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Pregnancy Care Guidelines

11 Nutrition and physical activity

Consuming a wide variety of nutritious foods during pregnancy is important to ensure that the nutritional requirements of both mother and baby are met. In some situations, supplementation of some vitamins or minerals may be advisable. Regular low to moderate-intensity physical activity is generally safe during pregnancy with likely benefits for mother and baby.

11.1 Background

11.1.1 Nutrition

The nutritional status of a woman before and during pregnancy plays a vital role in fetal growth and development. While requirements for some nutrients (eg iron, folic acid) increase, the basic principles of healthy eating remain the same.

Risks associated with nutrition during pregnancy

  • Over and under-nutrition: Too little weight gain during pregnancy increases the risk of a low birth weight infant. Excess weight gain during pregnancy increases the risk of gestational diabetes and of the baby being large for gestational age. It is also associated with increased risk of obesity and metabolic syndrome in women and infants later in life.
  • Food safety: As the immune system in pregnancy is suppressed, pregnant women are more susceptible to foodborne illnesses, such as listeriosis, which can be transmitted to the unborn child and may cause miscarriage, premature birth or stillbirth (Pezdirc et al 2012). Fetal exposure to high levels of mercury (eg from maternal consumption of some fish species) may cause developmental delays (FSANZ 2011).

Access to healthy food

  • Geographical location: The decreased availability of nutritious foods (such as fresh fruit and vegetables, wholegrain bread and low fat milk products) in remote and regional areas in Australia has been described frequently. The cost of nutritious foods in these areas is also over 30% higher than in major cities and may affect food choices (NHMRC 2000; NT DHCS 2007; Harrison et al 2010; Landrigan & Pollard 2011).
  • Socioeconomic status: In some urban centres, people in lower socioeconomic groups have less access to supermarkets and greater access to fast food outlets than more advantaged groups (Burns & Inglis 2007; Ball et al 2009). Supermarkets generally offer a wider variety of food products, as well as fresh raw food.
  • Migrant and refugee women: Following migration, food habits may change out of choice, because of the limited availability of traditional and familiar foods, or because of change in economic circumstances in Australia. Similarly, financial and language difficulties may affect access to education and employment opportunities which then affects income, health and nutrition literacy, and access to nutritious foods. Some migrants experience disadvantages such as social isolation and poor housing, which can affect access to safe food and safe preparation of food, and are generally in a relatively vulnerable position in their new environments, regardless of the type of migration (WHO 2010).

11.1.2 Physical activity 

Physical activity can be defined as any body movement that involves the use of one or more large muscle groups and raises the heart rate. This includes sport, exercise and recreational activities and incidental activity that accrues throughout the day (eg walking to the shops, climbing stairs).

The Australian Physical Activity and Sedentary Behaviour Guidelines (DoH 2014) recommend that pregnant women try to do some physical activity every day and accumulate 150–300 minutes of moderate-intensity physical activity each week. Women are advised to talk with their health professional regarding the best form of activity and to check with them before undertaking vigorous intensity physical activity.

Levels of physical activity in Australia

Data specific to pregnant women are not available but results from national surveys give some indication of patterns of physical activity and sedentary behaviour.

In Australia in 2014–15, 55.5% of 18–64 year olds participated in sufficient physical activity in the last week (more than 150 minutes of moderate physical activity or more than 75 minutes of vigorous physical activity, or an equivalent combination of both, including walking) (ABS 2015). Nearly one in three (29.7%) 18–64 year olds were insufficiently active (less than 150 minutes in the last week) while 14.8% were inactive (no exercise in the last week). Women were slightly less likely than men to participate in sufficient physical activity in the last week (53.3 vs 57.7%).

Factors influencing levels of physical activity

Women may not be involved in physical activity for a range of reasons, including:

  • perceptions that being physically active may harm the baby
  • limited facilities (eg pools, gymnasiums) or infrastructure (eg walking paths), particularly in some rural areas (NRHA 2011)
  • limited access to group activities and/or facilities specifically for women
  • costs of attending activities
  • perceptions that being physically active for the sake of it is a waste of time and money
  • limited time for physical activity due to other commitments (eg looking after other children, working)
  • perception of personal safety in public places.

