The best food for babies born at term is human milk from healthy, well-fed mothers. According to the World Health Organization, the nutritional makeup of human milk is critical for a baby's growth, development, and general health, and breastfeeding is the most effective feeding method [1,2]. A newborn has the best start in life if they are breastfed exclusively for the first six months after birth [1,3]. As a result, it has been proposed that breastfed babies have higher IQs and are less likely to acquire diabetes, developmental disorders, or excessive weight gain [4,5,3]. According to World Health Organization guidelines, breastfeeding should be the infant's only source of nutrition during the first six months of life, beginning within an hour of delivery and continuing until the child is two years old or older. At six months, safe, nutritionally adequate complementary (solid) foods should be provided (WHO, 2023).

Breastfeeding exclusively for six months benefits both the mother and the child. Protection against gastrointestinal diseases, which occur in both developed and developing nations, is the most important of them. Breastfeeding within an hour of birth reduces newborn mortality and protects infants from sickness (WHO, 2023). Partial or nonexistent breast milk intake may make infants more prone to diarrhea and other infections, which could lead to death. Overweight and obesity are less common in children and teenagers who were breastfed as infants. Higher adult salaries are linked to breastfeeding. Both the nation and individual households can profit monetarily by enhancing child development and cutting health care costs [6]. However, a lot of babies and kids don't get the best nutrition possible. For instance, between 2015 and 2020, just over 44% of infants ages 0–6 months globally received just breast milk (WHO, 2023).

An important factor in a good lactation is the mother's diet. The mother has significant nutritional and energy requirements during pregnancy and lactation; if she does not receive enough of these, the amount and quality of her breastmilk may decline [7,8]. According to a comprehensive analysis, the amount of micronutrients in breast milk was correlated with the mother's consumption of certain micronutrients, such as fat-soluble vitamins B1 and C, and fatty acids [9,10]. Vitamins and micronutrients are also necessary for a newborn's growth and development. Research indicates that the quantity of breast milk produced by mothers is correlated with the amount of certain nutrients they ingest, such as omega-3 polyunsaturated fatty acids from fish [11].

Conversely, typical dietary deficits in nursing moms, such as those in iron, vitamin D, or iodine, may imperil the mother's health as well as the milk's nutritional composition [8]. The anti-oxidant and anti-infectious properties of minerals and vitamins are also crucial throughout infancy [7,12]. For instance, a mother's milk production and endurance may be lowered by insufficient protein or calories, and an infant's access to certain nutrients may be restricted by micronutrient deficiencies. The long-term health and early development of the kid are significantly impacted by the nutrition of nursing mothers. During nursing, there is a significant demand for nutrients and high energy levels. Maternal reserves may be depleted, even though it has been seen that nursing moms can still produce adequate high-quality human milk while having a low nutritional status. In reality, a number of factors affect the makeup of human milk. Maternal body composition, food intake, and fat storage all have a major impact on this [13].

Figure 1: Benefits of Breastfeeding.

Source: Aleksandra [14].

This review examines the extent of maternal nutrition in exclusive breastfeeding (EBF), as well as the impact of the mother's diet on the composition of milk, the prevalence and outcomes of maternal nutrient deficiencies, and nutrition interventions (e.g., education, community support, counselling, supplementation, and fortification) to support breastfeeding mothers. These measures affect the growth and development of the infant as well as the health of the mother. The purpose of this review is to gather the most recent information available from around the globe regarding how maternal nutrition affects the outcomes of exclusive breastfeeding. By combining research from multiple settings, it aims to educate scholars, medical professionals, and legislators on how to maximize maternal nutrition and encourage effective breastfeeding practices. Ultimately, a better understanding of these connections can direct international initiatives to improve the health and nutrition of expectant mothers and babies.

Human milk is a dynamic, complex fluid that contains micronutrients (vitamins, minerals) and macronutrients (fats, lactose, and protein) that are specific to the needs of infants. Approximately half of the energy content of breast milk comes from its 3.5 g of fat per 100 ml of milk. Another significant source of energy is breast milk, which has higher lactose than most other milks roughly 7 g per 100 ml. Oligosaccharides, or sugar chains, are another type of carbohydrate found in breast milk that offer significant anti-infection protection. Compared to animal milks, breast milk has a different amount and grade of protein, and because it has a balanced amino acid composition, it is far more suited for a baby. Compared to animal milks, breast milk has a lower protein content (0.9 g per 100 ml) [15]. Although comparatively constant, its composition is impacted by the mother's diet to some extent [12].

