Summary of Canadian Consensus on Female Nutrition

Friday, Dec 07, 2018

Reference:

Nutrition Working Group, O'Connor DL, Blake J, Bell R, Bowen A, Callum J, Fenton S, Gray-Donald K, Rossiter M, Adamo K, Brett K, Khatri N, Robinson N, Tumback L, Cheung A. Canadian Consensus on Female Nutrition: Adolescence, Reproduction, Menopause, and Beyond. J Obstet Gynaecol Can. 2016; 38(6): 508-554.
Link to PubMed
 

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RCOG Recommendation on Healthy Eating and Vitamin Supplements in Pregnancy

Background:

A clinical practice guideline for healthcare professionals with the basic knowledge and tools to provide nutrition guidance to women in different life stages, from adolescence to menopause and beyond. This summary focuses on the key recommendations for optimizing nutrition before, during and after pregnancy.
 

Summary of key recommendations:

Pre-conceptual nutrition

  • Folic acid supplementation:
    Category of women At childbearing age At child bearing age while at moderate and high risk for bearing an offspring with neural tube defects (NTD)
    Recommendation Consume 0.4 mg of folic acid in form of a daily multivitamin for at least 2 to 3 months before pregnancy Consume 1 mg of folic acid supplement for at least 3 months before conception
    Consume 4 mg of folic acid supplement until 12 weeks of gestational age
    Consume 0.4 – 1.0 mg of folic acid throughout pregnancy and after pregnancy if breastfeeding continues

 

Nutrition in pregnancy

  • Support women in understanding the recommended specific nutrients of concern during pregnancy, including folate, iron, choline, omega-3 fatty acids and iodine, where emerging evidence suggests that these nutrients (except folate and iron) may be limited in the diets which pregnant women consume
  • Folic acid supplementation:
    Category of pregnant women At low and moderate risk for bearing an offspring with NTD At high risk for bearing an offspring with NTD In good health
    Recommendation Consume 0.4 and 1 mg of folic acid respectively, in a form of multivitamin Consume 4.0 mg of folic acid supplement 12 weeks prior to and after conception, followed by 0.4 to 1 mg until weaning Recommend a supplement containing 16 to 20 mg of elemental iron

 

  • Iron supplementation for pregnant women in good health:
    Recommend a supplement containing 16 – 20 mg of elemental iron
  • Emphasize the importance of limiting or avoiding certain foods during pregnancy:
    E.g. Foods potentially contaminated with bacteria, fish with high levels of methylmercury
     

Postpartum nutrition and lactation

  • Emphasize the need for appropriate nutrition
  • Recommend breastfeeding mothers to provide their infants with 400 IU of vitamin D daily
  • Women should consume at least 150 g of fish per week, where fatty fish are an important source of docosahexaenoic acid (DHA). However, lactating women should limit the following fish to < 150 g per month:
    E.g. Tuna, swordfish, escolar, orange roughy, shark and marlin
  • It should be noted that maternal intake of the following foods have been associated with colic symptoms in exclusively breastfed young infants:
    • Allergy and infant colic-associated foods (dairy, eggs, peanuts, tree nuts, wheat, soy, and fish)
    • Cruciferous vegetables, cow’s milk, onion, and chocolate

     

Supplementary information:

Classification on the risk status of NTD1

Risk status Low Moderate High
Female partner No personal or family risk for NTD or folic acid-sensitive birth defects Personal history positive for folate sensitive anomalies

Family history for NTD in 1st or 2nd degree relative

Diabetes type I or II

Teratogenic medications by folic inhibition

GI malabsorption that decreases RBC folate
Personal NTD history

Previous NTD pregnancy
Male partner No personal or family risk for NTD or folic acid-sensitive birth defects Personal history positive for folate sensitive anomalies

Family history for NTD in 1st or 2nd degree relative
Personal NTD history

Previous NTD pregnancy

 

Reference:

  1. Wilson RD; Genetics Committee, Wilson RD, Audibert F, Brock JA, Carroll J, Cartier L, Gagnon A, Johnson JA, Langlois S, Murphy-Kaulbeck L, Okun N, Pastuck M; Special Contributors, Deb-Rinker P, Dodds L, Leon JA, Lowel HL, Luo W, MacFarlane A, McMillan R, Moore A, Mundle W, O'Connor D, Ray J, Van den Hof M. Pre-conception Folic Acid and Multivitamin Supplementation for the Primary and Secondary Prevention of Neural Tube Defects and Other Folic Acid-Sensitive Congenital Anomalies. J Obstet Gynaecol Can. 2015; 37(6): 534-552.

 

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