11.2 Discussing nutrition

Other than the recommendation on caffeine and the practice points, this section is a summary of information provided in the Australian Dietary Guidelines (NHMRC 2013).

11.2.1 Healthy eating during pregnancy and breastfeeding

Consuming a variety of nutritious foods is particularly important during pregnancy and breastfeeding.

  • Vegetables, legumes/beans and fruit: Vegetable and fruit consumption before and during pregnancy makes an important contribution to health outcomes for women and their children.
  • Grain (cereal) foods: Wholegrain foods are a valuable source of iron and zinc and fibre. Bread in Australia is fortified with folic acid and made with iodised salt.
  • Lean meats and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans: Lean red meat and chicken is a good source of protein, iron and zinc. Maternal consumption of fish during pregnancy is likely to have a range of health benefits for women and their children but the fish should be low in mercury. Nuts and seeds and legumes/beans are important foods for people who choose vegetarian or vegan dietary patterns and meals without meat as they can provide an alternative source of nutrients. For several nutrients, including iron, calcium and vitamin B12, animal foods are highly bioavailable sources and care needs to be taken to ensure a variety of alternatives if these foods are excluded.
  • Milk, yoghurt and cheese and/or their alternatives: Milk, yoghurt and cheese or their alternatives are good sources of calcium. Reduced fat milk, yoghurt and cheese products are recommended during pregnancy.
  • Water: Pregnant women have an increased water requirement because of expanding extracellular fluid space and the needs of the baby and the amniotic fluid.

Recommendation

  • Practice point
  • H

Eating the recommended number of daily serves of the five food groups and drinking plenty of water is important during pregnancy and breastfeeding.

Approved by NHMRC in June 2014; expires June 2019 UNDER REVIEW

Table C1: Recommended number of daily serves during pregnancy

Table C1: Recommended number of daily serves during pregnancy
Food group Sample serve Pregnancy Breastfeeding
    <19 yrs 19–50 yrs <19 yrs 19–50 yrs
Vegetables of different types and colours, and legumes/ beans half cup cooked green or orange vegetables; half cup legumes;1 cup raw green leafy vegetables; 1 small potato;half cup sweet corn; 1 medium tomato 5 5 5.5 7.5
Fruit 1 apple; 1 banana; 2 plums;4 dried apricot halves 2 2 2 2
Grain (cereal) foods, mostly wholegrain and/or high cereal fibre varieties, such as breads, cereals, rice, pasta, noodles, polenta, couscous, oats, quinoa and barley 1 slice bread; half cup cooked rice, pasta or noodles; half cup porridge; 2/3 cup wheat cereal flakes; quarter cup muesli; 3 crispbreads; 1 crumpet or English muffin or plain scone 8 8.5 9 9
Lean meats and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans 65 g cooked lean red meat; 80 g cooked chicken; 100 g cooked fish fillet; 2 large eggs; 1 cup cooked lentils or canned beans; 170 g tofu; 30 g nuts, seeds, peanut or almond butter or tahini or other nut or seed paste 3.5 3.5 2.5 2.5
Milk, yoghurt, cheese and/or their alternatives (mostly reduced fat) 1 cup milk; 200 g yoghurt;40 g hard cheese; 1 cup soy/ other cereal drink with added calcium 3.5 2.5 4 2.5
Approximate number of additional serves from the five food groups or discretionary choices 0–3 0–2.5 0–3 0–2.5

Source: (NHMRC 2013).

