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Costa SMB, Hallur RLS, Reyes DRA, Floriano JF, de Barros Leite Carvalhaes MA, de Carvalho Nunes HR, Sobrevia L, Valero P, Barbosa AMP, Rudge MCV. Role of dietary food intake patterns, anthropometric measures, and multiple biochemical markers in the development of pregnancy-specific urinary incontinence in gestational diabetes mellitus. Nutrition 2024; 117:112228. [PMID: 37948994 DOI: 10.1016/j.nut.2023.112228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/04/2023] [Accepted: 09/16/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES The aim of this study was to assess maternal dietary food intake patterns, anthropometric measures, and multiple biochemical markers in women with gestational diabetes mellitus and pregnancy-specific urinary incontinence and to explore whether antedating gestational diabetes mellitus environment affects the pregnancy-specific urinary incontinence development in a cohort of pregnant women with gestational diabetes mellitus and pregnancy-specific urinary incontinence. METHODS Maternal dietary information and anthropometric measurements were collected. At 24 wk of gestation, with a fasting venipuncture sample, current blood samples for biochemical markers of hormones, vitamins, and minerals were analyzed. The groups were compared in terms of numerical variables using analysis of variance for independent samples followed by multiple comparisons. RESULTS Of the 900 pregnant women with complete data, pregnant women in the gestational diabetes mellitus pregnancy-specific urinary incontinence group had higher body mass index during pregnancy, arm circumference, and triceps skinfold than the non-gestational diabetes mellitus continent and non-gestational diabetes mellitus pregnancy-specific urinary incontinence groups, characterizing an obesogenic maternal environment. Regarding dietary food intake, significant increases in aromatic amino acids, branched-chain amino acids, dietary fiber, magnesium, zinc, and water were observed in pregnancy-specific urinary incontinence group compared with the non-gestational diabetes mellitus continent group. Serum vitamin C was reduced in the gestational diabetes mellitus pregnancy-specific urinary incontinence group compared with the non-gestational diabetes mellitus pregnancy-specific urinary incontinence group. CONCLUSIONS This study emphasizes the necessity for a comprehensive strategy for gestational diabetes mellitus women with pregnancy-specific urinary incontinence in terms of deviation in maternal adaptation trending toward obesity and maternal micronutrients deficiencies.
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Affiliation(s)
- Sarah Maria Barneze Costa
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil
| | - Raghavendra Lakshmana Shetty Hallur
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil; College of Biosciences and Technology, Pravara Institute of Medical Sciences (DU), Loni-413736, Rahata Taluka, Ahmednagar District, Maharashtra State, India
| | - David Rafael Abreu Reyes
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil
| | - Juliana Ferreira Floriano
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil
| | | | | | - Luis Sobrevia
- Botucatu Medical School, São Paulo State University, São Paulo, Brazil; Cellular and Molecular Physiology Laboratory, Division of Obstetrics and Gynecology, Department of Obstetrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Centre for Clinical Research, Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, Australia; Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Institute for Obesity Research, School of Medicine and Health Sciences, Monterrey Institute of Technology and Higher Education, Monterrey, Mexico
| | - Paola Valero
- Botucatu Medical School, São Paulo State University, São Paulo, Brazil; Faculty of Health Sciences, Universidad de Talca, Talca, Chile
| | - Angélica Mércia Pascon Barbosa
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil; Department of Physiotherapy and Occupational Therapy, School of Philosophy and Sciences, São Paulo State University, Marília, Brazil
| | - Marilza Cunha Vieira Rudge
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil.
