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Nutrition Issues During Lactation

  • Deborah L. O’Connor
  • Susan Trang
  • Yen-Ming ChanEmail author
Chapter
Part of the Nutrition and Health book series (NH)

Abstract

Breastfeeding is the normal and unequalled method of feeding infants. The World Health Organization recommends human milk as the exclusive nutrient source for the first 6 months of life, with introduction of solids at this time, and continued breastfeeding up to 2 years of age or beyond. It will come as a surprise to many readers that the energy and nutrient needs of lactating women adhering to these optimal infant feeding guidelines will exceed those of pregnancy. However, like during pregnancy, the elevated nutritional requirements can be met by consuming an extra two to three servings of nutrient-dense foods. Early postpartum, many women are anxious to return to their prepregnancy body size. Indeed, postpartum weight retention is a significant contributor to the risk of obesity and associated adverse health outcomes. For many, weight management will be difficult, given personal circumstances and multiple demands on their time. Given the elevated nutrient requirements of lactation, to achieve prepregnancy weight or a healthy body weight, women will need to plan meals with care to maximize nutrient intake while limiting energy-dense foods. The purpose of this chapter is to provide an overview of the energy demands of lactation, as well as a select list of nutrients known to sometimes be provided in short supply for reproductive-age women from developed countries. The specific nutrients examined include calcium, vitamin D, folate, vitamin B12, and iron. As energy balance is a current area of concern for many lactating women and their health care providers, we will also review the literature in relation to dieting and exercise during lactation. Finally, we also include a discussion about long-chain polyunsaturated fatty acids (LC-PUFAs), variability in breast milk content, and the implications of maternal LC-PUFAs supplementation on infant outcomes.

Keywords

Breastfeeding Lactation Postpartum Nursing LC-PUFAs 

Notes

Acknowledgment

The authors wish to acknowledge the expert assistance of Aneta Plaga in helping consolidate the written work of the three authors and in manuscript preparation.

References

  1. 1.
    American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827–e41.Google Scholar
  2. 2.
    Health Canada. Nutrition for healthy term infants: recommendations from birth to six months. A joint statment of Health Canada, Canadian Paediatric Society, Dietitians of Canada, and Breastfeeding Committee for Canada. Available from http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/recom/index-eng.php. Accessed 18 Jun 2016.
  3. 3.
    World Health Organization. Global strategy for infant and young child feeding. 2003. http://apps.who.int/iris/bitstream/10665/42590/1/9241562218.pdf. Accessed 18 Jun 2016.
  4. 4.
    American Academy of Pediatrics Committee on Nutrition. Breastfeeding. In: Kleinman RE, Greer FR, editors. Pediatric nutrition, chap. 3, 7th ed. Elk Grove Village: American Academy of Pediatrics; 2014. p. 41–56.Google Scholar
  5. 5.
    Victora CG, Bahl R, Barros AJ, Franca GV, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475–90.PubMedGoogle Scholar
  6. 6.
    Anderson JW, Johnstone BM, Remley DT. Breast-feeding and cognitive development: a meta-analysis. Am J Clin Nutr. 1999;70(4):525–35.PubMedGoogle Scholar
  7. 7.
    Nutrition Working Group, O’Connor DL, Blake J, Bell R, Browen A, Callum J, et al. Canadian consensus on female nutrition: adolescence, reproduction, menopause and beyond. J Obstet Gynaecol Can. 2016;38(6):508–54.e18.Google Scholar
  8. 8.
    Picciano MF. Pregnancy and lactation: physiological adjustments, nutritional requirements and the role of dietary supplements. J Nutr. 2003;133(6):1997S–2002S.PubMedGoogle Scholar
  9. 9.
    Allen LH. B vitamins in breast milk: relative importance of maternal status and intake, and effects on infant status and function. Adv Nutr. 2012;3(3):362–9.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Butte NF, King JC. Energy requirements during pregnancy and lactation. Public Health Nutr. 2005;8(7A):1010–27.PubMedGoogle Scholar
  11. 11.
    Institute of Medicine. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients). Washington: National Academy Press; 2005.Google Scholar
  12. 12.
    He X, Zhu M, Hu C, Tao X, Li Y, Wang Q, et al. Breast-feeding and postpartum weight retention: a systematic review and meta-analysis. Public Health Nutr. 2015;18(18):3308–16.PubMedGoogle Scholar
  13. 13.
    Neville CE, McKinley MC, Holmes VA, Spence D, Woodside JV. The relationship between breastfeeding and postpartum weight change—a systematic review and critical evaluation. Int J Obes. 2014;38(4):577–90.Google Scholar
  14. 14.
    Onyango AW, Nommsen-Rivers L, Siyam A, Borghi E, de Onis M, Garza C, et al. Post-partum weight change patterns in the WHO Multicentre Growth Reference Study. Matern Child Nutr. 2011;7(3):228–40.PubMedGoogle Scholar
  15. 15.
    Lederman SA. Influence of lactation on body weight regulation. Nutr Rev. 2004;62(7 Pt 2):S112–9.PubMedGoogle Scholar
  16. 16.
    Lovelady CA, Stephenson KG, Kuppler KM, Williams JP. The effects of dieting on food and nutrient intake of lactating women. J Am Diet Assoc. 2006;106(6):908–12.PubMedGoogle Scholar
  17. 17.
    Kirkegaard H, Stovring H, Rasmussen KM, Abrams B, Sorensen TI, Nohr EA. How do pregnancy-related weight changes and breastfeeding relate to maternal weight and BMI-adjusted waist circumference 7 y after delivery? Results from a path analysis. Am J Clin Nutr. 2014;99(2):312–9.PubMedGoogle Scholar
  18. 18.