Practical advice on nutritious foods during pregnancy

Vegetables, legumes/ beans and fruit
  • Many women need to increase their consumption of vegetables, legumes/beans and fruit
  • Due to the risk of listeriosis, pre-prepared or pre-packaged cut fruit or vegetables should be cooked. Pre-prepared salad vegetables (eg from salad bars) should be avoided
Grain (cereal) foods
  • While bread in Australia contains iodine and folate, supplementary folate is recommended preconception and in the first trimester and iodine should be supplemented preconception and throughout pregnancy and breastfeeding
Lean meats and poultry, fish, eggs, tofu, nuts and seeds, legumes/beans
  • Raw or undercooked meat, chilled pre-cooked meats, and pâté and meat spreads should be avoided during pregnancy due to risk of listeriosis
  • Care needs to be taken with consumption of some fish species (eg shark/flake, marlin or broadbill/swordfish, orange roughy and catfish) due to the potentially higher mercury content
  • Foods containing raw eggs should be avoided due to the risk of salmonella
  • Nuts need only be avoided if the woman has an allergy to them
Milk, yoghurt, cheese and/or alternatives
  • Unpasteurised dairy products and soft, semi-soft and surface-ripened cheese should be avoided due to the risk of listeriosis
  • Women who avoid milk products should consume alternative calcium-fortified products
Water
  • Fluid need is 750–1,000 mL a day above basic needs

Source: (NHMRC 2013)

Foods that should be limited

  • Foods containing saturated fat, added salt, added sugars: Intake of these foods should be limited in general and during pregnancy. The additional energy requirements of pregnancy should be met through additional serves of foods from the five food groups rather than energy-dense foods.
  • Alcohol: Not drinking alcohol is the safest option during pregnancy (see Chapter 13).

Maternal diet and infant allergy

Maternal diet during pregnancy and while breastfeeding does not appear to affect the risk of asthma, eczema or other allergy symptoms in infants (Hattevig et al 1989;  Chatzi et al 2008; De Batlle et al 2008; Shaheen et al 2009; Lange et al 2010).

Caffeine

There is insufficient evidence to confirm or refute the effectiveness of caffeine avoidance on birth weight or other pregnancy outcomes (Jahanfar & Sharifah 2009; Peck et al 2010; Milne et al 2011). The Australian Department of Health and Ageing suggests limiting intake during pregnancy to around three cups of coffee or six cups of tea a day (eg 300 mg of caffeine) (DoHA 2009). Other caffeinated beverages (eg colas, energy drinks, green tea) should also be limited.

Recommendation

  • Grade C
  • 5

Reassure women that small to moderate amounts of caffeine are unlikely to harm the pregnancy. 

Approved by NHMRC in June 2014; expires June 2019 UNDER REVIEW

Appropriate weight gain

Appropriate, steady weight gain during pregnancy is important to optimise the health outcomes (short and long term) for the infant and mother (NHMRC 2013). Calculation of body mass index (BMI) at the first antenatal visit (see Chapter 19) allows appropriate advice about nutrition to be given early in pregnancy as the optimal amount of weight gained depends on the woman’s pre-pregnancy BMI. Supporting weight management is discussed in Section 19.2.4.

Recommendation

  • Practice point
  • I

For women who are underweight, additional serves of the five food groups may contribute to healthy weight gain.

Approved by NHMRC in June 2014; expires June 2019 UNDER REVIEW

Recommendation

  • Practice point
  • J

For women who are overweight or obese, limiting additional serves and avoiding energy-dense foods may limit excessive weight gain. Weight loss diets are not recommended during pregnancy. 

Approved by NHMRC in June 2014; expires June 2019 UNDER REVIEW

11.3 Nutritional supplements

There is evidence to support routine supplementation with folic acid preconception and in the first trimester and to support iodine supplementation preconception and during pregnancy and breastfeeding. Iron supplementation may prevent iron deficiency in women with limited dietary iron intake. Vitamin B12 supplementation may be needed if a woman has a vegetarian or vegan diet. Vitamin D supplementation may be a consideration for women with vitamin D levels lower than 50 nmol/L (see Chapter 47). Other nutritional supplements do not appear to be of benefit unless there is an identified deficiency.

