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Review Nutritional requirements and dietary advice
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Commonwealth of Australia 2011, Electronic document. This work is copyright You may download display print and reproduce the whole or part of this work in unaltered form for your own personal use or if you are part of an organisation for internal use within your organisation. but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction Apart from rights to use as permitted by the. Copyright Act 1968 or allowed by this copyright notice all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way electronic or otherwise without first being given the. specific written permission from the Commonwealth to do so Requests and enquiries concerning reproduction and rights are to be sent to Strategic Communications National Health and Medical Research Council GPO Box. 1421 Canberra ACT 2600 or via email to nhmrc publications nhmrc gov au. ISBN Online 1864965843, Acknowledgements, The review of nutritional requirements and dietary advice targeted for pregnant and breastfeeding women was co funded by the Australian Government Department of Health and Ageing. Relevant contributions were provided by the Nutrition Section of the Population Health Division. The NHMRC commissioned Adelaide Research and Innovation to undertake this review. The Adelaide Research and Innovation team included. Ms Philippa Middleton, Professor Maria Makrides, Dr Carmel Collins. Dr Alice Rumbold, Dr Jo Zhou, Professor Caroline Crowther. Associate Professor Vicki Flenady, Suggested citation.
National Health and Medical Research Council 2012 Review Nutritional requirements and dietary advice targeted for pregnant and breastfeeding women Canberra National Health and Medical Research Council. To obtain information regarding NHMRC publications contact. Email nhmrc publications nhmrc gov au, Phone Toll free 13 000 NHMRC 13 000 64672 or call 02 6217 9000. Internet http www nhmrc gov au, NHMRC Publication reference N55n. Published August 2011, Abbreviations 7, Review Methods 9. Pregnancy and breastfeeding dietary patterns 12, Included Studies 12. Evidence Summaries 14, Evidence Tables 23, References 78.
Caffeine 81, Included Studies 81, Evidence Summaries 82. Evidence Tables 85, References 106, Cereal 107, Included Studies 107. Evidence Summaries 108, Evidence Table 111, References 132. Dairy Foods 134, Included studies 134, Evidence Summary 136. Evidence Tables 142, References 197, Dairy foods and eggs 200.
Included Studies 200, Evidence summaries 201, Evidence Tables 202. References 207, Included Studies 208, Evidence Summaries 209. Evidence Tables 211, References 225, Fats and Oils 226. Included Studies 226, Evidence Summaries 227, Evidence Tables 230. References 251, Included Studies 253, Evidence Summary 256.
Evidence Tables 264, References 343, Included Studies 348. Evidence Summaries 349, Evidence Tables 353, References 386. Fruit Vegetables 388, Included Studies 388, Evidence Summaries 389. Evidence Tables 391, References 402, Legumes 403, Included Studies 403. Evidence Statements 404, Evidence Tables 406, References 415.
Included Studies 416, Evidence Summaries 418, Evidence Tables 422. References 461, Nuts and Seeds 464, Included Studies 464. Evidence Summaries 465, Evidence Tables 466, References 476. Salt Sodium 477, Included studies 477, Evidence summaries 478. Evidence Tables 479, References 483, Included Studies 484.
Evidence Summaries 485, Evidence Tables 487, References 501. Vegetables 502, Included Studies 502, Evidence Statements 504. Evidence Tables 509, References 545, Excluded Studies 547. References 548, Abbreviations, Abbreviation Meaning. AHEI P Alternate Healthy Eating Index for Pregnancy. BaP Benzo a pyrene, BMC Bone Mineral Content, BMI Body Mass Index.
CI Confidence Interval, DQI P Diet Quality Index Pregnancy. EPA Eicosapentaenoic acid, FFQ Food frequency questionnaire. GA Gestational age, GDM Gestational diabetes mellitus. GI Glycaemic index, GWG Gestational weight gain, IGT Impaired glucose tolerance. IQR Interquartile range, IUGR Intrauterine growth restriction.
LA Linoleic acid, LC PUFAs Long chain polyunsaturated fatty acids. LGA Large for gestational age, MD Mean Difference, PAH Polycyclic aromatic hydrocarbons. PCA Principal component factor analysis, Pns P value not significant. PTB Preterm birth, RCTs Randomised controlled trials. RRR Reduced risk regression, SD Standard deviation.
