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Index A Absorption of supplements amount needed to prevent deficiency, 292 calcium, 20, 246 iron, 246, 285-293 test doses, 2~289 therapeutic trials, 289-291 zinc, 302 Acrodermatitis enteropathica, 301 Accutane, 340 Adipose tissue, postpartum retention of, 4 see also Body fat Adolescent mothem birth weights of children of, 185, 193 energy intake and gestational weight gain in, 140, 266 ethnic origin and weight gain in, 113 iron deficiency in, 279 nutrient intakes, 265, 266, 269 nutrient supplementation of, IS, 22, 238 239, 373 pregnancy outcome and weight gain in, 113-114, 185, 192, 193 rates of weight gain, 102, 109, 111-112, 118 research needs on, 21, 22, 114 skinfold thickness and fetal outcomes in, 132 weight-for-height standards for, 8~81 weight gain goals for, 10, 205 449 Africa, birth weights of twins, 214 see also specific countries Age and adequacy of nutrient intakes, 19 and calcium supplements, 21 of menarche, 43 see also Adolescents; Maternal age Alcohol use definitions, 395 effects on developing fetus and child, 48, 115, 242, 394 and gestational weight gain, 115, 117 and multivitamin-mineral supplements, 20 nutrition-related effects, 1~17, 18, 395-397 prevalence of, 39~395 trends in, 48, 58 and vitamin C needs, 369 and zinc status, 304 see also Drug abuse and Fetal alcohol syndrome American Academy of Pediatrics, 239 American College of Obstetricians and Gynecologists, Committee on Nutrition, 38, 39, 238, 239, 251 American Dental Association, 311 American Dietetic Association, 38-39, 238, 251 American Institute of Nutrition, 238

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450 American Medical Association Council on Drugs, 358 American Society for Clinical Nutrition, 238 Amino acids essential, 380 importance, 381 metabolism, 352, 361, 370 nonessential, 380 plasma concentrations in pregnant women, 108 utilization, 382 Anemia defined, 274 energy intake and, 30 folate deficiency and, 237, 361, 363 hemoglobin concentration and criteria for, 2~285 hemolytic, and vitamin K supplementation of newborns, 345, 346 iron deficiency, 21, 30, 274-276, 277, 283, 284 285, 293 iron supplementation in, 292 nutritional status and, 276 pernicious, 366 with twins, 213 vitamin A-responsive, 339 vitamin E and, 341, 342, 344 WHO criteria for, 284 Ancephaly, 417 Animal studies of body composition changes during pregnancy, 121 of copper, 305 expansion of maternal tissues, 98 extrapolation to humans, 202 of gestational weight gain and lactation performance, 202 of gestational weight gain and pregnancy outcomes, 176 identification of models, 14 of manganese, 310 of neural tube defects, 414 of selenium, 308 of vitamin A, 339 of vitamin Be, 354 of vitamin D, 327 of zinc, 30~301, 304 Apgar scores, 358-359 Appetite changes during pregnancy, 264 Arm circumference measurements, 125, 193 Aspirin use, and iron deficiency, 278 Assessment of gestational weight gain, 9-11 clinical implications, 93 INDEX final weight and rates of gain, 88 gestational duration, 65 66, 87-91 height measurement, 65 interpretation of research, 82-91 measurement techniques, 64-65 methodological issues, 6~82 part-whole correlation, 88 prepregnan~y weight estimates and, 5-6, 86 87 weight-for-height, prepregnancy, 6~67 weight gain charts, 68 82, 429 430 using weight-gain data in the clinic, 67~2 Attitudes, see Maternal attitudes Australia, energy intake and gestational weight gain in, 143, 148 B Balance studies, nutrient needs assessment, 248, 249, 302, 303 Bangladesh, miscarriage rates, 199 Basal metabolism, energy balance during pregnancy and, 165, 166, 169, 170 Behavioral Risk Factor Surveillance System, 391 Bioimpedance analysis, 126 Biotin, 373 Birth asphyxia, 181, 187, 190, 204, 228, 229 Birth length, 125, 181, 194, 215 Birth rates, 44-46 Birth weight age of mother and, 43, 185-186 of Canadian infants, 52-53 and child health, 178 energy intake and, 139-147, 151-164, 170, 171, 224, 226 and ethnic origin of mother, 46, 52, 186 187 and fetal growth, 181 and food intake, 37-38, 149 and gestational duration, 181, 215-216 and gestational weight gain, 4, 8, 27, 28, 38, 57, 97, 167, 170, 183-191, 201, 217-218, 220 importance as a pregnancy outcome, 4, 28, 43, 52-56, 100, 178-182 and infant mortality, 4, 28, 51, 178-181, 215 and labor and delivery complications, 8, 27 maternal body composition and, 125, 193 maternal nutritional status and, 163-164, 385-386 maternal weight for height and, 8, 43, 151, 227 parity and, 43

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INDEX physical activity and, 167 prepregnangy height and, 43 prepregnancy weight and, 38, 43 total maternal body water and, 99 trends in, 5, 28, 38, 5~51, 52-56, 58 in twin pregnancies, 210216, 220 vitamin A status and, 339 vitamin D supplementation and, 32~327, 328 WIC participation and, 162 Blacks birth rates, 46 birth weight trends, 5, 8, 28, 46, 54-55, 125, 186 187 calcium intakes, 265, 269, 322 gestation duration in, 113 gestational weight gain goals for, 10, 12, 187, 205 gestational weight gain in, 7, 112, 186 187 infant mortality among, 51 iron deficiency anemia in, 276 obesity among, 42 prenatal care trends among, 49 skinfold thickness and fetal outcomes in, 132 vitamin D synthesis, 325 Blood donation, and iron deficiency, 278, 280, 286 Blood loss, from menorrhagia, 278 Blood volume and birth weight, 125 expansion of, 98, 99, 161, 219, 226, 284 and iron deficiency, 278, 284 Body composition during pregnancy BMI and, 67 correction factors for measurement methods, 134 estimates from from skinfold thickness, 5, 124-125, 132-134 and fetal growth, 8, 125, 193-194 and gestational weight gain, 6, 13, 128, 130 methods, 122-124, 126 modeling of, 134 potassium (total body), 123-124, 129-132, 134 twin pregnancies, 219 underwater weighing for body density, 123, 129, 134 water content (total body), 122-123, 127-129, 134 Body density, by underwater weighing, 123, 129, 134 Body fat, maternal amount accumulated during pregnancy, 9~99, 130 451 calorie requirements for storage of, 132 change during pregnancy, 130 distribution of, 124 energy balance and, 169, 170 energy supplementation and, 160 estimates from body water studies, 12~129, 132 estimates from skinfold thickness measurement, 12~125, 133, 134, 160 excess energy stored as, 108, 137 and fetal growth, 193 food intake and, 132 and infant fatness, 125 and lactation performance, 201-202 measurements of, 41, 42, 122-123, 12~129 postpartum, 129, 133-134 research needs on, 134 weight change and, 6, 13, 12~130 Body mass index (BMI) for adolescents, 81 and birth weight, 188 190, 19~198 calculation, 5, 10, 41, 66, 93, 431~33 cutoffs, 14, 109 defined, 5, 6, 66 and gestational weight gain, 10, 11-12, 100 102, 109, 111, 188 190, 19~198, 219 and nutritional status, 67, 93 prepregnancy, provisional weight gain charts by, 429~31 recommended weight gain by, 10, 11-12 reference values, 80, 93 research needs on, 81 trends in, 42, 43 and twin pregnancies, 219 underestimation, 87 Body size, see Maternal body size Bone loss, maternal, calcium and, 19, 320-321 Brachial plexus injury, 181, 187, 228 Bronchopulmonary dysplasia, 34~343 C Cadmium, 304, 393 Caffeine effects on developing fetus, 19, 398 nutrition-related effects, 1~17, 19, 399 pharmacologic effects, 398 Calcium absorption, 20-21, 318, 319-321, 323 for adolescents, 238, 239, 331 assessment of requirements, 248 balance, 219, 247, 319-320, 322 caffeine and, 19, 399 deficiency, 21, 322