11.3.1 Vitamins

Folic acid

Folic acid supplementation prevents first and second time occurrence of neural tube defects (De-Regil et al 2010). In Australia, the rates of anomalies such as encephalocele, anencephaly and spina bifida have fallen with promotion of folic acid supplements and voluntary fortification (Bower et al 2009). However, no such falls have been seen for Aboriginal babies (Bower et al 2009) and the prevalence of neural tube defects among Aboriginal and Torres Strait Islander babies is almost double that in the non-Indigenous population (Bower et al 2004). Levels of knowledge about folic acid supplementation appear to be lower among Aboriginal and Torres Strait Islander women (55% vs 67.5% of the mostly non-Indigenous women surveyed), particularly among adolescent women (38%) (Bower et al 2004). Restricted food choices and higher costs in rural and remote areas may also contribute to lower levels of folate intake and higher prevalence of neural tube defects (Bower et al 2004).

Women taking medicines that are folate antagonists (eg carbamazepine, lamotrigine) should be encouraged to take high-dose folate supplements preconception and during the first trimester (Austin et al 2017).

Recommendation

  • Grade A
  • 6

Inform women that dietary supplementation with folic acid, from 12 weeks before conception and throughout the first 12 weeks of pregnancy, reduces the risk of having a baby with a neural tube defect and recommend a dose of 500 micrograms per day.

Approved by NHMRC in December 2011; expires December 2016 UNDER REVIEW

Recommendation

  • Practice point
  • K

Specific attention needs to be given to promoting folic acid supplementation to Aboriginal and Torres Strait Islander women of childbearing age and providing information to individual women at the first antenatal visit.

Approved by NHMRC in December 2011; expires December 2016 UNDER REVIEW

Other vitamins

There is insufficient evidence on supplementation during pregnancy of vitamin C (Rumbold et al 2015b), vitamin E (Rumbold et al 2015a), vitamin A (van den Broek et al 2010) or vitamin B6 (Thaver et al 2006) to show whether these are beneficial. However, supplementation has been associated with:

  • preterm birth (500–1,000 mg vitamin C per day) (Rumbold et al 2015b)
  • perinatal death and preterm rupture of the membranes (1,000 mg vitamin C and 400 IU vitamin E per day) (Xu et al 2010)
  • congenital malformation (vitamin A) (Oakley & Erickson 1995; Rothman et al 1995; Dolk et al 1999).

There is insufficient evidence about the effects of other combinations of vitamins on pregnancy outcomes (Rumbold et al 2011).

Recommendation

  • Grade B
  • 7

Advise women that taking vitamin A, C or E supplements is not of benefit in pregnancy and may cause harm.

Approved by NHMRC in December 2011; expires December 2016 UNDER REVIEW

11.3.2 Minerals 

Iodine

This section, including the consensus-based recommendation, is based on NHMRC (2010) NHMRC Public Statement: Iodine Supplementation for Pregnant and Breastfeeding Women. Canberra: National Health and Medical Research Council.

Increased thyroid activity during pregnancy increases iodine requirements. If iodine intake is inadequate before pregnancy, maternal stores may run low and be inadequate to support the unborn baby in later stages of pregnancy (Smyth 2006). Iodine deficiency is of particular concern during pregnancy because abnormal function of the mother’s thyroid has a negative impact on the nervous system of the unborn baby, and increases the risk of infant mortality (Zimmerman 2009). Adverse effects on early brain and nervous system development are generally irreversible and can have serious implications for mental capacity in later life (WHO 2005–09).

There are limited studies specific to the iodine status of pregnant women in Australia, but those available prior to fortification suggest it was inadequate (APHDPC 2007). With the introduction of mandatory iodine fortification of bread, most of the Australian population will get enough iodine (Food Standards Australia New Zealand 2008) and women of child-bearing age should enter pregnancy with adequate iodine intake. However, the extra iodine available through fortified bread is not enough to meet the additional needs of pregnancy and during breastfeeding (Burgess et al 2007).

