JOGC

Canadian Consensus on Female Nutrition: Adolescence, Reproduction, Menopause, and Beyond

      Abstract

      Objectives

      To provide health care professionals in Canada with the basic knowledge and tools to provide nutrition guidance to women through their lifecycle.

      Outcomes

      Optimal nutrition through the female lifecycle was evaluated, with specific focus on adolescence, pre-conception, pregnancy, postpartum, menopause, and beyond. The guideline begins with an overview of guidance for all women, followed by chapters that examine the evidence and provide recommendations for the promotion of healthy nutrition and body weight at each life stage. Nutrients of special concern and other considerations unique to each life stage are discussed in each chapter.

      Evidence

      Published literature, governmental and health agency reports, clinical practice guidelines, grey literature, and textbook sources were used in supporting the recommendations made in this document.

      Values

      The quality of evidence was rated using the criteria described in the report of the Canadian Task Force on Preventive Health Care.

      Chapter 2: General Female Nutrition

      Summary Statements
      • 1.
        A balanced and varied diet higher in vegetables, fruit, whole grains, low- or non-fat dairy, seafood, legumes, and nuts; moderate in alcohol (for non-pregnant and non-lactating women); lower in red and processed meats; and low in sugar-sweetened beverages and refined grains reduces the risk of chronic diseases including type 2 diabetes, cardiovascular disease, and cancer. (II-2)
      • 2.
        Women’s health, including their nutritional status, can be adversely affected by psycho-social, economic, or geographic circumstances which comprise their “food environment.” Barriers to healthy eating may include individual factors (e.g., physical ability, income), social factors (e.g., family situation, social support), community factors (e.g., proximity to grocery stores), and relevant policies (e.g., eligibility for social support programs). Women at high risk for poor nutritional status may benefit from additional dietary counselling or targeted interventions. (III)
      • 3.
        A carefully planned vegetarian diet is healthy throughout the lifecycle; careful attention to protein is required. Other nutrients of concern for strict vegetarians (e.g., vegans) include zinc, iron, vitamin B12, and omega-3 fatty acids. (II-2)
      Recommendations
      • 1.
        Emphasize the importance of sound nutrition throughout the female lifecycle, with an overall focus on women’s intake of nutritious foods in appropriate amounts for maintaining a healthy weight. (I-A)
      • 2.
        Discussions of dietary intake with women should identify practical, easy to understand, easy to implement, and sustainable dietary practices. (III-B)
      • 3.
        Stress the importance of maintaining a healthy body weight throughout the lifecycle. Body mass index (weight in kg/height in metres 2) and waist circumference (cm) provide a general idea of health risk and should be measured as a routine part of physical assessments. (II-2A) This recommendation does not apply to adolescents and women with eating disorders or women who are pregnant.
      • 4.
        Support women in understanding specific nutrients of concern across the female lifecycle, which include calcium, iron, folate, vitamin B12, and vitamin D. Ensure that women are aware of foods rich in these nutrients, and encourage their regular consumption in appropriate amounts. (III-A)
      • 5.
        Women who are at high risk for iron deficiency (e.g., low or no meat intake; low socioeconomic status; immigrants from developing countries; First Nations, Inuit, and Métis women; significant blood loss due to menstruation, child birth) should be screened by measuring hemoglobin and serum ferritin. If iron deficiency is identified, oral elemental iron therapy should be initiated and continued for at least 6 months; higher doses are required for women with severe anemia. Iron should be taken with a source of vitamin C. (III-A) Patients with an underlying condition that causes iron deficiency or who do not respond to treatment should be referred for further investigation and management.
      • 6.
        Routine testing of healthy women without symptoms or risk factors for vitamin B12 deficiency is not recommended. Consider supplementary vitamin B12 for women with risk factors for deficiency (e.g., vegetarian/vegan diet, over age 50, gastric disorders such as atrophic gastritis or gastric bypass, small bowel disease, and regular use of metformin, chronic H 2-blockers, or proton pump inhibitors). (III-A)
      • 7.
        Women who are not able to consume the recommended dietary allowance of calcium in their diet may benefit from a calcium supplement. (II-2A) When counselling a woman in the selection of a calcium supplement, ensure that the supplement provides an adequate dose of “elemental calcium” and that the woman understands she needs to look specifically for this on the label. It is best to take multiple small doses of calcium as absorption is inversely related to intake; no more than 500 to 600 mg of elemental calcium at any one time. (II-2A) Caution should be used to avoid exceeding the upper limit for calcium from diet and supplements combined (2500 mg for adult women).
      • 8.
        Recommend a vitamin D supplement to all Canadian women who consume insufficient dietary vitamin D (I-A), particularly those with decreased cutaneous synthesis due to being homebound, having darker skin pigmentation, or who cover their skin.
      • 9.
        Screening for vitamin D deficiency by measuring serum 25(OH)D is not necessary for the general population but should be carried out in high risk women such as those with a history of fractures, malabsorption, renal disease, or using medications that impact vitamin D or bone metabolism (e.g., chronic steroid use, anticonvulsant therapy). (III-A)
      • 10.
        During routine visits, advise all women of reproductive age about the benefits of adequate intake of folate from foods (e.g., dark green, leafy vegetables and legumes) and folic acid in a multivitamin supplement. (I-A)

      Chapter 3: Adolescence Nutrition

      Summary Statements
      • 1.
        Adolescence is a key time to continue or initiate obesity prevention. (III)
      • 2.
        The highest prevalence of eating disorders occurs among female adolescents. (II-2)
      Recommendations
      • 1.
        Discuss good nutrition and explore and address potential body image concerns with all adolescent female patients. Teach adolescents and their parents about the benefits of a varied diet higher in vegetables, fruit, whole grains, low- or non-fat dairy, seafood, legumes, and nuts; lower in red or processed meat; and low in sugar-sweetened beverages and refined grains. (III-A)
      • 2.
        Since it is known to produce widespread positive outcomes, encourage adolescents and their families to eat meals together. (I-A)
      • 3.
        The weight and height of all adolescents should be measured and their body mass index calculated using the World Health Organization Growth Charts which are for children and youth up to 19 years. (III-A)
      • 4.
        To ensure optimal bone development, adolescent females should be counselled to consume their RDAs for calcium (1300 mg/day) and vitamin D (600 IU/day), ideally through food or, if necessary, through supplementation. (I-A)
      • 5.
        Be alert to eating patterns and body image of all preteen and adolescent females. (III-A)

