Nutrition for pregnancy
Eating Right During Pregnancy
• 40 weeks of pregnancy are a magical time.
• Keeping a healthy lifestyle throughout pregnan...
Unhealthy eating trends
• Irregular meal time (skip main meal)
• Craving for sweet snack or drinks
• High fat food intake ...
• Sugary foods and beverages
• Fat (fried foods or processed foods)
Optimal weight gain during pregnancy
BMI before
pregnancy
Ideal weight gain Rate of weight gain
after 1st trimester
Underw...
The First Trimester
• A time of rapid cell division, organ
development, and preparation for the
demands of rapid fetal gro...
The 2nd and 3rd Trimesters
• Energy intake is especially important since 90% of
fetal growth occurs during the last half o...
Energy Requirements
During Pregnancy
• Additional Energy Needs for Normal Weight
Women:1
– 2nd trimester + 360 kilocalorie...
An Additional 300
Calories Isn’t Much!
• A more healthy food choices are:
1. Steam fish (240 Kcal) + fruit (1 slice) (60 K...
Regular meal time to get
balance and complete nutrients
My Plate Method
CARBOHYDRATE
RNI for
pregnancy
50 – 60 %
Function Main energy supply
Promotes weight gain of the fetus,
placenta and other...
PROTEIN
RNI 15 – 20 % Pregnancy: 55 g +7.5 =62.5 g protein
Lactation : 1st 6 mths 55g + 20 g
2nd 6 mths 55g + 15 g
Functio...
1 piece
drumstick
2 piece chicken
breast
2 match box
lean meat
2 pieces
tempe
1 fish
( 6inches)
2 match box
fish
2 medium
...
Milk & Dairy products: 7 g PROTEIN
1 glass milk
(250ml)
4 rounded tablespoon
powdered milk
¾ cup yogurt 2 thin slices chee...
Example: 60-65g protein
Breakfast @
7- 8 am
Morning Tea
@ 10 am
Lunch @
1 pm
Afternoon
snack @
4pm
Dinner @
7 pm
Supper @
...
Healthy choices:
ENCOURAGE
Take fish twice in a week
Take more beans and soy products (tofu, tempeh or dhall)
Priority fre...
FAT
RNI for
pregnancy
20-30%
2nd trimester: 54- 82g/ day
3rd trimester: 57 – 85g/ day
Saturated fat < 10%
Monounsaturated ...
FAT: Omega-3 (PUFA)
• Important for fetal’s brain and eye development
• Encourage take at least 8 to 12 ounces (240 to
360...
Healthy fat choice:
• Choose healthy fat (vegetables oil and fish)
• Reduce fried foods intake, fatty foods, high in
satur...
Avoid empty calories food choices
• “Empty calories” means high-energy foods with
little nutritional value
• Example:
– Ad...
Kuih
Limit Healthy choice
POPIAH
BASAH
APAM
TANPA
KELAPA
SANDWICH
POPIA GORENG
KUIH MANIS/ BERSANTAN
KARIPAP
Air
Limit Healthy choice
Vitamin and Minerals that
necessary for pregnant women
IRON
RDA for
pregnancy
27 mg/day
Function Carry oxygen to cells development
and for infants iron storage
Inadequate
intake...
Heme iron and non heme iron
Heme iron (25 %
absorption)
Non Heme iron (< 25 %
absorption)
Fish / Seafood Dark green leafy
...
Factors affect iron bioavaibility
Enhancer Inhibitor
Ascorbic acid
(vitamin C)
Phytates (wholegrain, legumes,
nuts and see...
Dietary Sources of Iron DRI 15-30 mg/day
Food item Serving sie Food item Serving sie
Excellent > 4 mg Good 2- 4 mg
Beef li...
Vitamin C
RNI pregnancy
RNI lactation
80 mg /day
95 mg/day
Function Aids in formulation of connective
tissue and vascular ...
FOLIC ACID/ FOLATE
RNI / CDC 600 mcg (pregnancy)
500 mcg (lactation)
Function Vitamin B (water soluble) for synthesis
nucl...
Food item Serving
size
Food item Serving
size
Excellent > 100 ug
Asparagus/ Spinach ½ cup Kidney beans/
peanuts
1 cup
(120...
CALCIUM
RNI 1000 mg/day
Function Involved in mineralization of bones and teeth,
energy and cell production
Fetal bone and ...
