Title: The International Federation of Gynecology and Obstetrics (FIGO) recommendations on adolescent, preconception, and maternal nutrition: “Think Nutrition First”<sup>#</sup>
Abstract: International Journal of Gynecology & ObstetricsVolume 131, Issue S4 p. S213-S253 Open Access The International Federation of Gynecology and Obstetrics (FIGO) recommendations on adolescent, preconception, and maternal nutrition: “Think Nutrition First”# Mark A. Hanson, Mark A. Hanson Institute of Developmental Sciences, University of Southampton; and NIHR Nutrition Biomedical Research Centre, University Hospital Southampton; Southampton, UKSearch for more papers by this authorAnne Bardsley, Anne Bardsley Liggins Institute, University of Auckland, Auckland, New ZealandSearch for more papers by this authorLuz Maria De-Regil, Luz Maria De-Regil Micronutrient Initiative, Ottawa, CanadaSearch for more papers by this authorSophie E. Moore, Sophie E. Moore MRC Human Nutrition Research, Cambridge, UKSearch for more papers by this authorEmily Oken, Emily Oken Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute; and Department of Nutrition, Harvard TH Chan School of Public Health; Boston, MA, USASearch for more papers by this authorLucilla Poston, Lucilla Poston King's College London, London, UKSearch for more papers by this authorRonald C. Ma, Ronald C. Ma Department of Medicine and Therapeutics, The Chinese University of Hong Kong; and the Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, ChinaSearch for more papers by this authorFionnuala M. McAuliffe, Fionnuala M. McAuliffe UCD School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, IrelandSearch for more papers by this authorKen Maleta, Ken Maleta University of Malawi College of Medicine, Blantyre, MalawiSearch for more papers by this authorChittaranjan N. Purandare, Chittaranjan N. Purandare Grant Medical College, Mumbai, IndiaSearch for more papers by this authorChittaranjan S. Yajnik, Chittaranjan S. Yajnik Indian College of Obstetricians and Gynaecologists, Mumbai, IndiaSearch for more papers by this authorHamid Rushwan, Hamid Rushwan International Federation of Gynecology and Obstetrics, London, UKSearch for more papers by this authorJessica L. Morris, Corresponding Author Jessica L. Morris [email protected] International Federation of Gynecology and Obstetrics, London, UKCorresponding author at International Federation of Gynecology and Obstetrics, FIGO House, Suite 3, Waterloo Court, 10 Theed Street, London, SE1 8ST, UK. Tel.: +44 207 928 1166Search for more papers by this author Mark A. Hanson, Mark A. Hanson Institute of Developmental Sciences, University of Southampton; and NIHR Nutrition Biomedical Research Centre, University Hospital Southampton; Southampton, UKSearch for more papers by this authorAnne Bardsley, Anne Bardsley Liggins Institute, University of Auckland, Auckland, New ZealandSearch for more papers by this authorLuz Maria De-Regil, Luz Maria De-Regil Micronutrient Initiative, Ottawa, CanadaSearch for more papers by this authorSophie E. Moore, Sophie E. Moore MRC Human Nutrition Research, Cambridge, UKSearch for more papers by this authorEmily Oken, Emily Oken Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute; and Department of Nutrition, Harvard TH Chan School of Public Health; Boston, MA, USASearch for more papers by this authorLucilla Poston, Lucilla Poston King's College London, London, UKSearch for more papers by this authorRonald C. Ma, Ronald C. Ma Department of Medicine and Therapeutics, The Chinese