      Chapter 4: Pre-conceptual Nutrition

      Summary Statement
      • 1.
        It is estimated that approximately one half of pregnancies in Canada are unplanned and thus it is important that all women of reproductive age maintain good nutrition. (III)
      Recommendations
      • 1.
        Follow the 2015 Society of Obstetricians and Gynaecologists of Canada guideline for the supplementary use of folic acid by women of reproductive age. Women of childbearing age should consume 0.4 mg folic acid in a daily multivitamin for at least 2 to 3 months prior to pregnancy. Women of childbearing age at moderate or high risk for bearing an offspring with a neural tube defect should consume a 1 and 4.0 mg folic acid supplement, respectively, at least 3 months prior to conceiving and until 12 weeks gestational age. Thereafter, daily supplementation should consist of a multivitamin with 0.4 to 1.0 mg folic acid throughout pregnancy and postpartum as long as breastfeeding continues.(III-A)
      • 2.
        Promote increased dietary intake for women who are ovulating abnormally due to underweight by encouraging increased meal frequency and size, and avoidance of fasting, meal-skipping, and excessive exercise. (II-3A)
      • 3.
        Provide a weight-management strategy for women who are ovulating abnormally due to overweight by recommending strategies such as appropriate dietary adjustments, increased physical activity, and reduced sedentary behaviour. (II-2A)
      • 4.
        Recommend a low glycemic index diet to overweight women with polycystic ovary syndrome to improve insulin sensitivity and fertility. (I-A)

      Chapter 5: Nutrition in Pregnancy

      Summary Statements
      • 1.
        High-quality dietary intake and appropriate food selections are important for all pregnant women, and can be achieved by following Canada’s Food Guide as applied to pregnancy. Food selections should emphasize choosing a variety of nutrient-dense foods from all 4 food groups, as opposed to energy-dense, nutrient-poor foods. A nutrient-rich, energy-appropriate diet will help to ensure a woman’s own nutritional requirements are met and facilitate healthy development of her fetus throughout the pregnancy. (III)
      • 2.
        The amount of energy required to support pregnancy (for women with a pre-pregnancy body mass index of 18.5 to 25) is modest, with no recommended increase in calorie intake during the first trimester and an increase of only 340 and 450 kcal/day in the second and third trimesters, respectively. This generally equates to only 2 to 3 additional Canada’s Food Guide servings per day from any of the 4 food groups in the second and third trimesters. (III) Energy requirements for women with a pre-pregnancy body mass index above 25 kg/m are not well established.
      Recommendations
      • 1.
        Measure and discuss weight gain for pregnancy with all women as early in pregnancy and as regularly as is feasible. Recommendations for the range of pregnancy-related weight gain should be based on the woman’s pre-pregnancy body mass index ( Table 6). Gaining weight within recommended ranges will help to optimize maternal, infant, and child health outcomes. (III-A)
      • 2.
        Women who have not met the minimum or have exceeded the maximum amount of weight gain recommended for a specific gestational age require additional follow-up and assessment. They should be encouraged to increase or slow their rate of weight gain to fall within the recommended ranges of weekly rate of gain until delivery. (III-A)
      • 3.
        Support women in understanding how to meet recommendations for specific nutrients of concern during pregnancy, which include folate, iron, choline, omega-3 fatty acids, and iodine. (III-A)
      • 4.
        Follow the 2015 Society of Obstetricians and Gynaecologists of Canada guideline for the supplementary use of folic acid by pregnant women. Pregnant women at low or moderate risk for bearing an offspring with a neural tube defect should consume 0.4 and 1 mg folic acid, respectively, in a daily multivitamin or if they are at high risk for bearing offspring with neural tube defects, a 4.0 mg folic acid supplement 12 weeks prior to and after conception followed by 0.4 to 1 mg until weaning. (II-2A) Caution women not to take more than 1 daily dose of their multivitamin. (III-B)
      • 5.
        Recommend a supplement containing 16 to 20 mg of elemental iron to pregnant women who are in good health. Therapeutic doses of iron may be required for women demonstrating biochemical evidence of iron deficiency. (e.g., a low hemoglobin and a serum ferritin <30 ug/L at any point during pregnancy). (I-A)
      • 6.
        Emerging evidence suggests that choline (II-2B), omega-3 fatty acids (I-A), and iodine (I-B) are important nutrients that may be limited in the diets that pregnant women consume. Discuss foods rich in these nutrients (e.g., eggs for choline; fatty fish and nuts/seeds for omega-3 fatty acids; saltwater fish low in methylmercury; and iodized salt) with women as the pregnancy progresses.
      • 7.
        Emphasize the importance of limiting or avoiding certain foods during pregnancy (e.g., avoid foods potentially contaminated with bacteria and fish with high levels of methylmercury). Many herbs should be limited or avoided during pregnancy ( Appendix B). (III-A)
      • 8.
        Follow the 2010 Society of Obstetricians and Gynaecologists of Canada guideline for alcohol use during pregnancy. There is evidence that alcohol consumption in pregnancy can cause fetal harm. (II-2A) There is insufficient evidence regarding fetal safety or harm at low levels of alcohol consumption in pregnancy. (III-C)