    Winkvist A, Brantsaeter AL, Brandhagen M, Haugen M, Meltzer HM, Lissner L. Maternal prepregnant body mass index and gestational weight gain are associated with initiation and duration of breastfeeding among Norwegian mothers. J Nutr. 2015;145(6):1263–70.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Butte NF, Hopkinson JM. Body composition changes during lactation are highly variable among women. J Nutr. 1998;128(2 Suppl):381S–5S.PubMedGoogle Scholar
  20. 20.
    Chou TW, Chan GM, Moyer-Mileur L. Postpartum body composition changes in lactating and non-lactating primiparas. Nutrition. 1999;15(6):481–4.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Nehring I, Schmoll S, Beyerlein A, Hauner H, von Kries R. Gestational weight gain and long-term postpartum weight retention: a meta-analysis. Am J Clin Nutr. 2011;94(5):1225–31.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Institute of Medicine. Weight gain during pregnancy: reexamining the guidelines. Washington: National Academies Press; 2009.Google Scholar
  23. 23.
    Baker JL, Gamborg M, Heitmann BL, Lissner L, Sorensen TI, Rasmussen KM. Breastfeeding reduces postpartum weight retention. Am J Clin Nutr. 2008;88(6):1543–51.PubMedPubMedCentralGoogle Scholar
  24. 24.
    ACOG Committee opinion no. 650: physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol. 2015;126(6):e135–42.Google Scholar
  25. 25.
    Larson-Meyer DE. Effect of postpartum exercise on mothers and their offspring: a review of the literature. Obes Res. 2002;10(8):841–53.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Lovelady CA, Garner KE, Moreno KL, Williams JP. The effect of weight loss in overweight, lactating women on the growth of their infants. N Engl J Med. 2000;342(7):449–53.PubMedPubMedCentralGoogle Scholar
  27. 27.
    McCrory MA, Nommsen-Rivers LA, Mole PA, Lonnerdal B, Dewey KG. Randomized trial of the short-term effects of dieting compared with dieting plus aerobic exercise on lactation performance. Am J Clin Nutr. 1999;69(5):959–67.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Amorim Adegboye AR, Linne YM. Diet or exercise, or both, for weight reduction in women after childbirth. Cochrane Database Syst Rev. 2013;(7):CD005627.Google Scholar
  29. 29.
    Dewey KG, McCrory MA. Effects of dieting and physical activity on pregnancy and lactation. Am J Clin Nutr. 1994;59(2 Suppl):446S–52S; discussion 52S–53S.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Bertz F, Brekke HK, Ellegard L, Rasmussen KM, Wennergren M, Winkvist A. Diet and exercise weight-loss trial in lactating overweight and obese women. Am J Clin Nutr. 2012;96(4):698–705.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Lovelady CA, Bopp MJ, Colleran HL, Mackie HK, Wideman L. Effect of exercise training on loss of bone mineral density during lactation. Med Sci Sports Exerc. 2009;41(10):1902–7.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Davies GA, Wolfe LA, Mottola MF, MacKinnon C, Society of Obstetricians and gynecologists of Canada, SOGC Clinical Practice Obstetrics Committee. Joint SOGC/CSEP clinical practice guideline: exercise in pregnancy and the postpartum period. Can J Appl Physiol. 2003;28(3):330–41.PubMedPubMedCentralGoogle Scholar
  33. 33.
    U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 dietary guidelines for Americans. 8th ed. 2015. http://health.gov/dietaryguidelines/2015/guidelines/.U.S. Accessed 18 Jun 2016.
  34. 34.
    Health Canada. Canada’s food guide. Available at http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php. Accessed 18 Jun 2016.
  35. 35.
    United States Department of Agriculture. ChooseMyPlate. Available at http://www.choosemyplate.gov/pregnancy-breastfeeding/breastfeeding-nurtitional-needs.html. Accessed 18 Jun 2016.
  36. 36.
    Institute of Medicine. Dietary reference intakes for calcium and vitamin D. Washington: National Academy Press; 2010.Google Scholar
  37. 37.
    Prentice A. Micronutrients and the bone mineral content of the mother, fetus and newborn. J Nutr. 2003;133(5 Suppl 2):1693S–9S.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Kovacs CS. Calcium and bone metabolism disorders during pregnancy and lactation. Endocrinol Metab Clin N Am. 2011;40(4):795–826.Google Scholar
  39. 39.
    Kovacs CS, Kronenberg HM. Maternal-fetal calcium and bone metabolism during pregnancy, puerperium, and lactation. Endocr Rev. 1997;18(6):832–72.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Sowers M. Pregnancy and lactation as risk factors for subsequent bone loss and osteoporosis. J Bone Miner Res. 1996;11(8):1052–60.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Cross NA, Hillman LS, Allen SH, Krause GF. Changes in bone mineral density and markers of bone remodeling during lactation and postweaning in women consuming high amounts of calcium. J Bone Miner Res. 1995;10(9):1312–20.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Kalkwarf HJ, Specker BL, Bianchi DC, Ranz J, Ho M. The effect of calcium supplementation on bone density during lactation and after weaning. N Engl J Med. 1997;337(8):523–8.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Prentice A, Jarjou LM, Cole TJ, Stirling DM, Dibba B, Fairweather-Tait S. Calcium requirements of lactating Gambian mothers: effects of a calcium supplement on breast-milk calcium concentration, maternal bone mineral content, and urinary calcium excretion. Am J Clin Nutr. 1995;62(1):58–67.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Polatti F, Capuzzo E, Viazzo F, Colleoni R, Klersy C. Bone mineral changes during and after lactation. Obstet Gynecol. 1999;94(1):52–6.PubMedPubMedCentralGoogle Scholar
  45. 45.
    Ritchie LD, Fung EB, Halloran BP, Turnlund JR, Van Loan MD, Cann CE, et al. A longitudinal study of calcium homeostasis during human pregnancy and lactation and after resumption of menses. Am J Clin Nutr. 1998;67(4):693–701.PubMedPubMedCentralGoogle Scholar
  46. 46.