University of Hong Kong; and the Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, ChinaSearch for more papers by this authorFionnuala M. McAuliffe, Fionnuala M. McAuliffe UCD School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, IrelandSearch for more papers by this authorKen Maleta, Ken Maleta University of Malawi College of Medicine, Blantyre, MalawiSearch for more papers by this authorChittaranjan N. Purandare, Chittaranjan N. Purandare Grant Medical College, Mumbai, IndiaSearch for more papers by this authorChittaranjan S. Yajnik, Chittaranjan S. Yajnik Indian College of Obstetricians and Gynaecologists, Mumbai, IndiaSearch for more papers by this authorHamid Rushwan, Hamid Rushwan International Federation of Gynecology and Obstetrics, London, UKSearch for more papers by this authorJessica L. Morris, Corresponding Author Jessica L. Morris [email protected] International Federation of Gynecology and Obstetrics, London, UKCorresponding author at International Federation of Gynecology and Obstetrics, FIGO House, Suite 3, Waterloo Court, 10 Theed Street, London, SE1 8ST, UK. Tel.: +44 207 928 1166Search for more papers by this author First published: 08 October 2015 https://doi.org/10.1016/S0020-7292(15)30034-5Citations: 188 # This document was endorsed by the FIGO Executive Board at its annual meeting held on May 30–31, 2015, in Melbourne, Australia AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References [1] World Health Organization Global status report on noncommunicable diseases 2010 2011 WHO Geneva, Switerland [2] World Health Organization Noncommunicable diseases country profiles 2014 2014 WHO Geneva, Switzerland [3] United Nations Millenium Development Goals and Beyond http://www.un.org/millenniumgoals/ 2015 [4] World Health Organization Global action plan for the prevention and control of noncommunicable diseases 2013–2020 2013 WHO Geneva, Switzerland [5]World Health Organization. Global Targets 2025. http://www.who.int/nutrition/global-target-2025/en/, . [6]Morton SB Maternal nutrition and fetal growth and development PD Gluckman MA Hanson Developmental Origins of Health and Disease 2006 Cambridge University Press Cambridge, UK 98 129 [7]Scholl TO Perinatal nutrition: Maternal nutrition and pregnancy outcome C Duggan JB Watkins WA Walker Nutrition in pediatrics basic science, clinical applications 2008 B.C. Decker Hamilton, Ontario, Canada; and Lewiston, NY, USA [8]Velazquez MA, Fleming TP Maternal diet, oocyte nutrition and metabolism and offspring health G Coticchio DF Albertini L De Santis Oogenesis 2013 Springer New York, USA [9]West-Eberhard MJ Phenotypic plasticity and the origins of diversity Annu. Rev. Ecol. Syst 20 1989 249 278 [10]Gluckman PD, Hanson MA, Low FM The role of developmental plasticity and epigenetics in human health Birth Defects Res C Embryo Today 93 (1) 2011 12 18 [11]Waterland RA, Kellermayer R, Laritsky E, Rayco-Solon P, Harris RA, Travisano M et al. Season of conception in rural gambia affects DNA methylation at putative human metastable epialleles PLoS Genet 6 (12) 2010 e1001252 [12]Dominguez-Salas P, Moore SE, Baker MS, Bergen AW, Cox SE, Dyer RA et al. Maternal nutrition at conception modulates DNA methylation of human metastable epialleles Nat Commun 5 2014 3746 [13]Drake AJ, Reynolds RM Impact of maternal obesity on offspring obesity and cardiometabolic disease risk Reproduction 140 (3) 2010 387 398 [14]Purcell SH, Moley KH The impact of obesity on egg quality J Assist Reprod Genet 28 (6) 2011 517 524 [15]Radford