Pregnancy and Breastfeeding put Strain on Bone Health

Knowing exactly what nutrition is best for you and your child during pregnancy and breastfeeding can be difficult, however many do not consider the necessity for calcium and other nutrients for bone health and development. The increased demand for calcium from the developing fetus is important to think about as this may significantly draw on the critical supplies of the pregnant woman leaving her deficient and prone to bone disorders such as osteoporosis.

Feeding for two sounds like fun. However, it’s not that simple. Pregnant women do however require an increased intake of food and essential nutrients for both the woman’s health, and the development of the fetus. It is important to get the right advice about optimal nutrition during pregnancy, as there are specific needs of the mother and baby during this critical time.

During pregnancy and breastfeeding, the mother’s nutrient demand increases dramatically [1]. If mothers do not consume a sufficient amount of nutrients during these times, they are at risk of becoming nutrient deficient, which may negatively affect the health of both mother and child. Fetal birth weight can correlate with the general health of the newborn in infancy and later life. An increase in nutrition and intake of essential vitamins and minerals should improve the chances of your baby having an optimal birth weight.

Increased need during Pregnancy for Woman and Child

Having a child is difficult for any mother, both physically and psychologically. Physically, making another human requires an enormous amount of energy. Fortunately for those mothers that enjoy eating, pregnant women need to eat much more than usual. This doesn’t mean eating anything and everything, but specific foods that contain essential nutrients required during this critical phase of a woman’s life. These requirements change over the course of pregnancy, with specific nutrients especially important to particular trimesters.

First Trimester

  • Most crucial for fetal development, as vital organs are made
  • Large amounts of protein required
  • Maintain energy with complex carbohydrates (cereals, pasta, bread etc.)
  • Folate is essential for preventing neural tube defects*
  • As the blood volume increases to supply the developing fetus, it is important to seek iron to improve oxygen carrying capacity for the fetus and mother

Second Trimester

  • Fetal skeleton begins to mineralize
  • Large amounts of calcium, phosphorus and magnesium are required

Calcium: for strong bones and teeth, muscle development, and nerve and muscle function

Phosphorus: for healthy bones and teeth, energy generation, and milk production

Magnesium: for liver and heart function, protein and carbohydrate metabolism, building muscles and nerves

  • Manganese is also essential to stimulate enzymes to produce cartilage and bone involved in skeletal bone development

Third Trimester

  • Brain development dominants and requires essential fatty acids such as omega-3 DHA and EPA
  • Priming the developing fetus with the essential nutrients for birth is important

This includes DHA and EPA for vision and neural development

  • Iron remains important during this phase for the blood
  • An increased intake of vitamin C is recommended during this time, which helps to enhance iron absorption
  • The requirement of zinc is twice the recommended level than for non-pregnant women

Zinc is necessary for the immune system and the developing brain, and also reduces preterm births [2]

  • Magnesium is particularly important in the management of blood pressure in pregnant women, as it reduces the risk of pre-eclampsia [3]

Folate is essential in the diet for women who intend on becoming pregnant and then during pregnancy. Research has shown that maternal folate supplementation significantly reduces the risk of neural tube defects in newborns. Furthermore, folate is necessary for nervous system development and red blood cell synthesis.

Focus: Bone Health

Bone health and development can often be overlooked during development of the fetus. The formation of bone during growth and development requires calcium and protein. Recent research has suggested that calcium and protein intake of the developing baby in the womb may influence the bone health of the newborn for the rest of their life. It is thought that low calcium and protein has significant bone health consequences later in life, such as lower bone density and increased risk of osteoporosis [4].

The average age of women during pregnancy has increased over the last 50 years, which has particular significance for bone health. An increasing number of women are now having children in their 30s and even early 40s. Peak bone mass occurs in the early 20s, however we generally gain bone up until the age of 30. After this time, bone loss (resorption) exceeds the rate of bone formation. This means that extra pressure is put on pregnant women and their skeletal system during pregnancy as the developing child requires a large source of calcium for bone growth. Significant complications for pregnancy can occur such as transient osteoporosis.

Transient osteoporosis develops when pregnant women have low calcium before and during pregnancy. Most often during the third trimester, fractures of the hip associated with a low bone density confirm the diagnosis of osteoporosis [5, 6], which can significantly affect mother and child. More severely, fractures of the vertebral bodies of the spine are particularly serious and cause considerable back pain [7]. Vitamin D has been shown to improve women who suffer from this condition during pregnancy [6]. During development, vitamin D is required for skeletal mineralization and growth of bones and muscles. It is thought that during pregnancy, the development of the skeletal can has long term effects in later life in relation to fractures, falls and osteoporosis [8].

Calcium plays a crucial role in bone development of the fetus, with around 30g of calcium being required by pregnant women over the duration of pregnancy and breastfeeding. It is recommended that pregnant and breastfeeding women get 1000-1200mg of calcium per day, to cope with the needs of the baby.

After Delivery and Breastfeeding

A healthy and nutritious diet after birth is equally important as it was before and during your pregnancy, especially for the quality of breast milk. For breastfeeding mothers, energy and nutrients are required to support milk production. Iron is an important mineral here for the blood and relieving the effects of tiredness. Drink plenty of water, because you can lose more than half a litre of fluid a day, especially due to the increased fluid demand during breastfeeding. As the main supplier of nutrients to your baby, you should also maintain your intake of essential vitamins and minerals. Calcium and vitamin D are particularly important for breast milk production, improving the quality of breast milk for the baby. During lactation, 20mg/day of vitamin C is passed into the breast milk, therefore it is recommended that breastfeeding women increase their vitamin C intake to 70mg/day to meet the needs of both mother and baby. An increase in manganese and magnesium (50-55mg/day) intake is also required during lactation for bone development. As with pregnancy, you should avoid alcohol, tobacco, caffeine and recreational drugs while you breastfeed, because these substances will end up in your breast milk.

ABExtra Bone-Care+ contains a rich source of calcium, magnesium, zinc, manganese, vitamin C, vitamin D and folate, essential for bone health and development.


  1. Cooper C, Harvey N, Javaid K, Hanson M, Dennison E: Growth and bone development. Nestle Nutr Workshop Ser Pediatr Program 2008, 61:53-68.
  2. Mahomed K, Bhutta Z, Middleton P: Zinc supplementation for improving pregnancy and infant outcome. Cochrane Database Syst Rev 2007(2):CD000230.
  3. Woolhouse M: Complementary medicine for pregnancy complications. Aust Fam Physician 2006, 35(9):695.
  4. Lanham SA, Roberts C, Cooper C, Oreffo RO: Intrauterine programming of bone. Part 1: alteration of the osteogenic environment. Osteoporos Int 2008, 19(2):147-156.
  5. Xyda A, Mountanos I, Natsika M, Karantanas AH: Postpartum bilateral transient osteoporosis of the hip: MR imaging findings in three cases. Radiol Med 2008, 113(5):689-694.
  6. Aynaci O, Kerimoglu S, Ozturk C, Saracoglu M: Bilateral non-traumatic acetabular and femoral neck fractures due to pregnancy-associated osteoporosis. Arch Orthop Trauma Surg 2008, 128(3):313-316.
  7. Ofluoglu O, Ofluoglu D: A case report: pregnancy-induced severe osteoporosis with eight vertebral fractures. Rheumatol Int 2008, 29(2):197-201.
  8. Pasco JA, Wark JD, Carlin JB, Ponsonby AL, Vuillermin PJ, Morley R: Maternal vitamin D in pregnancy may influence not only offspring bone mass but other aspects of musculoskeletal health and adiposity. Med Hypotheses 2008, 71(2):266-269.


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