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Wan CS, Nankervis A, Teede H, Aroni R. Priorities to improve woman-centred gestational diabetes mellitus care: A qualitative study to compare views between clinical and consumer end-users. J Hum Nutr Diet 2023; 36:1636-1648. [PMID: 37282816 DOI: 10.1111/jhn.13191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Immigrants worldwide have a two-fold higher risk of gestational diabetes mellitus (GDM) than women of the host country. Providing culturally appropriate woman-centred GDM care to attenuate adverse maternal and neonatal health outcomes is a persistent challenge for health services. Underpinned by the Knowledge to Action Framework, understanding and comparing the views of patients from different ethnic backgrounds and healthcare professionals (HCPs) about current and optimal GDM care can highlight priority areas to improve woman-centred care. This qualitative study aimed to compare the views of ethnic Chinese and Australian-born Caucasian women and their HCPs, including endocrinologists, obstetricians, midwives, diabetes nurse educators and dietitians, about what constitutes optimal GDM care and how to improve woman-centred GDM care. METHODS Purposive sampling was used to recruit 42 Chinese and 30 Caucasian women with GDM and 17 HCPs from two large Australian hospital maternity services to complete in-depth, semi-structured interviews. Patients' and HCPs' views were thematically analysed and compared. RESULTS Four out of nine themes showed misalignments between patients' and HCPs' views on GDM care, reflecting priority areas to improve woman-centred care by (i) reaching agreement on the attitudes towards different treatment targets between HCPs; (ii) enhancing inter-professional communication; (iii) improving GDM care transition to postpartum care; and (iv) providing detailed dietary advice tailored to Chinese patients' cultural diet. CONCLUSIONS Further research on reaching consensus on treatment targets, enhancing inter-professional communication, developing a perinatal care transition model from pregnancy to postpartum, and developing Chinese patient-oriented educational resources is required to improve woman-centred care.
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Affiliation(s)
- Ching Shan Wan
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Melbourne, VIC, Australia
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Clayton, VIC, Australia
| | - Alison Nankervis
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
- Departments of Diabetes and Endocrinology, The Royal Melbourne and Royal Women's Hospitals, Parkville, VIC, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Clayton, VIC, Australia
- Department of Endocrinology and Diabetes, Monash Health, Clayton, Victoria, Australia
| | - Rosalie Aroni
- Medical School, College of Health and Medicine, Canberra, ACT, Australia
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Lawrence RL, Wall CR, Bloomfield FH. Adherence to Dietary Guidelines among Women with and without Gestational Diabetes: Evidence from the Growing up in New Zealand Study. Nutrients 2022; 14:nu14102145. [PMID: 35631286 PMCID: PMC9144046 DOI: 10.3390/nu14102145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/15/2022] [Accepted: 05/19/2022] [Indexed: 11/21/2022] Open
Abstract
Diet is thought to play a role in the development and management of gestational diabetes mellitus (GDM). Dietary guidelines provide practical recommendations for achieving nutrient requirements and mitigating the risk of chronic disease. The aim of this study was to describe the adherence to dietary guidelines by women with and without GDM and determine whether adherence is associated with the development of GDM. Adherence to Ministry of Health food group recommendations was assessed in 5391 pregnant women participating in the Growing Up in New Zealand study. A food frequency questionnaire (FFQ) administered during pregnancy provided dietary data. The presence of GDM was determined using diagnostic coding in clinical data and blood glucose results. A quarter of women did not meet any food group recommendations. There were no significant differences in the number of food group targets met by women with or those without GDM. Meeting food group recommendations was not associated with odds of having GDM in adjusted analyses. This study found adherence to dietary recommendations is poor in both women with and without GDM and no association between adherence to food group recommendations and the development of GDM. Greater support is required to assist women to achieve food and nutrition recommendations.