    Kovacs CS. Calcium and bone metabolism in pregnancy and lactation. J Clin Endocrinol Metab. 2001;86(6):2344–8.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Wiklund PK, Xu L, Wang Q, Mikkola T, Lyytikainen A, Volgyi E, et al. Lactation is associated with greater maternal bone size and bone strength later in life. Osteoporos Int. 2012;23(7):1939–45.PubMedGoogle Scholar
  48. 48.
    Bolzetta F, Veronese N, De Rui M, Berton L, Carraro S, Pizzato S, et al. Duration of breastfeeding as a risk factor for vertebral fractures. Bone. 2014;68:41–5.PubMedGoogle Scholar
  49. 49.
    Mori T, Ishii S, Greendale GA, Cauley JA, Ruppert K, Crandall CJ, et al. Parity, lactation, bone strength, and 16-year fracture risk in adult women: findings from the Study of Women’s Health Across the Nation (SWAN). Bone. 2015;73:160–6.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Ervin RB, Wang CY, Wright JD, Kennedy-Stephenson J. Dietary intake of selected minerals for the United States population: 1999-2000. Adv Data. 2004;(341):1–5.Google Scholar
  51. 51.
    Shakur YA, Tarasuk V, Corey P, O’Connor DL. A comparison of micronutrient inadequacy and risk of high micronutrient intakes among vitamin and mineral supplement users and nonusers in Canada. J Nutr. 2012;142(3):534–40.PubMedPubMedCentralGoogle Scholar
  52. 52.
    Bailey RL, Dodd KW, Goldman JA, Gahche JJ, Dwyer JT, Moshfegh AJ, et al. Estimation of total usual calcium and vitamin D intakes in the United States. J Nutr. 2010;140(4):817–22.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Fulgoni V 3rd, Nicholls J, Reed A, Buckley R, Kafer K, Huth P, et al. Dairy consumption and related nutrient intake in African-American adults and children in the United States: continuing survey of food intakes by individuals 1994-1996, 1998, and the National Health and Nutrition Examination Survey 1999-2000. J Am Diet Assoc. 2007;107(2):256–64.PubMedPubMedCentralGoogle Scholar
  54. 54.
    O’Neil CE, Nicklas TA, Keast DR, Fulgoni VL. Ethnic disparities among food sources of energy and nutrients of public health concern and nutrients to limit in adults in the United States: NHANES 2003-2006. Food Nutr Res. 2014;58:15784.PubMedPubMedCentralGoogle Scholar
  55. 55.
    Mackey AD, Picciano MF, Mitchell DC, Smiciklas-Wright H. Self-selected diets of lactating women often fail to meet dietary recommendations. J Am Diet Assoc. 1998;98(3):297–302.PubMedPubMedCentralGoogle Scholar
  56. 56.
    Durham HA, Lovelady CA, Brouwer RJ, Krause KM, Ostbye T. Comparison of dietary intake of overweight postpartum mothers practicing breastfeeding or formula feeding. J Am Diet Assoc. 2011;111(1):67–74.PubMedPubMedCentralGoogle Scholar
  57. 57.
    Hoy CM, Goldman J. United States Department of Agriculture ARS. Calcium intake of the U.S. population. What we eat in America, NHANES 2009-2010. Available at http://www.ars.usda.gov/main/site_main.htm?modecode=80-40-05-30. Accessed 18 Jun 2016.
  58. 58.
    Heaney RP. Measuring calcium absorption. Am J Clin Nutr. 2005;81(6):1451; author reply 1451–2.PubMedPubMedCentralGoogle Scholar
  59. 59.
    Heaney RP, Rafferty K, Bierman J. Not all calcium-fortified beverages are equal. Nutr Today. 2005;40:39–44.Google Scholar
  60. 60.
    Miller GD, Jarvis JK, McBean LD. The importance of meeting calcium needs with foods. J Am Coll Nutr. 2001;20(2 Suppl):168S–85S.PubMedGoogle Scholar
  61. 61.
    Straub DA. Calcium supplementation in clinical practice: a review of forms, doses, and indications. Nutr Clin Pract. 2007;22(3):286–96.PubMedGoogle Scholar
  62. 62.
    Heaney RP. Calcium supplements: practical considerations. Osteoporos Int. 1991;1(2):65–71.PubMedGoogle Scholar
  63. 63.
    Haddad JG, Matsuoka LY, Hollis BW, Hu YZ, Wortsman J. Human plasma transport of vitamin D after its endogenous synthesis. J Clin Invest. 1993;91(6):2552–5.PubMedPubMedCentralGoogle Scholar
  64. 64.
    Matsuoka LY, Wortsman J, Haddad JG, Hollis BW. In vivo threshold for cutaneous synthesis of vitamin D3. J Lab Clin Med. 1989;114(3):301–5.PubMedPubMedCentralGoogle Scholar
  65. 65.
    Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004;80(6 Suppl):1678S–88S.PubMedPubMedCentralGoogle Scholar
  66. 66.
    Looker AC, Johnson CL, Lacher DA, Pfeiffer CM, Schleicher RL, Sempos CT. Vitamin D status: United States, 2001-2006. NCHS Data Brief. 2011;(59):1–8.Google Scholar
  67. 67.
    Sarafin K, Durazo-Arvizu R, Tian L, Phinney KW, Tai S, Camara JE, et al. Standardizing 25-hydroxyvitamin D values from the Canadian Health Measures Survey. Am J Clin Nutr. 2015;102(5):1044–50.PubMedPubMedCentralGoogle Scholar
  68. 68.
    Balk SJ, Council on Environmental Health, Section on Dermatology. Ultraviolet radiation: a hazard to children and adolescents. Pediatrics. 2011;127(3):e791–817.PubMedPubMedCentralGoogle Scholar
  69. 69.