EJ, Ito M, Shi H, Corish JA, Yamazawa K, Isganaitis E et al. In utero effects. In utero undernourishment perturbs the adult sperm methylome and intergenerational metabolism Science 345 (6198) 2014 1255903 [16]Young SS, Eskenazi B, Marchetti FM, Block G, Wyrobek AJ The association of folate, zinc and antioxidant intake with sperm aneuploidy in healthy non-smoking men Hum Reprod 23 (5) 2008 1014 1022 [17]Colagar AH, Marzony ET, Chaichi MJ Zinc levels in seminal plasma are associated with sperm quality in fertile and infertile men Nutr Res 29 (2) 2009 82 88 [18]Hammiche F, Laven JS, Twigt JM, Boellaard WP, Steegers EA, Steegers-Theunissen RP Body mass index and central adiposity are associated with sperm quality in men of subfertile couples Hum Reprod 27 (8) 2012 2365 2372 [19] World Health Organization Health topics: Nutrition http://www.who.int/topics/nutrition/en/ [20] Food and Agriculture Organization, World Health Organization Second International Conference on Nutrition. Conference Outcome Document: Rome Declaration on Nutrition. ICN2 2014/2. October 2014 http://www.fao.org/3/a-ml542e.pdf [21]Misra A, Vikram NK Insulin resistance syndrome (metabolic syndrome) and obesity in Asian Indians: evidence and implications Nutrition 20 (5) 2004 482 491 [22]Yajnik CS, Deshmukh US Maternal nutrition, intrauterine programming and consequential risks in the offspring Rev Endocr Metab Disord 9 (3) 2008 203 211 [23]Misra A, Singhal N, Sivakumar B, Bhagat N, Jaiswal A, Khurana L Nutrition transition in India: secular trends in dietary intake and their relationship to diet-related non-communicable diseases J Diabetes 3 (4) 2011 278 292 [24]Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L et al. Maternal and child undernutrition: consequences for adult health and human capital Lancet 371 (9609) 2008 340 357 [25]Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M et al. Maternal and child undernutrition: global and regional exposures and health consequences Lancet 371 (9608) 2008 243 260 [26]Oken E, Gillman MW Fetal origins of obesity Obes Res 11 (4) 2003 496 506 [27]Gluckman PD, Seng CY, Fukuoka H, Beedle AS, Hanson MA Low birthweight and subsequent obesity in Japan Lancet 369 (9567) 2007 1081 1082 [28]Painter RC, Osmond C, Gluckman P, Hanson M, Phillips DI, Roseboom TJ Transgenerational effects of prenatal exposure to the Dutch famine on neonatal adiposity and health in later life BJOG 115 (10) 2008 1243 1249 [29]Freedman DS, Khan LK, Serdula MK, Dietz WH, Srinivasan SR, Berenson GS The relation of childhood BMI to adult adiposity: the Bogalusa Heart Study Pediatrics 115 (1) 2005 22 27 [30]Maffeis C, Tato L Long-term effects of childhood obesity on morbidity and mortality Horm Res 55 (Suppl 1) 2001 42 45 [31]Reilly JJ, Kelly J Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review Int J Obes (Lond) 35 (7) 2011 891 898 [32]Popkin BM Global nutrition dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases Am J Clin Nutr 84 (2) 2006 289 298 [33]Antony AC Vegetarianism and vitamin B-12 (cobalamin) deficiency Am J Clin Nutr 78 (1) 2003 3 6 [34]Craig WJ Nutrition concerns and health effects of vegetarian diets Nutr Clin Pract 25 (6) 2010 613 620 [35]Combs GF Jr Selenium in global food systems Br J Nutr 85 (5) 2001 517 547 [36] Food and Agriculture Organization of the United Nations, World Health Organization Human vitamin and mineral requirements. Report of a joint FAO/WHO expert consulation, Bangkok, Thailand 2001 FAO Rome, Italy [37]Pearce EN, Andersson M, Zimmermann MB Global