Recommendation

  • Consensus-based
  • III

Advise women who are pregnant to take an iodine supplement of 150 micrograms each day. Women with pre-existing thyroid conditions should seek advice from their medical practitioner before taking a supplement.

Approved by NHMRC in December 2011; expires December 2016 UNDER REVIEW

Iron

Demand for iron increases during pregnancy and insufficient iron intake or absorption or blood loss (eg due to gastrointestinal parasites) can result in deficiency or anaemia (see Chapter 30).

There is a lack of evidence that, in otherwise healthy women, the benefits of treatments for mild iron-deficiency anaemia in pregnancy will outweigh the adverse effects associated with them (Reveiz et al 2007). There is a potential dose response relationship between dose of iron and reported adverse events (Reveiz et al 2007)

Recommendation

  • Grade B
  • 8

Do not routinely offer iron supplementation to women during pregnancy.

Approved by NHMRC in December 2011; expires December 2016 UNDER REVIEW

Daily supplementation with iron during pregnancy reduces the risk of maternal iron deficiency and anaemia and low birth weight (Pena-Rosas et al 2012a; Haider et al 2013) but is associated with side effects (constipation, nausea, vomiting and diarrhoea and an increased risk of high haemoglobin concentration at term) (Pena-Rosas et al 2012a). These effects need to be weighed against the risks of iron deficiency (Pena-Rosas et al 2012a). Intermittent iron+folic acid regimens produce similar maternal and infant outcomes at birth and are associated with fewer side effects (Pena-Rosas et al 2012b).

Recommendation

  • Grade B
  • 9

Advise women with low dietary iron intake that intermittent supplementation is as effective as daily supplementation in preventing iron-deficiency anaemia, with fewer side effects.

Approved by NHMRC in June 2014; expires June 2019 UNDER REVIEW

Iron-rich staple foods can help women reach dietary targets for iron (Bokhari et al 2012). Absorption is aided by vitamin C and limited by tea and coffee (Marsh et al 2009). Where iron-rich foods are not available (eg due to geographical location or socioeconomic factors), women may be at high risk of iron deficiency. Ferritin concentrations should be checked and supplementation considered if iron stores are low or if they are normal but dietary intake is likely to remain low.

Recommendation

  • Practice point
  • L

Women at risk of iron deficiency due to limited access to dietary iron may benefit from practical advice on increasing intake of iron-rich foods.

Approved by NHMRC in June 2014; expires June 2019 UNDER REVIEW

Other minerals

  • Calcium: While calcium supplements are useful in decreasing pre-eclampsia risk if dietary intake is low (see Chapter 26), they do not appear to be of benefit in preventing preterm birth or low infant birth weight (Buppasiri et al 2011).
  • Magnesium: There is insufficient evidence to show whether dietary magnesium supplementation during pregnancy is beneficial (Makrides & Crowther 2001).
  • Zinc: While some studies have found benefits from zinc supplementation among women in areas of high perinatal mortality (Wieringa et al 2010; Mori et al 2012), these results may not be generalisable to the Australian context.

11.3.3 Other nutritional supplements

  • Multiple micronutrients: While multiple micronutrients improve nutrient status of pregnant women (Brough et al 2010) and reduced rates of small-for-gestational-age (Haider et al 2011) and low birth weight babies (Haider & Bhutta 2012), more evidence is needed to understand which groups of women may benefit from these supplements.
  • Omega-3 fatty acids: While there is emerging evidence of benefits associated with supplementing omega-3 fatty acids during pregnancy (eg reduced risk of early preterm birth) (Makrides et al 2010; Leung et al 2011; Imhoff-Kunsch et al 2012; Larque et al 2012; Mozurkewich & Klemens 2012), the benefits of routine supplementation are not known.
  • Probiotics: While there is also emerging evidence on the benefits of probiotics combined with dietary counselling during pregnancy (eg improved blood glucose control) (Laitinen et al 2009;  Luoto et al 2010; Ilmonen et al 2011), again the benefits of routine supplementation are not known.
  • Multivitamins: An observational study has shown an association between risk of preterm birth and multivitamins and minerals if taken daily in the third trimester by women who were unlikely to be deficient in these nutrients (Alwan et al 2010).