      Chapter 6: Postpartum Nutrition and Lactation

      Summary Statements
      • 1.
        Optimal postpartum nutrition can be achieved by consuming a high-quality and varied diet following Canada’s Food Guide. The elevated nutritional requirements of breastfeeding women can be met by consuming 2 to 3 extra servings each day from any of the 4 groups from Canada’s Food Guide and a multivitamin supplement, as during pregnancy. These extra servings will supply the modest increase in energy requirements to support lactation (∼ 350 to 400 kcal over pre-pregnancy requirements). (III)
      • 2.
        Gradual weight loss postpartum to achieve pre-pregnancy weight and a healthy body weight is encouraged. There is little evidence that either breastmilk volume or nutrient content is adversely affected by gradual postpartum weight loss and exercise. (I)
      • 3.
        Breastfeeding is the normal and unequalled method of feeding infants. Exclusive breastfeeding should be encouraged for the first 6 months, and sustained for up to 2 years or longer, with appropriate complementary feeding of infants. (I)
      Recommendations
      • 1.
        Emphasize the need for appropriate nutrition to achieve a healthy body weight postpartum (I-A) and promote lactation. (II-2B)
      • 2.
        Discuss the benefits of exclusive breastfeeding for improving short- and long-term health outcomes for the mother and infant. (II-2A)
      • 3.
        A reduction in caloric intake of 500 kcal/day and participation in moderate aerobic exercise (walking, jogging, dancing; 65% to 80% maximum heart rate) 4 days per week should promote a gradual measured weight loss of 0.5 kg/week postpartum. (I-A)
      • 4.
        Advise lactating mothers to provide their infants with 400 IU of vitamin D per day. (I-A)
      • 5.
        Women should consume at least 150 g of fish each week, as fatty fish are an important source of docosahexaenoic acid. However, lactating women need to limit consumption of tuna, shark, swordfish, marlin, orange roughy, and escolar to < 150 g per month. Lactating women should avoid canned albacore (white) tuna, but may consume up to 300 g/week of light canned tuna. (III-A)
      • 6.
        Maternal intake of allergy and infant colic-associated foods (dairy, eggs, peanuts, tree nuts, wheat, soy, and fish) and cruciferous vegetables, cow’s milk, onion, and chocolate have been associated with colic symptoms in exclusively breastfed young infants, but not allergy formation in the child. Eliminate foods one at a time to determine association with infant symptoms. (I-B)
      • 7.
        Bulk-forming laxatives (psyllium or methylcellulose) are not absorbed by the gut and should not have negative consequences for the breastfed infant. Stimulant laxatives should be avoided. (III-A)
      • 8.
        Women with hemorrhoids or perineal injury are advised to eat a high-fibre diet along with adequate water intake ( Table 7). (I-A)

      Chapter 7: Nutrition During Menopause and Beyond

      Summary Statement
      • 1.
        Changes in women’s health, social, or family circumstances at the time of menopause may adversely impact nutrition (e.g., changes in meal habits, distracted eating, ill health, mood, family stresses). (III)
      Recommendations
      • 1.
        Women are often concerned with perimenopausal weight gain; advise that weight gain can be reduced by modest calorie restriction, along with adequate protein intake (0.8 to 1.2 g/kg divided over 3 meals). (III-B)
      • 2.
        Insulin resistance increases with age; recommend that menopausal women consume complex carbohydrates with a low glycemic index. (II-2B)
      • 3.
        Recommend regular, weight-bearing exercise to preserve skeletal muscle mass. (I-A)
      • 4.
        To preserve bone health, advise a daily intake of 1200 mg calcium and 800 IU vitamin D to menopausal women, along with regular moderate- to vigorous-intensity physical activity of at least 2.5 hours per week which includes weight-bearing activity (see Chapter 2 for more detail on calcium supplementation). (I-A)
      • 5.
        Menopausal women are less likely to absorb naturally occurring vitamin B12 (II-2A) and should aim to consume 2.4 μg/day through fortified foods (e.g., non-dairy milks, meat substitutes) or supplements, and may benefit from having their B12 status assessed. (I-A)

      Key Words

      Abbreviations:

      AI ( adequate intake), ALA ( alpha-linolenic acid), BMI ( body mass index), CFG ( Canada’s Food Guide), CPNP ( Canada Prenatal Nutrition Program), CVD ( cardiovascular disease), DASH ( Dietary Approaches to Stop Hypertension), DHA ( docosahexaenoic acid), DRI ( Dietary Reference Intakes), EAR ( estimated average requirement), GDM ( gestational diabetes mellitus), GWG ( gestational weight gain), LGA ( large for gestational age), NTD ( neural tube defect), PCOS ( polycystic ovary syndrome), PHAC ( Public Health Agency of Canada), RDA ( recommended dietary allowance), SGA ( small for gestational age), SOGC ( Society of Obstetricians and Gynaecologists of Canda), UL ( tolerable upper intake level), WHI ( Women’s Health Initiative)
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      Chapter 3: Adolescent Nutrition

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        Family dinner meal frequency and adolescent development: relationships with developmental assets and high-risk behaviors.
        J Adolesc Health. 2006; 39: 337-345
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        • Institute of Medicine
        Dietary Reference Intakes for calcium and vitamin D.
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        • Corey P.
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        A comparison of micronutrient inadequacy and risk of high micronutrient intakes among vitamin and mineral supplement users and nonusers in Canada.
        J Nutr. 2012; 142: 534-540
        • Taylor C.L.
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        Appropriateness of the probability approach with a nutrient status biomarker to assess population inadequacy: a study using vitamin D.
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        • Vatanparast H.
        • Greene-Finestone L.
        The vitamin status of Canadians relative to the 2011 Dietary Reference Intakes: an examination in children and adults with and without supplement use.
        Am J Clin Nutr. 2011; 94: 128-135
        • Rosen D.
        Identification and management of eating disorders in children and adolescents.
        Pediatrics. 2010; 126: 1240-1253
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        • Micali N.
        • House J.
        Assessment measures for child and adolescent eating disorders: a review.
        Child Adolesc Mental Health. 2010; 16: 122-127
        • Golden N.H.
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        Eating disorders in adolescents: position paper of the Society for Adolescent Medicine.
        J Adolesc Health. 2003; 33: 496-503
        • Ozier A.
        • Henry B.
        • The American Dietetic Association
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        J Am Diet Assoc. 2011; 111: 1236-1241
      4. Feeding and eating disorders.
        (DSM-5)in: American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. American Psychiatric Association, Arlington, VA2013
      5. Canadian Pediatric Society. Condition-Specific Screening Tools and Rating Scales. 2014. Available at: http://www.cps.ca/en/tools-outils/condition-specific-screening-tools-and-rating-scales#eating-disorders. Accessed on August 20, 2015.

        • Maloney M.J.
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        • Daniels S.R.
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        J Am Acad Child Adolesc Psychiatry. 1988; 27: 541-543
        • Golden N.H.
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        J Adolesc Health. 2015; 56: 370-375
        • Society for Adolescent Health and Medicine
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        • Katzman D.K.
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        J Adolesc Health. 2015; 56: 121-125

      Chapter 4: Pre-conceptual Nutrition

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        • Margerison Zilko C.E.
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        Association of maternal gestational weight gain with short- and long-term maternal and child health outcomes.
        Am J Obstet Gynecol. 2010; 202: 574-578
      2. Tjepkema M. Measured obesity. Adult obesity in Canada: measured height and weight. 2005. Available at: http://aboutmen.ca/application/www.aboutmen.ca/asset/upload/tiny_mce/page/link/Adult-Obesity-in-Canada.pdf. Accessed on April 16, 2016.