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452 dietary sources, 322-323, 331 and 1,25-dihydroxycholecalciferol levels, 319, 321, 324, 327 ethnic differences in intakes, 267, 269, 322, 331 and hypertension, 321-322, 331 intakes during pregnancy, 16, 239, 265-268, 269, 330 interaction with other nutrients, 21, 254, 288 lactose intolerance and, 19, 267-268, 322-323, 331 and leg cramps, 322, 331 and maternal bone loss, 19, 320-321 metabolism, 31~319, 322 phosphorus interaction with, 318, 319, 321 recommendations, 2~21, 322-323, 331 research needs on, 21 supplementation, 239, 321-322, 330 toxicity, 306 Canada birth weight trends in, 52-53 energy intake, gestational weight gain, and birth weight in, 141, 161, 164, 224 preterm delivery rates for twins, 215 Cardiomyopathies, 308 309 Carotene supplementation during pregnancy, 19 Carotenoids, 326, 337, 340 Casemontrol studies definition, 248 of periconceptional multivitamin use, 415-417 Centers for Disease Control criteria for anemia, 284 nutrition surveillance fly, 91-92 Child Health and Development Study (San Francisco Bay area), 195 Chile, energy intake, maternal weight gain, and birth weight in, 154, 161 China, cumulative increase in maternal weight, 103 Chloride, 16 Chromium, 31~311 Cigarette smoking characteristics of married pregnant women, 47 educational attainment and, 4608 effects on developing fetus and child, 5, 46~8, 51, 55, 242, 391-392 and folate status, 366 and gestational weight gain, 4, 5, 115, 118, 217-218, 220 interventions for pregnant women, 47 INDEX and multivitamin mineral supplements, 20 nutrition-related edects, 16-17, 18, 392-394 prevalence, 4~47, 391 and vitamin C requirements, 369-370 and zinc-to-cadmium ratios, 304 Clavicular fracture, 181, 187, 228 Clinical recommendations bases for, 15, 28-29, 33-34 calcium, 2~21, 323-324 copper, 307 counseling, 11-12 dietary assessment, 19 folate, 20 iron, 20, 293 magnesium, 330 measurement, 9-11 monitoring progress, 12-13 multivitamin mineral supplements, 20 nutrient interactions and, 17 nutrition supplementation in special circumstances, 2~21 trends in, 37~0 vitamin D, 20, 328 weight gain, 37~0 zinc, 305 Cocaine use effects on developing fetus and infant, 402-403 and gestational weight gain, 116 nutrition-related effects, 16-17, 403 prevalence, 402 trends in, 48, 58 Coffee, nutrition-related effects, 1~17, 399 Cognitive development, 181-182, 223, 229, 308 Cohort studies definition, 248 of periconceptional multivitamin use, 415~17 Collaborative Perinatal Project, 27, 112, 177-178, 185, 203, 228, 275 Colombia, energy intake, maternal weight gain, and fetal outcomes, 151, 153, 164, 194, 385 Complications of pregnancy, labor, and delivery birth weight and, 4, 8, 27, 37, 178, 204, 228 gestational weight gain and, 200 201, 228 magnesium status and, 329 in twin pregnancies, 213 zinc deficiency and, 301 Computerized axial tomography, 126 Conceptus, 32, 33, 98, 99, 131-132, 185, 220

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INDEX Congenital anomalies folate status and, 361-362 gestational weight gain and, 9, 199, 204, 228 iodine deficiency and, 308 IUGR and, 182 vitamin A status and, 340 zinc deficiency and, 301 Continuing Survey of Food Intakes by Individuals, 21, 241, 259, 267, 268, 269, 365, 371 Copper deficiency, 21, 307 dosage range and toxicity, 306 estimated requirements during pregnancy, 306 importance in pregnancy, 305-306 intakes (usual), 306, 312 interactions with other nutrients, 21, 254, 300, 303, 30~7, 311 recommendations for supplementation, 307 research needs on, 21 status, criteria for assessment, 307 Counseling dietary, 17, 22, 93, 161, 224, 249, 251, 255 and energy intake, 224 importance of, 222 recommended, 11-12 weight gain goals, 11-12 D Deafness, 308 Deficiencies, see Nutrient deficiencies Delivery, see Complications of pregnancy, labor and delivery Developing countries anemia in, 276 body fat content changes in pregnant women, 133, 202 energy intake, maternal weight gain, and birth weights in, 144-148, 150155, 160 161, 163-164, 225 resting metabolic rate in pregnant women, 165, 166 usual energy intakes in, 164 vitamin A deficiencies in, 337 see also specific countries Diabetes, 54 Dietary goitrogens, 308 Dietary intake adequacy, assessment of, 7, 12, 19, 249-252, 255 and birth weight, 37-38, 149 compared with RDAs, 262-263 453 computerized diet analysis programs, 25~251 data on, 249-251, 255, 25~265 and ethnic background, 267-268 and fetal growth, 55 interventions to improve, 251-252 limitations of data, 16, 259-265, 266 of magnesium, adequacy of, 329 maternal age and, 269 and maternal body fat, 132 nutrient status assessment through, 17 and nutrient supplements, 15-22 of nutrients, 263-263, 265-267; see also . . specific numents previous recommendations Mom professional organizations, 238 239 questions to identifier special problems, 251, 255 recommended assessment of, 12, 19 and skinfold thickness, 149 and socioeconomic and demographic factors, 268 in twin pregnancies, 213, 215 and vitamin D deficiency, 325-326 and weight gain, 107-108, 148, 149 and WIC participation, 268 269 Dosages of nutrients during pregnancy, see specific nutrients Drug abuse and gestational weight gain, 115 and multivitamin mineral supplements, 20 and nutrient supplementation, 18, 22, 369 and pregnancy outcomes, 48, 242 trends in, 48 see also Alcohol use; Cocaine use; Marijuana use E Ectopic pregnancy, 200 Ecuador, calcium supplementation and hypertension in, 321 Edema, 6, 38, 98, 122-123, 193-194, 200 Educational attainment and birth weight, 54 and cigarette smoking, 46~8 and gestational weight gain, 7, 116, 118 and iron deficiency, 276, 278, 279 Endemic cretinism, 308 Energy balance basal metabolism and, 137, 165-166, 170 and birth weight, 160 daily energy expenditure (total) and, 168 169

