National Academies Press: OpenBook
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Nutrition During Pregnancy and Lactation: Exploring New Evidence: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25841.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Nutrition During Pregnancy and Lactation: Exploring New Evidence: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25841.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Nutrition During Pregnancy and Lactation: Exploring New Evidence: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25841.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Nutrition During Pregnancy and Lactation: Exploring New Evidence: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25841.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Nutrition During Pregnancy and Lactation: Exploring New Evidence: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25841.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Nutrition During Pregnancy and Lactation: Exploring New Evidence: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25841.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Nutrition During Pregnancy and Lactation: Exploring New Evidence: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25841.
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Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Nutrition During Pregnancy and Lactation: Exploring New Evidence: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25841.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Nutrition During Pregnancy and Lactation: Exploring New Evidence: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25841.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Nutrition During Pregnancy and Lactation: Exploring New Evidence: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25841.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Nutrition During Pregnancy and Lactation: Exploring New Evidence: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25841.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Nutrition During Pregnancy and Lactation: Exploring New Evidence: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25841.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Meghan Harrison, Rapporteur Food and Nutrition Board Health and Medicine Division PREPUBLICATION COPY—Uncorrected Proofs

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by a contract between the National Academy of Sci- ences and the National Institutes of Health’s Office of Dietary Supplements (HHSN 263201800029I/75N98019F00858), with additional support from the Academy of Nutrition and Dietetics, Health Canada, and the Kellogg Endowment Fund of the National Academies of Sciences, Engineering, and Medicine’s Health and Medicine Division. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/25841 Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2020 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2020. Nutrition during pregnancy and lactation: Exploring new evidence: Proceed- ings of a workshop. Washington, DC: The National Academies Press. https://doi. org/10.17226/25841. PREPUBLICATION COPY—Uncorrected Proofs

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the char- ter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY—Uncorrected Proofs

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typi- cally include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY—Uncorrected Proofs

PLANNING COMMITTEE ON NUTRITION DURING PREGNANCY AND LACTATION: EXPLORING NEW EVIDENCE1 ANNA MARIA SIEGA-RIZ (Chair), University of Massachusetts Amherst PATRICK CATALANO, Tufts University School of Medicine, Boston, Massachusetts ERICA P. GUNDERSON, Kaiser Permanente Northern California, Oakland TAMERA HATFIELD, University of California, Irvine DEBORAH O’CONNOR, University of Toronto, Ontario ANGELA ODOMS-YOUNG, University of Illinois at Chicago EMILY OKEN, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts Health and Medicine Division Staff MEGHAN HARRISON, Study Director ZARIA FYFFE, Senior Program Assistant ANN YAKTINE, Director, Food and Nutrition Board 1  The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. ­ The responsibility for the published Proceedings of a Workshop rests with the workshop r ­ apporteur and the institution. v PREPUBLICATION COPY—Uncorrected Proofs

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Reviewers This Proceedings of a Workshop was reviewed in draft form by indi- viduals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical com- ments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this proceedings: STEPHANIE GOODWIN, Danone North America CAROLYN HIGHTOWER, Vitamix Foundation JAMIE STANG, University of Minnesota School of Public Health Although the reviewers listed above provided many constructive com- ments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by SUSAN SCRIMSHAW, Nevin Scrimshaw International Nutrition Foundation. She was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies. vii PREPUBLICATION COPY—Uncorrected Proofs

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Contents 1 INTRODUCTION 1 Setting the Stage for the Workshop, 1 Sponsor Remarks, 3 Organization of the Proceedings, 5 2 MACRONUTRIENT REQUIREMENTS 7 Dietary Fat, Fatty Acids, and the Specific Health Effects of Omega-3 Fatty Acids in Pregnancy and Lactation, 7 Discussion with Maria Makrides, 12 Protein and Amino Acid Requirements in Pregnancy and Lactation: New Evidence Challenges Current Recommendations, 13 Carbohydrates and Energy Requirements, 17 Discussion with Rajavel Elango and Leanne Redman, 21 3 ONE-CARBON METABOLISM MICRONUTRIENTS 25 Discrepancies in Folate and Vitamin B12 Status of Pregnant Women Across Population Groups and the Possible Implications for Child Outcomes, 25 The Growing Science on the Benefits of Choline for Mothers and Infants, 31 Discussion, 35 ix PREPUBLICATION COPY—Uncorrected Proofs