According to reviews, some components of breastmilk are impacted by the mother's nutritional intake [9,10]. The makeup of fatty acids, in particular, is highly influenced by food. For instance, moms who consume more fish or omega-3 supplements had far higher levels of DHA, EPA, and ALA in their milk, which is correlated with higher quantities of important polyunsaturated fatty acids (PUFAs) in milk [3]. On the other hand, consuming a lot of saturated fat may cause some healthy milk fats to decrease. Consistently significant associations between milk and maternal omega-3 intake were found in more than 17 research [3].

Fatty acids, vitamins, and other bioactive substances that a mother consumes affect the milk's nutrient content and quality, which in turn affects how well the milk supports the growth, development, and immune system of her unborn child [16,17]. To varied degrees, a number of vitamins and minerals in milk also indicate the state of the mother. According to systematic reviews, maternal consumption or supplementation increases the amount of fat-soluble vitamins (A, D, and E) and some B-vitamins in milk [9]. For instance, giving vitamins A, D, B1, B2, or C to nursing moms frequently raises the levels of those vitamins in colostrum and milk. In contrast, the majority of minerals (such as zinc and iron) exhibit less variation with maternal consumption and are more closely regulated in milk [9]. According to one review's overall findings, "the amount of certain micronutrients (fat-soluble vitamins B1, C) and maternal dietary intake, especially fatty acids, was related to their content in breast milk" [10].

Milk quality might be deteriorated by specific nutritional deficits or maternal undernutrition. It has been noted that nursing mothers can produce enough high-quality human milk even if their nutritional status is inadequate, yet this could lead to a depletion of maternal reserves Carretero [8]. According to several studies, nursing women around the world frequently suffer from deficits in important nutrients (such as vitamins A, D, and B12; iron; iodine; and omega-3), according to Carretero [8]. The diet and the mother's biological storage provide the energy, proteins, and nutrients found in human milk. Women who do not get enough nutrients from their food may be at risk for deficiencies in certain vitamins and minerals that are essential for vital processes. If the mother takes nutritional supplements or makes dietary changes, these deficiencies can be avoided [18].

Low levels of these vitamins in milk are caused by poor maternal vitamin A or D status, which may leave the baby lacking. In a similar vein, moms who are deficient in iodine or selenium may produce insufficient milk, which may impact the thyroid function and antioxidant defenses of their infants. Even the volume of milk may decrease in severe situations (such as starvation or severe malnutrition). In summary, chronic maternal nutrient deficiencies, particularly of vitamins and critical fatty acids, frequently result in worse milk nutrition, even though human milk is incredibly resilient [8,10].

Table 1: Key components of breast milk and influence of maternal diet.

Infants may be directly impacted by common maternal shortages in iron, zinc, vitamin D, vitamin A, iodine, and B vitamins. Vitamins and micronutrients are crucial components of an infant's growth and development. Children's brain development, metabolic functions, the growth of soft tissues and muscles, oxygen transport, and DNA synthesis are all significantly impacted by micronutrients and vitamins. Low-birth-weight (LBW4; less than 2.5 kg) newborns are more likely to be born to undernourished mothers. Preterm birth and stunting are two poor outcomes that may be linked to periconception nutrition, however improving fetal growth during pregnancy also improves fetal nutrition [22]. The relationship between preconception folate status and neural tube defect risk is the most well-known [23]. More recent research indicates that maternal diet during conception affects placental growth and function [24].

Furthermore, maternal periconception diet is directly linked to the long-term health of the child due to its impact on fetal genomic imprinting and programming during conception [25]. Diseases like rickets and vitamin D, hemolytic anemia and severe iron-related anemia, hydrocephalus and vitamin B12, xerophthalmia and vitamin A, and recurrent infectious diseases with vitamin A and E are caused by deficiencies in certain micronutrients and vitamins [26,27]. Stunted growth and decreased immunity can result from insufficient zinc in milk and breastfed newborns, which can also be caused by zinc deficiency in moms [9]. Since iodine is essential for thyroid hormones and brain development, even minor maternal shortage can result in inferior cognitive results for breastfed infants. Mothers who are iodine deficient also produce milk that is iodine deficient. The effects of fat-soluble vitamin deficiencies are also well established.