    Wagner CL, Greer FR, American Academy of Pediatrics Section on Breastfeeding, American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008;122(5):1142–52.Google Scholar
  70. 70.
    Hollis BW, Wagner CL, Howard CR, Ebeling M, Shary JR, Smith PG, et al. Maternal versus infant vitamin D supplementation during lactation: a randomized controlled trial. Pediatrics. 2015;136(4):625–34.PubMedPubMedCentralGoogle Scholar
  71. 71.
    Kulie T, Groff A, Redmer J, Hounshell J, Schrager S. Vitamin D: an evidence-based review. J Am Board Fam Med. 2009;22(6):698–706.PubMedGoogle Scholar
  72. 72.
    Perumal N, Al Mahmud A, Baqui AH, Roth DE. Prenatal vitamin D supplementation and infant vitamin D status in Bangladesh. Public Health Nutr. 2017;20:1865–73.PubMedGoogle Scholar
  73. 73.
    Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr. 2006;84(1):18–28.PubMedGoogle Scholar
  74. 74.
    Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R. Estimates of optimal vitamin D status. Osteoporos Int. 2005;16(7):713–6.PubMedGoogle Scholar
  75. 75.
    Vieth R, Bischoff-Ferrari H, Boucher BJ, Dawson-Hughes B, Garland CF, Heaney RP, et al. The urgent need to recommend an intake of vitamin D that is effective. Am J Clin Nutr. 2007;85(3):649–50.Google Scholar
  76. 76.
    Hathcock JN, Shao A, Vieth R, Heaney R. Risk assessment for vitamin D. Am J Clin Nutr. 2007;85(1):6–18.PubMedGoogle Scholar
  77. 77.
    Arunabh S, Pollack S, Yeh J, Aloia JF. Body fat content and 25-hydroxyvitamin D levels in healthy women. J Clin Endocrinol Metab. 2003;88(1):157–61.PubMedGoogle Scholar
  78. 78.
    Buffington C, Walker B, Cowan GS Jr, Scruggs D. Vitamin D deficiency in the morbidly obese. Obes Surg. 1993;3(4):421–4.PubMedGoogle Scholar
  79. 79.
    Liel Y, Ulmer E, Shary J, Hollis BW, Bell NH. Low circulating vitamin D in obesity. Calcif Tissue Int. 1988;43(4):199–201.PubMedGoogle Scholar
  80. 80.
    Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000;72(3):690–3.PubMedGoogle Scholar
  81. 81.
    Barger-Lux MJ, Heaney RP, Dowell S, Chen TC, Holick MF. Vitamin D and its major metabolites: serum levels after graded oral dosing in healthy men. Osteoporos Int. 1998;8(3):222–30.PubMedGoogle Scholar
  82. 82.
    Hollis BW, Wagner CL. Vitamin D requirements during lactation: high-dose maternal supplementation as therapy to prevent hypovitaminosis D for both the mother and the nursing infant. Am J Clin Nutr. 2004;80(6 Suppl):1752S–8S.PubMedGoogle Scholar
  83. 83.
    O’Connor DL, Green T, Picciano MF. Maternal folate status and lactation. J Mammary Gland Biol Neoplasia. 1997;2(3):279–89.PubMedGoogle Scholar
  84. 84.
    Institute of Medicine. Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin and choline. Washington: The National Academy Press; 1998.Google Scholar
  85. 85.
    Centers for Disease Control and Prevention (CDC). Folic acid. Recommenations. Available at http://www.cdc.gov/ncbddd/folicacid/recommendations.html. Accessed 18 Jun 2016.
  86. 86.
    Wilson RD, Genetics Committee, Wilson RD, Audibert F, Brock JA, Carroll J, et al. Pre-conception folic acid and multivitamin supplementation for the primary and secondary prevention of neural tube defects and other folic acid-sensitive congenital anomalies. J Obstet Gynaecol Can. 2015;37(6):534–52.PubMedGoogle Scholar
  87. 87.
    Kim YI. Folate, colorectal carcinogenesis, and DNA methylation: lessons from animal studies. Environ Mol Mutagen. 2004;44(1):10–25.PubMedGoogle Scholar
  88. 88.
    Dixon SC, Ibiebele TI, Protani MM, Beesley J, deFazio A, Crandon AJ, et al. Dietary folate and related micronutrients, folate-metabolising genes, and ovarian cancer survival. Gynecol Oncol. 2014;132(3):566–72.PubMedGoogle Scholar
  89. 89.
    Heine-Broring RC, Winkels RM, Renkema JM, Kragt L, van Orten-Luiten AC, Tigchelaar EF, et al. Dietary supplement use and colorectal cancer risk: a systematic review and meta-analyses of prospective cohort studies. Int J Cancer. 2015;136(10):2388–401.PubMedPubMedCentralGoogle Scholar
  90. 90.
    Qin X, Cui Y, Shen L, Sun N, Zhang Y, Li J, et al. Folic acid supplementation and cancer risk: a meta-analysis of randomized controlled trials. Int J Cancer. 2013;133(5):1033–41.PubMedPubMedCentralGoogle Scholar
  91. 91.
    Stevens VL, McCullough ML, Sun J, Jacobs EJ, Campbell PT, Gapstur SM. High levels of folate from supplements and fortification are not associated with increased risk of colorectal cancer. Gastroenterology. 2011;141(1):98–105, 105.e1.PubMedPubMedCentralGoogle Scholar
  92. 92.
    Wien TN, Pike E, Wisloff T, Staff A, Smeland S, Klemp M. Cancer risk with folic acid supplements: a systematic review and meta-analysis. BMJ Open. 2012;2(1):e000653.PubMedPubMedCentralGoogle Scholar
  93. 93.