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454 and gestational weight gain, 31, 107, 14~149, 169 physical activity and, 116, 167-168 during pregnancy, 169-170 research needs on, 132 thermogenesis and, 165, 167 Energy expenditure daily total, and energy balance during pregnancy, 168-169 dietary intake and, 107-108 and gestational weight gain, 107-108, 117, 222 hormonal adjustments and, 108, 117 for lactation, 202 measurement of, 149, 16~169 physical activity and, 31 by trimester, 16~169 Energy intake and anemia, 30 assessment of, 7, 14~149, 160, 225 and birth weight, 139-147, 151-163, 224, 226 and body size, 7 energy supplementation during pregnancy and, 224-225 and fetal growth, 30 and gestational weight gain, 4, 7, 56, 108, 138 164, 170, 171, 222, 225-226 maternal attitudes and, 225 for maternal fat storage, 132 nutritional counseling and, 224 and physical exercise, 7 recommendations, 4~41, 138, 225, 252 research needs on, 14 studies of, 138-148 trends in, 149-150, 265, 269 and weight-for-height status (prepregnancy), 14 WIC participation and, 50, 224, 268, 269 Energy requirements, 4~41, 138, 137, 170, 171 Energy supplementation and birth length and head circumference, 194 and birth weights, ~9, 13~162, 170, 171 in developing countries, 15~155, 16~161 and energy intake, 220225 gender-specific fetal effects, 151 and gestational weight gain, 13~164 in industrialized countries, 161-164 and nutritional status, 170 Enzootic neonatal ataxia, 305 Epidemiologic studies of neural tube defects, 414 nutrient needs assessment, 248, 249 recommended, 13-14 INDEX types, 248 on weight gain, 8, 13-14 Ethiopia energy intake and gestational weight gain in, 144 physical activity, maternal weight gain, and birth weights, 167 vitamin A levels in fetuses, 338 Ethnicity, see Race or ethnic origin F Fat, see Body fat Fetal alcohol syndrome (FAS), 304, 394, 395, 397, 397, 401 Fetal and infant outcomes alcohol use and, 394 birth length, 125, 181, 194, 215 caffeine and, 19, 398 cigarette smoking and, 391-392 cocaine use and, 402~03 composition of tissues gained and, 193-194 congenital anomalies, 199 gestational duration and, 19~198 head circumference, 181, 194 IUGR heterogeneity, 182 marijuana use and, 400~01 short-term distinguished from long-term, 34, 233 weight gain patterns and, 192-193 see also Birth weight; Fetal growth; Infant mortality; Miscarriage Fetal growth age of mother and, 185-186 alcohol intake and, 115 birth length and head circumference, 194 cigarette smoking and, 5, 46, 55 composition of weight gain and, 8, 125, 193-194 edema and, 193-194 energy intake and, ~9, 30, 108, 137, 148, 170 gestational weight gain and, 4, 7~, 28, 86, 17~183, 204, 226, 228 height (maternal) and, 5 maternal tissue changes and, 121, 125 maternal weight for height and, 8, 82, 183-184, 204 nutritional status and, 38, 306 optimal, 190 pattern of weight gain and, 192-193 physical activity and, 167 prenatal care and, 5 prepregnancy weight and, 5, 28 protein intake and, 381 racial/ethnic differences in, 18~187

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INDEX rate of, 98 WIC participation and, 5 see also Birth weight; Intrauterine growth retardation Fetal macrosomia, 11 Fetal mortality fetal growth and, 178 gestational weight gain and, 177-178 in twin pregnancies, 215 see also Miscarriage Fetal weight in total weight gain, 8~89, 98 vitamin A status and, 339 Finland birth weights of twins, 214, 216 vitamin D deficiencies in, 325 Five Nation Study, 107, 170 Fluid retention, 6, 38, 98, 161 Fluoride, 311-312 Folate clinical recommendations, 20, 239, 366 367 and course and outcome of pregnancy, 361-362 data collection on status of, 21 deficiency, 18, 21, 361, 363, 364, 367 dosage range and toxicity, 366 estimated requirements for pregnancy, 238, 362-363 food sources, 20, 36~365, 418 importance, 361 inadequacy, prevalence, 365-366 intakes, 16, 265-268, 364 365 interactions with zinc, 304-305 and neural tube defects, 41~416 RDAs, 239, 240 research recommendations on, 21 status, criteria for assessment, 363-364 supplementation, need for, 18, 237, 239, 373 Follicular keratosis, 339 Food cravings and aversions, 21, 26~265 Food supplementation programs importance of, 251 and pregnancy outcomes, 51 trends in use of, 49 see also WIC participation France energy intake and gestational weight gain in, 141 maternal weight gain and birth weight in, 192, 216 vitamin D supplementation studies, 326, 328 455 G The Gambia body fat in first trimester, 133 energy cost of pregnancy, 169, 170 energy efficiency of weight-bearing activities, 168 energy intake, maternal weight gain, and fetal outcomes in, 144, 154, 164}161, 163, 164, 194, 225 folate deficiency in, 362 lactation performance relative to fat deposition, 202 physical activity patterns of pregnant women, 167 resting metabolic rate in pregnant women, 165, 166 skinfold thickness in pregnant women, 132-133 time-motion studies, 169 Gestational diabetes, 358 Gestational duration assessment of, 10, 65-66, 87-91, 93, 195, 227 and birth weight, 181, 215-216 energy supplementation and, 164 ethnic origin and, 113 and favorable pregnant outcome, 4 and fetal weight, 88 89 final maternal weight, 88 and infant mortality, 181 and iron absorption, 286-288 from last menstrual period, 65-66, 92, 93, 195, 196, 215 maternal characteristics associated with, 7 maternal weight gain and, 9, 12, 34, 86, 91, 93, 19~198, 204, 216, 227-229 from neonatal examination, 195 physical activity/work and, 116-117 research needs on, 204 in twin pregnancies, 213, 215-216 see also Preterm delivery Glucose intolerance, 310 Guatemala, energy intake, maternal weight gain, and birth weight, 15(}152, 164, 385 H Head circumference, gestational weight gain and, 193, 194 Height, maternal and birth weight, 164 and gestational weight gain, 4, 5, 112, 164 measurement, 10, 65, 93