Dietary Sources of Calcium DRI 1000-1300 mg/day
Food item Serving size
Good > 200 mg
Milk 1 cup (250 ml)
Yogurt 240 ml
Che...
Factors affecting calcium absorption
Enhancer Calcium chelators from plants
sources (Bind to calcium, reduce
absorption)
R...
Caffeine intake
Moderate intake
(< 300 mg/day)
2 to 3 servings consumption not
linked to adverse effects on
pregnancy
High...
Caffeinated beverages
Type of Caffeinated
beverages (150 ml)
Caffeine
Coffee 115 mg
Iced Tea 40 mg
Cola 15 mg
Hot chocolat...
ZINC
RNI for pregnancy (Requirement increases due to accrual of fetal
and maternal tissues)
Function Synthesis of nucleic ...
Dietary Sources of Zinc DRI 15-19 mg/day
Food item Serving size Mg/ serving
Excellent > 4 mg
Beef (lean, cooked) 90 g 5.1
...
IODINE
• Iodine requirement increased
– To provide the needs of the fetus
– To compensate for the increased loss of iodine...
VITAMIN A
• Vitamin A- most pregnant women do not need
supplemental vitamin A
• Essential for embryogenesis, growth and
ep...
REMINDER
• Don't rely on supplements to make up for an
unhealthy diet.
• Vitamin and mineral supplements cannot replace
a ...
Complications of Pregnancy that may
Impact Nutritional Status
• Nausea and Vomiting
• Constipation
• Food safety -food bor...
Nausea and vomiting
• Small and frequent meal
• Eat dry/cold foods
• Add ginger into meal
• Sniff lemon
• Suck on candy
• ...
Food to avoid
• Raw or unpasteurized milk
• Raw or partially cooked eggs
• Undercooked meat and poultry
• Raw or undercook...
Constipation
• Foods high in dietary fiber, including cereals,
bread, fruits and vegetables
• Choose high fiber snacks suc...
CONCLUSION
• Pregnant mother are encourage to get a balance diet
to ensure sufficient nutrients for fetal growth and
devel...
Example of one day MENU
(1800 kcal/hari)
• BREAKFAST
Roti Bijirin Penuh 3 keping
Marjerin 1 sudu teh
Atau Oat 9 sudu makan...
• LUNCH AND DINNER
Nasi 1 chinese bowl
Ikan/ayam/daging 1 hidangan
Sayur 2 hidangan
Buah-buahan 1 hidangan
Minuman (tanpa ...
• Minum Pagi/ Minum Petang / Minum Malam
Crackers 3 keping
Atau Popiah Basah 2 ketul
Atau Kacang Kuda Rebus ½ cawan
Susu T...
My Plate Method
REFERENCES
• Malaysia Dietary Guidelines, 2010
• Institute of Medicine, Subcommirrww on Nutrition and Lactation. National
...
Nutrition (Pregnancy)
Nutrition (Pregnancy)
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Nutrition (Pregnancy)

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I believe pregnancy is a long and difficult process for every mum in the world. Through a better diet planning for pregnant women, they can have a healthier body to welcome their beloved baby.

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Transcript of "Nutrition (Pregnancy)"

  1. 1. Nutrition for pregnancy
  2. 2. Eating Right During Pregnancy • 40 weeks of pregnancy are a magical time. • Keeping a healthy lifestyle throughout pregnancy, as well as before and after • Important steps to a healthy pregnancy include – Eating a balanced diet; – Gaining the right amount of weight; – Enjoying light regular physical activity; – Taking a vitamin and mineral supplement if recommended by a physician; – Avoiding alcohol, tobacco and other harmful substances.
  3. 3. Unhealthy eating trends • Irregular meal time (skip main meal) • Craving for sweet snack or drinks • High fat food intake (fried foods and processed foods) • Imbalance meal
  4. 4. • Sugary foods and beverages
  5. 5. • Fat (fried foods or processed foods)
  6. 6. Optimal weight gain during pregnancy BMI before pregnancy Ideal weight gain Rate of weight gain after 1st trimester Underweight (BMI <18.5) 12.5 – 18kg ~0.5kg/week Normal (BMI 18.5 – 24.9) 11.5 – 16kg ~0.4kg/week Overweight (BMI >25) 7 – 11.5kg ~0.3kg/week Obesity (BMI >30) < 7.0kg ~0.3kg/week IOM, 1990
  7. 7. The First Trimester • A time of rapid cell division, organ development, and preparation for the demands of rapid fetal growth that occur during 2nd and 3rd trimester • Critical nutrients during this phase include: –Protein –Folic acid –Vitamin B12 –Zinc King JC. Physiology of pregnancy and nutrient metabolism. Am J Clin Nutr 2000;71:1218S-1215S.