    Boyles AL, Yetley EA, Thayer KA, Coates PM. Safe use of high intakes of folic acid: research challenges and paths forward. Nutr Rev. 2016;74(7):469–74.PubMedPubMedCentralGoogle Scholar
  94. 94.
    Yajnik CS, Deshpande SS, Jackson AA, Refsum H, Rao S, Fisher DJ, et al. Vitamin B12 and folate concentrations during pregnancy and insulin resistance in the offspring: the Pune Maternal Nutrition Study. Diabetologia. 2008;51(1):29–38.PubMedGoogle Scholar
  95. 95.
    Kiefte-de Jong JC, Timmermans S, Jaddoe VW, Hofman A, Tiemeier H, Steegers EA, et al. High circulating folate and vitamin B-12 concentrations in women during pregnancy are associated with increased prevalence of atopic dermatitis in their offspring. J Nutr. 2012;142(4):731–8.PubMedPubMedCentralGoogle Scholar
  96. 96.
    Crider KS, Cordero AM, Qi YP, Mulinare J, Dowling NF, Berry RJ. Prenatal folic acid and risk of asthma in children: a systematic review and meta-analysis. Am J Clin Nutr. 2013;98(5):1272–81.PubMedPubMedCentralGoogle Scholar
  97. 97.
    Haberg SE, London SJ, Stigum H, Nafstad P, Nystad W. Folic acid supplements in pregnancy and early childhood respiratory health. Arch Dis Child. 2009;94(3):180–4.PubMedGoogle Scholar
  98. 98.
    Orjuela MA, Cabrera-Munoz L, Paul L, Ramirez-Ortiz MA, Liu X, Chen J, et al. Risk of retinoblastoma is associated with a maternal polymorphism in dihydrofolatereductase (DHFR) and prenatal folic acid intake. Cancer. 2012;118(23):5912–9.PubMedPubMedCentralGoogle Scholar
  99. 99.
    Valera-Gran D, Garcia de la Hera M, Navarrete-Munoz EM, Fernandez-Somoano A, Tardon A, Julvez J, et al. Folic acid supplements during pregnancy and child psychomotor development after the first year of life. JAMA Pediatr. 2014;168(11):e142611.PubMedPubMedCentralGoogle Scholar
  100. 100.
    Butte NF, Calloway DH, Van Duzen JL. Nutritional assessment of pregnant and lactating Navajo women. Am J Clin Nutr. 1981;34(10):2216–28.PubMedPubMedCentralGoogle Scholar
  101. 101.
    Keizer SE, Gibson RS, O'Connor DL. Postpartum folic acid supplementation of adolescents: impact on maternal folate and zinc status and milk composition. Am J Clin Nutr. 1995;62(2):377–84.PubMedPubMedCentralGoogle Scholar
  102. 102.
    Sneed SM, Zane C, Thomas MR. The effects of ascorbic acid, vitamin B6, vitamin B12, and folic acid supplementation on the breast milk and maternal nutritional status of low socioeconomic lactating women. Am J Clin Nutr. 1981;34(7):1338–46.PubMedPubMedCentralGoogle Scholar
  103. 103.
    Tamura T, Yoshimura Y, Arakawa T. Human milk folate and folate status in lactating mothers and their infants. Am J Clin Nutr. 1980;33(2):193–7.PubMedPubMedCentralGoogle Scholar
  104. 104.
    Houghton LA, Sherwood KL, Pawlosky R, Ito S, O’Connor DL. [6S]-5-Methyltetrahydrofolate is at least as effective as folic acid in preventing a decline in blood folate concentrations during lactation. Am J Clin Nutr. 2006;83(4):842–50.PubMedPubMedCentralGoogle Scholar
  105. 105.
    Masih SP, Plumptre L, Ly A, Berger H, Lausman AY, Croxford R, et al. Pregnant Canadian women achieve recommended intakes of one-carbon nutrients through prenatal supplementation but the supplement composition, including choline, requires reconsideration. J Nutr. 2015;145(8):1824–34.PubMedPubMedCentralGoogle Scholar
  106. 106.
    Plumptre L, Masih SP, Ly A, Aufreiter S, Sohn KJ, Croxford R, et al. High concentrations of folate and unmetabolized folic acid in a cohort of pregnant Canadian women and umbilical cord blood. Am J Clin Nutr. 2015;102(4):848–57.PubMedPubMedCentralGoogle Scholar
  107. 107.
    Ray JG, Vermeulen MJ, Boss SC, Cole DE. Increased red cell folate concentrations in women of reproductive age after Canadian folic acid food fortification. Epidemiology. 2002;13(2):238–40.PubMedPubMedCentralGoogle Scholar
  108. 108.
    Colapinto CK, O’Connor DL, Tremblay MS. Folate status of the population in the Canadian Health Measures Survey. CMAJ. 2011;183(2):E100–6.PubMedPubMedCentralGoogle Scholar
  109. 109.
    Dietrich M, Brown CJ, Block G. The effect of folate fortification of cereal-grain products on blood folate status, dietary folate intake, and dietary folate sources among adult non-supplement users in the United States. J Am Coll Nutr. 2005;24(4):266–74.PubMedGoogle Scholar
  110. 110.
    Sherwood KL, Houghton LA, Tarasuk V, O’Connor DL. One-third of pregnant and lactating women may not be meeting their folate requirements from diet alone based on mandated levels of folic acid fortification. J Nutr. 2006;136(11):2820–6.PubMedGoogle Scholar
  111. 111.
    Morris MS, Jacques PF, Rosenberg IH, Selhub J. Folate and vitamin B-12 status in relation to anemia, macrocytosis, and cognitive impairment in older Americans in the age of folic acid fortification. Am J Clin Nutr. 2007;85(1):193–200.PubMedPubMedCentralGoogle Scholar
  112. 112.