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Affiliation(s)
- Robyn L. Lawrence
- The Liggins Institute, The University of Auckland, Auckland 1023, New Zealand;
| | - Clare R. Wall
- Disciple of Nutrition and Dietetics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1023, New Zealand;
| | - Frank H. Bloomfield
- The Liggins Institute, The University of Auckland, Auckland 1023, New Zealand;
- Correspondence: ; Tel.: +64-9-923-6107 (ext. 86107)
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Lawrence RL, Ward K, Wall CR, Bloomfield FH. New Zealand women's experiences of managing gestational diabetes through diet: a qualitative study. BMC Pregnancy Childbirth 2021; 21:819. [PMID: 34886814 PMCID: PMC8662890 DOI: 10.1186/s12884-021-04297-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/23/2021] [Indexed: 12/25/2022] Open
Abstract
Background For women with gestational diabetes mellitus (GDM) poor dietary choices can have deleterious consequences for both themselves and their baby. Diet is a well-recognised primary strategy for the management of GDM. Women who develop GDM may receive dietary recommendations from a range of sources that may be inconsistent and are often faced with needing to make several dietary adaptations in a short period of time to achieve glycaemic control. The aim of this study was to explore how women diagnosed with GDM perceive dietary recommendations and how this information influences their dietary decisions during pregnancy and beyond. Methods Women diagnosed with GDM before 30 weeks’ gestation were purposively recruited from two GDM clinics in Auckland, New Zealand. Data were generated using semi-structured interviews and thematic analysed to identify themes describing women’s perceptions and experiences of dietary recommendations for the management of GDM. Results Eighteen women from a diverse range of sociodemographic backgrounds participated in the study. Three interconnected themes described women’s perceptions of dietary recommendations and experiences in managing their GDM through diet: managing GDM is a balancing act; using the numbers as evidence, and the GDM timeframe. The primary objective of dietary advice was perceived to be to control blood glucose levels and this was central to each theme. Women faced a number of challenges in adhering to dietary recommendations. Their relationships with healthcare professionals played a significant role in their perception of advice and motivation to adhere to recommendations. Many women perceived the need to follow dietary recommendations to be temporary, with few planning to continue dietary adaptations long-term. Conclusions The value of empathetic, individually tailored advice was highlighted in this study. A greater emphasis on establishing healthy dietary habits not just during pregnancy but for the long-term health of both mother and baby is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04297-0.
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Affiliation(s)
- R L Lawrence
- The Liggins Institute, The University of Auckland, Building 505, Level 2, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - K Ward
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - C R Wall
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - F H Bloomfield
- The Liggins Institute, The University of Auckland, Building 505, Level 2, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
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Breastfeeding and growth trajectory from birth to 5 years among children exposed and unexposed to gestational diabetes mellitus in utero. J Perinatol 2021; 41:1033-1042. [PMID: 33510423 DOI: 10.1038/s41372-021-00932-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/09/2020] [Accepted: 01/15/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This study aims to evaluate the association between exposure to gestational diabetes mellitus and growth trajectory from birth to 5 years and to test whether breastfeeding influences this association among children exposed and unexposed to gestational diabetes. STUDY DESIGN Weight at 0, 6, 12, and 18 months and 2, 3, 4, and 5 years were retrospectively collected for 103 children exposed and 63 children unexposed to gestational diabetes. Weight-for-age z-score was calculated. Mixed linear model for repeated measurements were computed to test whether breastfeeding was associated differently with weight-for-age z-score of children exposed or unexposed to diabetes. RESULTS Children exposed to gestational diabetes had greater z-score values at 6 months and 4 and 5 years (p < 0.10). Breastfeeding duration was not associated with weight-for-age z-score trajectory in any children. CONCLUSION Children exposed to gestational diabetes had a different growth trajectory in early life, but breastfeeding duration did not seem to influence this association.
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Meloncelli N, Wilkinson SA, de Jersey S. Searching for Utopia, the Challenge of Standardized Medical Nutrition Therapy Prescription in Gestational Diabetes Mellitus Management: A Critical Review. Semin Reprod Med 2021; 38:389-397. [PMID: 33429445 DOI: 10.1055/s-0040-1722316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Gestational diabetes mellitus (GDM) is a common pregnancy disorder and the incidence is increasing worldwide. GDM is associated with adverse maternal outcomes which may be reduced with proper management. Lifestyle modification in the form of medical nutrition therapy and physical activity, as well as self-monitoring of blood glucose levels, is the cornerstone of GDM management. Inevitably, the search for the "ultimate" diet prescription has been ongoing. Identifying the amount and type of carbohydrate to maintain blood glucose levels below targets while balancing the nutritional requirements of pregnancy and achieving gestational weight gain within recommendations is challenging. Recent developments in the area of the gut microbiota and its impact on glycemic response add another layer of complexity to the success of medical nutrition therapy. This review critically explores the challenges to dietary prescription for GDM and why utopia may never be found.
