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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.

This study was supported by project no. MCJ 117018 from the Maternal and Child Health Program (Title V, Social Security Act), Health Resources and Services Administration, U.S. Department of Health and Human Services.

Library of Congress Cataloging-in-Publication Data

Institute of Medicine (U.S.). Subcommittee for a Clinical Application Guide.

Nutrition during pregnancy and lactation : an implementation guide / Subcommittee for a Clinical Application Guide, Committee on Nutritional Status during Pregnancy and Lactation, Food and Nutrition Board, Institute of Medicine, National Academy of Sciences.

p. cm.

Includes bibliographical references and index.

ISBN 0-309-04738-2

1. Pregnancy—Nutritional aspects. 2. Lactation—Nutritional aspects. 3. Nutrition counseling. I. Title.

[DNLM: 1. Lactation. 2. Nutrition—in pregnancy. 3. Prenatal Care—standards. WQ 175 I595n]

RG559.156 1992



for Library of Congress 92-19175


Copyright 1992 by the National Academy of Sciences

The body mass index and weight gain charts and materials designated for the patient may be reproduced for patient use and for other educational purposes. No other part of this book may be reproduced by any mechanical, photographic, or electronic process, or in the form of a phonographic recording, nor may it be stored in a retrieval system, transmitted, or otherwise copied for public or private use, without written permission from the publisher, except for the purposes of official use by the U.S. Government.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

First Printing, July 1992

Second Printing, September 1993

Third Printing, November 1993

Fourth Printing, May 1997

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