    Specker BL, Black A, Allen L, Morrow F. Vitamin B-12: low milk concentrations are related to low serum concentrations in vegetarian women and to methylmalonic aciduria in their infants. Am J Clin Nutr. 1990;52(6):1073–6.PubMedGoogle Scholar
  113. 113.
    Jones KM, Ramirez-Zea M, Zuleta C, Allen LH. Prevalent vitamin B-12 deficiency in twelve-month-old Guatemalan infants is predicted by maternal B-12 deficiency and infant diet. J Nutr. 2007;137(5):1307–13.PubMedGoogle Scholar
  114. 114.
    Dror DK, Allen LH. Effect of vitamin B12 deficiency on neurodevelopment in infants: current knowledge and possible mechanisms. Nutr Rev. 2008;66(5):250–5.PubMedGoogle Scholar
  115. 115.
    Stabler SP, Allen RH. Vitamin B12 deficiency as a worldwide problem. Annu Rev Nutr. 2004;24:299–326.PubMedGoogle Scholar
  116. 116.
    Trugo NM, Sardinha F. Cobalamin and cobalamin-binding capacity in human milk. Nutr Res. 1994;14:22–33.Google Scholar
  117. 117.
    Donangelo CM, Trugo NM, Koury JC, Barreto Silva MI, Freitas LA, Feldheim W, et al. Iron, zinc, folate and vitamin B12 nutritional status and milk composition of low-income Brazilian mothers. Eur J Clin Nutr. 1989;43(4):253–66.PubMedGoogle Scholar
  118. 118.
    Lildballe DL, Hardlei TF, Allen LH, Nexo E. High concentrations of haptocorrin interfere with routine measurement of cobalamins in human serum and milk. A problem and its solution. Clin Chem Lab Med. 2009;47(2):182–7.PubMedGoogle Scholar
  119. 119.
    Greibe E, Lildballe DL, Streym S, Vestergaard P, Rejnmark L, Mosekilde L, et al. Cobalamin and haptocorrin in human milk and cobalamin-related variables in mother and child: a 9-mo longitudinal study. Am J Clin Nutr. 2013;98(2):389–95.PubMedGoogle Scholar
  120. 120.
    Farmer B, Larson BT, Fulgoni VL 3rd, Rainville AJ, Liepa GU. A vegetarian dietary pattern as a nutrient-dense approach to weight management: an analysis of the national health and nutrition examination survey 1999-2004. J Am Diet Assoc. 2011;111(6):819–27.PubMedGoogle Scholar
  121. 121.
    Pawlak R, Lester SE, Babatunde T. The prevalence of cobalamin deficiency among vegetarians assessed by serum vitamin B12: a review of literature. Eur J Clin Nutr. 2014;68(5):541–8.PubMedGoogle Scholar
  122. 122.
    Yang Q, Cogswell ME, Hamner HC, Carriquiry A, Bailey LB, Pfeiffer CM, et al. Folic acid source, usual intake, and folate and vitamin B-12 status in US adults: National Health and Nutrition Examination Survey (NHANES) 2003-2006. Am J Clin Nutr. 2010;91(1):64–72.PubMedGoogle Scholar
  123. 123.
    Health Canada. Canadian Community Health Survey, cycle 2.2, nutrition focus. Available at http://www.hc-sc.gc.ca/fn-an/surveill/nutrition/commun/cchs_focus-volet_escc-eng.php. Accessed 16 Jun 2016.
  124. 124.
    Bailey RL, Carmel R, Green R, Pfeiffer CM, Cogswell ME, Osterloh JD, et al. Monitoring of vitamin B-12 nutritional status in the United States by using plasma methylmalonic acid and serum vitamin B-12. Am J Clin Nutr. 2011;94(2):552–61.PubMedPubMedCentralGoogle Scholar
  125. 125.
    Statistics Canada. Vitamin B12 status of Canadians, 2009 to 2011. Ottawa, ON: 2013. Accessed 18 Jun 2016.Google Scholar
  126. 126.
    MacFarlane AJ, Greene-Finestone LS, Shi Y. Vitamin B-12 and homocysteine status in a folate-replete population: results from the Canadian Health Measures Survey. Am J Clin Nutr. 2011;94(4):1079–87.PubMedGoogle Scholar
  127. 127.
    Brody T. Nutritional biochemistry. 2nd ed. San Diego: Academic Press; 1999.Google Scholar
  128. 128.
    Institute of Medicine. Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium and zinc. Washington: The National Academy Press; 2001.Google Scholar
  129. 129.
    Akesson A, Bjellerup P, Berglund M, Bremme K, Vahter M. Soluble transferrin receptor: longitudinal assessment from pregnancy to postlactation. Obstet Gynecol. 2002;99(2):260–6.PubMedGoogle Scholar
  130. 130.
    Beard JL, Dawson H, Pinero DJ. Iron metabolism: a comprehensive review. Nutr Rev. 1996;54(10):295–317.PubMedPubMedCentralGoogle Scholar
  131. 131.
    Dijkhuizen MA, Wieringa FT, West CE, Muherdiyantiningsih, Muhilal. Concurrent micronutrient deficiencies in lactating mothers and their infants in Indonesia. Am J Clin Nutr. 2001;73(4):786–91.PubMedPubMedCentralGoogle Scholar
  132. 132.
    Ettyang GA, van Marken Lichtenbelt WD, Oloo A, Saris WH. Serum retinol, iron status and body composition of lactating women in Nandi, Kenya. Ann Nutr Metab. 2003;47(6):276–83.PubMedPubMedCentralGoogle Scholar
  133. 133.
    Haidar J, Muroki NM, Omwega AM, Ayana G. Malnutrition and iron deficiency in lactating women in urban slum communities from Addis Ababa, Ethiopia. East Afr Med J. 2003;80(4):191–4.PubMedPubMedCentralGoogle Scholar
  134. 134.