SEM Standard error of the mean, SES Socio economic status. SGA Small for gestational age, SHBG Sex Hormone Binding Globulin. SIDs Sudden infant death syndrome, Abbreviations, Abbreviation Meaning. SR Systematic review, SSB Sugar sweetened beverages. Review Methods, The principal question addressed in this systematic review was.
What food groups consumed by pregnant and breastfeeding women are associated with health outcomes for the mother and or child. The groups included dietary patterns fruit vegetables meat dairy foods cheese milks and yoghurt cereals grains legumes nuts and seeds fish poultry eggs. fat oil salt sodium sugars and beverages, Search strategy. We searched the following databases and sources, Cochrane Library issue 8 2010 published 4 August 2010. Other databases and sources to 31 July 2010 including Pubmed EMBASE Austhealth Google Scholar Google government and agency sources other. dietary guidelines, These sources were searched from inception with no date restrictions applied. We made extensive use of pearling and snowballing strategies on retrieved references. We did not apply language or publication status restrictions. Search terms included, Maternal diet pregnancy diet pregnancy intake breastfeeding diet breastfeeding intake alone and in combination with the food patterns and food. groups specified above, We used Endnote to manage the references.
Inclusion and exclusion criteria, Studies needed to. be applicable to an Australian population, be food based not nutrient based or assessing food supplements and. report maternal fetal infant child or child as an adult health outcomes. Data extraction, We designed a data extraction sheet specifically for this project For each included study one person extracted descriptive information study design study. results potential risk of bias and relevance of the study At least one other person checked the data extraction. We used the NHMRC Hierarchies of Evidence to assign a level of evidence to each study according to its particular hierarchy Most included studies fell into the. aetiology or intervention hierarchies, Risk of bias. We used the Cochrane risk of bias tool to criticially appraise randomised controlled trials and adapted this tool and the set of NICE critical appraisal tools to assess. other study designs such as cohort aetiology and case control studies. Each included study was assessed as being of low low moderate moderate moderate high or high risk of bias. Structure of report, For each food group we provided.
A table of included studies alphabetical by first author s surname with list of outcomes included in the study. An evidence summary arranged chronologically by outcome e g pre pregnancy fetal maternal antenatal maternal postnatal infant child child as an. adult and giving a quantitative results summary for each included study. Evidence tables of the detailed data extraction for each study arranged alphabetically by first author s surname and. References for that particular food group, Included studies. We included a total of 170 studies with the following breakdown by food group there is some overlap as some studies addressed multiple food groups and. multiple outcomes, Food group Number of included studies Number of participants. Dietary patterns 38 198 037, Caffeine 13 42 710, Cereal 20 27 201. Dairy foods 45 91 797, Dairy foods and eggs 4 3 918. Eggs 14 17 892, Fats and oils 18 68 398, Fish 63 359 332.
Fruit 28 136 026, Fruit vegetables 10 91 247, Legumes 9 17 640. Meat 32 99 772, Nuts and seeds 9 9 581, Salt sodium 4 6 275. Sugar 14 20 286, Vegetables 31 89 753, Excluded studies. We excluded 116 studies in the following categories. Narrative review 2, No perinatal outcomes 20, Nutrient not food based 49. Supplements 21, Pregnancy and breastfeeding dietary patterns.
Included Studies, Study Outcomes, 1 Aaltonen 2008 Birthweight birth length head circumference at birth infant blood pressure at 6 months infant heart rate at 6 months infant. weight length and head circumference at 6 months, 2 Brantsaeter 2009 Pre eclampsia. 3 Chatzi 2008 Gestational age at birth birthweight child persistent wheeze atopic wheeze atopy all at 6 5 years. 4 Cole 2009 Child bone mass lean mass fat mass all at 9 years. 5 De Batlle 2008 Asthma wheeze rhinitis sneezing itchy watery eyes all at 6 7 years. 6 Duarte Salles 2010 Birthweight, 7 Hattevig 1989 Eczema asthma other atopic allergic manifestations Infant weight gain maternal return to pre pregnancy weight within 3. months after birth breastfeeding, 8 Haugen 2008 Preterm birth. 9 Haugen 2005 Fetal ductus shunting fetal liver blood flow. 10 Hill 2005 Infant colic, 11 Kinnunen 2007a Achieving recommended dietary pattern gestational weight gain high birthweight low birthweight.
