphate with recovery of bone mass following weaning. J Bone Miner Res 1990; 5:361.
  19. Lamke B, Brundin J, Moberg P. Changes of bone mineral content during pregnancy and lactation. Acta Obstet Gynecol Scand 1977; 56:217.
  20. Specker BL, Tsang RC, Ho ML. Changes in calcium homeostasis over the first year postpartum: effect of lactation and weaning. Obstet Gynecol 1991; 78:56.
  21. Sowers M, Corton G, Shapiro B, et al. Changes in bone density with lactation. JAMA 1993; 269:3130.
  22. Aloia JF, Cohn SH, Vaswani A, et al. Risk factors for postmenopausal osteoporosis. Am J Med 1985; 78:95.
  23. Kreiger N, Kelsey JL, Holford TR, O'Connor T. An epidemiologic study of hip fracture in postmenopausal women. Am J Epidemiol 1982; 116:141.
  24. Cumming RG, Klineberg RJ. Breastfeeding and other reproductive factors and the risk of hip fractures in elderly women. Int J Epidemiol 1993; 22:684.
  25. Bauer DC, Browner WS, Cauley JA, et al. Factors associated with appendicular bone mass in older women. The Study of Osteoporotic Fractures Research Group. Ann Intern Med 1993; 118:657.
  26. Fox KM, Magaziner J, Sherwin R, et al. Reproductive correlates of bone mass in elderly women. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 1993; 8:901.
  27. Kritz-Silverstein D, Barrett-Connor E, Hollenbach KA. Pregnancy and lactation as determinants of bone mineral density in postmenopausal women. Am J Epidemiol 1992; 136:1052.
  28. Institute of Medicine (US) Subcommittee on Lactation. Nutrition during lactation, Committee on Nutritional Status during Pregnancy and Lactation, Food and Nutrition Board, Institute of Medicine, National Academy of Sciences. National Academy Press, Washington, DC, 1991.
  29. Neville MC, Keller R, Seacat J, et al. Studies in human lactation: milk volumes in lactating women during the onset of lactation and full lactation. Am J Clin Nutr 1988; 48:1375.
  30. Macy IG, Hunscher HA, Donelson E, et al. Human milk flow. Am J Dis Child 1930; 39:1186.
  31. Saint L, Maggiore P, Hartmann PE. Yield and nutrient content of milk in eight women breast-feeding twins and one woman breast-feeding triplets. Br J Nutr 1986; 56:49.
  32. Michaelsen KF, Larsen PS, Thomsen BL, Samuelson G. The Copenhagen Cohort Study on Infant Nutrition and Growth: breast-milk intake, human milk macronutrient content, and influencing factors. Am J Clin Nutr 1994; 59:600.
  33. Dewey KG, Heinig MJ, Nommsen LA, Lonnerdal B. Maternal versus infant factors related to breast milk intake and residual milk volume: the DARLING study. Pediatrics 1991; 87:829.
  34. Butte NF, Garza C, Johnson CA, et al. Longitudinal changes in milk composition of mothers delivering preterm and term infants. Early Hum Dev 1984; 9:153.
  35. Butte NF, Garza C, Smith EO, Nichols BL. Human milk intake and growth in exclusively breast-fed infants. J Pediatr 1984; 104:187.
  36. Stuff JE, Nichols BL. Nutrient intake and growth performance of older infants fed human milk. J Pediatr 1989; 115:959.
  37. Dewey KG, Heinig MJ, Nommsen LA, Lönnerdal B. Adequacy of energy intake among breast-fed infants in the DARLING study: relationships to growth velocity, morbidity, and activity levels. Davis Area Research on Lactation, Infant Nutrition and Growth. J Pediatr 1991; 119:538.
  38. Schanler RJ, Hurst NM. Human milk for the hospitalized preterm infant. Semin Perinatol 1994; 18:476.
  39. Hopkinson JM, Schanler RJ, Fraley JK, Garza C. Milk production by mothers of premature infants: influence of cigarette smoking. Pediatrics 1992; 90:934.
  40. Vio F, Salazar G, Infante C. Smoking during pregnancy and lactation and its effects on breast-milk volume. Am J Clin Nutr 1991; 54:1011.
  41. Andersen AN, Lund-Andersen C, Larsen JF, et al. Suppressed prolactin but normal neurophysin levels in cigarette smoking breast-feeding women. Clin Endocrinol (Oxf) 1982; 17:363.
