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Nutritional guidelines for pregnant and lactating females
Nutrition in pregnancy and lactation is defined in India by the ICMR-National Institute of Nutrition Recommended Dietary Allowances, which state the extra energy, protein, iron, folic acid, calcium and iodine a woman needs above her normal requirement, and by the national supplementation schedules that deliver them. It matters because the mother's intake decides her haemoglobin, her weight gain and the baby's birth weight, and because more than half of Indian pregnant women are still anaemic, which remains a leading contributor to maternal death and low birth weight.
- Energy: an additional 350 kcal a day is recommended in pregnancy from the second trimester onwards, and an additional 600 kcal a day in the first six months of lactation falling to about 520 kcal a day in the second six months; protein requirement also rises stepwise, most in the third trimester and in early lactation.
- Iron and folic acid under Anemia Mukt Bharat: one red tablet containing 60 mg elemental iron and 500 micrograms of folic acid daily for 180 days in pregnancy starting from the second trimester and for a further 180 days after delivery; folic acid 400 micrograms daily is started before conception and continued through the first trimester to prevent neural tube defects.
- Calcium: 500 mg twice a day, giving 1 g of elemental calcium daily, from the 14th week of pregnancy until six months after delivery, and it must be taken at least two hours apart from the iron tablet because calcium blocks iron absorption.
- Iodine requirement rises in pregnancy and lactation and deficiency causes abortion, stillbirth, neonatal hypothyroidism and cretinism; the national answer is universal salt iodisation, which requires iodised salt to carry at least 15 parts per million of iodine at the consumer end, stored in a closed container away from heat.
- Albendazole 400 mg is given as a single dose after the first trimester in hookworm-endemic areas, and calcium, iron and deworming together are the standard antenatal supplementation package delivered at the Village Health, Sanitation and Nutrition Day.
- Expected weight gain in pregnancy is about 10 to 12 kg in a woman of normal body mass index, roughly 2 kg in the first trimester and 0.4 to 0.5 kg a week thereafter; a woman gaining less than about 1 kg a month in the second half of pregnancy needs dietary review and screening for anaemia and infection.
- Anaemia in pregnancy is a haemoglobin below 11 g/dL, moderate below 10, severe below 7 and very severe below 4; Anemia Mukt Bharat Abhiyaan (operational guidelines of June 2026) uses a 7×7×7 strategy — seven beneficiary groups, seven interventions and seven institutional mechanisms, up from the 6×6×6 of 2018 — with saturation testing by digital invasive haemoglobinometers and the T4 approach (Test, Treat, Talk, Track).
- Practical dietary counselling matters more than the numbers: iron-rich foods (green leafy vegetables, jaggery, pulses, liver and eggs), a vitamin C source with the iron tablet, avoiding tea and coffee within an hour of meals because tannins block iron, and a pregnant or lactating mother also receives 600 kcal and 22 to 25 g of protein as supplementary nutrition (a hot cooked meal and take-home ration) from the anganwadi centre.
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