  8. 8. The 2nd and 3rd Trimesters • Energy intake is especially important since 90% of fetal growth occurs during the last half of gestation. • Critical nutrients during this phase include: – Protein – Iron – Calcium – Magnesium – B vitamins – Omega-3 fatty acid, docosahexaenoic acid (DHA) King JC. Physiology of pregnancy and nutrient metabolism. Am J Clin Nutr 2000;71:1218S-1215S. Kline DA. Macronutrient requirements during pregnancy. Today’s Dietitian Jan 2004:20-24.
  9. 9. Energy Requirements During Pregnancy • Additional Energy Needs for Normal Weight Women:1 – 2nd trimester + 360 kilocalories – 3rd trimester + 470 kilocalories – Lactation + 500 kilocalories RNI 2005 • Different Energy requirement for differences in age, body size, pre-pregnancy weight and lifestyles.1 1. Butte NF, Wong WW, Treuth MS, Ellis KJ, Smith EO. Energy requirements during pregnancy based on total energy expenditure and energy deposition. Am J Clin Nutr 2004;79:1078-1087.
  10. 10. An Additional 300 Calories Isn’t Much! • A more healthy food choices are: 1. Steam fish (240 Kcal) + fruit (1 slice) (60 Kcal) 2. Egg Sandwich (185 Kcal) + Milk (125 Kcal)
  11. 11. Regular meal time to get balance and complete nutrients
  12. 12. My Plate Method
  13. 13. CARBOHYDRATE RNI for pregnancy 50 – 60 % Function Main energy supply Promotes weight gain of the fetus, placenta and other maternal tissues Dietary Sources Rice, Noodles, Whole grain breads and cereals (starch), milk , fruit, starchy vegetables Precaution Limit refined sugar intake (sweet beverages and foods) that can increase risk of gestational diabetes mellitus
  14. 14. PROTEIN RNI 15 – 20 % Pregnancy: 55 g +7.5 =62.5 g protein Lactation : 1st 6 mths 55g + 20 g 2nd 6 mths 55g + 15 g Function For growth an maintenance of tissue and overall metabolism Greatest need is in 3rd trimester Dietary Sources Meat, poultry, fish and eggs Milk For vegetarian: Soybase milk and soy products, beans, nuts and legumes Precaution Commercial protein supplements are not recommended
  15. 15. 1 piece drumstick 2 piece chicken breast 2 match box lean meat 2 pieces tempe 1 fish ( 6inches) 2 match box fish 2 medium eggs (hen) 1 ½ piece tauhu PROTEIN : 14 g/ serving (2 – 4 serving/ day)
  16. 16. Milk & Dairy products: 7 g PROTEIN 1 glass milk (250ml) 4 rounded tablespoon powdered milk ¾ cup yogurt 2 thin slices cheese
  17. 17. Example: 60-65g protein Breakfast @ 7- 8 am Morning Tea @ 10 am Lunch @ 1 pm Afternoon snack @ 4pm Dinner @ 7 pm Supper @ 9.30pm
  18. 18. Healthy choices: ENCOURAGE Take fish twice in a week Take more beans and soy products (tofu, tempeh or dhall) Priority fresh foods Use natural spices, herbs and less seasonings in cooking REDUCE Red meat intake (beef/ pork) Processed foods intake (sausage, nugget, canned foods) Preserved foods (salted fish, salted eggs, pickled vegetables) and junk foods (chips/ keropok)
  19. 19. FAT RNI for pregnancy 20-30% 2nd trimester: 54- 82g/ day 3rd trimester: 57 – 85g/ day Saturated fat < 10% Monounsaturated fat 12 – 15 % Polyunsaturated fat 5 – 7 % Function (energy) Fat deposits in the fetus increase from 2% at mid-pregnancy to almost 12% at term Precaution More completely absorbed during pregnancy causing marked increase in serum lipids, and cholesterol
  20. 20. FAT: Omega-3 (PUFA) • Important for fetal’s brain and eye development • Encourage take at least 8 to 12 ounces (240 to 360g) each week • Good sources of Omega-3 fatty acids as following: – Flaxseed oil (50 -60 % ALA) – Canola oil, rapeseed oil (11% ALA) – Soybean oil – Deep sea colded fish (DHA+ EPA) – Omega 3 enriched eggs( EPA + DHA) – Fish oil (cod liver oil) EPA+ DHA – Pulses (beans, dhall), nuts/ seeds (walnut, linseed) American Dietetic Association