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        Pre-conception folic acid and multivitamin supplementation for the primary and secondary prevention of neural tube defects and other folic acid-sensitive congenital anomalies.
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        • Practice Committee of the American Society for Reproductive Medicine
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        Fertil Steril. 2016; 105: 364-368
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      3. Canadian Diabetes Association. The Glycemic Index. 2015. Available at: http://www.diabetes.ca/diabetes-and-you/healthy-living-resources/diet-nutrition/the-glycemic-index. Accessed on November 13, 2015.

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        Fertil Steril. 2004; 81: 1578-1584

      Chapter 5: Nutrition in Pregnancy

      1. Health Canada. Canada’s Food Guide: Pregnancy and Breastfeeding. 2011. Available at: http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/choose-choix/advice-conseil/women-femmes-eng.php. Accessed on November 17, 2015.

      2. Health Canada. Prenatal Nutrition. 2011. Available at: http://www.hc-sc.gc.ca/fn-an/nutrition/prenatal/index-eng.php. Accessed on November 17, 2015.

        • King J.
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        The nutritional basis of the fetal origins of adult disease.
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        J Hum Nutr Diet. 2015; 28: 1-14
        • Institute of Medicine
        Dietary Reference Intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids.
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        Protein requirements of healthy pregnant women during early and late gestation are higher than current recommendations.
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      3. Rasmussen KM, Yaktine AL. Weight Gain During Pregnancy: Reexamining the Guidelines. 2009. Available at: http://www.nap.edu/catalog.php?record_id=12584. Accessed on November 17, 2015.

      4. Health Canada. Prenatal Nutrition Guidelines for Health Professionals. Gestational Weight Gain. 2010. Available at: http://www.hc-sc.gc.ca/fn-an/nutrition/prenatal/ewba-mbsa-eng.php. Accessed on April 16, 2016.

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        The association between pregnancy weight gain and birthweight: a within-family comparison.
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        Health Rep. 2010; 21: 31-36
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        J Nutr. 2015; 145: 1263-1270
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        J Obstet Gynaecol Can. 2009; 31: 28-35
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        Contribution of prepregnancy body mass index and gestational weight gain to adverse neonatal outcomes: population attributable fractions for Canada.
        BMC Pregnancy Childbirth. 2015; 15: 21
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        Obesity and early cessation of breastfeeding in Denmark.
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        Obes Rev. 2013; 15: 338-347
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        Gestational weight gain in accordance to the IOM/NRC criteria and the risk for childhood overweight: a meta-analysis.
        Pediatr Obes. 2013; 8: 218-224
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        Am J Obstet Gynecol. 2007; 196: 322-328
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        Trends in pre-pregnancy obesity in nine states, 1993-2003.
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        Am J Obstet Gynecol. 2010; 202: 574-578
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        Committee on Implementation of the Institute of Medicine Pregnancy Weight Gain Guidelines, Board on Children, Youth, and Families, Food and Nutrition Board, Institute of Medicine, National Research Council. Leveraging action to support dissemination of the pregnancy weight gain guidelines.
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        Health Rep. 2012; 23: 3-10
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        J Nutr. 2015; 145: 1824-1834
        • Institute of Medicine
        Dietary Reference Intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline.
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        • Institute of Medicine
        Dietary Reference Intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc.
        The National Academies Press, Washington, DC2001
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        Omega-3 supplementation during pregnancy to prevent recurrent intrauterine growth restriction: systematic review and meta-analysis of randomized controlled trials.
        Ultrasound Obstet Gynecol. 2015; 46: 659-664
        • Swanson C.A.
        • Pearce E.N.
        Iodine insufficiency: a global health problem?.
        Adv Nutr. 2013; 4: 533-535
      7. Canadian Food Inspection Agency. Labelling Requirements for Salt: Iodide Declaration. 2015. Available at: http://inspection.gc.ca/food/labelling/food-labelling-for-industry/salt/eng/1391790253201/1391795959629?chap=5#s6c5. Accessed on August 23, 2015.

      8. Statistics Canada. Iodine Status of Canadians, 2009-2011. 2013. Available at: http://www.statcan.gc.ca/pub/82-625-x/2012001/article/11733-eng.htm. Accessed on August 23, 2015.

        • Zimmermann M.B.
        • Andersson M.
        Assessment of iodine nutrition in populations: past, present, and future.
        Nutr Rev. 2012; 70: 553-570
        • Caldwell K.L.
        • Jones R.
        • Hollowell J.G.
        Urinary iodine concentration: United States National Health and Nutrition Examination Survey 2001-2002.
        Thyroid. 2005; 15: 692-699
        • Perrine C.G.
        • Herrick K.
        • Serdula M.K.
        • Sullivan K.M.
        Some subgroups of reproductive age women in the United States may be at risk for iodine deficiency.
        J Nutr. 2010; 140: 1489-1494
        • Charlton K.E.
        • Yeatman H.
        • Brock E.
        • Lucas C.
        • Gemming L.
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        • et al.
        Improvement in iodine status of pregnant Australian women 3 years after introduction of a mandatory iodine fortification programme.
        Prev Med. 2013; 57: 26-30
        • Andersen S.L.
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        • Krejbjerg A.
        • Moller M.
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        Iodine status in Danish pregnant and breastfeeding women including studies of some challenges in urinary iodine status evaluation.
        J Trace Elem Med Biol. 2015; 31: 285-289
        • Bath S.C.
        • Furmidge-Owen V.L.
        • Redman C.W.
        • Rayman M.P.
        Gestational changes in iodine status in a cohort study of pregnant women from the United Kingdom: season as an effect modifier.
        Am J Clin Nutr. 2015; 101: 1180-1187
        • Mian C.
        • Vitaliano P.
        • Pozza D.
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        Iodine status in pregnancy: role of dietary habits and geographical origin.
        Clin Endocrinol (Oxf). 2009; 70: 776-780
      9. Public Health Agency of Canada. Summative Evaluation of the Canada Prenatal Nutrition Program 2004-2009. 2010. Available at: http://www.phac-aspc.gc.ca/about_apropos/evaluation/reports-rapports/2009-2010/cpnp-pcnp/index-eng.php. Accessed on April 16, 2016.