iodine nutrition: Where do we stand in 2013? Thyroid 23 (5) 2013 523 528 [38]Andrieu E, Darmon N, Drewnowski A Low-cost diets: more energy, fewer nutrients Eur J Clin Nutr 60 (3) 2006 434 436 [39]Townsend MS, Peerson J, Love B, Achterberg C, Murphy SP Food insecurity is positively related to overweight in women J Nutr 131 (6) 2001 1738 1745 [40]Scheier LM What is the hunger-obesity paradox? J Am Diet Assoc 105 (6) 2005 883 884 886. [41]Laraia BA, Bodnar LM, Siega-Riz AM Pregravid body mass index is negatively associated with diet quality during pregnancy Public Health Nutr 10 (9) 2007 920 926 [42]Rifas-Shiman SL, Rich-Edwards JW, Kleinman KP, Oken E, Gillman MW Dietary quality during pregnancy varies by maternal characteristics in Project Viva: a US cohort J Am Diet Assoc 109 (6) 2009 1004 1011 [43]Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data Lancet Glob Health 1 (1) 2013 e16 e25 [44] World Health Organization Global prevalence of vitamin A deficiency in populations at risk 1995–2005. WHO Global Database on Vitamin A Deficiency http://www.who.int/vmnis/database/vitamina/table4/en/ [45] World Health Organization, UNICEF, ICCIDD Assessment of iodine deficiency disorders and monitoring their elimination: A guide for programme managers, 2007 (updated 1st September 2008) Third edition 2007 WHO Geneva, Switzerland [46]von Grebmer K, Saltzman A, Birol E, Wiesmann D, Prasai N, Yin S et al. Global Hunger Index: The Challenge of Hidden Hunger 2014 International Food Policy Research Institute, and Concern Worldwide Bonn, Washington, D.C., USA and Dublin [47] World Health Organization Guideline: Daily iron and folic acid supplementation in pregnant women 2012 WHO Geneva, Switzerland [48]Bhutta ZA, Haider BA Maternal micronutrient deficiencies in developing countries Lancet 371 (9608) 2008 186 187 [49] UNICEF, World Health Organization, United Nations University Composition of a multi-micronutrient supplement to be used in pilot programmes among pregnant women in developing countries: report of a United Nations Children's Fund (UNICEF), World Health Organization (WHO) and United Nations University workshop http://www.who.int/iris/handle/10665/75358-sthash.z47fFqPF.dpuf [50] World Health Organization, World Food Programme, United Nations Children's Fund Preventing and controlling micronutrient deficiencies in populations affected by an emergency: Multiple vitamin and mineral supplements for pregnant and lactating women, and for children aged 6 to 59 months 2006 WHO, WFP, UNICEF Geneva, Switzerland [51] World Health Organization United Nations Children's Fund, Reaching optimal iodine nutrition in pregnant and lactating women and young children 2007 WHO, UNICEF Geneva, Switzerland [52] Public Health Committee of the American Thyroid Association Becker DV, Braverman LE, Delange F, Dunn JT, Franklyn JA et al. Iodine supplementation for pregnancy and lactation-United States and Canada: recommendations of the American Thyroid Association Thyroid 16 (10) 2006 949 951 [53] National Health and Medical Research Council NHMRC Public Statement: Iodine Supplementation for Pregnant and Breastfeeding Women 2010 Australian Government Canberra, Australia [54] World Health Organization WHO Guideline: Intermittent iron and folic acid supplementation in menstruating women 2011 WHO Geneva, Switzerland [55] Codex Alimentarius Commission General Principles for the Addition of Essential Nutrients to Foods, CAC/GL 09-1987 (amended 1989, 1991) 1994 FAO/WHO Rome, Italy [56]Horton S, Shekar M, McDonald