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456 posture changes during pregnancy, 65 recalled, 87 research needs on, 112 trends in, 42, 57 see also Weight for height, prepregnancy Hemoglobin concentration, and criteria for anemia, 284-285 impaired production, 274, 283-284 normal values during pregnancy, 275 High birth weight, 52, 55-56, 58, 178, 180, 187, 192, 201, 204, 227-230 High-risk groups, research recommendations, 22 Hispanic Health and Nutrition Examination Survey (HHANES), 278, 279 Hispanics birth weight trends among, 46, 5~55 weight gain and obesity, 4 see also Race and ethnic origin Hormonal levels, in twin pregnancies, 219 Human chorionic somatomammotropin, 108 Human placental calcium-binding protein, 324 Human placental lactogen, 108 Hydrocephalus, 340 Hypercalcemia, 327 Hyperemesis gravidarum, 192, 352 Hyperparathyroidism, 319 Hypertension and birth weight, 53 calcium supplementation and, 321-322, 331 gestational weight gain and, 9, 200, 201, 204 maternal mortality from, 200 in twin pregnancies, 213, 215 zinc deficiency and, 301-303 Hypocalcemia, 181, 229, 325 Hypocalciuria, 321 Hypoglycemia, 181, 229, 326 Hypoparathyroidism, 327 Hypothyroidism, 308 I India cumulative increase in maternal weight, 102, 104 energy intake, maternal weight gain, and birth weight, 152, 153 malnutrition and calcium balance in, 321 vitamin D supplementation studies, 328 Indonesia INDEX energy intake, maternal weight gain, and birth weight, 154 energy supplementation and lactation performance, 202 weight gain rates of pregnant women, 102, 104, 105 Industrialized countries body fat content changes in pregnant women, 133, 202 energy intake, maternal weight gain, and birth weight in, 138-143, 149-150, 15~159, 163 energy supplementation of pregnant women in, 161-164 folate deficiency in, 18 iron deficiency in, 272-273, 278 maternal mortality in, 199 resting metabolic rate in pregnant women, 165 see also specific countries Infant mortality anemia and, 274, 275 birth weight and, 4, 28, 51, 178, 180, 181, 215, 218 fetal deaths, 178, 180, 181 gestational age and, 181, 229 gestational weight gain and, 8, 97, 177-179, 204, 228, 229 high-protein supplements and, 163 IUGR and, 182, 204, 229 preterm births and, 28 by race, 180 in twin pregnancies, 212, 215, 218, 220 trends in, 50, 51, 58 Insulin resistance, 108 Interactions among nutrients calcium, 254, 288 copper, 254, 300, 303, 307, 311 folate, 366 iron, 254, 288, 290, 300, 303, 304, 310, 330 magnesium, 254, 288, 330 manganese, 310 molybdenum, 311 protein, 254 phosphorus, 254 potential for, 16, 242, 255, 373 research needs on, 21 vitamin Be, 254 zinc, 254, 290, 300, 303, 304 305, 307 Intrauterine devices, 280 Intrauterine growth retardation (IUGR) birth length and head circumference, 194, 229 and child health problems, 181, 182, 229 energy supplementation and, ~9 factom contributing to decrease in, 55

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INDEX folate status and, 361-362 gestational weight gain and, 11, 183, 192, 204, 226, 229-230 heterogeneity of, 182 incorrect diagnosis of, 87, 196, 227 and infant mortality, 182, 204, 229 magnesium supplementation and, 329 and neurocognitive performance, 181-182, 229 and prepregnancy weight for height, 183-184 in twin pregnancies, 216 vitamin A status and, 339 zinc deficiency and, 301-303 see also Fetal growth Iodine, 307-30S, 312 Iron deficiency anemia, 27~276, 277, 283, 284 285, 293 aspirin use and, 280 blood donation and, 278, 280, 286 cesarean delivery and, 283 characteristics, 274, 283-285 contraceptive use and, 280 defined, 274 laboratory characteristics of impaired hemoglobin production, 283-284 and maternal and fetal health, 18 maternal, edects on newborns, 274-276 menorrhagia and, 278, 280, 282 physiologic changes in hemoglobin concentration, 28028S prevalence, 267, 272-273, 277-278 prevention without supplements, 22 risk factors, 272, 276, 27~279, 280 tests for, 17, 248 Iron nutrition during pregnancy absorption of nonheme and heme iron from food, 281-282 bioavailability, 281 caffeine and, 19 data collection on status of, 21 essential and storage iron, 279-280 gestation stage and, 286-288 importance, 18, 272-276 intakes by pregnant women, 16, 265, 266, 268, 269 intestinal regulation, 282 loss of iron, 280 metabolism, 279-282, 303 regulation of body iron, 281 requirements for pregnancy, 282 283, 289 research recommendations on, 21 Iron supplementation absorption of supplements, 20, 285-293 of adolescents, 238 457 amount to prevent iron deficiency, 292, 293 and blood volume expansion, 98 compliance, 293 conclusions on needs of pregnant women, 17-18, 312 duration and dose, 292 interaction with other nutrients, 21, 254, 290, 300, 303, 304 305, 310, 330 research recommendations, 22 recommendations, 20, 237, 238, 284-285, 293 side effects, 254, 289, 290, 293 test dose, absorption from, 285, 286 289 therapeutic trials, 278, 286, 289-291 vitamin C with, 20, 281, 289, 368 Isotretinoin, 340 Israel, vitamin D deficiencies in, 325 J Jamaica, energy intakes and gestational weight gain, 145 Japan, cumulative increase in maternal weight, 102, 104 K Keshan disease, 308 L Labor and delivery, see Complications of pregnancy, labor, and delivery Laboratory assays effects of stage of gestation on, 16 of copper status, 307 of folate, 414 of iron status, 17, 274, 277, 283-284 nutrient status assessment with, 17, 242, 255, 299, 331 of protein deficiency, 384 of selenium status, 309-310 of trace element status, 299, 312 for water-soluble vitamins, 35~357, 373 of zinc status, 30~304 Lactation performance, gestational weight gain and, 201-202, 204, 228 Lactose intolerance and calcium intake, 19, 267-268, 322-323, 331 and need for supplements, 18, 19 Last menstrual period (LMP) accuracy of recall, 65 66 and misdiagnosis of IUGR, 87 Lean body mass estimation of, 122-123, 125, 131-132

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458 and fetal growth, 125, 193 losses during pregnancy, 129, 131 metabolic rates and, 165 water content of, 107, 117, 12~123 Leg cramps, 322, 331, 372 Low birth weight anemia and, 274, 275 and child health, 179-181 cigarette smoking and, 47 defined, 52, 180 energy intake and, 151, 160, 161, 164 folate status and, 362 gestation length and, 215-216 and infant mortality, 179, 181, 215 maternal age and, 53 maternal characteristics associated with, 54 by maternal weight gain and prepregnancy BMI, 188-190, 19~198, 218 parity and, 53 pattern of maternal weight gain and, 192 race/ethnic origin and, 54-55 small-for-gestational age (S GA), 181; see also Intrauterine growth retardation in twin pregnancies, 212-213, 215-216, 218 trends, 5, 52-54, 58 vitamin Be and, 356 vitamin D status and, 326-327 zinc deficiency and, 301 M Macrocytosis, 309 Magnesium deficiency, 21 dosage, 330 intake adequacy, 16, 265, 26~269, 329 interaction with other nutrients, 254, 288, 330 metabolism, 328-329 recommendations, 330, 331 research needs on, 21, 330 Manganese, 310 Marijuana use effects on developing fetus and child, 400001 and gestational weight gain, 116 nutrition-related effects of, 1017, 401 pharmacologic effects, 400 prevalence of, 399000 trends in, 48 Marital status and birth weight, 54 and gestational weight gain, 7, 116, 118 Maternal age INDEX birth rates by, 11 45 and birth weight, 53 and gestational weight gain, 4, 7, 8, 13, 113-115 and nutrient intake during pregnancy, 269 and parity, 4, 43 45, 113-115 and pregnancy outcome, 13, 43 and skinfold thickness measurement, 125 see also Adolescents Maternal attitudes and energy intake, 225 and gestational weight gain, 31, 222, 223 Maternal body size age of menarche and, 43 energy intake and, 7 and pregnancy outcomes, 43, 51 trends in maternal nutritional status and, 41~3 Maternal mortality, gestational weight gain and, 9, 37, 199-200, 204, 228 Maternal outcomes complications of pregnancy, labor, and delivery, 200 201 gestational weight gain and, 199-204, 223 lactation performance, 201-202 maternal mortality, 199-200 postpartum obesity, 20~204, 223 short-term distinguished from long-term, 34 Maternal physiology adaptations during twin pregnancies, 219 effects on laboratory and functional tests, 16 homeostatic responses to nutrient demands, 246-247 Maternal tissues changes in, and fetal growth, 121 energy intake and accretion of, 148, 161, 170 weight gain attributed to expansion of, 98, 99 Measurement of basal metabolism, 165 of BMI (prepregnancy), 10 of body composition, 122-124 charts, 1~11 control of errors in, 64 equipment calibration, 64, 65, 93 errors in, 68, 160 frame size indicators, 64 functional, of nutritional status, 246-247 gestational duration, 10, 65-66, 87-91, 93 height (prepregnancy), 10, 65, 93 incremental weight gain, 84 net maternal weight gain, 83~4 nutrient turnover, 248-249