        • Lee N.M.
        • Saha S.
        Nausea and vomiting of pregnancy.
        Gastroenterol Clin North Am. 2011; 40 (vii): 309-334
        • Gadsby R.
        • Barnie-Adshead A.M.
        • Jagger C.
        A prospective study of nausea and vomiting during pregnancy.
        Br J Gen Pract. 1993; 43: 245-248
        • Arsenault M.Y.
        • Lane C.A.
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        • et al.
        The management of nausea and vomiting of pregnancy.
        J Obstet Gynaecol Can. 2002; 24 (quiz 32–3): 817-831
        • Carson G.
        • Cox L.V.
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        • Croteau P.
        • Graves L.
        • Kluka S.
        • et al.
        Alcohol use and pregnancy consensus clinical guidelines.
        J Obstet Gynaecol Can. 2010; 32: S1-S31

      Chapter 6: Postpartum Nutrition and Lactation

        • Ip S.
        • Chung M.
        • Raman G.
        • Chew P.
        • Magula N.
        • DeVine D.
        • et al.
        Breastfeeding and maternal and infant health outcomes in developed countries [evidence report/technology assessment No. 153].
        Agency for Healthcare Research and Quality, Rockville, MD2007
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        • Layte R.
        Obesity levels in a national cohort of women 9 months after delivery.
        Am J Obstet Gynecol. 2013; 209: 124.e1-124.e7
        • Callegari L.S.
        • Sterling L.A.
        • Zelek S.T.
        • Reed S.D.
        Interpregnancy body mass index change and success of vaginal birth after cesarean.
        Am J Obstet Gynecol. 2014; 210: 330.e1-330.e7
        • Turcksin R.
        • Bel S.
        • Galjaard S.
        • Devlieger R.
        Maternal obesity and breastfeeding intention, initiation, intensity and duration: a systematic review.
        Matern Child Nutr. 2014; 10: 166-183
        • Monasta L.
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        • Cattaneo A.
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        • et al.
        Early-life determinants of overweight and obesity: a review of systematic reviews.
        Obes Rev. 2010; 11: 695-708
        • Chowdhury R.
        • Sinha B.
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        • Taneja S.
        • Bhandari N.
        • Rollins N.
        • et al.
        Breastfeeding and maternal health outcomes: a systematic review and meta-analysis.
        Acta Paediatr. 2015; 104: 96-113
        • Slusser W.
        Breastfeeding and maternal and infant health outcomes in developed countries.
        AAP Grand Rounds. 2007; 18: 15-16
        • Rasmussen K.M.
        • Kjolhede C.L.
        Prepregnant overweight and obesity diminish the prolactin response to suckling in the first week postpartum.
        Pediatrics. 2004; 113: e465-e471
        • Powe C.E.
        • Allen M.
        • Puopolo K.M.
        • Merewood A.
        • Worden S.
        • Johnson L.C.
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        Recombinant human prolactin for the treatment of lactation insufficiency.
        Clin Endocrinol (Oxf). 2010; 73: 645-653
        • Powe C.E.
        • Puopolo K.M.
        • Newburg D.S.
        • Lonnerdal B.
        • Chen C.
        • Allen M.
        • et al.
        Effects of recombinant human prolactin on breast milk composition.
        Pediatrics. 2011; 127: e359-e366
      1. Health Canada. Canada’s Food Guide: Pregnancy and Breastfeeding. 2011. Available at: http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/choose-choix/advice-conseil/women-femmes-eng.php. Accessed on November 17, 2015.

        • Wilson D.R.
        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: 534-549
        • Institute of Medicine
        Dietary Reference Intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids.
        The National Academies Press, Washington, DC2005
        • Endres L.K.
        • Straub H.
        • McKinney C.
        • Plunkett B.
        • Minkovitz C.S.
        • Schetter C.D.
        • et al.
        Postpartum weight retention risk factors and relationship to obesity at 1 year.
        Obstet Gynecol. 2015; 125: 144-152
        • Institute of Medicine
        Weight gain during pregnancy: reexamining the guidelines.
        The National Academies Press, Washington, DC2009
        • Begum F.
        • Colman I.
        • McCargar L.J.
        • Bell R.C.
        Gestational weight gain and early postpartum weight retention in a prospective cohort of Alberta women.
        J Obstet Gynaecol Can. 2012; 34: 637-647
        • Kirkegaard H.
        • Stovring H.
        • Rasmussen K.M.
        • Abrams B.
        • Sorensen T.I.
        • Nohr E.A.
        How do pregnancy-related weight changes and breastfeeding relate to maternal weight and BMI-adjusted waist circumference 7 y after delivery? Results from a path analysis.
        Am J Clin Nutr. 2014; 99: 312-319
      2. National Institute for Clinical Health and Excellence. Weight Management Before, During and After Pregnancy. 2010. Available at: https://www.nice.org.uk/guidance/ph27. Accessed on November 17, 2015.

        • Brauer P.
        • Connor Gorber S.
        • Shaw E.
        • Singh H.
        • Bell N.
        • Shane A.R.
        • et al.
        Recommendations for prevention of weight gain and use of behavioural and pharmacologic interventions to manage overweight and obesity in adults in primary care.
        Can Med Assoc J. 2015; 187: 184-195
        • Lau D.
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        • Morrison K.
        • Hramiak I.
        • Sharma A.
        • Ur E.
        Canadian clinical practice guidelines on the management and prevention of obesity in adults and children.
        Can Med Assoc J. 2007; 176 ([summary]): S1-S13
        • Canadian Task Force on Preventive Health Care
        Recommendations for growth monitoring, and prevention and management of overweight and obesity in children and youth in primary care.
        CMAJ. 2015; 187: 411-421
        • Spear B.
        • Barlow S.
        • Ervin C.
        • Ludwig D.
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        • et al.
        Recommendations for the treatment of child and adolescent overweight and obesity.
        Pediatrics. 2007; 120: S254-S288
        • O’Connor D.L.
        • Houghton L.A.
        • Sherwood K.L.
        Nutrition issues during lactation.
        in: Lammi-Keefe C.J. Couch S.C. Elliot H. Handbook of nutrition and pregnancy. Humana Press, Totowa, NJ2008: 257-282
      3. Health Canada. Prenatal Nutrition Guidelines for Health Professionals. Gestational Weight Gain. 2010. Available at http://www.hc-sc.gc.ca/fn-an/nutrition/prenatal/ewba-mbsa-eng.php. Accessed on April 16, 2016.