  42. Nommsen-Rivers LA, Dolan LM, Huang B. Timing of stage II lactogenesis is predicted by antenatal metabolic health in a cohort of primiparas. Breastfeed Med 2012; 7:43.
  43. Matias SL, Dewey KG, Quesenberry CP Jr, Gunderson EP. Maternal prepregnancy obesity and insulin treatment during pregnancy are independently associated with delayed lactogenesis in women with recent gestational diabetes mellitus. Am J Clin Nutr 2014; 99:115.
  44. Hopkinson JM, Schanler RJ, Garza C. Milk production by mothers of premature infants. Pediatrics 1988; 81:815.
  45. Butte NF, Garza C, Stuff JE, et al. Effect of maternal diet and body composition on lactational performance. Am J Clin Nutr 1984; 39:296.
  46. Michaelsen KF. Nutrition and growth during infancy. The Copenhagen Cohort Study. Acta Paediatr Suppl 1997; 420:1.
  47. Hennart P, Vis HL. Breast-feeding and post partum amenorrhoea in Central Africa. 1. Milk production in rural areas. J Trop Pediatr 1980; 26:177.
  48. van Steenbergen WM, Kusin JA, Kardjati S, de With C. Energy supplementation in the last trimester of pregnancy in East Java, Indonesia: effect on breast-milk output. Am J Clin Nutr 1989; 50:274.
  49. Brown KH, Akhtar NA, Robertson AD, Ahmed MG. Lactational capacity of marginally nourished mothers: relationships between maternal nutritional status and quantity and proximate composition of milk. Pediatrics 1986; 78:909.
  50. Imong SM, Jackson DA, Wongsawasdii L, et al. Predictors of breast milk intake in rural northern Thailand. J Pediatr Gastroenterol Nutr 1989; 8:359.
  51. de Kanashiro HC, Brown KH, Lopez de Romaña G, et al. Consumption of food and nutrients by infants in Huascar (Lima), Peru. Am J Clin Nutr 1990; 52:995.
  52. Orr-Ewing AK, Heywood PF, Coward WA. Longitudinal measurements of breast milk output by a 2H2O tracer technique in rural Papua New Guinean women. Hum Nutr Clin Nutr 1986; 40:451.
  53. Prentice A, Paul A, Prentice A, et al. Cross-cultural differences in lactational performance. In: Human Lactation 2: Maternal and Environmental Factors, Hamosh M, Goldman AS (Eds), Plenum Press, New York 1986. p.13.
  54. Butte NF, Villalpando S, Wong WW, et al. Human milk intake and growth faltering of rural Mesoamerindian infants. Am J Clin Nutr 1992; 55:1109.
  55. Dewey KG, Lovelady CA, Nommsen-Rivers LA, et al. A randomized study of the effects of aerobic exercise by lactating women on breast-milk volume and composition. N Engl J Med 1994; 330:449.
  56. Tankeyoon M, Dusitsin N, Chalapati S, et al. Effects of hormonal contraceptives on milk volume and infant growth. WHO Special Programme of Research, Development and Research Training in Human Reproduction Task force on oral contraceptives. Contraception 1984; 30:505.
  57. Hurst NM, Valentine CJ, Renfro L, et al. Skin-to-skin holding in the neonatal intensive care unit influences maternal milk volume. J Perinatol 1997; 17:213.
  58. Strode MA, Dewey KG, Lönnerdal B. Effects of short-term caloric restriction on lactational performance of well-nourished women. Acta Paediatr Scand 1986; 75:222.
  59. Dusdieker LB, Hemingway DL, Stumbo PJ. Is milk production impaired by dieting during lactation? Am J Clin Nutr 1994; 59:833.
  60. McCrory MA, Nommsen-Rivers LA, Molé PA, et al. Randomized trial of the short-term effects of dieting compared with dieting plus aerobic exercise on lactation performance. Am J Clin Nutr 1999; 69:959.
  61. Butte NF. Dieting and exercise in overweight, lactating women. N Engl J Med 2000; 342:502.
  62. Lovelady CA, Garner KE, Moreno KL, Williams JP. The effect of weight loss in overweight, lactating women on the growth of their infants. N Engl J Med 2000; 342:449.
