Breastfeeding has recognised health benefits for both baby and mother. However, it’s natural for mothers to have concerns about the quantity and quality of their breastmilk.
Mothers can be reassured that the body is good at adapting during pregnancy and breastfeeding. Nutrients from food are typically absorbed more efficiently, and milk content is maintained at the expense of maternal stores, so it is important that women have adequate intakes to protect their health. Overall, the nutritional quality of human milk is highly conserved, although maternal diet will influence the fatty acid composition in particular.
What should breastfeeding mothers be eating and drinking?
Breastfeeding women don’t need to eat a special diet, but should eat a healthy, balance of foods. Healthy dietary patterns include plenty of fruit and vegetables, wholegrains (like wholegrain breakfast cereals, wholewheat pasta and wholemeal bread), good quality protein such as beans and pulses, lean meat, oily fish, eggs, nuts and seeds, some dairy or calcium-fortified dairy alternatives (choosing lower fat/lower sugars varieties) and small amounts of unsaturated oils such as rapeseed or olive oil and spreads made from these (see The Eatwell Guide1). Eligible families should be signposted to the Healthy Start scheme, to get vouchers to spend on milk, fresh and frozen fruit and vegetables, as well as free vitamins (see resources).
Foods high in fat, sugars and salt like chocolate, cakes, biscuits and sugary soft drinks are not needed in the diet, so should be consumed less often and in smaller amounts.
Hydration is also an important consideration for breastfeeding – the European Food Safety Authority (EFSA) recommend around 10-12 glasses a day in total – water or plain lower fat milks are good choices.2 Mothers may find it useful to keep a glass of water by their side when they are breastfeeding.
What are the nutrient requirements for breastfeeding?
Historically, energy estimations for exclusive breastfeeding have been calculated at 500 extra calories a day, although more recently it has since been suggested that around 330 calories a day is more likely.3 If women don’t feel hungrier and are eating well there is no need for them to eat more – the additional energy requirement may help them return to their pre-pregnancy weight. Nutritious snacks such as plain yogurt topped with fruit and seeds, small sandwiches or fruit can be advised if women do feel hungrier during the lactation period.
Although requirements for some nutrients may increase during breastfeeding, almost all vitamins and minerals can be obtained from eating a varied and balanced diet, apart from vitamin D.
| Nutrient requirements during breastfeeding and examples of food sources | |||
|---|---|---|---|
| Nutrient | RNI/daya | Extra during breastfeeding? | Examples of food sources |
| Energy | 1,940kcal | +330kcal for exclusive breastfeeding | Good sources of energy include potatoes, bread, rice, pasta or other starchy carbohydrates – choosing wholegrains where possible |
| Protein | 45g | +11g (56g in total) | Beans, pulses, fish, eggs, lean meat |
| Long chain omega 3 | 140g (one portion of oily fish per week)b | No extra requirement | Salmon, trout, mackerel, sardines |
| Vitamin A | 600mcg | +350mcg | Eggs, cheese, fortified fat spreads, carrots, green leafy vegetables, orange-coloured fruits and vegetables |
| Vitamin B2 (riboflavin) | 1.1mg |
+0.5mg |
Milk and milk products, eggs, fortified breakfast cereals, rice, mushrooms |
| Niacin | 13.2mg | +2.2mg | Meat, fish, bread, pasta, eggs, milk and milk products |
| Vitamin B12 | 1.5mcg |
+0.5mcgc |
Meat, fish, milk and milk products, eggs, yeast extract, some fortified breakfast cereals |
| Folate | 200mcg | +60mcg | Green leafy vegetables, fortified breakfast cereals, bread, pulses, some other vegetables (e.g. peas, asparagus), some fruit (e.g. oranges, berries, bananas) |
| Vitamin C | 40mg | +30mg | Fruit (e.g. citrus fruits, berries) and vegetables (e.g. peppers, Brussels sprouts) |
| Vitamin D | 10mcg | Everyone, including pregnant and breastfeeding women, should consider taking a daily supplement containing 10 mcg of vitamin D | Salmon, trout, mackerel, sardines, eggs, some fortified breakfast cereals, fortified fat spreads |
| Calcium | 700mg (for girls under 18 years, 800mg) | +550mg | Milk and milk products, bread, some vegetables (e.g. kale, okra, rocket), fortified dairy alternatives |
| Magnesium | 270mg | +50mg | Some vegetables (e.g. spinach, okra), nuts, wholegrains, dried fruit (e.g. apricots, figs) |
| Iron | 14.8mg | No extra requirement | Red meat, fortified breakfast cereals, pulses, nuts/seeds, dried fruit, wholegrains, green leafy vegetables |
| Selenium | 60mcg | +15mcg | Brazil nuts, fish, meat and eggs |
| Zinc | 7.0mg |
+6.0 (1-4 months) +2.5 (4+ months) |
Meat, cheese, eggs, shellfish, wholegrain cereals, nuts and seeds |
| a Reference nutrient intakes per day for average women of child bearing age b Breastfeeding women shouldn’t eat more than two portions of oily fish a week and like all adults no more than one portion of shark, swordfish or marlin a week c Mothers on a vegan diet should ensure a reliable intake of vitamin B12 from fortified foods or a supplement |
There is no specific national intake data for breastfeeding women but nutrition surveys report that women of childbearing age for example, on average, have higher intake of protein, and a significant proportion have lower intakes of calcium and iron, than recommendations. 4
Are there any foods that they need to be aware of?