    Takimoto H, Yoshiike N, Katagiri A, Ishida H, Abe S. Nutritional status of pregnant and lactating women in Japan: a comparison with non-pregnant/non-lactating controls in the National Nutrition Survey. J Obstet Gynaecol Res. 2003;29(2):96–103.PubMedPubMedCentralGoogle Scholar
  135. 135.
    Villalpando S, Latulippe ME, Rosas G, Irurita MJ, Picciano MF, O’Connor DL. Milk folate but not milk iron concentrations may be inadequate for some infants in a rural farming community in San Mateo, Capulhuac, Mexico. Am J Clin Nutr. 2003;78(4):782–9.PubMedPubMedCentralGoogle Scholar
  136. 136.
    Beard JL, Hendricks MK, Perez EM, Murray-Kolb LE, Berg A, Vernon-Feagans L, et al. Maternal iron deficiency anemia affects postpartum emotions and cognition. J Nutr. 2005;135(2):267–72.PubMedPubMedCentralGoogle Scholar
  137. 137.
    Corwin EJ, Murray-Kolb LE, Beard JL. Low hemoglobin level is a risk factor for postpartum depression. J Nutr. 2003;133(12):4139–42.PubMedPubMedCentralGoogle Scholar
  138. 138.
    Perez EM, Hendricks MK, Beard JL, Murray-Kolb LE, Berg A, Tomlinson M, et al. Mother-infant interactions and infant development are altered by maternal iron deficiency anemia. J Nutr. 2005;135(4):850–5.PubMedPubMedCentralGoogle Scholar
  139. 139.
    Sheikh M, Hantoushzadeh S, Shariat M, Farahani Z, Ebrahiminasab O. The efficacy of early iron supplementation on postpartum depression, a randomized double-blind placebo-controlled trial. Eur J Nutr. 2017;56:901.PubMedPubMedCentralGoogle Scholar
  140. 140.
    Bodnar LM, Cogswell ME, Scanlon KS. Low income postpartum women are at risk of iron deficiency. J Nutr. 2002;132(8):2298–302.PubMedPubMedCentralGoogle Scholar
  141. 141.
    Colombo J, Kannass KN, Shaddy DJ, Kundurthi S, Maikranz JM, Anderson CJ, et al. Maternal DHA and the development of attention in infancy and toddlerhood. Child Dev. 2004;75(4):1254–67.PubMedPubMedCentralGoogle Scholar
  142. 142.
    Jensen CL, Voigt RG, Prager TC, Zou YL, Fraley JK, Rozelle JC, et al. Effects of maternal docosahexaenoic acid intake on visual function and neurodevelopment in breastfed term infants. Am J Clin Nutr. 2005;82(1):125–32.PubMedGoogle Scholar
  143. 143.
    Lauritzen L, Jorgensen MH, Mikkelsen TB, Skovgaard M, Straarup EM, Olsen SF, et al. Maternal fish oil supplementation in lactation: effect on visual acuity and n-3 fatty acid content of infant erythrocytes. Lipids. 2004;39(3):195–206.PubMedGoogle Scholar
  144. 144.
    Raiten DJ, Talbot JM, Waters JH. Assessment of nutrient requirements for infant formulas. J Nutr. 1998;128(11 Suppl):i–iv, 2059S–293S.Google Scholar
  145. 145.
    Salem N Jr, Wegher B, Mena P, Uauy R. Arachidonic and docosahexaenoic acids are biosynthesized from their 18-carbon precursors in human infants. Proc Natl Acad Sci U S A. 1996;93(1):49–54.PubMedPubMedCentralGoogle Scholar
  146. 146.
    Agostoni C, Trojan S, Bellu R, Riva E, Bruzzese MG, Giovannini M. Developmental quotient at 24 months and fatty acid composition of diet in early infancy: a follow up study. Arch Dis Child. 1997;76(5):421–4.PubMedPubMedCentralGoogle Scholar
  147. 147.
    Birch EE, Garfield S, Hoffman DR, Uauy R, Birch DG. A randomized controlled trial of early dietary supply of long-chain polyunsaturated fatty acids and mental development in term infants. Dev Med Child Neurol. 2000;42(3):174–81.PubMedPubMedCentralGoogle Scholar
  148. 148.
    Birch EE, Hoffman DR, Castaneda YS, Fawcett SL, Birch DG, Uauy RD. A randomized controlled trial of long-chain polyunsaturated fatty acid supplementation of formula in term infants after weaning at 6 wk of age. Am J Clin Nutr. 2002;75(3):570–80.PubMedPubMedCentralGoogle Scholar
  149. 149.
    Birch EE, Hoffman DR, Uauy R, Birch DG, Prestidge C. Visual acuity and the essentiality of docosahexaenoic acid and arachidonic acid in the diet of term infants. Pediatr Res. 1998;44(2):201–9.PubMedPubMedCentralGoogle Scholar
  150. 150.
    Carlson SE, Ford AJ, Werkman SH, Peeples JM, Koo WW. Visual acuity and fatty acid status of term infants fed human milk and formulas with and without docosahexaenoate and arachidonate from egg yolk lecithin. Pediatr Res. 1996;39(5):882–8.PubMedPubMedCentralGoogle Scholar
  151. 151.
    Makrides M, Neumann M, Simmer K, Pater J, Gibson R. Are long-chain polyunsaturated fatty acids essential nutrients in infancy? Lancet. 1995;345(8963):1463–8.PubMedPubMedCentralGoogle Scholar
  152. 152.
    Willatts P, Forsyth JS, DiModugno MK, Varma S, Colvin M. Effect of long-chain polyunsaturated fatty acids in infant formula on problem solving at 10 months of age. Lancet. 1998;352(9129):688–91.PubMedPubMedCentralGoogle Scholar
  153. 153.
