Signs that a lactating mother is at risk of poor nutrition/ malnutrition:

fatigue, irritability and depression - yes  but I wonder if poor women in
developing countries ever have the luxuary to complain about the last two

Poor weight gain in pregnancy
current weight has dropped below pre-pregnancy weight
lethergy
Sign of anaemia - pallor of mucous membranes (inside mouth), breathlessness,
listlesness, fast pulse. low HB
Dry skin, hair and poor  quality nails
loss of appetite, severe weakness especially in the legs in thiamine
deficiency
decrease in breastmilk supply, especially if baby is not suckling often

Risk factors that would alert you to the potential for malnutrition:

poor social circumstances, poverty, known domestic violence, developing
countries and families living off subsistance incomes, teenagers etc.

Effect on breastmilk and lactation:

a poorly malnourished women is able to produce enough breastmilk to feed her
baby but often requires that the baby suckle frequently to maintain supply.

the quality of the breastmilk is not effected - but the mothers health can
be further compromised as she is using her own already poor nutrient stores

severly malnoursihed women - drop of breastmilk supply 20 - 30% - may still
produce about 500mil per day with frequent stimulation.

quality of breastmilk:

fat in breastmilk may decrease about 10%
Amount of protein in breastmilk remains high
slight decrease in anti-inffective properties
Iodine may be very poor
Iron supplies usually remains adequate even in mother anaemic
Vit A breastmilk rapidly becomes deficient - mothers are reliant on vit A
intake from   food as no large stores in the body. - Vit A deficiency in
babe.

Effect on infant:

poor weight gain and malnutrition specifically anaemia, Iron and iodine
and Vit A deficiency. leading to mental retardation and death.

Ref:  Felicity Savage King and Anne Burgess Nutrition for Developing
Countries.

Kind Regards

Mandy O'Reilly
Nurse Midwife
IBCLC
Indonesia

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