Maternal intake of docosahexaenoic acid (DHA) found in oily fish contributes to the normal development of a baby. Breastfeeding mothers should try to eat one portion (140g) of oily fish a week, and as long as they don’t eat more than two portions a week, the health benefits of eating oily fish are far greater than the risks from the mercury content.
Small amounts of what a mother consumes can be passed to their baby through breast milk. There is a slight risk that drinking alcohol regularly may affect a baby’s development. Although the occasional alcoholic drink is unlikely to do any harm, the safest option is to avoid alcohol altogether.5 If alcohol is consumed, recommendations are for no more than one or two units of alcohol (a standard glass (175ml) of wine contains around two units), once or twice a week, and to wait at least two hours after a single drink to breastfeed.6
The EFSA and UK Committee on Toxicity’s (COT) advise that breastfeeding mothers should limit regular caffeine consumption to 200mg per day. This roughly equates to two mugs of instant coffee, two mugs of tea, or one mug of filter coffee.7,8 Energy drinks are high in both caffeine and sugars so best avoided.9
COT also found that infants may exceed the tolerable upper limit of vitamin A if they are exclusively breastfed by mothers taking dietary supplements containing high levels of vitamin A.8 Breastfeeding mothers should always ensure any supplements they take are appropriate for breastfeeding.
Breastfeeding and peanut allergy advice changed in 2009 after a major review showed there was no clear evidence that eliminating peanuts during pregnancy and breastfeeding had any effect on a child developing a peanut allergy.10 So peanuts are fine for breastfeeding mothers to eat, unless they are allergic to them of course. If a baby has a family history of allergies, exclusive breastfeeding for 6 months may actually help lower their risk.11
A good time for nutrition information
Women may be more receptive to lifestyle changes when pregnant or breastfeeding, so this is an opportune time to offer nutrition advice. Do also remember that women who choose not to breastfeed will also benefit from good nutritional advice.
Helena Gibson-Moore is a nutrition scientist with the British Nutrition Foundation
References
- NHS Choices. The Eatwell Guide. London;NHS:2016
- European Food Safety Authority. Scientific Opinion on Dietary Reference Values for water. Parma;EFSA:2010
- Scientific Advisory Committee on Nutrition. Dietary Reference Values for Energy. London;SACN:2011
- Food Standards Agency, Public Health England. National Diet and Nutrition Survey: results from years 7 and 8 (combined). London;Gov.uk:2018
- Royal College of Obstetricians and Gynaecologists. Alcohol and pregnancy. London;RCOG:2018
- NHS. Breastfeeding and drinking alcohol. London;NHS:2016
- European Food Safety Authority. Scientific Opinion on the safety of caffeine. Parma;EFSA:2015
- Scientific Advisory Committee on Nutrition. Feeding in the first year of life: draft SACN report. London;PHE:2017
- NHS. Caffeine and breastfeeding. London;NHS:2016
- Food Standards Agency. Testing of government advice on peanut consumption during early life. London;FSA:2009
- Committee on Toxicity. Joint SACN/COT Working Group on the timing of introduction of allergenic foods into the infant diet: 9 Dec 2016. London;COT:2017
Resources
- British Nutrition Foundation nutrition.org.uk
- NHS. Health Start Scheme healthystart.nhs.uk
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