A mother's breastmilk may not contain enough retinol if her diet is low in vitamin A, which puts newborns at risk for xerophthalmia and increased infection rates [9]. Low maternal vitamin A indicates that babies are already low in vitamin A by the time they are six months old (at which point breastfeeding may not be sufficient to meet their needs). This is in line with research showing that babies of moms who are vitamin A deficient have subclinical deficiencies by that time. In a similar vein, babies need either their mother's or their own supplements because insufficient maternal vitamin D results in almost little D in breastmilk. Deficits in B vitamins (e.g., folate, B12) in mothers have been associated with poor developmental outcomes for infants, including growth deficits and delayed reflexes [10].

Infant health can be greatly impacted by maternal nutritional deficits through a number of interrelated processes. These include altered immune system development, placental disturbances, decreased fetal growth, and possible long-term health effects on the child. Both direct and indirect mechanisms are involved. The levels of such nutrients delivered in milk are directly decreased by insufficient food intake and restricted maternal reserves [8]. Milk may have low quantities of micronutrients even if its volume is maintained. Indirectly, undernourished moms might be less healthy or exhausted, which could reduce the amount of time they can nurse exclusively and hence restrict the nutrition of their babies. Additionally, certain maternal deficits have an impact on the unborn child while they are still in the womb. For instance, a maternal iron shortage results in low ferritin levels in the newborn. In conclusion, a breastfed newborn is more likely to experience growth faltering, developmental delays, anemia, and an increased susceptibility to infections if the mother is malnourished (caloric or micronutrient deficiencies) [8,9].

Table 2: Common maternal nutrient deficiencies and associated infant outcomes.

Some nutrients are particularly crucial for lactation and the growth of the baby. The omega-3 fatty acids: As mentioned, these fatty acids are significantly increased in milk by DHA and other long-chain omega-3s in the mother's diet [3]. Breastmilk with enough DHA promotes the development of the baby's brain and retina. Higher breastmilk DHA (from the mother's fish consumption) has been linked in studies to better visual acuity and cognitive scores in infants. Consuming omega-3 fatty acids during breastfeeding also promotes the production of high-quality milk fat.

The following are some specific nutrients and how they help with lactation and baby growth:

Energy and Protein: Breastfeeding mothers typically require additional calories to meet their nutritional demands, even though the majority of mothers in populations with adequate nutrition consume enough calories and protein. Lactating women require about 300–400 extra kcal per day to be well-nourished compared to their pre-pregnancy intake. This translates to roughly 2,000-2,800 kcal per day for nursing mothers and 1,600-2,400 kcal per day for moderately active, non-pregnant, non-breastfeeding women [30]. Sufficient protein and energy keep mothers from losing weight and guarantee that they continue to produce milk. On the other hand, adequate intake sustains supply, whereas severe calorie restriction can reduce milk volume.

Galactagogues: Galactagogues are meals or plants that are thought to increase the production of milk. Fenugreek, blessed thistle, Coleus amboinicus (culantro), and palm date (fruit) are common examples. A recent meta-analysis revealed that fenugreek significantly enhanced measured milk supply compared to a placebo, however clinical research yield conflicting findings [31]. According to that investigation, moms who took fenugreek made around 11 milliliters more milk per feeding than those who did not. Although further research is required, many lactation professionals believe that galactagogues can help moms who are having trouble supplying milk.

Fats: The most significant component of breast milk is fat, which provides energy and aids in the development of the central nervous system. Additionally, milk fat conveys flavor and fragrance. During breastfeeding, the fat content of human breast milk typically falls between 3.5% and 4.5%. About 95% of total lipids are triglycerides, the primary lipid portion. With palmitic acid (C16:0) accounting for 23% of total fatty acids, over half of milk's fatty acids are saturated fatty acids [32]. The largest proportion of monounsaturated fatty acids in milk (36%) is oleic acid (18:1w9). Two important fatty acids are also present in human breast milk: alpha-linolenic acid (C18:3w3) at 0.35% and linoleic acid (C18: 2w6) at 15% [32]. Arachidonic acid (AA, C20: 4w6) and eicosapentaenoic acid (EPA, C20: 5w3) are the products of the conversion of these two essential fatty acids, respectively. The latter is then further transformed into docosahexaenoic acid (DHA, 22: 6w3). Newborns' growth, inflammatory reactions, immune system, vision, cognitive development, and motor systems are all regulated by AA, EPA, and DHA.