  21. 21. Healthy fat choice: • Choose healthy fat (vegetables oil and fish) • Reduce fried foods intake, fatty foods, high in saturated fat and cholesterol (internal organs, skin of chicken, egg yolk, seafood) • Reduce trans fat food sources (cake, fast foods or creamy biscuit)
  22. 22. Avoid empty calories food choices • “Empty calories” means high-energy foods with little nutritional value • Example: – Added sugars (soft drinks, desserts, sweet sugary beverages or foods) – Solid fats (Fried foods, cheese, whole milk, and fatty meats) • Look for choices that are low-fat, fat-free, unsweetened, or with no added-sugars. They have fewer or no "empty calories.“
  23. 23. Kuih Limit Healthy choice POPIAH BASAH APAM TANPA KELAPA SANDWICH POPIA GORENG KUIH MANIS/ BERSANTAN KARIPAP
  24. 24. Air Limit Healthy choice
  25. 25. Vitamin and Minerals that necessary for pregnant women
  26. 26. IRON RDA for pregnancy 27 mg/day Function Carry oxygen to cells development and for infants iron storage Inadequate intake Anemia (Pale face, tired) Measure through Hemoglobin level < 10.4 g/dl Diet alone Not sufficient Recommended Prenatal Supplements contain 27 mg Excessive Constipation
  27. 27. Heme iron and non heme iron Heme iron (25 % absorption) Non Heme iron (< 25 % absorption) Fish / Seafood Dark green leafy vegetables (Spinach and Kangkung) Meat (Beef/ Lamb/ Pork) Legumes (Bean, dried fruits and Seed) Poultry Eggs
  28. 28. Factors affect iron bioavaibility Enhancer Inhibitor Ascorbic acid (vitamin C) Phytates (wholegrain, legumes, nuts and seed, soy protein) Organic acids (citric acid, lactic acid, stomach acid) Phosphates (snack foods, processed meats and cola drinks) Heme iron (meat, poultry, fish and other seafood) Iron binding polyphenols Fermented vegetables and soy sauces Calcium, caffeine, tannic acid (tea) EDTA (food addictives) Oxalates (beets, nuts, chocolate) FAO/WHO, 2002, RNI 2005 Take meat, poultry or fish together with VEGETABLES AND FRUITS, avoid together with COFFEE, TEA, SOFT DRINKS OR MILK
  29. 29. Dietary Sources of Iron DRI 15-30 mg/day Food item Serving sie Food item Serving sie Excellent > 4 mg Good 2- 4 mg Beef liver 90 g Beef 90 g Clams ½ cup Egg yolks 3 whole Kidney beans 1 cup Lamb 90 g Dried peaches 10 halves Oyster 90 g Sunflower seeds (dried) 2/3 cup Peas 1 cup Raisins 2/3 cup
  30. 30. Vitamin C RNI pregnancy RNI lactation 80 mg /day 95 mg/day Function Aids in formulation of connective tissue and vascular functioning Enhance iron absorption Recommended Supplements should take together with iron supplements Dietary Sources Vegetables and fruits (Citrus, tomatoes, strawberries, potatoes, broccoli, leafy greens)
  31. 31. FOLIC ACID/ FOLATE RNI / CDC 600 mcg (pregnancy) 500 mcg (lactation) Function Vitamin B (water soluble) for synthesis nucleotide and cells division to prevent serious birth defects Inadequate intake Neural tube defects - cleft lip and congenital heart disease Diet alone Not sufficient due to low bioavailability Need take fortified folate foods Recommended Important for any women who prepare to pregnant and during pregnant period Prenatal supplements contain up to 600 micrograms CDC (Center for disease control)
  32. 32. Food item Serving size Food item Serving size Excellent > 100 ug Asparagus/ Spinach ½ cup Kidney beans/ peanuts 1 cup (120g) Baked beans/ Black eye peas 1 cup Lentils 1 cup Fortified grain and cereal products depend label Beef/chicken 105 g Good 15-99 ug Broccoli/cauliflower ½ cup Orange 1 medium Dietary Sources of Folate DRI 500-600 ug/day Complete your meal with vegetables and fruits (3 main meal)
  33. 33. CALCIUM RNI 1000 mg/day Function Involved in mineralization of bones and teeth, energy and cell production Fetal bone and teeth calcification primarily occurs in last trimester of pregnancy Inadequate intake Demineralization of mothers bones and teeth may occur Recommended Calcium supplementation is recommended for those diet deficient in calcium (<900mg/day), adolescent, have prepregnancy hypertension, history of preeclampsia (IOM, 1991) Institute of Medicine, Subcommirrww on Nutrition and Lactation, 1991
