National Nutrition and HIV/AIDS Guidelines for Service Providers of ...

CHAPTER 7
NUTRITIONAL CARE AND SUPPORT FOR PREGNANT AND LACTATING
Good maternal nutrition before and during pregnancy and in lactation is vital for the survival
and well being of the developing infant. During pregnancy and lactation, the needs for energy,
protein and various micronutrients are increased to meet the demands for enough gestational
weight gain, growth and development of the fetus, and milk production.
In addition to the above burden, HIV infection puts an extra demand on the body. HIV also
causes excess nutrient loss and mal-absorption, further increasing the nutritional needs of HIV
infected pregnant or lactating woman, increasing their risk of developing malnutrition and
mortality. The nutritional status of an HIV infected woman before, during and after pregnancy
influence her own health and the risk of transmitting HIV to her infant. In order to maintain
good health as well as for optimum pregnancy outcome, the HIV infected pregnant or lactating
woman needs additional food to meet the extra energy demands.
7.1 Nutritional Requirements
WOMEN
7.1.1 Energy Requirements in Pregnant/lactating HIV Infected Women/Adolescents
Energy requirements vary according to the stage of the disease. Table 1 illustrates the
changes in the recommended energy intakes for pregnant/lactating women based on the
stage of the disease. The amount of the increase in energy is the same for HIV-infected
persons who are taking ARVs. The level of additional energy intake for the HIV-infected
pregnant/lactating woman depends on the presence and severity of symptoms. Thus, the
energy needs for a pregnant symptomatic woman, would be equal to the energy need of a
non infected woman of about the same age, weight and stature plus an additional 20% (for
HIV infection) plus 285 Kcal/day for pregnancy. Using the same table, the energy needs for
an asymptomatic lactating mother would be equivalent to the energy needs of a non
infected woman of the same age and physical status plus an additional 10% ( for HIV
infection) plus 500 kcal/day for lactation.
Table 7.1 Estimated Changes in the Daily Energy Needs
Stage In The
Disease
Nutritional Needs For Pregnant
Women/Adolescent
Nutritional Needs For Lactating
Woman/Adolescent
Asymptomatic 10% + 285 10% +500
Early symptomatic 20% + 285 20% + 500
symptomatic 30% + 285 30 % + 500
10
Energy can be measured using kilocalories or Kilojoules. To convert kilocalories into kilojoules multiply
kilocalories by 4.2
Additional
energy due to
HIV (kcal)
Additional
10
energy due to
pregnancy (kcal)
Additional
energy due to
HIV(kcal)
Additional
energy for
Lactation(kcal)
31