  63. Lönnerdal B, Forsum E, Gebre-Medhin M, Hambraeus L. Breast milk composition in Ethiopian and Swedish mothers. II. Lactose, nitrogen, and protein contents. Am J Clin Nutr 1976; 29:1134.
  64. Villalpando SF, Butte NF, Wong WW, et al. Lactation performance of rural Mesoamerindians. Eur J Clin Nutr 1992; 46:337.
  65. Sanchez-Pozo A, Lopez Morales J, Izquierdo A, et al. Protein composition of human milk in relation to mothers' weight and socioeconomic status. Hum Nutr Clin Nutr 1987; 41:115.
  66. Forsum E, Lönnerdal B. Effect of protein intake on protein and nitrogen composition of breast milk. Am J Clin Nutr 1980; 33:1809.
  67. Jensen RG. The Lipids of Human Milk, CRC Press, Boca Raton 1989.
  68. Chappell JE, Francis T, Clandinin MT. Vitamin A and E content of human milk at early stages of lactation. Early Hum Dev 1985; 11:157.
  69. Hachey DL, Silber GH, Wong WW, Garza C. Human lactation. II: Endogenous fatty acid synthesis by the mammary gland. Pediatr Res 1989; 25:63.
  70. Sanders TA, Ellis FR, Dickerson JW. Studies of vegans: the fatty acid composition of plasma choline phosphoglycerides, erythrocytes, adipose tissue, and breast milk, and some indicators of susceptibility to ischemic heart disease in vegans and omnivore controls. Am J Clin Nutr 1978; 31:805.
  71. Delgado-Noguera MF, Calvache JA, Bonfill Cosp X. Supplementation with long chain polyunsaturated fatty acids (LCPUFA) to breastfeeding mothers for improving child growth and development. Cochrane Database Syst Rev 2010; :CD007901.
  72. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2012; 129:e827.
  73. Butte NF, Calloway DH. Evaluation of lactational performance of Navajo women. Am J Clin Nutr 1981; 34:2210.
  74. Hollis BW, Lambert PW, Horst RL. Factors affecting the antirachitic sterol content of native milk. In: Perinatal Calcium and Phosphorous Metabolism, Holick MF, Gray TK, Anast CS (Eds), Elsevier Science Publishers BV, Amsterdam 1983. p.157.
  75. Greer FR, Hollis BW, Napoli JL. High concentrations of vitamin D2 in human milk associated with pharmacologic doses of vitamin D2. J Pediatr 1984; 105:61.
  76. von Kries R, Shearer M, McCarthy PT, et al. Vitamin K1 content of maternal milk: influence of the stage of lactation, lipid composition, and vitamin K1 supplements given to the mother. Pediatr Res 1987; 22:513.
  77. Bates CJ, Prentice AM, Prentice A, et al. The effect of vitamin C supplementation on lactating women in Keneba, a West African rural community. Int J Vitam Nutr Res 1983; 53:68.
  78. Byerley LO, Kirksey A. Effects of different levels of vitamin C intake on the vitamin C concentration in human milk and the vitamin C intakes of breast-fed infants. Am J Clin Nutr 1985; 41:665.
  79. PRATT JP, HAMIL BM, MOYER EZ, et al. Metabolism of women during the reproductive cycle. XVIII. The effect of multivitamin supplements on the secretion of B vitamins in human milk. J Nutr 1951; 44:141.
  80. Kang-Yoon SA, Kirksey A, Giacoia G, West K. Vitamin B-6 status of breast-fed neonates: influence of pyridoxine supplementation on mothers and neonates. Am J Clin Nutr 1992; 56:548.
  81. Metz J, Zalusky R, Herbert V. Folic acid binding by serum and milk. Am J Clin Nutr 1968; 21:289.
  82. Johnson PR Jr, Roloff JS. Vitamin B12 deficiency in an infant strictly breast-fed by a mother with latent pernicious anemia. J Pediatr 1982; 100:917.
  83. Prentice A. Calcium supplementation during breast-feeding. N Engl J Med 1997; 337:558.
  84. Dallman PR. Iron deficiency in the weanling: a nutritional problem on the way to resolution. Acta Paediatr Scand Suppl 1986; 323:59.
  85. Siimes MA, Salmenperä L, Perheentupa J. Exclusive breast-feeding for 9 months: risk of iron deficiency. J Pediatr 1984; 104:196.