C, Mahal A, Krystene Brooks J et al. Scaling up nutrition: what will it cost? 2010 World Bank Washington, D.C., USA [57]Martorell R, Ascencio M, Tacsan L, Alfaro T, Young MF, Yaw Addo O et al. Effectiveness evaluation of the food fortification program of Costa Rica: impact on anemia prevalence and hemoglobin concentrations in women and children Am J Clin Nutr 101 (1) 2015 210 217 [58]Blencowe H, Cousens S, Modell B, Lawn J Folic acid to reduce neonatal mortality from neural tube disorders Int J Epidemiol 39 (Suppl 1) 2010 i110 i121 [59]Williams J, Mai CT, Mulinare J, Isenburg J, Flood TJ, Ethen M et al. Updated estimates of neural tube defects prevented by mandatory folic Acid fortification – United States, 1995–2011 MMWR Morb Mortal Wkly Rep 64 (1) 2015 1 5 [60] World Health Organization Guideline: fortification of food-grade salt with iodine for the prevention and control of iodine deficiency disorders 2014 WHO Geneva, Switzerland [61]De-Regil L, Jefferds MD, Pena-Rosas JP Point-of-use fortification of foods with micronutrient powders containing iron in children of preschool and school age (Protocol) Cochrane Database Syst Rev 2 2012 CD009666 [62]Home Fortification Technical Advisory Group http://www.hftag.org [63] MRC Vitamin Study Research Group Prevention of neural tube defects: results of the Medical Research Council Vitamin Study Lancet 338 (8760) 1991 131 137 [64]Lopez-Camelo JS, Castilla EE, Orioli IM INAGEMP (Instituto Nacional de Genética Médica Populacional), ECLAMC (Estudio Colaborativo Latino Americano de Malformaciones Congénitas), Folic acid flour fortification: impact on the frequencies of 52 congenital anomaly types in three South American countries Am J Med Genet A 152A (10) 2010 2444 2458 [65]Hertrampf E, Cortes F National food-fortification program with folic acid in Chile Food Nutr Bull 29 (2 Suppl) 2008 S231 S237 [66] World Health Organization Recommendations on Wheat and Maize Flour Fortification Meeting Report: Interim Consensus Statement 2009 WHO Geneva, Switerland [67]Fardet A, Boirie Y Associations between food and beverage groups and major diet-related chronic diseases: an exhaustive review of pooled/meta-analyses and systematic reviews Nutr Rev 72 (12) 2014 741 762 [68]Newby PK, Tucker KL Empirically derived eating patterns using factor or cluster analysis: a review Nutr Rev 62 (5) 2004 177 203 [69]Skerrett PJ, Willett WC Essentials of healthy eating: a guide J Midwifery Womens Health 55 (6) 2010 492 501 [70]Heidemann C, Schulze MB, Franco OH, van Dam RM, Mantzoros CS, Hu FB Dietary patterns and risk of mortality from cardiovascular disease, cancer, and all causes in a prospective cohort of women Circulation 118 (3) 2008 230 237 [71]McGowan CA, McAuliffe FM Maternal dietary patterns and associated nutrient intakes during each trimester of pregnancy Public Health Nutr 16 (1) 2013 97 107 [72] World Health Organization and Food and Agriculture Organization of the United Nations Diet, nutrition and the prevention of chronic diseases, in WHO Technical Report Series 2003 WHO Geneva, Switzerland [73]Monteagudo C, Mariscal-Arcas M, Palacin A, Lopez M, Lorenzo ML, Olea-Serrano F Estimation of dietary folic acid intake in three generations of females in Southern Spain Appetite 67 2013 114 118 [74]Castro-Quezada I, Roman-Vinas B, Serra-Majem L The Mediterranean diet and nutritional adequacy: a review Nutrients 6 (1) 2014 231 248 [75]Silva-del Valle MA, Sanchez-Villegas A, Serra-Majem L Association between the adherence to the Mediterranean diet and overweight