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INDEX of prepregnangy weight, 5-6, 10, 6~65. 123 recommended procedures, 9-11 research needs on, 14 resting metabolic rate, 165 serial weight, 5 staff training in, 93 static, of nutritional status, 24~247 total body potassium, 123-124 total body water, 122-123, 124 total weight gain, 83 underwater weighing, 123, 124 weight for height, 3, 5, 9, 65, 6~67, 93 weight gain as percentage of body weight, 84 weight gain as percentage of recommended gain, 85 units of, for vitamin A, 338 see also Body mass index; Skinfold thickness Meconium aspiration, 181, 190, 228 Menarche, age of, 43 Menorrhagia, 278, 280 Mental retardation, 308, 327 Metabolism calcium, 318-319 magnesium, 328-329 vitamin D, 323-324 see also Basal metabolism Methodologic issues in assessment of gestational weight gain, 63~2, 182-183, 187, 196 in assessment of vitamin E requirements, 343-344 in associations between fetal growth and gestational weight gain, 183, 196, 204 causal paths, 29-32 confounding variables, 30 consequences, 29-33 cost-benefit analysis of interventions, 230 criteria for formulating recommendations, 17 cross-study comparisons, 109-110 data collection in clinical settings, 63~2 data limitations, 16-17, 259-265 decision analysis of outcomes, 230 definition of IUGR, 182, 196 determinants, 29-33 determining value of nutrient supplements, 16-17 dietary intake data collection, 250, 259-265 effect modifiers, 30-33, 177 in energy supplementation studies, 160 164, 225 generalizability of studies, 187 459 gestational age measurement, 182, 183, 227 gestational weight gain related to fetal growth, 182-183 mediating variables, 30 in nutrient intake assessment, 259, 264-265 recalled weights and heights, 8~87 reverse causality, 34, 226, 227 in total body water studies, 12~129 Metropolitan Life Insurance Company weight-for-height standards basis for, 81 BMI compared with, 81-82 classification criteria, 81~2 cutoff points, 6, 81~2 height assessment with, 65 medium frame, 187, 190 NHANES values compared with, 80, 81 obesity prevalence based on, 42 prepregnancy weight-for-height assessment from, 6~67, 109, 178 Methylxanthines pharmacologic effects, 398 see also Caffeine Mexico, energy intake and gestational weight gain in, 146, 148 Microcephaly, 340, 343 Minerals, see specific minerals Miscarriage folate status and, 361-362 gestational weight gain and, 9, 199, 204, 228 nutrient deficiency and, 308 vitamin A status and, 340 Molybdenum, 311 Monitoring progress, recommendations for, 12-13 Morning sickness, 21, 264, 293, 358 Mortality, see Fetal mortality; Infant mortality; Maternal mortality Multivitamin mineral supplements clinical recommendations, 20, 312, 252 and interactions of nutrients, 2~289, 290, 304 label information, 239, 309 recommendations of expert groups, 237 usage patterns, 239, 241 Myxedematous cretinism, 308 N National Center for Health Statistics, 8~81, 177 National Commission for the Prevention of Infant Mortality, 1, 178 National Fetal Mortality Survey, 177, 228

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460 National Health and Nutrition Examination Surveys (NHANES), 21, 42, 80, 81, 89, 240, 259, 269, 277, 279, 280, 365, 366, 368 National Health Examination Survey, 42 National Household Survey on Drug Abuse, 402 National Institute of Neurologic and Communicative Disorders and Stroke, 275 National Maternal and Infant Health Survey, 57 National Natality Surveys, 3, 4, 8, a, 67, 82, 99-100, 111-113, 115, 116, 177, 186 187, 196, 218, 139, 391 Nationwide Food Consumption Surveys, 259 Nausea, 264 Neonatal intensive care, 51 Neonatal mortality, 28, 51, 163, 178, 180, 181 Netherlands birth weights of twins, 214 body fat in first trimester, 133 energy balance during pregnancy, 168-170 energy intake and fetal growth, 149, 194 energy intake and gestational weight gain, 13S, 143, 226 energy intake and toxemia, 200 miscarriage rates, 199 pattern of weight gain and fetal growth, 192 postpartum obesity, 203 resting metabolic rate, 166 Neural tube defects animal model studies, 414 case-control and cohort studies, 415~17 causes, 362, 413 epidemiologic observations, 248, 414 evidence of effects of nutrients, 19, 413-415 laboratory assays, 414 limitations of evidence, 417 occurrence, 412-413 New Guinea, physical activity patterns of pregnant women, 167 Newborn maturity indicators, 87 Niacin assessment methodology, 370-371 dosage range and toxicity, 371 estimated requirements, 370 importance, 370 intakes by pregnant women, 265, 266, 269, 371 Nonnutrient substances, zinc interactions with, 304-305 INDEX Nutrient deficiencies clinical indicators of, 251 defined, 258 and homeostatic responses, 245-246, 309, 310 in Hindu vegetarian women in London, 301, 303 laboratory indices of, 242 prevalence of, 246 risk categorization, 253 see also specific nutrients Nutrient intakes during pregnancy, 265-270; see also Dietary intake Nutrient needs assessment of, 17, 247-249 defined, 247 factors influencing, 25~253 homeostatic responses, 2454246 nutritional status assessment, 246-247 postpartum, 202 Nutrient supplements/supplementation basis for recommendations, 15 conclusions on, 17-19 dietary intake and, 1~22 dosage, 303 factom influencing need for, 242, 252-253 interactions of nutrients, 16, 17, 242, 253-254, 300305 patient compliance with recommendations, 242 previous recommendations from professional organizations, 238 239 usage patterns, 239-241 and toxicity, 254, 303 see also Multivitamin-mineral supplements; Preconceptional vitamin supplementation; and specific nutrients Nutrient turnover, 248 249 Nutritional assessment, 3, 16, 246-247, 303-304 copper, 307 through dietary intake data, 17 folate, 36~364 recommended, 21 thiamin, riboflavin, and niacin, 370 vitamin Be, 35~355 vitamin C, 368 zinc, 303-304 Nutritional status and anemia, 276 and birth length and head circumference, 194 and birth weight, 163-164 clinical practice trends, 41-49 energy supplementation and, 170