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Affiliation(s)
- Nina Meloncelli
- Nutrition and Dietetics, Sunshine Coast University Hospital, Birtinya, Australia.,Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Shelley A Wilkinson
- School of Human Movements and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia.,Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Susan de Jersey
- Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
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Lawrence RL, Wall CR, Bloomfield FH. Dietary Patterns and Dietary Adaptations in Women with and without Gestational Diabetes: Evidence from the Growing Up in New Zealand Study. Nutrients 2020; 12:nu12010227. [PMID: 31952314 PMCID: PMC7019595 DOI: 10.3390/nu12010227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 01/13/2020] [Indexed: 12/18/2022] Open
Abstract
Diet is a cornerstone of the management of gestational diabetes (GDM). We investigated differences in dietary patterns and dietary adaptations among pregnant women with and without GDM participating in the Growing Up in New Zealand study. Presence of GDM was determined using coded clinical data and plasma glucose results meeting the New Zealand Society for the Study of Diabetes diagnostic criteria. Women answered a food frequency questionnaire and questions regarding dietary changes and information received during pregnancy. Women with GDM had lower adherence scores than those without GDM for 'Junk' (mean (SD) score -0.28 (0.95) versus 0.02 (1.01) p < 0.0005) and 'Traditional/White bread' dietary patterns (-0.18 (0.93) versus 0.01 (1.01) p = 0.002). More women with GDM reported avoiding foods high in fat or sugar (25.3% versus 5.7%, p < 0.05) compared to women without GDM. A greater proportion of women with GDM compared with those without GDM received information from dietitians or nutritionists (27.0% versus 1.7%, p < 0.05) or obstetricians (12.6% versus 7.5%, p < 0.05). More women diagnosed before the antenatal interview received advice from dietitians or nutritionists compared with those diagnosed after (46.9% versus 6.0%, p < 0.05). Women with GDM appear to make positive changes to their diet in response to advice received from health care professionals.
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Affiliation(s)
- Robyn L. Lawrence
- The Liggins Institute, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand;
| | - Clare R. Wall
- Discipline of Nutrition and Dietetics, School of Medical Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand;
| | - Frank H. Bloomfield
- The Liggins Institute, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand;
- Correspondence: ; Tel.: +64-9-923-6107
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Feig DS, Berger H, Donovan L, Godbout A, Kader T, Keely E, Sanghera R. Diabetes and Pregnancy. Can J Diabetes 2018; 42 Suppl 1:S255-S282. [DOI: 10.1016/j.jcjd.2017.10.038] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Li L, Xu J, Zhu W, Fan R, Bai Q, Huang C, Liu J, Li Z, Sederholm M, Norstedt G, Wang J. Effect of a macronutrient preload on blood glucose level and pregnancy outcome in gestational diabetes. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2016; 5:36-41. [PMID: 29067233 PMCID: PMC5644440 DOI: 10.1016/j.jcte.2016.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/21/2016] [Accepted: 04/08/2016] [Indexed: 01/14/2023]
Abstract
Gestational diabetes (GDM) is associated with risks for both the mother and the child. A food composition, macro-nutrient preload, was given half an hour before each meal. Thirty-three GDM patients were given macro-nutrient preload and 33 a control comparator. A two-month macro-nutrient preload treatment of GDM improved post-prandial glycemia. Macro-nutrient preload treatment is of a potential value for future management of GDM.
Aim To investigate the effect of a macro-nutrient preload (Inzone Vitality) on blood glucose levels and pregnancy outcomes of gestational diabetes. The preload method involves the ingestion of a smaller amount of a macronutrient composition half an hour before regular meals. The hypothesis was that preload treatment will reduce postprandial glycemia in gestational diabetes. Methods Sixty-six diagnosed cases of gestational diabetes were randomly selected from gynecology and obstetrics outpatient clinic at Xinqiao Hospital in Chongqing. The patients were divided into an intervention group (33 cases) and a control group (33 cases), according to odd–even numbers of the random cases. The intervention group was treated with a macro-nutrient preload given 0.5 h before regular meals and the control group was given a comparative treatment consisting of a milk powder with similar energy content. The two groups were studied until delivery and the measured parameters included fasting blood glucose (FBG), 2-hour postprandial blood glucose (2h-PBG), delivery mode and neonatal birth weight. Results The two groups showed no differences in FBG or 2h-PBG before the nutritional intervention. FBG and 2h-PBG after intervention and before delivery were significantly lower in the intervention group, treated with the macro nutrient preload compared to the control group (P < 0.01). Changes in FBG and 2h-PBG before and after the intervention were investigated and the difference in the intervention group was significantly greater than corresponding values in the control group (P < 0.05, P < 0.01). The neonatal birth weight and delivery mode was not significantly different (P > 0.05). Conclusion A macro-nutrient composition, used as a preload, is effective in controlling FBG and PBG of gestational diabetes.