and obesity in pregnant women in Gran Canaria Nutr Hosp 28 (3) 2013 654 659 [76]Knudsen VK, Orozova-Bekkevold IM, Mikkelsen TB, Wolff S, Olsen SF Major dietary patterns in pregnancy and fetal growth Eur J Clin Nutr 62 (4) 2008 463 470 [77]Timmermans S, Steegers-Theunissen RP, Vujkovic M, den Breeijen H, Russcher H, Lindemans J The Mediterranean diet and fetal size parameters: the Generation R Study Br J Nutr 108 (8) 2012 1399 1409 [78]Gesteiro E, Rodríguez Bernal B, Bastida S, Sánchez-Muniz FJ Maternal diets with low healthy eating index or Mediterranean diet adherence scores are associated with high cord-blood insulin levels and insulin resistance markers at birth Eur J Clin Nutr 66 (9) 2012 1008 1015 [79]Foote JA, Murphy SP, Wilkens LR, Basiotis PP, Carlson A Dietary variety increases the probability of nutrient adequacy among adults J Nutr 134 (7) 2004 1779 1785 [80]Arimond M, Wiesmann D, Becquey E, Carriquiry A, Daniels MC, Deitchler M et al. Simple food group diversity indicators predict micronutrient adequacy of women's diets in 5 diverse, resource-poor settings J Nutr 140 (11) 2010 2059S 2069S [81]Dodd JM Dietary and Lifestyle Advice for Pregnant Women Who Are Overweight or Obese: The LIMIT Randomized Trial Ann Nutr Metab 64 (3–4) 2014 197 202 [82]Frisch RE Body fat, menarche, fitness and fertility Hum Reprod 2 (6) 1987 521 533 [83]Jensen TK, Andersson AM, Jørgensen N, Andersen AG, Carlsen E, Petersen JH et al. Body mass index in relation to semen quality and reproductive hormones among 1,558 Danish men Fertil Steril 82 (4) 2004 863 870 [84]Sallmen M, Sandler DP, Hoppin JA, Blair A, Baird DD Reduced fertility among overweight and obese men Epidemiology 17 (5) 2006 520 523 [85]Balen AH, Anderson RA Impact of obesity on female reproductive health: British Fertility Society, Policy and Practice Guidelines Hum Fertil (Camb) 10 (4) 2007 195 206 [86]Jokela M, Elovainio M, Kivimaki M Lower fertility associated with obesity and underweight: the US National Longitudinal Survey of Youth Am J Clin Nutr 88 (4) 2008 886 893 [87]Ehrenberg HM, Dierker L, Milluzzi C, Mercer BM Low maternal weight, failure to thrive in pregnancy, and adverse pregnancy outcomes Am J Obstet Gynecol 189 (6) 2003 1726 1730 [88]Dean SV, Lassi ZS, Imam AM, Bhutta ZA Preconception care: nutritional risks and interventions Reprod Health 11 (Suppl 3) 2014 S3 [89]Ronnenberg AG, Wang X, Xing H, Chen C, Chen D, Guang W et al. Low preconception body mass index is associated with birth outcome in a prospective cohort of Chinese women J Nutr 133 (11) 2003 3449 3455 [90]Stein AD, Kahn HS, Rundle A, Zybert PA, van der Pal-de Bruin K, Lumey LH Anthropometric measures in middle age after exposure to famine during gestation: evidence from the Dutch famine Am J Clin Nutr 85 (3) 2007 869 876 [91]Hult M, Tornhammar P, Ueda P, Chima C, Bonamy AK, Ozumba B et al. Hypertension, diabetes and overweight: looming legacies of the Biafran famine PLoS One 5 (10) 2010 e13582 [92]Zheng X, Wang Y, Ren W, Luo R, Zhang S, Zhang JH et al. Risk of metabolic syndrome in adults exposed to the great Chinese famine during the fetal life and early childhood Eur J Clin Nutr 66 (2) 2012 231 236 [93]Murthy AS Obesity and contraception: emerging issues Semin Reprod Med 28 (2) 2010 156 163 [94] The American College of Obstetricians and Gynecologists, Obesity in pregnancy ACOG Committee opinion 549 2013 ACOG Washington, D.C. [95]Chu SY, Callaghan WM, Kim SY, Schmid CH, Lau J, England LJ et al. Maternal obesity and risk of gestational diabetes mellitus