Nutritional requirements and dietary advice targeted for pregnant

556 Pages·2013·4.74 MB·English

Review: Nutritional requirements and dietary advice
targeted for pregnant and breastfeeding women
2011
© Commonwealth of Australia 2011
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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: [email protected]
Phone: Toll free 13 000 NHMRC (13 000 64672) or call [phone]
Internet: http://www.nhmrc.gov.au
NHMRC Publication reference: N55n
Published: August 2011
Contents
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
Eggs ............................................................................................................................................................................................................................................... 208
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
Fish ................................................................................................................................................................................................................................................ 253
Included Studies .................................................................................................................................................................................................................................. 253
Evidence Summary .............................................................................................................................................................................................................................. 256
Evidence Tables ................................................................................................................................................................................................................................... 264
References ........................................................................................................................................................................................................................................... 343
Fruit............................................................................................................................................................................................................................................... 348
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
Meat.............................................................................................................................................................................................................................................. 416
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
Sugar ............................................................................................................................................................................................................................................. 484
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
7
Abbreviations
Abbreviation Meaning
SR Systematic review
SSB Sugar sweetened beverages
Review Methods
Questions
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.

9
Methods
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.