  34. 34. Dietary Sources of Calcium DRI 1000-1300 mg/day Food item Serving size Good > 200 mg Milk 1 cup (250 ml) Yogurt 240 ml Cheese (cheddar, parmesan, mozzarella) 30 g Ice cream 1 cup Canned salmon/ tuna with bones/ anchovies 90 g Calcium fortified foods (juice, cereal) Depend label Broccoli/ Chinese kale (Kailan)/ Spinach 2 cups Tofu (+ calcium sulfate)/tempeh(fermented soybeans) Soybeans, black eyed peas (cow peas), and white beans
  35. 35. Factors affecting calcium absorption Enhancer Calcium chelators from plants sources (Bind to calcium, reduce absorption) Recommended vitamin D is similar non pregnant to 5 ug/day(RNI 2005) Phytate (wholegrain, legumes, nuts and seed, soy protein) Stomach acid Phosphates (snack foods, processed meats and cola drinks) Lactose Iron Growth hormone Oxalate Tannic acid (tea) Sodium (competes with calcium reabsorption in renal)RNI 2005 Reduce snack/ junk foods, processed meats and cola drinks
  36. 36. Caffeine intake Moderate intake (< 300 mg/day) 2 to 3 servings consumption not linked to adverse effects on pregnancy High intake (> 500 mg/day) 6 to 18 servings consumption is inked to increase rsk 2.2x of first trimester spontaneous abortions (Goldenberg, R. et al 1995) Side effects Decrease bioavailability of iron, calcium and zinc Precaution Caffeine does pass into breast milk, consumption during lactation should be limited
  37. 37. Caffeinated beverages Type of Caffeinated beverages (150 ml) Caffeine Coffee 115 mg Iced Tea 40 mg Cola 15 mg Hot chocolate 4 mg
  38. 38. ZINC RNI for pregnancy (Requirement increases due to accrual of fetal and maternal tissues) Function Synthesis of nucleic acids DNA and RNA and important in reproduction Inadequate intake Few case reports severe human zinc deficiency in pregnancy led to major obstetric complication and congenital malformation in fetus Diet Vegetarians may need more zinc Recommended Zinc supplementation is recommended when iron supplementation > 30 mg/day (IOM, 1991) as large amount iron supplement decrease zinc 1st trimester 5.5 mg 3rd trimester 10 mg 2nd trimester 7 mg Lactation 9.5 mg
  39. 39. Dietary Sources of Zinc DRI 15-19 mg/day Food item Serving size Mg/ serving Excellent > 4 mg Beef (lean, cooked) 90 g 5.1 Lamb (lean, cooked) 90 g 4 Oyster/ shellfish 90 g 6.3 Good 0.9- 3.4 mg Black-eye peas (cooked) ½ cup 3.4 Chicken 90 g 2.4 Green peas (cooked) ½ cup 0.9 Milk 1 cup (250 ml) 0.9 Yogurt 1 cup (250 ml) 1.1
  40. 40. IODINE • Iodine requirement increased – To provide the needs of the fetus – To compensate for the increased loss of iodine in the urine due to increased renal clearance – To prevent hypothyroidism of mother and fetus during pregnancy (risk of brain damage) • 3.5 ug/kg/day or 200 ug/day • Food sources: Seaweed, fish, eggs, meat, milk, dried legumes, dried vegetables and fruits. FAO/WHO, 2002
  41. 41. VITAMIN A • Vitamin A- most pregnant women do not need supplemental vitamin A • Essential for embryogenesis, growth and epithelial differentiation • High doses (> 25,000 IU/ 3000 ug/day Retinol) might relate with birth defects (fetal toxicity)
  42. 42. REMINDER • Don't rely on supplements to make up for an unhealthy diet. • Vitamin and mineral supplements cannot replace a healthy diet. • Most pregnant women are recommend to take a prenatal vitamin and mineral supplement every day in addition to eating a healthy diet. • Taking a supplement ensures that you and your baby get enough important nutrients like folic acid and iron. But don't overdo it. Taking extra can be harmful for you and your baby.