12 Kinnunen 2007b Postpartum weight retention, 13 Knudsen 2008 SGA birthweight. 14 Koebnick 2004 Vitamin B 12 deficiency maternal, 15 Koebnick 2001 Folate status during pregnancy. 16 Lange 2010 Child recurrent wheeze asthma eczema lower respiratory tract infection atopy all at 3 years. 17 Laraia 2007 Pre pregnancy BMI, 18 Mikkelsen 2008 Preterm birth. 19 Moses 2009a Women s need for insulin birth outcomes. 20 North 2000 Child hypospadias, 21 Olafsdottir 2006 Gestational weight gain. 22 Radesky 2008 IGT GDM, 23 Rifas Shiman 2009 Pre eclampsia GDM IGT blood glucose SGA LGA gestational weight gain.
24 Robinson 2007 Infant diet, 25 Rodriguez Bernal FGR weight length head circumference at birt6h. 26 Ross 1996 Childhood leukemia, Dietary guidelines for pregnant and breastfeeding women DRAFT evidence report. 27 Shaheen 2009 Wheeze at 6 months transient later onset persistent wheezing at 3 5 years eczema at 2 5 and 7 5 years IgE at 7 years hay. fever at 7 5 years bronchial responsiveness at 8 9 years lung function FEV1 and FVC at 8 9 years. 28 Siega Riz 2001 Preterm birth, 29 Stuebe 2009 Gestational weight gain. 30 Thompson 2010 SGA, 31 Tieu 2008 Birthweight LGA fasting blood glucose gestational weight gain GDM. 32 Uusitalo 2009 Gestational weight gain, 33 Vujkovic 2009 Spina bifida.
34 Vujkovic 2007 Cleft palate postpartum maternal BMI. 35 Wolff 1995 Birthweight, 36 Xiang 2005 Breastmilk composition infant growth. 37 Zeiger 1989 Allergy various outcomes birthweight weight and height at 4 12 and 24 months maternal third trimester weight gain. 38 Zhang 2006 GDM, Pregnancy and Breastfeeding Dietary Patterns. Evidence Summaries, N Level References, 1 In a Norwegian cohort study 23 423 II Brantsaeter 2009. significantly reduced rates of pre eclampsia were associated with. o a high or medium vegetable pattern compared with a low vegetable pattern aOR 0 72 95 CI. 0 62 to 0 85 high aOR 0 84 95 CI 0 73 to 0 97 medium. significantly increased rates of pre eclampsia were associated with. o a high processed food pattern compared with a low processed food pattern aOR 1 21 95 CI. 1 03 to 1 41, no significant differences in pre eclampsia rates were seen between. o low and medium processed food patterns aOR 1 06 95 CI 0 91 to 1 23. o low and medium potato and fish pattern aOR 0 99 95 CI 0 86 to 1 15. o low and high potato and fish pattern aOR 1 00 95 CI 0 84 to 1 18. o low and medium cakes and sweets pattern aOR 1 00 95 CI 0 86 to 1 15. o low and high cakes and sweets pattern aOR 0 90 95 CI 0 76 to 1 06. 2 In a US cohort study significantly reduced rates of pre eclampsia in the 2nd trimester were associated with 1777 II Rifas Shiman 2009. higher diet quality AHEI P although a significant reduction was not apparent in the 1st trimester. 1st trimester aOR 0 96 95 CI 0 84 to 1 10, 2nd trimester aOR 0 87 95 CI 0 76 to 1 00.
3 In a US cohort study women who were obese but not overweight before pregnancy were significantly 2394 II Laraia 2007. more likely to have a poorer quality diet less grain fruit and vegetables more fat during pregnancy. compared with normal weight women, DQI P score 53 3 SD 12 0 for obese women 55 3 SD 11 3 for normal weight women p 0 05. 4 In a retrospective cohort study from Finland pregnant women 3360 III 3 Uusitalo 2009. gained more kilograms a week with diets high in fast food 1 3 kg and traditional bread 0 9 kg p for. trend 0 0001 and 0 002 respectively, gained less weight per week 0 7 kg with a diet high in alcohol and butter p for trend 0 014. and showed no significant differences in weight gain with healthy traditional meats low fat and. 5 In a US cohort study neither excessive or inadequate weight gain during pregnancy were associated with 1777 II Rifas Shiman 2009. dietary quality as assessed by AHEI P per 5 points. Excessive weight gain aOR 0 99 95 CI 0 94 to 1 04 1st trime. The review of nutritional requirements and dietary advice targeted for pregnant and breastfeeding women was co funded by the Australian Government Department of Health and Ageing Relevant contributions were provided by the Nutrition Section of the Population Health Division

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