        • Davies G.A.
        • Wolfe L.A.
        • Mottola M.F.
        • MacKinnon C.
        Society of Obstetricians and Gynaecologists of Canada, SOGC Clinical Practice Obstetrics Committee. Joint SOGC/CSEP clinical practice guideline: exercise in pregnancy and the postpartum period.
        Can J Appl Physiol. 2003; 28: 330-341
        • Amorim Adegboye A.R.
        • Linne Y.M.
        • Lourenco P.M.
        Diet or exercise, or both, for weight reduction in women after childbirth.
        Cochrane Database Syst Rev. 2007; 18: CD005627
        • Lovelady C.
        Balancing exercise and food intake with lactation to promote post-partum weight loss.
        Proc Nutr Soc. 2011; 70: 181-184
        • Lovelady C.A.
        • Garner K.E.
        • Moreno K.L.
        • Williams J.P.
        The effect of weight loss in overweight, lactating women on the growth of their infants.
        N Engl J Med. 2000; 342: 449-453
        • He X.
        • Zhu M.
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        • Wang Q.
        • et al.
        Breast-feeding and postpartum weight retention: a systematic review and meta-analysis.
        Public Health Nutr. 2015; 18: 3308-3316
        • Neville C.E.
        • McKinley M.C.
        • Holmes V.A.
        • Spence D.
        • Woodside J.V.
        The relationship between breastfeeding and postpartum weight change—a systematic review and critical evaluation.
        Int J Obes (Lond). 2014; 38: 577-590
        • Fehler K.L.
        • Kennedy L.E.
        • McCargar L.
        • Bell R.
        • Ryan E.
        Postpartum dietary changes in women with previous gestational diabetes mellitus.
        Can J Diabetes. 2007; 31: 54-61
        • Gunderson
        • et al.
        Lactation and Progression to Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus: A Prospective Cohort Study.
        Ann Intern Med. 2015; 163 (http://dx.doi.org/10.7326/M15-0807): 889-898
        • Allen L.H.
        B vitamins in breast milk: relative importance of maternal status and intake, and effects on infant status and function.
        Adv Nutr. 2012; 3: 362-369
        • Shakur Y.A.
        • Tarasuk V.
        • Corey P.
        • O’Connor D.L.
        A comparison of micronutrient inadequacy and risk of high micronutrient intakes among vitamin and mineral supplement users and nonusers in Canada.
        J Nutr. 2012; 142: 534-540
        • Institute of Medicine
        Dietary Reference Intakes for vitamin C, vitamin E, selenium, and carotenoids.
        The National Academies Press, Washington, DC2000
        • Pfeiffer C.M.
        • Sternberg M.R.
        • Schleicher R.L.
        • Haynes B.M.
        • Rybak M.E.
        • Pirkle J.L.
        The CDC’s second national report on biochemical indicators of diet and nutrition in the U.S. population is a valuable tool for researchers and policy makers.
        J Nutr. 2013; 143: 938S-947S
      4. Statistics Canada. Iodine status of Canadians, 2009-2011. 2013. Available at: http://www.statcan.gc.ca/pub/82-625-x/2012001/article/11733-eng.htm. Accessed on August 23, 2015.

        • Caldwell K.L.
        • Jones R.
        • Hollowell J.G.
        Urinary iodine concentration: United States National Health And Nutrition Examination Survey 2001-2002.
        Thyroid. 2005; 15: 692-699
        • Perrine C.G.
        • Herrick K.
        • Serdula M.K.
        • Sullivan K.M.
        Some subgroups of reproductive age women in the United States may be at risk for iodine deficiency.
        J Nutr. 2010; 140: 1489-1494
      5. Health Canada. Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months. 2015. Available at: http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/recom/index-eng.php. Accessed on August 29, 2015.

        • Hollis B.W.
        • Wagner C.L.
        • Howard C.R.
        • Ebeling M.
        • Shary J.R.
        • Smith P.G.
        • et al.
        Maternal versus infant vitamin D supplementation during lactation: a randomized controlled trial.
        Pediatrics. 2015; 136: 625-634
        • Kulie T.
        • Groff A.
        • Redmer J.
        • Hounshell J.
        • Schrager S.
        • Vitamin D.
        an evidence-based review.
        J Am Board Fam Med. 2009; 22: 698-706
        • Wagner C.L.
        • Hulsey T.C.
        • Fanning D.
        • Ebeling M.
        • Hollis B.W.
        High-dose vitamin D3 supplementation in a cohort of breastfeeding mothers and their infants: a 6-month follow-up pilot study.
        Breastfeed Med. 2006; 1: 59-70
        • Perumal N.
        • Al Mahmud A.
        • Baqui A.H.
        • Roth D.E.
        Prenatal vitamin D supplementation and infant vitamin D status in Bangladesh.
        Public Health Nutr. 2015; ([e-pub ahead of print]): 1-9
        • Institute of Medicine
        Dietary Reference Intakes for calcium and vitamin D.
        The National Academies Press, Washington, DC2011
        • March K.M.
        • Chen N.N.
        • Karakochuk C.D.
        • Shand A.W.
        • Innis S.M.
        • von Dadelszen P.
        • et al.
        Maternal vitamin D(3) supplementation at 50 μg/d protects against low serum 25-hydroxyvitamin D in infants at 8 wk of age: a randomized controlled trial of 3 doses of vitamin D beginning in gestation and continued in lactation.
        Am J Clin Nutr. 2015; 102: 402-410
        • Innis S.M.
        Impact of maternal diet on human milk composition and neurological development of infants.
        Am J Clin Nutr. 2014; 99: 734S-741S
        • Delgado-Noguera M.F.
        • Calvache J.A.
        • Bonfill Cosp X.
        • Kotanidou E.P.
        • Galli-Tsinopoulou A.
        Supplementation with long chain polyunsaturated fatty acids (LCPUFA) to breastfeeding mothers for improving child growth and development.
        Cochrane Database Syst Rev. 2015; 7: CD007901
      6. Gionet L. Health at a Glance: Breastfeeding Trends in Canada [Statistics Canada]. 2013. Available at: http://www.statcan.gc.ca/pub/82-624-x/2013001/article/11879-eng.pdf. Accessed on April 17, 2016.