11.4 Discussing physical activity

Systematic reviews and RCTs have found that regular physical activity during pregnancy:

  • appears to improve (or maintain) physical fitness (Kramer & McDonald 2006; Ramírez-Vélez et al 2011)
  • improves health-related quality of life (Montoya Arizabaleta et al 2010) and maternal perception of health status (Barakat et al 2011)
  • may reduce depressive symptoms (Robledo-Colonia et al 2012)
  • can prevent urinary incontinence (pelvic floor muscle training) (Boyle et al 2012).

Calculation of BMI at the first antenatal visit (see Chapter 19) allows appropriate advice about physical activity to be given early in pregnancy. Supporting weight management is discussed in Section 19.2.4.

There is insufficient evidence for reliable conclusions about the effect of physical activity on:

  • maternal and fetal outcomes (Kramer & McDonald 2006)
  • preventing gestational diabetes or glucose intolerance in pregnancy (Han et al 2012) or improving glucose tolerance in women with gestational diabetes (Ceysens et al 2006); or
  • preventing pre-eclampsia and its complications (Meher & Duley 2006).

RCTs into specific types of physical activity during pregnancy have found:

  • specifically designed exercise programs prevented pelvic girdle pain (n=301) (Morkved et al 2007) and reduced severity of back pain (Kashanian et al 2009)
  • yoga reduced perceived stress (n=90) (Satyapriya et al 2009), improved quality of life and enhanced interpersonal relationships (n=102) (Rakhshani et al 2010) and women reported less pain during labour (n=74) (Chuntharapat et al 2008).

The safety of moderate physical activity during pregnancy is supported by a number of RCTs:

  • walking, joint mobilisation and light resistance exercises (three 35-minute sessions a week in the second and third trimester) (n=160) did not affect fetal cardiovascular responses (Barakat et al 2010), maternal anaemia (Barakat et al 2009a), type of birth (Barakat 2009b), gestational age at birth (Barakat et al 2008) or the newborn’s body size or overall health (Barakat et al 2009c)
  • aerobic dance exercise was not associated with reduction in birth weight, preterm birth rate or neonatal wellbeing (Haakstad & Bø 2011)
  • stationary cycling (up to five 40-minute sessions a week from 20 weeks gestation) (n=84) was associated with normalisation of birth weight (Hopkins et al 2010)
  • water aerobics (three 50-minute sessions a week from 16–20 weeks gestation) (n=71) was not associated with any alteration in maternal body composition, type of birth, preterm birth rate, neonatal wellbeing or weight (Cavalcante et al 2009).

Recommendation

  • Grade B
  • 10

Advise women that low- to moderate-intensity physical activity during pregnancy is associated with a range of health benefits and is not associated with adverse outcomes.

Approved by NHMRC in June 2014; expires June 2019 UNDER REVIEW

Pregnant women should avoid physical activity that involves the risk of abdominal trauma, falls or excessive joint stress, such as in high impact sports, contact sports and vigorous racquet sports (NICE 2008). They are also recommended not to scuba dive, because the risk of birth defects seems to be greater among those who do, and there is a serious risk of fetal decompression disease (Camporesi 1996).

11.5 Practice summary: nutrition and physical activity

Nutrition

When

All antenatal visits.

Who

  • Midwife
  • GP
  • obstetrician
  • Aboriginal and Torres Strait Islander Health Practitioner
  • Aboriginal and Torres Strait Islander Health Worker
  • multicultural health worker
  • accredited dietitian
  • nutritionist.