Micronutrients: During lactation, iodine and choline are especially crucial. During breastfeeding, a mother's iodine needs increase to about 290 μg per day, according to the CDC [30]. Sufficient milk iodine for newborn thyroid function is ensured by enough iodine. Similarly, choline consumption (550 mg/day) improves baby brain development (via milk choline). Multivitamins can assist meet these increased needs if diets are vegetarian or restricted [30]. Minerals found in human breast milk support a number of physiological processes, are biochemically significant for molecules and structures, and are vital components of numerous enzymes. Milk from cows and milk from humans both have similar mineral concentrations. Hormones, growth factors, and immunological factors are among the several other bioactive substances that have been discovered in human milk throughout the years [33].

In conclusion, nutrients like as DHA, vitamins A, D, and E, and iodine that directly increase the composition of milk or maternal reserves are beneficial to the growth and health of infants. Adequate calories/protein sustain milk volume, and some specific substances (galactagogues) may aid enhance production. A crucial tactic for promoting exclusive breastfeeding and the development of healthy infants is to ensure these nutrients through diet or supplements [31,3].

Interventions that increase maternal nutrition can promote exclusive breastfeeding rates and newborn outcomes. Nutrition counseling and education is one successful strategy. According to clinical investigations, EBF rates are considerably increased when pregnant women get dietary and nursing counseling. For example, a cluster trial conducted in Ethiopia revealed that women who received breastfeeding education and maternal nutrition practiced EBF significantly more frequently (74% compared to 61% in controls) and started nursing earlier [34]. Nutrition education raised the odds of EBF by about 70% in adjusted analysis [34].

The significance of getting enough nutrients during pregnancy and lactation is usually covered in this type of education, which is frequently given in group settings or during home visits. The World Health Organization highlights the importance of providing "supportive health services with infant and young child feeding counseling during all contacts with caregivers," such as prenatal and postnatal care visits (WHO, 2023). The prevalence of EBF is considerably reduced by regular counseling and lactation assistance [34].

Another tactic is dietary supplementation, particularly in areas where deficiencies are prevalent. Mothers are frequently given food supplements or prenatal/postnatal vitamins through national programs. Research shows that giving micronutrient supplements (iron, multivitamins, and omega-3) to nursing moms enhances their nutritional status and improves the quality of their breast milk. A "positive association between the concentration of certain nutrients in human milk and the lactating mother's nutritional supplementation" was observed in a recent narrative review [8]. For example, continuing a prenatal multivitamin postpartum can maintain maternal iron, folate and other levels. In populations with endemic vitamin D or iodine deficiency, targeted supplements can prevent infant rickets or hypothyroidism.

While some debate remains on routine high-dose supplements during lactation, it is clear that addressing maternal deficiencies (through diet or pills) supports milk quality. Support services for breastfeeding are essential. It has been highly successful to make sure that moms have access to support groups, qualified lactation counselors, and healthcare facilities that are baby-friendly. These programs give moms the information, abilities, and self-assurance they need to overcome obstacles, start nursing successfully, and handle any problems that may arise. It would be possible to assist mothers who might not be thinking about breastfeeding in making educated decisions about what to give their babies and kids.

Counselling may stress the wide and resounding data on the benefits of breastfeeding, as well as providing mothers with scientific, unbiased and truthful knowledge on various infant and young child feeding choices, so that they can safely and responsively feed their child. Ultimately, this assistance supports a happy breastfeeding experience and enhances the health of both mother and child. WHO’s Ten Steps to Successful Breastfeeding (e.g. instant skin-to-skin contact, rooming-in, feeding on demand) drastically enhance exclusive breastfeeding duration. Combined with maternal nutrition support, such measures boost the benefit. In fact, WHO states that “breastfeeding practices are highly responsive to supportive interventions, meaning coordinated nutrition and breastfeeding programs can significantly boost EBF rates within a few years (WHO, 2023).

Long-term effects of maternal nutrition during nursing are felt by both the mother and the child. Sufficient diet and continued nursing are beneficial to moms' health. According to pooled data, nursing for more than 12 months is linked to a 26% lower risk of breast cancer and a 37% lower risk of ovarian cancer. Nursing alone, when combined with a healthy diet, reduces the mother's chance of developing chronic illnesses [35]. Additionally, it lowers the maternal risk of type 2 diabetes by about 32%. A natural spacing of pregnancies, postpartum amenorrhea, is prolonged by exclusive breastfeeding [35]. A malnourished nursing mother, on the other hand, is more likely to experience postpartum anemia, poor bone repair (caused by calcium loss), fatigue, and even depression. These conditions might decrease the amount of time she can breastfeed and cause her own recuperation to be delayed. Restoring nutrient storage, preserving health, and regaining strength are all facilitated by making sure moms are getting enough calories and nutrients.