x CONTENTS 4 IRON, VITAMIN D, CALCIUM, ANTIOXIDANTS, AND IODINE 39 Iron, Vitamin D, and Calcium: New Evidence During Pregnancy and Lactation, 39 Nutritional Antioxidants During Pregnancy and Lactation, 46 Iodine in Pregnancy and Lactation, 49 Discussion, 53 5 DIETARY SUPPLEMENTS 57 Dietary Supplement Use and Its Micronutrient Contribution During Pregnancy and Lactation in the United States, 57 Prenatal Supplement Formulations, 63 Discussion, 67 Reflection on the Day, 70 6 NEW DEVELOPMENTS AND EMERGING TOPICS 71 Caffeine in Pregnancy and Lactation: What Is New?, 72 Maternal Diet During Pregnancy and Lactation and the Interaction with the Developing Infant Microbiome, 75 Fructose and Oligosaccharides in Human Breast Milk and Effects on Infant Body Composition and Cognitive Outcomes, 79 Discussion, 83 7 MATERNAL INTAKES AND NUTRITIONAL STATUS DURING LACTATION AND THE IMPLICATIONS FOR MATERNAL AND INFANT HEALTH 87 Maternal Micronutrient Status and Intake: Effects on Human Milk Composition, 87 The Implications of Maternal Weight and Metabolic Status for Lactation and Breast Milk Composition, 93 Lactation and the Future Risk of Cardiometabolic Diseases in Women, 99 Discussion, 104 8 MATERNAL NUTRIENT INTAKE AND EARLY-LIFE PROGRAMMING 107 The Role of the Placenta in Delivering Nutrients and in Developmental Programming, 107 Panel Discussion, 113 Questions from the Audience, 115 PREPUBLICATION COPY—Uncorrected Proofs

CONTENTS xi 9 THE ROLE OF SYSTEMS AND POLICIES IN PROVIDING SOLUTIONS TO NUTRITION ACCESS AND EQUITY DURING PREGNANCY AND LACTATION 119 Systems Changes for Improving Maternal Nutrition During Pregnancy and Lactation Among U.S. Women, 119 Using Nutrition Science to Reduce Perinatal Health Disparities, 125 Food Insecurity and Stress as Common Challenges to Optimal Nutrition During Pregnancy, 126 How WIC Supports Pregnancy and Lactation, 128 Panel Discussion, 130 Questions from the Audience, 132 10 REFLECTIONS ON THE WORKSHOP 135 Invited Reflections on the Workshop, 135 Reflections from the Audience, 139 Closing Remarks, 142 REFERENCES 143 APPENDIXES A ACRONYMS AND ABBREVIATIONS 161 B WORKSHOP AGENDA 165 C BIOGRAPHICAL SKETCHES OF WORKSHOP SPEAKERS AND MODERATORS 175 PREPUBLICATION COPY—Uncorrected Proofs

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The National Academies of Sciences, Engineering, and Medicine last reviewed the state of the science on nutrition during pregnancy and lactation 30 years ago. The resulting consensus study reports from the Institute of Medicine—Nutrition During Pregnancy (IOM, 1990) and Nutrition During Lactation (IOM, 1991)—summarized the scientific evidence and provided nutrient recommendations. In the decades since the release of these two reports, the body of evidence on the relationships between nutrition during pregnancy and lactation and maternal and infant health and chronic disease has continued to grow and evolve. At the same time, the demographics of the population have shifted, giving rise to new considerations. To explore the evidence that has emerged, the National Academies conducted a 2-day workshop in January 2020. This publication summarizes the presentations and discussions from the workshop.

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