        • Brown C.R.
        • Dodds L.
        • Legge A.
        • Bryanton J.
        • Semenic S.
        Factors influencing the reasons why mothers stop breastfeeding.
        Can J Public Health. 2014; 105: e179-e185
      7. Dietitians of Canada. Registered Dietitians in Aboriginal Communities: Feeding Mind, Body and Spirit. 2012. Available at: http://www.dietitians.ca/Downloads/Public/ANN-Report-Final-2012.aspx. Accessed on November 18, 2015.

      8. Health Canada. Breastfeeding Initiation in Canada: Key Statistics and Graphics (2009-2010). 2012. Available at: http://www.hc-sc.gc.ca/fn-an/surveill/nutrition/commun/prenatal/initiation-eng.php. Accessed on November 19, 2015.

      9. La Leche League. La Leche League Canada - Supporting breastfeeding families since 1961. Available at: www.lllc.ca. Accessed on November 19, 2015.

      10. Public Health Agency of Canada. Ten Valuable Tips for Successful Breastfeeding. 2009. Available at: http://www.phac-aspc.gc.ca/hp-ps/dca-dea/stages-etapes/childhood-enfance_0-2/nutrition/tips-cons-eng.php. Accessed on November 19, 2015.

        • Greer F.R.
        • Sicherer S.H.
        • Burks A.W.
        • American Academy of Pediatrics Committee on Nutrition, American Academy of Pediatrics Section on Allergy and Immunology
        Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas.
        Pediatrics. 2008; 121: 183-191
        • Nocerino R.
        • Pezzella V.
        • Cosenza L.
        • Amoroso A.
        • Di Scala C.
        • Amato F.
        • et al.
        The controversial role of food allergy in infantile colic: evidence and clinical management.
        Nutrients. 2015; 7: 2015-2025
      11. Health Canada. Nutrition for Healthy Term Infants: Recommendations from Six to 24 Months. 2015. Available at: http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/recom/recom-6-24-months-6-24-mois-eng.php. Accessed on November 18, 2015.

        • Hall B.
        • Chesters J.
        • Robinson A.
        Infantile colic: a systematic review of medical and conventional therapies.
        J Paediatr Child Health. 2012; 48: 128-137
        • Iacovou M.
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        • Walker K.Z.
        • Truby H.
        Dietary management of infantile colic: a systematic review.
        Matern Child Health J. 2012; 16: 1319-1331
        • Lust K.D.
        • Brown J.E.
        • Thomas W.
        Maternal intake of cruciferous vegetables and other foods and colic symptoms in exclusively breast-fed infants.
        J Am Diet Assoc. 1996; 96: 46-48
        • Critch J.
        Infantile colic: is there a role for dietary interventions?.
        Paediatr Child Health. 2011; 16: 47-49
        • Thalheimer J.C.
        Recognizing cow’s milk protein allergy in infants - evidence shows eliminating milk and soy can help.
        Today’s Dietitian. 2012; 14: 14
      12. Health Canada. Consumption Advice: Making Informed Choices about Fish. 2008. Available at: http://www.hc-sc.gc.ca/fn-an/securit/chem-chim/environ/mercur/cons-adv-etud-eng.php. Accessed on November 18, 2011.

        • Ross C.
        Maternal caffeine consumption and infant nighttime waking: prospective cohort study.
        Breastfeed Rev. 2012; 20: 56
        • Bowen A.
        • Tumback L.
        Alcohol and breastfeeding: dispelling the myths and promoting the evidence.
        Nurs Womens Health. 2010; 14: 454-461
      13. Queensland Government. Community Profiles for Health Care Providers. 2011. Available at: https://www.health.qld.gov.au/multicultural/health_workers/profiles-complete.pdf. Accessed on November 17, 2015.

        • Chen L.W.
        • Low Y.L.
        • Fok D.
        • Han W.M.
        • Chong Y.S.
        • Gluckman P.
        • et al.
        Dietary changes during pregnancy and the postpartum period in Singaporean Chinese, Malay and Indian women: the GUSTO birth cohort study.
        Pub Health Nutr. 2014; 17: 1930-1938
        • Ravindran A.V.
        • Lam R.W.
        • Filteau M.J.
        • Lesperance F.
        • Kennedy S.H.
        • Parikh S.V.
        • et al.
        Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. V. Complementary and alternative medicine treatments.
        J Affect Disord. 2009; 117: S54-S64
        • Price Judge M.
        • Tatano Beck C.
        Postpartum depression and the role of nutritional factors.
        in: Lammi-Keefe C.J. Couch S.C. Philipson E.H. Handbook of nutrition and pregnancy. Human Press, Totowa, NJ2008
        • von Soest T.
        • Wichstrom L.
        The impact of becoming a mother on eating problems.
        Int J Eat Disord. 2008; 41: 215-223
        • Mazzeo S.E.
        • Slof-Op’t Landt M.C.
        • Jones I.
        • Mitchell K.
        • Kendler K.S.
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        • et al.
        Associations among postpartum depression, eating disorders, and perfectionism in a population-based sample of adult women.
        Int J Eat Disord. 2006; 39: 202-211
      14. National Institute for Health and Clinical Excellence. Routine postnatal care of women and their babies. 2006. Available at: https://www.nice.org.uk/guidance/cg37/evidence/full-guideline-485782237. Accessed on April 17, 2016.

        • Shin G.H.
        • Toto E.L.
        • Schey R.
        Pregnancy and postpartum bowel changes: constipation and fecal incontinence.
        Am J Gastroenterol. 2015; 110 (quiz 30): 521-529
        • Nice F.J.
        • Snyder J.L.
        • Kotansky B.C.
        Breastfeeding and over-the-counter medications.
        J Hum Lact. 2000; 16: 319-331
        • Han Y.H.
        • Yon M.Y.
        • Hyun T.S.
        Effect of prune supplementation on dietary fiber intake and constipation relief.
        Korean J Community Nutr. 2008; 13: 426-438
        • Derbyshire E.
        • Davies J.
        • Costarelli V.
        • Dettmar P.
        Diet, physical inactivity and the prevalence of constipation throughout and after pregnancy.
        Matern Child Nutr. 2006; 2: 127-134
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        • Rohwer A.C.
        Interventions for treating postpartum constipation.
        Cochrane Database Syst Rev. 2014; 9: CD010273
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      Chapter 7: Nutrition During Menopause and Beyond