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Affiliation(s)
- Li Li
- Department of Nutrition, Xinqiao Hospital, Chongqing 400037, China
| | - Jing Xu
- Department of Endocrinology, Xinqiao Hospital, Chongqing 400037, China
| | - Wenyi Zhu
- Department of Nutrition, Xinqiao Hospital, Chongqing 400037, China
| | - Rong Fan
- Department of Nutrition, Xinqiao Hospital, Chongqing 400037, China
| | - Qian Bai
- Department of Nutrition, Xinqiao Hospital, Chongqing 400037, China
| | - Chen Huang
- Department of Nutrition, Xinqiao Hospital, Chongqing 400037, China
| | - Jun Liu
- Department of Nutrition, Xinqiao Hospital, Chongqing 400037, China
| | - Zhen Li
- Department of Obstetrics and Gynecology, Xinqiao Hospital, Chongqing 400037, China
| | - Magnus Sederholm
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Norstedt
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Jian Wang
- Department of Nutrition, Xinqiao Hospital, Chongqing 400037, China
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Morisset AS, Weiler HA, Dubois L, Ashley-Martin J, Shapiro GD, Dodds L, Massarelli I, Vigneault M, Arbuckle TE, Fraser WD. Rankings of iron, vitamin D, and calcium intakes in relation to maternal characteristics of pregnant Canadian women. Appl Physiol Nutr Metab 2016; 41:749-57. [PMID: 27324651 DOI: 10.1139/apnm-2015-0588] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Iron, vitamin D, and calcium intakes in the prenatal period are important determinants of maternal and fetal health. The objective of this study was to examine iron, vitamin D, and calcium intakes from diet and supplements in relation to maternal characteristics. Data were collected in a subsample of 1186 pregnant women from the Maternal-Infant Research on Environmental Chemicals (MIREC) Study, a cohort study including pregnant women recruited from 10 Canadian sites between 2008 and 2011. A food frequency questionnaire was administered to obtain rankings of iron, calcium, and vitamin D intake (16-21 weeks of pregnancy). Intakes from supplements were obtained from a separate questionnaire (6-13 weeks of pregnancy). Women were divided into 2 groups according to the median total intake of each nutrient. Supplement intake was an important contributor to total iron intake (median 74%, interquartile range (IQR) 0%-81%) and total vitamin D intake (median 60%, IQR 0%-73%), while the opposite was observed for calcium (median 18%, IQR 0%-27%). Being born outside of Canada was significantly associated with lower total intakes of iron, vitamin D, and calcium (p ≤ 0.01 for all). Consistent positive indicators of supplement use (iron, vitamin D, and calcium) were maternal age over 30 years and holding a university degree. In conclusion, among Canadian women, the probability of having lower iron, vitamin D, and calcium intakes is higher among those born outside Canada; supplement intake is a major contributor to total iron and vitamin D intakes; and higher education level and age over 30 years are associated with supplement intake.
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Affiliation(s)
- Anne-Sophie Morisset
- a Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada.,b Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC H3T 1C5, Canada
| | - Hope A Weiler
- c School of Dietetics and Human Nutrition, McGill University, Montreal, QC H9X 3V9, Canada
| | - Lise Dubois
- d School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Jillian Ashley-Martin
- e Perinatal Epidemiology Research Unit, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Gabriel D Shapiro
- b Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC H3T 1C5, Canada
| | - Linda Dodds
- e Perinatal Epidemiology Research Unit, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | | | | | - Tye E Arbuckle
- g Environmental Health, Science and Research Bureau, Health Canada, Ottawa, ON K1A 0K9, Canada
| | - William D Fraser
- a Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada.,b Sainte-Justine University Hospital Research Center, University of Montreal, Montreal, QC H3T 1C5, Canada
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