临床实践指南：加拿大女性营养共识（五）
前情提要
第四章 孕前期营养
概述
据估计，加拿大大约有一半的怀孕是计划外的，因此所有育龄妇女保持良好的营养很重要。（III）
推荐意见
遵循2015年加拿大妇产科医师学会指南，育龄妇女要补充叶酸。育龄妇女应在怀孕前至少2～3个月每天从复合维生素中摄取0.4mg叶酸。所怀后代有神经管畸形中到高风险的育龄妇女应分别补充1mg和4mg的叶酸，从怀孕前至少3个月开始直到怀孕12周。此后，每日补充应包括含0.4～1mg叶酸的复合维生素，从怀孕到产后，只要母乳喂养继续。（III-A）
提倡因体重低致排卵异常的女性增加饮食摄入，通过鼓励其增加进餐频率和摄入量，并避免禁食、不按顿吃饭、过度运动。（II-3A）
向因超重致排卵异常的女性提供体重管理策略，推荐如适当的饮食调整、增加身体活动、减少久坐行为等措施。（II-2A）
对患多囊卵巢综合征的超重女性推荐低血糖指数饮食，以改善胰岛素敏感性和生育能力。（I-A）
Chapter 4: Pre-conceptual Nutrition
Summary Statement
It is estimated that approximately one half of pregnancies in Canada are unplanned and thus it is important that all women of reproductive age maintain good nutrition. (III)
Recommendations
Follow the 2015 Society of Obstetricians and Gynaecologists of Canada guideline for the supplementary use of folic acid by women of reproductive age. Women of childbearing age should consume 0.4 mg folic acid in a daily multivitamin for at least 2 to 3 months prior to pregnancy. Women of childbearing age at moderate or high risk for bearing an offspring with a neural tube defect should consume a 1 and 4.0 mg folic acid supplement, respectively, at least 3 months prior to conceiving and until 12 weeks gestational age. Thereafter, daily supplementation should consist of a multivitamin with 0.4 to 1.0 mg folic acid throughout pregnancy and postpartum as long as breastfeeding continues.(III-A)
Promote increased dietary intake for women who are ovulating abnormally due to underweight by encouraging increased meal frequency and size, and avoidance of fasting, meal-skipping, and excessive exercise. (II-3A)
Provide a weight-management strategy for women who are ovulating abnormally due to overweight by recommending strategies such as appropriate dietary adjustments, increased physical activity, and reduced sedentary behaviour. (II-2A)
Recommend a low glycemic index diet to overweight women with polycystic ovary syndrome to improve insulin sensitivity and fertility. (I-A)
翻译：肖慧娟（天津市第三中心医院营养科）
