In a message dated 8/3/04 3:57:07 PM Eastern Standard Time,
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I had revised the section on Maternal Nutrition & Breastfeeding last year for
our Hospital's diet manual.  I don't have all of the references in front of
me now (I will send them next week as they are at work), but the following are
some of the sources I used.  I do agree that it is a very difficult thing to
evaluate and that a lot of the reseach is inconclusive.  One of the points that
I did get was that the last trimester of pregnancy and weight gain during
pregnancy were important for the initial quality of the milk.  The fat and
vitamin stores laid down during pregnancy are used to make "early milk."

Zinc levels in maternal milk:  the influence of nutritional status with
respect to zinc during the third trimester of pregnancy:  European Journal of
Clinical Nutrition 1997 Apr 51 (4) 253-8

Riboflavin Levels in Maternal Milk:  The Influence of B2 Status dduring the
Third Trimester of Pregnancy:  Journal of the American College of Nutrition,
vol 18, no. 4, 324-399 (1999).

Maternal & Infant Nutrition--a home-study course that I did published by
Nutrition Dimension.  "Slow weight loss is recommended during the first 6 months
of lactation because moderate to severe caloric restriction compromises the
ability to synthesize milk.  This is especially signficant in the early weeks of
lactation before the milk supply is established."  For many women,e ating to
appetite results in adequate calorie intake and  slow return to prepregnancy
weight.  Typical weight loss is 1 to 2 lb. per month.  Advise breastfeeding
women to limit their weight loss to 4 to 4 1/2 lb per month for the first six
months postpartum.  Faster rates of weight loss could adversely affect milk
volume."  If the woman gained less than 20 lb during her pregnancy, or her weight
falls below the standard the her height, the maternal diet should provide 650
kcal/day" (vs. 500 kcal per day).

Properties of human milk and their relationship with maternal nutritoin.
Early Human Development 49 S (1997) S7-S28 - "There is some evidence that volumes
of breast milk produced by mothers in countries where food is scarce are
lower than those produced by mothers in Europe and the USA."  Some studies found
that "the weight of the infant was the strongest determinant of the variation
in milk volume at 2 and 4 months.  Neville et al studied Caucasian women in
Denver USA and concluded that 'there was a characteristic milk volume for each
mother-infant pair that was strongly signficiantly related to infant weight at 1
month."''  "From the published studies it is difficult to resolve the
relationship between milk intake and infant size.  Is the result of lower demand from
smaller infants, or has the growth of the smaller infant been limited by a
meagre milk supply from the mother?"  "Maternal nutritional status appears to
affect ehf at and energy concentration of the milk.   Machaelsen et al working
in Denmark showed that, in breast milk collected when the child was 4 months
old, weight gain in pregnancy was associated with

Calcium levels in maternal milk:  relationships with calcium intake during
the third trimester of prengnacy.  British Journal of Nutrition.  79 (6):
501-7, 1998 Jun.

Ascorbic acid levels in maternal milk:  differences with respect to ascorbic
acid status during the third trimester of pregnancy.  British Journal of
Nutrition.  79(5):  431-7, 1998 May.

Old reference but I don't believe this has been updated by the government
yet--Nutrition during Lactation.  National Academy of Sciences 1991.  They state
that diets containing <1,800 kcal/day are discouraged because they may cause
decreased milk volume.  Low-calorie diets have been associated with lower fat
concentration (and therefore lower energy content in breast milk) and altered
fatty acid composition and immunological properties of breast milk (Energy and
protein requirements during lactation.  Annual Reviews in Nutrition 1997;
17:19-36.

I will try to dig up the other references I used.  I'd love to hear any new
input you had.  This seems to be a difficult thing to determine.

Thanks
Diane Giammarino, MSRD, CDN

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