临床实践指南：加拿大女性营养共识（七）

前情提要

• 临床实践指南：加拿大女性营养共识（一）

• 临床实践指南：加拿大女性营养共识（二）

• 临床实践指南：加拿大女性营养共识（三）

• 临床实践指南：加拿大女性营养共识（四）

• 临床实践指南：加拿大女性营养共识（五）

• 临床实践指南：加拿大女性营养共识（六）

第六章　产后营养及哺乳

概述

1. 最佳产后营养可通过按照加拿大饮食指南摄入高质量、多样化的饮食来实现。哺乳期妇女营养需求增加，可通过在孕期每天额外摄入2～3份加拿大饮食指南里4类食物中任何食物和复合维生素补充剂来满足。这些额外的食物份提供适量增加的能量需求以支持哺乳（比孕前能量需求多350～400kcal）。（III）

2. 鼓励产后体重逐渐降低以达到孕前体重及健康体重。泌乳量或乳汁营养含量受产后体重逐渐下降和运动不良影响的证据很少。（I）

3. 母乳喂养是喂养婴儿正常且最好的方法。应鼓励前6个月纯母乳喂养，之后母乳喂养持续到2岁或更长时间，同时适当地添加辅食。（I）

推荐意见

1. 强调需要适当的营养使产后达到健康体重（A）和促进泌乳。（II-2B）

2. 探讨纯母乳喂养对改善母亲和婴儿短期和长期健康结局的好处。（II-2A）

3. 能量摄入减少500kcal/d，且每周4天进行中等程度的有氧运动可促进产后体重以每周减少0.5kg的速度逐渐下降。（I-A）

4. 建议乳母每天给婴儿提供400IU维生素D。（I-A）

5. 女性每周应至少吃150g鱼，因为脂肪多的鱼是二十二碳六烯酸（DHA）的重要来源。但乳母要限制金枪鱼、鲨鱼、剑鱼、枪鱼、罗非鱼和玉梭鱼的摄入，每月＜150g。乳母应避免罐装长鳍（白色）金枪鱼的摄入，但罐装淡金枪鱼每周摄入最多可达300g。（III-A）

6. 母亲摄入过敏和婴儿腹绞痛相关的食物（乳制品、鸡蛋、花生、木本坚果、小麦、大豆和鱼）及十字花科蔬菜、牛奶、洋葱和巧克力与纯母乳喂养的早期婴儿出现腹绞痛的症状有关，而不是过敏形成与之有关。每次清除一种食物以确定其与婴儿症状的关系。（I-B）

7. 缓泻剂（车前草或甲基纤维素）不被肠道吸收，不会对母乳喂养婴儿产生副作用。刺激性泻剂应避免使用。（III-A）

8. 建议有痔疮或会阴损伤的女性摄入高纤维饮食和足量的水（见表7）。（I-A）

Chapter 6: Postpartum Nutrition and Lactation

Summary Statements

1. Optimal postpartum nutrition can be achieved by consuming a high-quality and varied diet following Canada's Food Guide. The elevated nutritional requirements of breastfeeding women can be met by consuming 2 to 3 extra servings each day from any of the 4 groups from Canada's Food Guide and a multivitamin supplement, as during pregnancy. These extra servings will supply the modest increase in energy requirements to support lactation (～ 350 to 400 kcal over pre-pregnancy requirements). (III)

2. Gradual weight loss postpartum to achieve pre-pregnancy weight and a healthy body weight is encouraged. There is little evidence that either breastmilk volume or nutrient content is adversely affected by gradual postpartum weight loss and exercise. (I)

3. Breastfeeding is the normal and unequalled method of feeding infants. Exclusive breastfeeding should be encouraged for the first 6 months, and sustained for up to 2 years or longer, with appropriate complementary feeding of infants. (I)

Recommendations

1. Emphasize the need for appropriate nutrition to achieve a healthy body weight postpartum (I-A) and promote lactation. (II-2B)

2. Discuss the benefits of exclusive breastfeeding for improving short- and long-term health outcomes for the mother and infant. (II-2A)

3. A reduction in caloric intake of 500 kcal/day and participation in moderate aerobic exercise (walking, jogging, dancing; 65% to 80% maximum heart rate) 4 days per week should promote a gradual measured weight loss of 0.5 kg/week postpartum. (I-A)

4. Advise lactating mothers to provide their infants with 400 IU of vitamin D per day. (I-A)

5. Women should consume at least 150 g of fish each week, as fatty fish are an important source of docosahexaenoic acid. However, lactating women need to limit consumption of tuna, shark, swordfish, marlin, orange roughy, and escolar to < 150 g per month. Lactating women should avoid canned albacore (white) tuna, but may consume up to 300 g/week of light canned tuna. (III-A)

6. Maternal intake of allergy and infant colic-associated foods (dairy, eggs, peanuts, tree nuts, wheat, soy, and fish) and cruciferous vegetables, cow's milk, onion, and chocolate have been associated with colic symptoms in exclusively breastfed young infants, but not allergy formation in the child. Eliminate foods one at a time to determine association with infant symptoms. (I-B)

7. Bulk-forming laxatives (psyllium or methylcellulose) are not absorbed by the gut and should not have negative consequences for the breastfed infant. Stimulant laxatives should be avoided. (III-A)

8. Women with hemorrhoids or perineal injury are advised to eat a high-fibre diet along with adequate water intake (Table 7). (I-A)

翻译：肖慧娟（天津市第三中心医院营养科）