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INDEX and fetal growth, 38, 194 measures of, 41, 67 and miscarriage, 199 and perinatal mortality, 177 prepregnan~y, defined, 3 and toxemia, 200 and weight-for-height, 3, 109 and weight gain, 2-14, 38 Nutritional surveillance of pregnant women, 14 uses of gestational weight gain in, 91-92 o Obesity/obese women basal metabolic rate, 165 and birth weight, 56, 185, 216, 218, 229, 230 BMI, 5, 6 dietary assessment and nutritional counseling, 12 energy expenditure during physical activity, 168 energy requirements, 171, 252 and gestational weight gain, 6, 8, 12, 68, 184 185, 230 health consequences of, 229 misclassification of, 67 postpartum, gestational weight gain and, 13, 20~204, 223, 22~229 prevalence of, 42 twin pregnancies, 216, 218 and weight gain in Hispanic women, 4 Oral contraceptives, 280, 36~361, 366 Osteomalacia, 325, 326 Osteoporosis, 19 Overweight women BMI, 5, 6 cutoff point, 67 and gestational weight gain, 6, 8, 12, 28, 111, 118 perinatal mortality among, 178 prevalence of, 43 weight gain charts for, 73, 80 Outcomes, see Fetal and Infant outcomes; Maternal outcomes; Pregnancy outcomes p Pantothenic acid, 372-373 Parathyroid hormone, 319, 321, 323, 328 Parity birth rates by, 45 and birth weight, 43, 53 folate status and, 366 461 and gestational weight gain, 4, 38, 96-97, 101, 104, 113-115 and iron deficiency, 278, 279, 28~287 maternal age and, 4, 43-45, 113-115 and postpartum body weight, 9, 203-204 and total body water, 124 Preconceptional supplements case-control and cohort studies, 415-417 and neural tube defects, 19, 412-418 limitations of evidence, 417 research recommendations, 22 Perinatal mortality, 177, 204, 215, 218, 228, 274, 275 Peruvian mothers birth weights of, 185 composition of weight gain and fetal growth, 193 Phenotypic isotretinoin syndrome, 340 Philippines body fat in first trimester, 133 energy balance during pregnancy, 146, 148, 169, 170 physical activity patterns of pregnant women, 167 resting metabolic rate in pregnant women, 166 Phosphorus, 16, 239, 254, 318, 319 Physical activity/work energy balance during pregnancy and, 7, 31, 167-168, 169 energy costs of, 167-168 and fetal growth, 167 and gestational weight gain, 11~117, 118 and miscarriage, 199 patterns of pregnant women, 167 and skinfold thickness measurement, 125 Physiology, see Maternal physiology Pica, 237, 264 Placenta amino acid transport, 382 calcium transfer, 319, 320, 324 growth, 98, 108, 170, 218 transfer of nutrients, 247 vitamin A transfer, 337-338 vitamin Be transport, 35~354 vitamin D transport, 324 zinc transport, 304 Polycythemia, 181, 229 Postneonatal mortality, 178, 180 Postpartum body weight gestational weight gain and, 11, 13, 202~204, 228 parity and, 9 research needs on, 228 retention of adipose tissue, 129 Potassium, 16 Potassium, total body

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462 eoneeptus contribution to, 131 measurement of, 12~124 results from studies, 12~132 and weight gain, 131 Preeelampsia, 9, 97, 200, 204, 213, 275, 321-322, 329, 358 Pregnancy depression, 358 Pregnant Nutrition Surveillance System, 92 Pregnancy outcomes age of menarehe and, 43 alcohol and drug use and, 48 birth weight, 4, 28, 43, 52-56, 100, 17~182 ethnic origin of mothers and, 13, 46 favorable, defined, 4, 218, 220 folate status and, 361-362 gestational weight gain and, 4, 7~, 28, 92, 97, 177-199 infant mortality, 51 maternal age and parity and, 13, 43 45, 113-114 maternal body size and, 41~3 nausea and vomiting and, 264 prenatal care and, 49 prepregnancy weight and, 40 reverse causality problem, 34, 226 smoking habits and, 46 48 total body water and, 193, 226 trends in, 5~56 vitamin Be status and, 355-359 see also Complications of pregnancy, labor, and delivery; Fetal and infant outcomes; Maternal outcomes Pregnancy Risk Assessment Monitoring System, 92 Prenatal care factor affecting use of, 49 and fetal growth, 5, 55 and gestational weight gain, 5 height and weight measurements, 93, 110 importance of, 12 and maternal mortality rates, 200 nutritional surveillance during, 14, 264 and pregnancy outcomes, 49 trends in use of, 49-51, 57, 58, 264 Preterm delivery anemia and, 274, 275 birth weight and, 55 and child health, 181, 229 copper status and, 305-306 energy intake and, 151, 163 folate status and, 361-362 gestational weight gain and, 9, 13, 91, 19~198, 216, 227-229 high-protein supplements and, 163 and infant mortality, 28, 178, 229 INDEX magnesium status and, 329 misclassification of, 227 physical aetivityhvork and, 116-117 of twins, 215-216 and vitamin E supplementation, 341, 342, 344, 346 vitamin A status and, 339 zinc status and, 301, 302 Prolaetin, 323 Prostaglandin metabolism, 301 Protein assessment of requirements, 248 deficiency, criteria for, 384 dietary sources of, 19 energy value, 380 estimated requirements, 238, 382-384 importance, 381 intakes by pregnant women, 265, 266, 268, 269, 384 interaction with other nutrients, 254 retention, 99 in supplemental food programs, 50 vitamin Be and, 355 Protein supplements/supplementation Atole, 150 and birth weight, 51, 163, 164 and gestational weight gain, 151 And neonatal deaths, 163 recommendations, 18-19, 386 sources of, 16 studies, 385-386 Proteinuria, 200 Pulmonary embolism, 200 Pyruvate carboxylase, 310 R Race or ethnic origin birth rates by, '11 46, 52 and birth weights, 5, 52-54, 18~187 and fetal growth, 18~187 and gestational weight gain, 4, 7, 13, 112-113, 118, 186-187 and infant mortality, 180 and iron deficiency, 278, 279 and nutrient intake during pregnancy, 19, 21, 265-266, 267-269 and pregnancy outcome, 13, 46 and skinfold thickness measurement, 125 and vitamin D deficiency, 325-326, 331 see also Blacks; Hispanics Recommendations criteria for formulating, 17 see also Clinical recommendations; Research recommendations

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INDEX Recommended Dietary Allowances (RDAs), 16, 40, 239, 240, 248, 252, 262-263, 265, 299, 308, 318, 338, 353, 384 Reference standards BMI, 80, 93 for gestational weight gain, 80 81, 86, 89-91 Metropolitan Life Insurance Company, 6, 42, 65-67, 81~2, 109, 178, 187, 190 variation with stage of gestation, 16 weight-for-height, 6, 65, 66, 73, 80~2 Reproduction, human copper and, 305 iodine and, 308 vitamin E and, 341 zinc and, 301-302 Research recommendations applied research, 14 basic research, 14 body composition, 134 epidemiologic studies, 13-14 gestational weight gain chart construction, 425028 iron supplementation, 22 nutritional assessment, 21 periconceptional supplements, 22 supplementation for high-risk groups, 22 survey needs, 21 weight gain and gestational duration, 204 Respiratory distress syndrome, 181 Retrolental fibroplasia, 181, 343 Riboflavin assessment methodology, 370-371 dosage range and toxicity, 371 estimated requirements, 370 excretion, 246 importance, 370 intakes lay pregnant women, 265, 266, 269, 371 Rickets, vitamin D-resistant, 327 S Scales, platform beam balance and electronic, 64 Scotland, studies of pregnant women body fat in first trimester, 133 cumulative increase in maternal weight, 102, 104, 107 energy balance during pregnancy, 169, 170 energy intake, maternal weight gain, and birth weight in, 138, 139, 142, 158 energy supplementation, 161-162 resting metabolic rate, 166 skinfold thickness, 124 463 total body water by period of gestation, 126 Seasonal differences in effects of energy supplementation on birth weight, 160, 164 in energy expenditure, 169 in lactation performance, 202 in magnesium levels, 329 in vitamin D status, 20, 32~326, 331 Selenium, 254, 308 310, 342 Senegal, maternal weight gain composition and birth weight, 193 Sensory neuropathy, 359 Sepsis, 181 Shoulder dystocia, 178, 187, 204, 228 Skeletal myopathies, 309 Skinfold thickness in pregnant women and birth weight, 164 dietary intake and, 149 direct comparisons of measurements, 125-126 Durnin-Womersley equations, 133 and gestational weight gain, 164 measurement of, 12~124 arm circumference measurements, 125 reproducibility and reliability of measurements, 5, 63 research needs on, 134, 134 results of studies, 129, 13~134 trends in, 42 and water retention, 124, 13~134 WIC participation and, 162 Socioeconomic status and birth weight, 53, 164 and gestational weight gain, 4, 7, 56, 104 105, 109, 116, 164 and iron deficiency, 276, 27~279 and nutrient intake during pregnancy, 268 Sodium, 16 Spastic dysplegia, 308 Special Supplemental Food Program for Women, Infants, and Children (WIC) creation of, 1 package content, 50 and vitamin A intake, 341 weight gain charts, 6~72 see also WIC participation Spina Linda, see Neural tube defects Spontaneous abortion, see Miscarriage Stadiometer, 65, 93 Sulfite oxidase, 311 Superoxide dismutase, 307, 310 Supplements, see multivitamin-mineral supplements, periconceptional supplements, and specific nutrients