Diabetes Care 30 (8) 2007 2070 2076 [96]Yu CK, Teoh TG, Robinson S Obesity in pregnancy BJOG 113 (10) 2006 1117 1125 [97]Nohr EA, Vaeth M, Baker JL, Sørensen TIa, Olsen J, Rasmussen KM Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy Am J Clin Nutr 87 (6) 2008 1750 1759 [98]Meehan S, Beck CR, Mair-Jenkins J, Leonardi-Bee J, Puleston R Maternal obesity and infant mortality: a meta-analysis Pediatrics 133 (5) 2014 863 871 [99]Perng W, Gillman MW, Mantzoros CS, Oken E A prospective study of maternal prenatal weight and offspring cardiometabolic health in midchildhood Ann Epidemiol 24 (11) 2014 793 800 [100]Hill JO, Peters JC Environmental contributions to the obesity epidemic Science 280 (5368) 1998 1371 1374 [101]American Nutrition Association, USDA defines food deserts Nutrition Digest 37 (2) 2010 [102]Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Roseboom T, Tomlinson JW et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence BMJ 344 2012 e2088 [103]Nicklas JM, Zera CA, England LJ, Rosner BA, Horton E, Levkoff SE et al. A web-based lifestyle intervention for women with recent gestational diabetes mellitus: a randomized controlled trial Obstet Gynecol 124 (3) 2014 563 570 [104]Blumfield ML, Hure AJ, MacDonald-Wicks LK, Smith R, Simpson SJ, Giles WB et al. Dietary balance during pregnancy is associated with fetal adiposity and fat distribution Am J Clin Nutr 96 (5) 2012 1032 1041 [105] Institute of Medicine, Food and Nutrition Board Dietary reference intakes for energy, carboyhdrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids 2005 Institute of Medicine Washington, D.C., USA [106]Sanders TA, Roshanai F Platelet phospholipid fatty acid composition and function in vegans compared with age- and sex-matched omnivore controls Eur J Clin Nutr 46 (11) 1992 823 831 [107]Clapp JF 3rd Maternal carbohydrate intake and pregnancy outcome Proc Nutr Soc 61 (1) 2002 45 50 [108]Weickert MO, Pfeiffer AF Metabolic effects of dietary fiber consumption and prevention of diabetes J Nutr 138 (3) 2008 439 442 [109]Threapleton DE, Greenwood DC, Evans CE, Cleghorn CL, Nykjaer C, Woodhead C et al. Dietary fibre intake and risk of cardiovascular disease: systematic review and meta-analysis BMJ 347 2013 f6879 [110]Threapleton DE, Greenwood DC, Evans CE, Cleghorn CL, Nykjaer C, Woodhead C et al. Dietary fiber intake and risk of first stroke: a systematic review and meta-analysis Stroke 44 (5) 2013 1360 1368 [111]Liu L, Wang S, Liu J Fiber consumption and all-cause, cardiovascular, and cancer mortalities: A systematic review and meta-analysis of cohort studies Mol Nutr Food Res 59 (1) 2015 139 146 [112]Champ M, Hoebler C Functional food for pregnant, lactating women and in perinatal nutrition: a role for dietary fibres? Curr Opin Clin Nutr Metab Care 12 (6) 2009 565 574 [113] World Health Organization Optimal serum and red blood cell folate concentrations in women of reproductive age for prevention of neural tube defects: Guideline 2015 WHO Geneva, Switzerland [114]Blumfield ML, Hure AJ, Macdonald-Wicks L, Smith R, Collins CE A systematic review and meta-analysis of micronutrient intakes during pregnancy in developed countries Nutr Rev 71 (2) 2013 118 132 [115]Wang M, Wang ZP, Gao LJ, Gong R, Sun XH, Zhao ZT Maternal body mass index and the association between folic acid supplements and neural tube defects Acta Paediatr 102 (9) 2013 908 913 [116] National Institute for Health and Care Excellence (NICE) Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period