  43. 43. Complications of Pregnancy that may Impact Nutritional Status • Nausea and Vomiting • Constipation • Food safety -food borne illness (high risk getting sick from eating unsafe food) – Pregnant mother have low ability to fight off infection. – Unborn baby's immune system is not fully developed – Increase risk of miscarriage or premature delivery
  44. 44. Nausea and vomiting • Small and frequent meal • Eat dry/cold foods • Add ginger into meal • Sniff lemon • Suck on candy • Supplement with vitamin B6 (25 mg, 3x/day) • Avoid spicy, acidic foods and strong odors • Low fat diet • Avoid caffeine • Drink plenty of fluids to avoid dehydration
  45. 45. Food to avoid • Raw or unpasteurized milk • Raw or partially cooked eggs • Undercooked meat and poultry • Raw or undercooked fish or shellfish • Mercury can harm the developing nervous system in an unborn child or young baby. – Choices that are lower in mercury include salmon, tilapia, trout, pollock, and catfish. – Avoid eat fish high in mercury like shark, swordfish, tilefish, and King mackerel.
  46. 46. Constipation • Foods high in dietary fiber, including cereals, bread, fruits and vegetables • Choose high fiber snacks such as wholegrain bread/ biscuits or fruits rather than sweets, creamy biscuits or cake • Adequate fluids
  47. 47. CONCLUSION • Pregnant mother are encourage to get a balance diet to ensure sufficient nutrients for fetal growth and development. • Those extra nutrients that essential included extra energy, protein (iron, zinc), healthy fat (omega-3 fatty acids), variety vegetables and fruits (folate, vitamin B, vitamin C) milk (calcium) and adequate fluid intake • Reduce unhealthy food choices such as high refined sugar beverage/ foods (empty nutrients dense calorie), high saturated fat (deep-fried foods, coconut milk) and salty foods (processed, preserved and canned foods)
  48. 48. Example of one day MENU (1800 kcal/hari) • BREAKFAST Roti Bijirin Penuh 3 keping Marjerin 1 sudu teh Atau Oat 9 sudu makan Atau Bubur nasi 3 cawan Atau Capati (kecil) 1 ½ keping Atau Mee/bihun 1 chinese bowl susu tepung (tanpa gula) 2 sudu makan
  49. 49. • LUNCH AND DINNER Nasi 1 chinese bowl Ikan/ayam/daging 1 hidangan Sayur 2 hidangan Buah-buahan 1 hidangan Minuman (tanpa gula)
  50. 50. • Minum Pagi/ Minum Petang / Minum Malam Crackers 3 keping Atau Popiah Basah 2 ketul Atau Kacang Kuda Rebus ½ cawan Susu Tepung 2 sudu makan
  51. 51. My Plate Method
  52. 52. REFERENCES • Malaysia Dietary Guidelines, 2010 • Institute of Medicine, Subcommirrww on Nutrition and Lactation. National Academy Press, Washington, DC, 1991 • Goldenberg, R., Tamura, T., and Neggers, Y., et al. JAMA 274:4631, 1995. • Recommended Nutrients Intake (RNI), 2005 • Judith E.Brown. Nutrtion thoughout the life cycle, second edition, 2005 • FAO/WHO (2002). Iron. In: Human vitamin and mineral requirements. Report of Joint FAO/WHO Expert Consultation. FAO, Rome; pp195 – 221. • Position of the American Dietetic Association: Nutrition and lifestyle for a healthy pregnancy outcome. J Am Diet Assoc 2002;102(10):1479-1490. • King JC. Physiology of pregnancy and nutrient metabolism. Am J Clin Nutr 2000;71:1218S-1225S • Whittaker P. Iron and zinc interactions in humans. Am J Clin Nutr 1998;68:442S-6S.

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