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464 Surgeon General's-Advisory Committee on Smoking and Health, 33 Surveys, recommended, 21 Sweden birth weights of twins, 214 composition of weight gain and fetal growth, 193 energy intakes and gestational weight gain in, 143 resting metabolic rate in pregnant women, 165, 166 skinfold thickness in pregnant women, 124, 133 total body water by period of gestation, 126 vitamin A levels in fetuses, 338 Switzerland, magnesium supplementation studies, 329 Symphysis-uterine fundal height, 87 T Taiwan energy intake, maternal weight gain, and birth weight, 151, 153, 160, 163, 385 skinfold thickness in pregnant women, 124, 132 Task Force on Adolescent Pregnancy, 238 Teratogenicity of cadmium, 304 of copper, 305 of folate, 361 of multivitamin-mineral supplements, 241, 242 of vitamin A, 19, 340 of zinc, 300-301 Tetany, 326 Thailand body fat in first trimester, 133 energy balance during pregnancy, 16~170 energy intake, maternal weight gain, and birth weight in, 146, 148, 153 physical activity patterns of pregnant women, 167 resting metabolic rate in pregnant women, 166 Thermogenesis, energy balance during pregnancy and, 165, 167 Thiamin assessment methodology, 370-371 dosage range and toxicity, 371 estimated requirements, 370 importance, 370 intakes (usual), 371 intakes by pregnant women, 265, 266, 269 INDEX Thyroid hormones, 307 Thyrotoxicosis, 308 Tooth enamel hypoplasia, 326 Total body electrical conductivity, 126 Total Diet Study, 308 Toxemia, 27, 38, 200, 358, 361; see also Preeclampsia Toxicity of nutrients, 254 copper, 306 folate, 366 selenium, 309 vitamin A, 340 vitamin Be, 359-360 vitamin C, 368 369 zinc, 303 Mace elements detection of deficiencies, 299 essentiality of, 299 interaction between, 21, 254, 300 supplementation needs, 312 toxicity, 299-300 see also specific elements Twin pregnancies birth weight, 21~216, 220 body composition of mother, 219 cigarette smoking and, 217, 220 diagnosis of, 213 fetal and infant mortality, 212, 215, 220 gestation length and low birth weight, 215-216 gestational weight gain in, 9, 13, 212-220, 226 and multivitamin mineral supplements, 20 nutritional assessment, 21 iron deficiencies in, 276 and nutrient supplementation, 18 physical characteristics of mother, 216-218 physiologic adaptations in mother, 219, 220 prevalence, 212 recommended maternal weight gain, 10, 11-12, 220 zygosity and outcomes, 213, 214, 216, 217 U Ultrasound, gestational duration estimated with, 66, 87, 93, 195 Underweight women BMI, 5, 12 gestational weight gain in, 110 recommended weight gain, 12, 40 perinatal mortality, 178 weight gain charts for, 73, 80, 429-430

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INDEX United Kingdom birth weights of twins, 214, 215 cumulative increase in maternal weight, 102, 103 effects of maternal anemia on newborns, 274 energy intake, maternal weight gain, and birth weight in, 141, 159, 164, 385 resting metabolic rate in pregnant women, 166 total body water by period of gestation, 126 vitamin-mineral deficiencies in, 18, 301, 325, 326-327 United States cumulative increase in maternal weight, 103 energy intake, maternal weight gain, and birth weight in, 139-141, 156-159, 164 energy supplementation by pregnant women in, 162-163 folate deficiency in, 18 resting metabolic rate in pregnant women, 165, 166 total body water by period of gestation, 126 U.S. Recommended Daily Allowances, 239, 240, 289 V Vegetarianism and need for supplements, 18, 20, 21, 328, 372, 373 and nutrient deficiencies, 237, 301, 303, 312, 326 and zinc intakes, 303 Very low birth weight, 52, 54, 58, 18~181, 213 Visual impairment vitamin A deficiency and, 337, 339 vitamin E deficiency and, 343 Vitamin A assessment of requirements, 248, 250, 338-339 carotenoids, 336-337 deficiency, 337-341 food sources of, 336-337 importance of, 336, 337 intake (usual), 341 intakes lay pregnant women, 266, 269 metabolism during pregnancy, 337-338 recommended intakes, 339-340 retinoids, 336-337 supplementation recommendations, 341, 346 465 teratogenicity and toxicity, 19, 254, 340, 346 units of measurements, 338 Vitamin Be compounds, 351-352 and course and outcome of pregnancy, 355-359 deficiency, 21, 354 dependency, 359-360 estimated requirements, 352-354 importance, 352 intakes by pregnant women, 16, 265, 266, 268, 269 intakes (usual), 267, 355 interaction with other nutrients, 254 and nausea during pregnancy, 264, 352, 356, 360 research recommendations on, 21 status, criteria for assessment, 35~355 supplementation recommendations, 36~361, 373 toxicity, 254, 359-360 Vitamin B12, 265, 266, 269, 364, 371-373 Vitamin C assessment of requirements, 248, 250, 368 deficiency, 369 dependency, 369 dose range and toxicity, 368 369 estimated requirements, 367-368 importance of, 342, 367-368 intakes by pregnant women, 265, 266, 269 and iron absorption, 20, 281, 289, 368 supplementation, 373 toxicity, 254 Vitamin D age and adequacy of intake, 19 and calcium metabolism, 318, 319, 321, 324, 327 deficiency, 267, 32~325, 330 dietary sources of, 323 indicators of nutritional status, 323 intakes by pregnant women, 16, 265, 266 lactose intolerance and, 19 magnesium interaction with, 328, 329 metabolism, 323-324, 328 requirements, 324, 331 research recommendations on, 21 supplementation, clinical recommendations, 20, 327-328, 331 supplementation, evidence for, 326-327 and toxicity, 254 Vitamin E absorption of, 342 classes of compounds, 341-342 deficiency, 308, 341-343