    Auestad N, Halter R, Hall RT, Blatter M, Bogle ML, Burks W, et al. Growth and development in term infants fed long-chain polyunsaturated fatty acids: a double-masked, randomized, parallel, prospective, multivariate study. Pediatrics. 2001;108(2):372–81.PubMedPubMedCentralGoogle Scholar
  154. 154.
    Auestad N, Montalto MB, Hall RT, Fitzgerald KM, Wheeler RE, Connor WE, et al. Visual acuity, erythrocyte fatty acid composition, and growth in term infants fed formulas with long chain polyunsaturated fatty acids for one year. Ross Pediatric Lipid Study. Pediatr Res. 1997;41(1):1–10.PubMedPubMedCentralGoogle Scholar
  155. 155.
    Auestad N, Scott DT, Janowsky JS, Jacobsen C, Carroll RE, Montalto MB, et al. Visual, cognitive, and language assessments at 39 months: a follow-up study of children fed formulas containing long-chain polyunsaturated fatty acids to 1 year of age. Pediatrics. 2003;112(3 Pt 1):e177–83.PubMedPubMedCentralGoogle Scholar
  156. 156.
    Lucas A, Stafford M, Morley R, Abbott R, Stephenson T, MacFadyen U, et al. Efficacy and safety of long-chain polyunsaturated fatty acid supplementation of infant-formula milk: a randomised trial. Lancet. 1999;354(9194):1948–54.PubMedPubMedCentralGoogle Scholar
  157. 157.
    Makrides M, Gibson RA. LCPUFA requirements in pregnancy and lactation. Am J Clin Nutr. 2000;71(1 Suppl):307S–11S.PubMedPubMedCentralGoogle Scholar
  158. 158.
    Scott DT, Janowsky JS, Carroll RE, Taylor JA, Auestad N, Montalto MB. Formula supplementation with long-chain polyunsaturated fatty acids: are there developmental benefits? Pediatrics. 1998;102(5):E59.PubMedPubMedCentralGoogle Scholar
  159. 159.
    Campoy C, Escolano-Margarit MV, Anjos T, Szajewska H, Uauy R. Omega 3 fatty acids on child growth, visual acuity and neurodevelopment. Br J Nutr. 2012;107(Suppl 2):S85–106.PubMedPubMedCentralGoogle Scholar
  160. 160.
    Qawasmi A, Landeros-Weisenberger A, Bloch MH. Meta-analysis of LCPUFA supplementation of infant formula and visual acuity. Pediatrics. 2013;131(1):e262–72.PubMedPubMedCentralGoogle Scholar
  161. 161.
    Qawasmi A, Landeros-Weisenberger A, Leckman JF, Bloch MH. Meta-analysis of long-chain polyunsaturated fatty acid supplementation of formula and infant cognition. Pediatrics. 2012;129(6):1141–9.PubMedPubMedCentralGoogle Scholar
  162. 162.
    Simmer K, Patole SK, Rao SC. Long-chain polyunsaturated fatty acid supplementation in infants born at term. Cochrane Database Syst Rev. 2011;(12):CD000376.Google Scholar
  163. 163.
    Innis SM. Impact of maternal diet on human milk composition and neurological development of infants. Am J Clin Nutr. 2014;99(3):734S–41S.PubMedPubMedCentralGoogle Scholar
  164. 164.
    Henderson RA, Jensen RG, Lammi-Keefe CJ, Ferris AM, Dardick KR. Effect of fish oil on the fatty acid composition of human milk and maternal and infant erythrocytes. Lipids. 1992;27(11):863–9.PubMedPubMedCentralGoogle Scholar
  165. 165.
    Jensen CL, Maude M, Anderson RE, Heird WC. Effect of docosahexaenoic acid supplementation of lactating women on the fatty acid composition of breast milk lipids and maternal and infant plasma phospholipids. Am J Clin Nutr. 2000;71(1 Suppl):292S–9S.PubMedPubMedCentralGoogle Scholar
  166. 166.
    Delgado-Noguera MF, Calvache JA, Bonfill CX. Supplementation with long chain polyunsaturated fatty acids (LCPUFA) to breastfeeding mothers for improving child growth and development. Cochrane Database Syst Rev. 2015;(7):CD007901.Google Scholar
  167. 167.
    Miller BJ, Murray L, Beckmann MM, Kent T, Macfarlane B. Dietary supplements for preventing postnatal depression. Cochrane Database Syst Rev. 2013;(10):CD009104.Google Scholar
  168. 168.
    Ortega RM, Rodriguez-Rodriguez E, Lopez-Sobaler AM. Effects of omega 3 fatty acids supplementation in behavior and non-neurodegenerative neuropsychiatric disorders. Br J Nutr. 2012;107(Suppl 2):S261–70.PubMedPubMedCentralGoogle Scholar
  169. 169.
    Simopoulos AP, Leaf A, Salem N Jr. Workshop on the essentiality of and recommended dietary intakes for omega-6 and omega-3 fatty acids. J Am Coll Nutr. 1999;18(5):487–9.PubMedGoogle Scholar
  170. 170.
    European Food Safety Authority. Scientific opinion on the tolerable upper intake level of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and docosapentaenoic acid (DPA). EFSA J. 2012;10(7):2815.Google Scholar
  171. 171.
    Pratt NS, Durham HA, Sherry CL. Nutrient intakes from food of lactating women do not meet many dietary recommendations important for infant development and maternal health. Food Nutr Sci. 2014;5:1644–51.Google Scholar
  172. 172.
    Health Canada. Prenatal nutrition guidelines for health professionals—fish and omega-3 fatty acids. Available at http://www.hc-sc.gc.ca/fn-an/pubs/nutrition/omega3-eng.php. Accessed 18 Jun 2016.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Deborah L. O’Connor
    • 1
  • Susan Trang
    • 1
  • Yen-Ming Chan
    • 1
    Email author
  1. 1.Department of Nutritional Sciences, The Hospital for Sick ChildrenUniversity of TorontoTorontoCanada

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