http://www.nice.org.uk/guidance/ng3/chapter/1-recommendations February 2015. [117]Blumer I, Hadar E, Hadden DR, Jovanovič L, Mestman JH, Murad MH et al. Diabetes and pregnancy: an endocrine society clinical practice guideline J Clin Endocrinol Metab 98 (11) 2013 4227 4249 [118]Dali-Youcef N, Andres E An update on cobalamin deficiency in adults QJM 102 (1) 2009 17 28 [119] Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate, Other B Vitamins, and Choline Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline 1998 National Academies Press Washington, D.C., USA [120]Schorah CJ, Smithells RW, Scott J Vitamin B12 and anencephaly Lancet 1 (8173) 1980 880 [121]Furness D, Fenech M, Dekker G, Khong TY, Roberts C, Hague W Folate, Vitamin B12, Vitamin B6 and homocysteine: impact on pregnancy outcome Matern Child Nutr 9 (2) 2013 155 166 [122]Koebnick C, Hoffmann I, Dagnelie PC, Heins UA, Wickramasinghe SN, Ratnayaka ID et al. Long-term ovo-lacto vegetarian diet impairs vitamin B-12 status in pregnant women J Nutr 134 (12) 2004 3319 3326 [123]Elmadfa I, Singer I Vitamin B-12 and homocysteine status among vegetarians: a global perspective Am J Clin Nutr 89 (5) 2009 1693S 1698S [124]Holick MF, Chen TC Vitamin D deficiency: a worldwide problem with health consequences Am J Clin Nutr 87 (4) 2008 1080S 1086S [125]Boeke CE, Gillman MW, Hughes MD, Rifas-Shiman SL, Villamor E, Oken E Choline intake during pregnancy and child cognition at age 7 years Am J Epidemiol 177 (12) 2013 1338 1347 [126]Shaw GM, Carmichael SL, Yang W, Selvin S, Schaffer DM Periconceptional dietary intake of choline and betaine and neural tube defects in offspring Am J Epidemiol 160 (2) 2004 102 109 [127]Shaw JG, Friedman JF Iron deficiency anemia: focus on infectious diseases in lesser developed countries Anemia 2011 2011 260380 [128]Prentice AM Iron metabolism, malaria, and other infections: what is all the fuss about? J Nutr 138 (12) 2008 2537 2541 [129]Berbel P, Mestre JL, Santamaría A, Palazón I, Franco A, Graells M et al. Delayed neurobehavioral development in children born to pregnant women with mild hypothyroxinemia during the first month of gestation: the importance of early iodine supplementation Thyroid 19 (5) 2009 511 519 [130] World Health Organization Iodine deficiency in Europe: a continuing public health problem 2007 WHO and UNICEF Geneva, Switzerland [131]Torheim LE, Oshaug A, Barikmo I, Dahl L, Henjum S Environmental implication of iodine in water, milk and other foods used in Saharawi refugees camps in Tindouf, Algeria J Food Comp Anal 24 (4–5) 2011 637 641 [132] Institute of Medicine (US) Panel on Micronutrients Dietary Reference Intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc 2001 The National Academies Press Washington, D.C., USA [133]Nordin BEC Calcium in health and disease. Food, Nutrition and Agriculture http://www.fao.org/3/a-w7336t/W7336t05.pdf 1997 [134]Ho SC, Leung PC, Swaminathan R, Chan C, Chan SS, Fan YK et al. Determinants of bone mass in Chinese women aged 21–40 years. II. Pattern of dietary calcium intake and association with bone mineral density Osteoporos Int 4 (3) 1994 167 175 [135]Weaver CM, Heaney RP, Nickel KP, Packard PI Calcium bioavailability from high oxalate vegetables: Chinese vegetables, sweet potatoes and rhubarb J Food Sci 62 1997 524 525 [136] Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium Dietary Reference Intakes for Calcium and Vitamin D 2011 The National Academies Press Washington, D.C., USA [137]Mistry HD, Broughton Pipkin F, Redman CW, Poston L Selenium in reproducti