What

  • Assess levels of nutrition
    Ask women about their current eating patterns.
  • Provide advice
    Explain the benefits of healthy nutrition for the mother and baby. Give examples of foods in the five food groups, sample serves for each group and how many serves are recommended a day. Discuss foods that are rich in iron (eg meat, seafood and poultry), dietary factors that aid or limit absorption, and supplementing iron if the woman has a low dietary intake.
  • Discuss use of nutritional supplements with women
    Explain that some supplements (folic acid, iodine) are recommended for all women during pregnancy, while others (vitamins A, C and E) are not of benefit and may be harmful and that iron should only be supplemented if a deficiency is identified.
  • Consider referral
    Referral to an accredited dietitian may be a consideration if there is concern about the quality of nutritional intake, the woman would like information about nutrition for herself and her family, clinical assessment confirms underweight or overweight of the woman or there are other factors of concern (eg diabetes, gastrointestinal disorders).
  • Take a holistic approach
    Consider the availability of foods appropriate to the woman’s cultural practices and preferences and the affordability of supplements.

Physical activity

When

All antenatal visits.

Who

  • Midwife
  • GP
  • obstetrician
  • Aboriginal and Torres Strait Islander Health Practitioner
  • Aboriginal and Torres Strait Islander Health Worker
  • multicultural health worker
  • physiotherapist or accredited exercise physiologist.

What

  • Assess levels of activity
    Ask women about their current levels of physical activity, including the amount of time spent being active and the intensity of activity.
  • Provide advice
    Explain the benefits of regular physical activity. Give examples of activities that are of sufficient intensity to achieve health benefits (eg brisk walking, swimming, cycling). Advise women to discuss their plans with a health professional before starting or continuing a program of physical activity.
  • Provide information
    Give information about local supports for physical activity (eg women’s walking groups, swimming clubs, yoga classes). Advise women to avoid exercising in the heat of the day and to drink plenty of water when active.
  • Take a holistic approach
    Assist women to identify ways of being physically active that are appropriate to their cultural beliefs and practices (eg activities they can do at home).

11.6 Resources

11.6.1 Nutrition

  • FSANZ (2011) Mercury in Fish. Food Standards Australia New Zealand. Accessed: 13 August 2018.
  • FSANZ (2011) Listeria. Food Standards Australia New Zealand. Accessed: 13 August 2018.
  • NHMRC (2013) Australian Dietary Guidelines. Canberra: National Health and Medical Research Council.
  • NHMRC (2010) NHMRC Public Statement: Iodine Supplementation for Pregnant and Breastfeeding Women. Canberra: National Health and Medical Research Council.
  • NHMRC (2006) Nutrient Reference Values for Australia and Nhttps://www.nrv.gov.au/ew Zealand. Canberra: National Health and Medical Research Council.

