Nutrition during pregnancy and lactation

Because appropriate maternal nutrition improves pregnancy outcome, improving maternal nutrition before, during, and after pregnancy is an excellent example of primary prevention. Providing assessment and intervention to encourage an optimal state of health will also benefit the many women who do not desire pregnancy. For these women, the provision of nutritional care as part of a periodic health assessment can serve not only as a way to enhance health status in preparation for a future pregnancy, but also as a mechanism for encouraging nutritional behaviors to improve health throughout life.

Changes in energy intakes during pregnancy and lactation in a national sample of US women

Increases in energy intakes during pregnancy and lactation were evaluated by examining dietary data for 458 pregnant women who participated in the Continuing Surveys of Food Intakes by Individuals conducted in 1985 and 1986. Energy intakes were well below recommendations during all reproductive states; however, increases during pregnancy approximated recommendations, while increases during lactation were low. Postpartum non-lactating intakes did not return to prepregnancy levels for Black women or women with lower incomes.

Development and validation of a food use checklist for evaluation of community nutrition interventions

We developed a new dietary assessment instrument, the Food Behavior Checklist (FBC), which measures food use related to adopting lower-fat and higher-fiber diets. The FBC is a simplification of the 24-hour diet recall that consists of 19 simple yes/no questions about foods consumed during the previous day. To develop the FBC, an expert committee generated a list of foods based on our intervention program, and we used focus groups and random-digit dialing pretests to refine the format and clarify items. To validate the FBC, we compared responses of 96 women on the FBC to information collected during a professionally administered 24-hour diet recall. For most items, agreement between the FBC and 24-hour recall, based on the kappa statistic, was good to excellent. Agreement was poor for items requiring detailed knowledge about food composition (e.g. high-fiber cereal). There was a trend to over-report general food categories (e.g. luncheon meats) but not specific food items (e.g. ice cream). In an embedded randomized study, we found that a set of introductory items designed to serve as a memory retrieval cue did not improve agreement between the FBC and 24-hour recall. These data provide preliminary evidence supporting the use of short checklist questionnaires on the previous day's food use as a means to assess diet at the group or community level. This relatively inexpensive and rapid measure can be used to inform the design of public health nutrition programs and as an evaluation tool in intervention research.

Prepregnancy weight, weight gain, and birth weight

The effect of maternal weight gain on birth weight in 2946 live births with delivery after 37 weeks' gestation was studied at Moffitt Hospital, University of California (San Francisco), between September, 1980, and December, 1983. The sample was stratified into four categories according to prepregnancy weight for height with use of a body mass index. To study the effect of maternal weight gain on infant birth weight, multiple regression analysis, controlled for selected covariables, was carried out on the entire sample and on each prepregnancy weight group. For the entire sample, both pregravid body mass and weight gain significantly influenced birth weight. For the underweight, ideal weight, and moderately overweight women, each kilogram of maternal weight gain significantly increased birth weight. This study supports recent evidence for the association between maternal weight gain and birth weight, but only for women whose prepregnancy weights are 135% of ideal or less. These results suggest that recommendations for a minimum weight gain for obese women are unnecessary.