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466 food sources of, 343-344 importance, 342-343 intakes, 16, 265, 266, 268, 343-344 recommended intakes, 343-344 special considerations, 344 supplementation recommendation, 344, 346 toxicity, 344 Vitamin K deficiency, 345 food sources of, 345 importance, 34~345 intake (usual), 346 recommended intakes, 345 supplementation recommendations, 346 Vitamin supplementation see Periconceptional vitamin supplementation and specific vitamins W Water retention, 6 component of gestational weight gain, 99 postpartum, 129 skinfold thickness and, 124, 133-134 Water, total body and birth weight, 125 calculation, 12~123 and fetal growth, 193, 226 by gestation period, 124 interpretive problems, 127 isotonically labeled water versus deuterium oxide, 12~129 results of studies, 127-129 total body fat calculated from, 132 Water-soluble vitamins biochemical indices of nutritional status, 356-357, 373 RDAs, 353 supplementation recommendations, 373 see also specific vitamins Weight, prepregnancy and birth weight, 55-56, 164 and gestational weight gain determination, 86, 93, 164 recalled, 86 87, 93, 100, 109 measurement, 5-6, 10, 6~65, 123 and pattern of weight gain, 111-112 postpartum, 4, 9 and pregnancy outcome, 40 Weight for height, prepregnancy for adolescents, 80~81 assessment, 65, 6~67, 93, 187; see also Body mass index and birth weight, 38, 151, 164, 184, 218, 227 cutoff points, 5-6, 67 INDEX energy intake and, 14 and fetal growth, 8, 28, 82, 183-184, 204 and gestational weight gain, 4, 6-9, 11-12, 28, 89-90, 101, 100112, 164, 183, 205 normal BMI, 67 and nutritional status, 3, 109 and perinatal mortality, 178 reference standards, 6, 65, 66, 73, 80 82; see also Metropolitan Life Insurance Company weight-for-height standards research needs on, 111 and toxemia, 200 trends in, 43 in weight gain charts, 69, 71 Weight gain (gestational) age and, 4, 109, 113-115, 118, 186 attitudes and, 31 and birth weight, 4, 8, 27, 28, 38, 57, 99, 170, 183-191, 196-198, 201, 217-218, 220, 230 and body composition, 6, 13, 128-130 by body mass index, 10, 11-12, 100-102, 109, 111 cigarette smoking and, 4, 5, 115, 217-218, 220 clinical recommendations, 9-13, 3700 consequences of, 7-9, 29-33 counseling on, 11-12 clinical data on, 63, 67~2 composition of, 98, 99, 121 as determinant of pregnancy outcomes, 6-7, 29-33, 222 documentation of, 38; see also Weight gain charts effect modifiers, 29-33, 177, 183, 185, 186, 222 energy balance and, 31, 169 energy intake and, 4, 7, 56, 107-108, 13~163, 170, 171, 225-226 energy utilization and, 107-108 estimates of, 86 ethnic origin and, 4, 7, 13, 112-113, 118, 186 187 excessive, defined, 39 expressions of, 83 86 and fetal and infant outcomes, 4, 7~, 28, 176-199, 220, 223, 228 and fetal growth, 4, 7-8, 28, 86, 17~183, 192-193, 204, 226, 228 fetal weight included in, 8~89 final weight, 88 food intake and, 7, 56, 107-108, 148, 149 and gestational duration, 9, 34, 86, 91, 194-198, 204, 227-228 height (maternal) and, 4, 5, 112

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INDEX historical perspective, 5, 27-28, 37 40, 56, 57-58 inadequate, defined, 39 incremental, 84 interpretation of research, 82-91 low, defined, 150-151 and maternal/child health, 4, 13, 22~229 maternal determinants of, 10~117, 223 and maternal outcomes, 4, 19~204, 223 measurement of, 9-11, 13, 14, 86, 93, 188 monitoring of, 12-13, 67-68 net, 4, 83~4, 18~190, 197, 198, 227 nonnutritional contributors to, 31, 34, 82, 121, 161, 193, 226 norms, 96-99 nutritional status and, 2~14, 38 in nutritional surveillance, 91-92 parity and, 4, 38, 113-115 pattern and amount, 13, 14, 38, 96-98, 99 117, 192-193 as percentage of recommended gain, 85, 86, 9~91 physical activity or work and, 116-117, 118 and postpartum maternal weight retention, 11, 13, 202-204, 228, 230 prenatal care and, 5 prepregnancy weight and, 4, 5, 84~6, 100 recommended, 10, 11-12, 117-118, 205, 220, 225 reference standards, 84}81, 86, 89-91 research recommendations, 13-14, 204 as risk marker for pregnancy outcome, 34, 222 socioeconomic status and, 4, 7, 56, 109, 116, 118 studies of, 3~39, 56-57, 10~102 total, 4, 83, 86, 88 89, 97-107, 110-112, 117, 127, 183, 188, 197, 198, 219, 227 and total body potassium, 131 trends in, 56-58, 103-104, 117 in twin pregnancies, 212-220, 226 types of, 3-4 variation in, 7 weight-for-height status and, 4, 6-9, 11-12, 28, 89-90, 101, 109-112, 183 WIC participation and, 5, 224 see also Assessment of gestational weight gain Weight gain charts for adolescents, 80-81 evolution of, 6~69 characteristics of, 69-72, 423-428 clinical uses of, 92 gestation age in, 93 467 grids, 6, 7~76, 90 interpretation problems, 78, 79~2 for low-income pregnant women, 73 provisional, by prepregnancy BMI, 10, 429~31 purpose of, 67-68 recommended, 1~11, 14 research needs on, 14, 78 Tompkins-Wlehl curves, 69, 70, 73 underweight/overweight allowances in, 73, 80 weight-for-height adjustments, 69, 71, 73, 78, 79 WIC, 6~77, 92 Weight gain rates and adjustment for gestational duration, HA _= applications of data on, 86 and birth weight, 189-190, 198 cigarette smoking and, 217-218 criteria for evaluating, 424 determination of, 68, 88 energy supplementation and, 150-151 final weight and, 88 maternal age and, 10~103 normal, estimated, 98, 107 and preterm delivery, 195-196 for primigravid women, 97-98 standard errors for, 107 and total weight gain, 10~101 by trimester, 90, 10~106, 117 for twin pregnancies, 219 per week, 4, 6, 100, 107, 117, 219, 220 WIC participation and birth weight, 162 and energy intake, 162, 224 and fetal growth, 5 and gestational weight gain, 5, 157, 159, 162, 224 and nutrient intake during pregnancy, 259, 264, 267-269, 384, 385 and skinfold thickness, 162 target groups, 50 trends in, 4~50, 57-58 Work, see Physical activity/work World Health Organization, criteria for anemia, 284 y Yugoslavia, birth weights of twins, 214 z Znc absorption, 302 assessment of requirements, 248, 303

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468 caffeine and, 19 and cell replication and differentiation, 300 deficiency, 21, 301-304 dosage range and toxicity, 303 estimated requirements during pregnancy, 302 intakes, 16, 265, 266, 267, 30~303, 312 interactions with other supplements and nonnutritive substances, 21, 254, 290, 300, 303, 30~305, 307 INDEX and neural tube defects, 417 recommendations for supplementation, 247, 305 and reproduction in animals, 30~301 and reproduction in humans, 301-302 research recommendations on, 21 status, criteria for assessment, 303-304 toxicity, 254 teratogenicity, 300 301