  86. Lönnerdal B, Keen CL, Hurley LS. Iron, copper, zinc, and manganese in milk. Annu Rev Nutr 1981; 1:149.
  87. Krebs NF, Reidinger CJ, Hartley S, et al. Zinc supplementation during lactation: effects on maternal status and milk zinc concentrations. Am J Clin Nutr 1995; 61:1030.
  88. Mannan S, Picciano MF. Influence of maternal selenium status on human milk selenium concentration and glutathione peroxidase activity. Am J Clin Nutr 1987; 46:95.
  89. Gushurst CA, Mueller JA, Green JA, Sedor F. Breast milk iodide: reassessment in the 1980s. Pediatrics 1984; 73:354.
  90. Picciano MF. Nutrient composition of human milk. Pediatr Clin North Am 2001; 48:53.
  91. DRI, Dietary Reference Intakes: For Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients). Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food, and Nutrition Board, Institute of Medicine. National Academy Press, Washington, DC 2005.
  92. Food and nutrition board, Institute of Medicine, National Academies. Dietary Reference Intakes (DRIs): Recommended dietary allowances and adequate intakes, Vitamins. http://iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity%20Files/Nutrition/DRIs/RDA%20and%20AIs_Vitamin%20and%20Elements.pdf (Accessed on July 10, 2013).
  93. DRI, Dietary Reference Intakes: For Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food, and Nutrition Board, Institute of Medicine. National Academy Press, Washington, DC 2000.
  94. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes IoM. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. National Academy Press, Washington DC 1998.
  95. DRI, Dietary Reference Intakes: For Vitamin C, Vitamin E, Selenium, and Carotenoid. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food, and Nutrition Board, Institute of Medicine. National Academy Press, Washington, DC 2000.
  96. Specker BL, Vieira NE, O'Brien KO, et al. Calcium kinetics in lactating women with low and high calcium intakes. Am J Clin Nutr 1994; 59:593.
  97. Kalkwarf HJ, Specker BL, Heubi JE, et al. Intestinal calcium absorption of women during lactation and after weaning. Am J Clin Nutr 1996; 63:526.
  98. Kent GN, Price RI, Gutteridge DH, et al. The efficiency of intestinal calcium absorption is increased in late pregnancy but not in established lactation. Calcif Tissue Int 1991; 48:293.
  99. Cross NA, Hillman LS, Allen SH, Krause GF. Changes in bone mineral density and markers of bone remodeling during lactation and postweaning in women consuming high amounts of calcium. J Bone Miner Res 1995; 10:1312.
  100. Kalkwarf HJ, Specker BL, Bianchi DC, et al. The effect of calcium supplementation on bone density during lactation and after weaning. N Engl J Med 1997; 337:523.
  101. Prentice A, Jarjou LM, Cole TJ, et al. Calcium requirements of lactating Gambian mothers: effects of a calcium supplement on breast-milk calcium concentration, maternal bone mineral content, and urinary calcium excretion. Am J Clin Nutr 1995; 62:58.
  102. Sowers M, Eyre D, Hollis BW, et al. Biochemical markers of bone turnover in lactating and nonlactating postpartum women. J Clin Endocrinol Metab 1995; 80:2210.
  103. Hopkinson JM, Butte NF, Ellis K, Smith EO. Lactation delays postpartum bone mineral accretion and temporarily alters its regional distribution in women. J Nutr 2000; 130:777.
  104. DRI, Dietary reference intakes: For calcium, phosphorus, magnesium, vitamin D, and fluoride. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food, and Nutrition Board, Institute of Medicine. National Academy Press, Washington, DC 1997.
  105. Dórea JG. Exposure to mercury during the first six months via human milk and vaccines: modifying risk factors. Am J Perinatol 2007; 24:387.
  106. Bloomingdale A, Guthrie LB, Price S, et al. A qualitative study of fish consumption during pregnancy. Am J Clin Nutr 2010; 92:1234.
  107. Lando AM, Fein SB, Choinière CJ. Awareness of methylmercury in fish and fish consumption among pregnant and postpartum women and women of childbearing age in the United States. Environ Res 2012; 116:85.
  108. United States Department of Health and Human Services and United States Environmental Protection Agency. What you need to know about mercury in fish and shellfish. www.cfsan.fda.gov/~dms/admehg3.html (Accessed on August 04, 2008).