11.6.2 Physical activity

References

  • Austin M-P, Highet N, Expert Working Group. Mental Health Care in the Perinatal Period: Australian Clinical Practice Guideline. Melbourne: Centre of Perinatal Excellence; 2017.
  • ABS (2015) National Health Survey First Results. Australia 2014–15. Cat No 4364.0.55.001. Canberra: ABS.
  • Alwan NA, Greenwood DC, Simpson NA et al (2010) The relationship between dietary supplement use in late pregnancy and birth outcomes: a cohort study in British women. BJOG 117(7): 821–29.
  • APHDPC (2007) The Prevalence and Severity of Iodine Deficiency in Australia. Australian Population Health Development Principal Committee. Report Commissioned by the Australian Health Ministers’ Advisory Committee.
  • Ball K, Timperio A, Crawford D (2009) Neighbourhood socioeconomic inequalities in food access and affordability. Health & Place 15(2): 578–85.
  • Barakat R, Stirling JR, Lucia A (2008) Does exercise training during pregnancy affect gestational age? A randomised controlled trial. Brit J Sports Med 42(8): 674–78.
  • Barakat R, Ruiz JR, Lucia A (2009a) Exercise during pregnancy and risk of maternal anaemia: a randomised controlled trial. Brit J Sports Med 43(12): 954–56.
  • Barakat R, Ruiz JR, Stirling JR et al (2009b) Type of delivery is not affected by light resistance and toning exercise training during pregnancy: a randomized controlled trial. Am J Obstet Gynecol 201(6): 590.e1–6.
  • Barakat R, Lucia A, Ruiz JR (2009c) Resistance exercise training during pregnancy and newborn’s birth size: a randomised controlled trial. Int J Obesity 33(9): 1048–57.
  • Barakat R, Ruiz JR, Rodriguez-Romo G et al (2010) Does exercise training during pregnancy influence fetal cardiovascular responses to an exercise stimulus? Insights from a randomised, controlled trial. Brit J Sports Med 44(10): 762–64.
  • Barakat R, Pelaez M, Montejo R et al (2011) Exercise during pregnancy improves maternal health perception: a randomized controlled trial. Am J Obstet Gynecol 204(5): 402.e1–7.
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  • Bower C, Eades S, Payne J et al (2004) Trends in neural tube defects in Western Australia in Indigenous and non-Indigenous populations. Paediatr Perinatal Epidemiol 18(4): 277–80.
  • Bower C, D’Antoine H, Stanley FJ (2009) Neural tube defects in Australia: Trends in encephaloceles and other neural tube defects before and after promotion of folic acid supplementation and voluntary food fortification.” Birth Defects Res A Clin Mol Teratol 85(4): 269–73.
  • Boyle R, Hay-Smith EJC, Cody JD et al (2012) Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev 2012, Issue 10. Art. No.: CD007471. DOI: 10.1002/14651858.CD007471.pub2.
  • Brough L, Rees GA, Crawford MA et al (2010) Effect of multiple-micronutrient supplementation on maternal nutrient status, infant birth weight and gestational age at birth in a low-income, multi-ethnic population. Br J Nutr 104(3): 437- 45.
  • Buppasiri P, Lumbiganon P, Thinkhamrop J et al (2011) Calcium supplementation (other than for preventing or treating hypertension) for improving pregnancy and infant outcomes. Cochrane Database Syst Rev (10): CD007079.
  • Burgess JR, Seal JA, Stilwell GM et al (2007) A case for universal salt iodisation to correct iodine deficiency in pregnancy: another salutary lesson from Tasmania. Med J Aust 186: 574–76.
  • Burns C & Inglis A (2007) Measuring food access in Melbourne: access to healthy and fast foods by car, bus and foot in an urban municipality in Melbourne. Health & Place 13(4): 877–85.
  • Camporesi EM (1996) Diving and pregnancy. Sem Perinatolo 20: 292–302.
  • Cavalcante SR, Cecatti JG, Pereira RI et al (2009) Water aerobics II: Maternal body composition and perinatal outcomes after a program for low risk pregnant women. Reprod Health 6(1): 1.
  • Ceysens G, Rouiller D, Boulvain M (2006) Exercise for diabetic pregnant women. Cochrane Database Sys Rev 2006, Issue 3. Art. No.: CD004225. DOI: 10.1002/14651858.CD004225.pub2.
  • Chatzi L, Torrent M, Romieu I et al (2008) Mediterranean diet in pregnancy is protective for wheeze and atopy in childhood. Thorax 63(6): 507.
  • Chuntharapat S, Petpichetchian W, Hatthakit U (2008) Yoga during pregnancy: effects on maternal comfort, labor pain and birth outcomes. Complement Ther Clin Pract 14(2): 105–15.
  • De Batlle J, Garcia Aymerich J, Barraza Villarreal A et al (2008) Mediterranean diet is associated with reduced asthma and rhinitis in Mexican children. Allergy 63(10): 1310–16.
  • De-Regil LM, Fernández-Gaxiola AC, Dowswell T et al (2010) Effects and safety of periconceptional folate supplementation for preventing birth defects. Cochrane Database of Systematic Reviews DOI: 10.1002/14651858.CD007950.pub2.
  • DoH (2014) Australia’s Physical Activity and Sedentary Behaviour Guidelines. Accessed 6 June 2017.
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Last updated: 
4 December 2018