        • Harlow S.D.
        • Gass M.
        • Hall J.E.
        • Lobo R.
        • Maki P.
        • Rebar R.W.
        • et al.
        Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging.
        Menopause. 2012; 19: 387-395
        • Bowman S.A.
        Television-viewing characteristics of adults: correlations to eating practices and overweight and health status.
        Prev Chronic Dis. 2006; 3: A38
        • Hingle M.D.
        • Wertheim B.C.
        • Tindle H.A.
        • Tinker L.
        • Seguin R.A.
        • Rosal M.C.
        • et al.
        Optimism and diet quality in the Women’s Health Initiative.
        J Acad Nutr Diet. 2014; 114: 1036-1045
        • Sowers M.
        • Zheng H.
        • Tomey K.
        • Karvonen-Gutierrez C.
        • Jannausch M.
        • Li X.
        • et al.
        Changes in body composition in women over six years at midlife: ovarian and chronological aging.
        J Clin Endocrinol Metab. 2007; 92: 895-901
        • Sternfeld B.
        • Wang H.
        • Quesenberry Jr., C.P.
        • Abrams B.
        • Everson-Rose S.A.
        • Greendale G.A.
        • et al.
        Physical activity and changes in weight and waist circumference in midlife women: findings from the Study of Women’s Health Across the Nation.
        Am J Epidemiol. 2004; 160: 912-922
        • Davis S.R.
        • Castelo-Branco C.
        • Chedraui P.
        • Lumsden M.A.
        • Nappi R.E.
        • Shah D.
        • et al.
        Understanding weight gain at menopause.
        Climacteric. 2012; 15: 419-429
        • Norman R.J.
        • Flight I.H.
        • Rees M.C.
        Oestrogen and progestogen hormone replacement therapy for peri-menopausal and post-menopausal women: weight and body fat distribution.
        Cochrane Database Syst Rev. 2000; : Cd001018
        • Jensen L.B.
        • Vestergaard P.
        • Hermann A.P.
        • Gram J.
        • Eiken P.
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        • et al.
        Hormone replacement therapy dissociates fat mass and bone mass, and tends to reduce weight gain in early postmenopausal women: a randomized controlled 5-year clinical trial of the Danish Osteoporosis Prevention Study.
        J Bone Miner Res. 2003; 18: 333-342
        • Guthrie J.R.
        • Dennerstein L.
        • Dudley E.C.
        Weight gain and the menopause: a 5-year prospective study.
        Climacteric. 1999; 2: 205-211
        • Chen Z.
        • Bassford T.
        • Green S.B.
        • Cauley J.A.
        • Jackson R.D.
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        • et al.
        Postmenopausal hormone therapy and body composition—a substudy of the estrogen plus progestin trial of the Women’s Health Initiative.
        Am J Clin Nutr. 2005; 82: 651-656
        • World Health Organization
        Diet, nutrition and the prevention of chronic diseases.
        World Health Organization, Geneva, Switzerland2003
        • Neuhouser M.L.
        • Aragaki A.K.
        • Prentice R.L.
        • Manson J.E.
        • Chlebowski R.
        • Carty C.L.
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      Références

      Appendix A∗: Dietary Reference Intakes Tables

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      Appendix B: Foods to Avoid/Limit During Pregnancy

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      8. Health Canada. Monograph: Fennel, Bitter. 2008. Available at: http://webprod.hc-sc.gc.ca/nhpid-bdipsn/monoReq.do?id=50&lang=eng. Accessed on April 17, 2016.

      9. Health Canada. Monograph: Hops. 2008. Available at: http://webprod.hc-sc.gc.ca/nhpid-bdipsn/monoReq.do?id=117&lang=eng. Accessed on April 16, 2016.

      10. European Medicines Agency, Committee on Herbal Medicinal Products. Community Herbal Monograph on Melissa Officinalis L. Folium. 2013. Available at: http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/herbal/medicines/herbal_med_000146.jsp&mid=WC0b01ac058001fa1d. Accessed on April 17, 2016.

      11. Health Canada. Monograph: Lemon Balm. 2008. Available at: http://webprod.hc-sc.gc.ca/nhpid-bdipsn/monoReq.do?id=125&lang=eng. Accessed on April 17, 2016.

      12. Health Canada. Mercury in Fish. 2008. Available at: http://www.hc-sc.gc.ca/fn-an/securit/chem-chim/environ/mercur/cons-adv-etud-eng.php. Accessed on April 17, 2016.

      13. Health Canada. Prenatal Nutrition Guidelines for Health Professionals: Fish and Omega-3 Fatty Acids. 2009. Available at: http://www.hc-sc.gc.ca/fn-an/alt_formats/hpfb-dgpsa/pdf/pubs/omega3-eng.pdf. Accessed on April 17, 2016.

      14. Health Canada. Nutrient Value of Some Common Foods. 2008. Available at: http://www.hc-sc.gc.ca/fn-an/alt_formats/pdf/nutrition/fiche-nutri-data/nvscf-vnqau-eng.pdf. Accessed on April 16, 2016.

      15. IOM DRI’s Institute of Medicine. Dietary Reference Intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington, DC: The National Academies Press; 2001.

      16. Health Canada. Caffeine in Foods. 2012. Available at: http://www.hc-sc.gc.ca/fn-an/securit/addit/caf/index-eng.php. Accessed on April 17, 2016.

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      17. Health Canada. Monograph: Peppermint. 2008. Available at: http://webprod.hc-sc.gc.ca/nhpid-bdipsn/monoReq.do?id=144. Accessed on April 17, 2016.

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      Linked Article

      • Consensus canadien sur la nutrition féminine : adolescence, reproduction, ménopause et au-delà
        Journal of Obstetrics and Gynaecology Canada Vol. 38Issue 6
        • In Brief
          Doter les professionnels de la santé du Canada de connaissances et d’outils de base, afin qu’ils puissent prodiguer des conseils nutritionnels aux femmes tout au long de leur cycle de vie.
        • Full-Text
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      • Correction
        Journal of Obstetrics and Gynaecology Canada Vol. 40Issue 2
        • In Brief
          The authors of the guideline1 would like to clarify advice on mercury in fish, found in italics below. The reader is advised to refer to the latest advice from Health Canada on mercury in fish at the following URL as this guidance is updated as new information becomes available.2
        • Full-Text
        • PDF