The effects are severe for infants and young children. Successful EBF and proper maternal nutrition enhance the growth, immunity, and cognitive development of the newborn. As mentioned, EBF lowers morbidity and mortality; infants who are breastfed are less likely to suffer from respiratory infections, diarrhea, and malnourishment (WHO, 2023). Additionally, they have a lower chance of growing up to be overweight or obese. Breastmilk that is nutrient-rich (from a woman who is well-nourished) promotes the best possible brain development; for instance, infants who receive enough DHA and iron in their milk have higher neurodevelopmental scores. These advantages are lessened by inadequate maternal nutrition; a baby who is deficient in important nutrients (such as iron, zinc, or vitamin A) may have delayed milestones, growth retardation, or a rise in infections.

In order for newborns to acquire the needed micronutrients and bioactive chemicals in breast milk which are critical for the best possible brain development, immune system maturation, and metabolic regulation, the mother must consume enough nutrients throughout lactation. Long-term neurodevelopmental deficits, lower educational attainment, and decreased economic output in adulthood have all been associated with deficiencies in important nutrients at this time, including iodine, iron, vitamin D, and omega-3 fatty acids [36]. For instance, babies with decreased thyroid function due to low iodine intake from nursing moms may experience lasting cognitive abnormalities [37].

Maternal nutrition may influence a child's lifetime risk of chronic diseases in addition to cognitive and developmental outcomes. The idea of "nutritional programming," which holds that early nutrition affects a person's subsequent risk of obesity, type 2 diabetes, cardiovascular disease, and hypertension, is supported by epidemiological data. Long-term health, educational attainment, and cognitive outcomes are often higher for children who receive high-quality breastmilk, which is indicative of a healthy mother's diet (WHO, 2023). The worldwide ramifications are particularly significant. A large percentage of infant malnutrition and mortality could be avoided by concentrating on maternal diet in low-resource environments, where maternal undernutrition is prevalent. Conversely, even in high-income nations, lack of dietary diversity or restrictive diets in women (e.g. vegan without supplementation) can risk breastfeeding deficiencies. Therefore, encouraging the best possible diet for mothers is a universal approach to enhancing the health of both mothers and children.

The importance of maternal nutrition in promoting the best exclusive breastfeeding (EBF) practices and guaranteeing the quality of breast milk for infant health is emphasized in this review. Recent international research consistently demonstrates that maternal dietary intake directly affects the concentrations of several micronutrients in breast milk, such as vitamin A, vitamin D, iodine, and essential fatty acids, which are vital for infants' immune development, cognitive function, and general growth. Key findings are shown in table 3 below:

Table 3:   Summary of Key Findings.

Assessment and advice on maternal nutrition should be incorporated into prenatal and postnatal care by healthcare professionals. This entails advising on a healthy, nutrient-dense diet, suggesting suitable supplements (such as iron, vitamin D, or prenatal vitamins), and keeping an eye on the nutritional status of the mother. Community health workers and lactation consultants can support breastfeeding education and dietary counseling, as combined support has been demonstrated to increase exclusive breastfeeding practices (WHO, 2023). The inclusion of breastfeeding women in food security and nutrition programs (such as increased maternal leave, food vouchers, or nursing mother supplements) should be a priority for policymakers. National infant feeding policies and international guidelines (WHO/UNICEF) should place a strong emphasis on the mother's diet as a key component of effective breastfeeding.

Future studies should concentrate on additional high-quality trials that are required to evaluate certain nutrition interventions for nursing moms, like diet plans or supplements, and their direct effects on the outcomes of the infants. How changes in a mother's diet affect the growth and neurodevelopment of her children over time should be monitored via longitudinal research. Mechanistic studies on the transport of nutrients into milk and how the infant uses them can improve dietary guidelines. Finally, research that is culturally specific and conducted in a variety of global populations will help to maximize recommendations. For instance, it may look at local diets or traditional galactagogues. The promotion of exclusive breastfeeding and the attainment of optimal health outcomes for mothers and children globally depend on sustained attention to maternal nutrition (WHO, 2023 [30]).

We thank all the researchers who contributed to the success of this research work.

Conflict of Interest

The authors declared that there are no conflicts of interest.

Funding

No funding was received for this research work.

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