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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,
KARNATAKA.
A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING
PROGRAMME REGARDING IMPORTANCE OF POSTNATAL DIET AMONG
POSTNATAL MOTHERS ATTENDING THE OUT PATIENT DEPARTMENT OF VANI
VILAS HOSPITAL BANGALORE, KARNATAKA.
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION.
Md. PYARI BEGUM
BANGALORE CITY COLLEGE OF NURSING
BANGALORE-560043 (KARNATAKA).
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,
KARNATAKA.
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION.
1.
NAME OF THE CANDIDATE AND Ms. Md.PYARI BEGUM
ADDRESS
Ist year M.Sc (N)
Bangalore City College of Nursing
Bangalore – 560043
Karnataka.
2.
NAME OF THE INSTITUTION
Bangalore City College of Nursing
Bangalore.
3.
COURSE OF THE STUDY AND
SUBJECT
Ist year M.Sc (N)
Obstetrical and Gynaecological Nursing
4.
DATE OF ADMISSION
20.05.2008
5.
TITLE OF THE TOPIC
“A study to assess the effectiveness of
structured teaching programme on the
importance of Postnatal Diet among
postnatal mothers attending Vani Vilas
Hospital, Bangalore.”
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Post Natal diet is the diet which is taken after delivery. The Customary amount and kind of food and drink
taken by person from day to day, a diet planned to meet specific requirements of an individual.
According to Margaret.S.Myles,19811 The mother should be informed that during lactation she needs
approximately 550 Kcal extra in a day for the first six months and 400 Kcal for the next 6 months compared to her
pre pregnancy diet. This is not only because she needs to regain her strength, but also because during the period of
exclusive breast feeding the baby relies solely on her for his/her nutritional requirements.

Food rich in calories, proteins, iron, vitamins and other micro nutrients should be advocated.

Food taboos immediately post partum and during lactation her usually stronger and more in number than during
pregnancy these should be enquired in to and if they are harming the woman and/or her baby. She should be
advised against them.

A Breast feeding mother will gradually loose weight of 08 to 09 kgs she chooses a well balanced diet with
nutrient dense foods, even with the increase intake foods with strong flavors may alter the flavor of breast milk
for the study. It is very important to drink plenty of water and caffeine and alcohol should be avoided.
According to Agarwal .KN, 20072 the prevalence of anemia during pregnancy and lactation was
significantly lower in the National Family Health Survey 1998 – 1999.
3
Kapil .U, Bhasin .S, 1991 states that the health education campaign must address and discourage
incorrect dietary beliefs and re in force correct beliefs.
There is a study conducted regarding nutritional and medical status of lactating woman and their Infants in
the Kathmandu valley of Nepal, The study was conducted on 26 lactating woman and their 2-6 months old infants.
Analysis of 24h duplicate diet composites indicated that mothers were consuming approximately 2100 Kcal
energy/day. The diets contain approximately 62g of protein, 392g of carbohydrates and 20.9g of fat and a mean of
24g neutral detergent fibril. Although anthropometric measurements indicated that the mothers had mild protein mal
nutrition and inadequate energy reserves, their Infants exhibited low – normal weight and length for age. All the
mothers had hepatitis ‘A’ antibodies, 92% had tropical eosinophilia, indicating intestinal parasites, 16% had
cheilosis and angular stomatitis, indicating possible ‘B’ Vitamin deficiency and 8% had elevated urinary nutrite,
indicating urinary tract infections.
There were no unusual physical findings on the infants. Although the children appeared healthy, the
mother showed evidence of multiple infections and possible nutrient deficiencies.
4
As per the study conducted by Baig – Ansari .N, 2008 , a high percentage of woman at 20 – 26 weeks of
pregnancy had mild to moderate anemia pica, tea consumption and low intake of eggs and red meat were associated
with anemia. Women of child bearing age should be provided nutritional education regarding food sources of iron,
especially prior to becoming pregnant, and taught how food choices can either enhance or interfere with iron
absorption.
5
According to the study done by Pinheiro. J 2008 , the study shows that although the majority of the
alterations of food eating habits were done in a proper manner there are still many adequate or unnecessary food
habit changes done in an empirical form, are based on myths, or indicated by some health professionals.
6
A study was conducted by Herman.DR 2008 and he states that intake of fruits and vegetables protects
against several common chronic diseases, and low income is associated with lower intake. We tested the
effectiveness of a subsidy for fruits and vegetables to the special supplemental nutrition program for women, Infants
and children. The women were enrolled for post partum services at 3 weeks sight in Los Angels were assigned to an
intervention, or control condition interventions were carried out for 6 months, and participants diets were followed
for an additional 6 months. He concluded that participants valued fresh fruits and vegetables and adding them to the
wick food packages will result in increased fruit and vegetable consumption.
7
Koletzko.B 2007 had conducted study on dietary fat intakes for pregnant and lactating woman, in this
study the adopted conclusions include dietary fat intake in pregnancy and lactation should be recommended for the
general population, pregnant and lactating woman should aim to achieve an average dietary intake of at least 200mg
DHA/d woman of child bearing age should aim to consume one or two portions of sea fish per week including oily
fish dietary inadequacies should be screened for during pregnancy and individual counselling be offered if needed.
6.1 NEED FOR THE STUDY
After delivery most of the mothers may land up with anemia due to excessive loss of blood during labour
process ,if the mother will not consume proper nutritious food during lactation, so many complications may arise
,and if the mother has given birth to twins she should take extra calcium in order to give breastfeeding to both the
8
babies. Apparently incorrect dietary beliefs are still existing in India .Only 45.39% of women were aware that
vegetarian foods will provide less strength when compared to non vegetarian foods .63.82% are mistakenly
believed that almonds were having more nutritive value when compared to the groundnuts ,fruits provide many
calories and proteins and apple are more nutritious than rice .Women do not know that low intake of iron content &
consumption of food with poor availability iron contributes greatly to anemia and intake of too many calories
causes people to be over weight.
Researcher gathered data from published and unpublished intervention studies that had followed up
women’s weight after child birth. Women who did not exercise did not lose significantly more than women who
have a standard post natal life style. However, when a healthy diet and exercise were combined, women were able to
lose more weight following the birth of their babies .This weight loss did not affect their ability to breastfeed.
In my opinion this study is important it is believed that excess weight gained during pregnancy is difficult
to lose and may affect a women’s long term risk of obesity .Health professionals have traditionally avoided giving
diet and exercise to new mothers in case this affects breast feeding .The findings of Cochrane Analysis should be
reassuring to many although the researcher claims that evidence from larger trials is needed in order to refine
recommendations.
Sharma . A Sharma.K Prasad .K 2007 had done a study on prevalence of anemia in
pregnant women &lactating women in India , and he found the prevalence was significantly lower in the National
Family Health Survey 1998-1999 using the hemocue method for hemoglobin estimation compared to earlier
surveys . A total of 1,751 women ,from seven states Himachal Pradesh and Haryana in north Assam in the east
,kerala and Tamilnadu I south and Madhya Pradesh in central India were selected and the result was prevalence as
well as severity of anemia was significantly higher in the present study as compared to NFHS-2 study data .The
difference could be due to hemocue method , which gives higher heamoglobin levels.
10
A study was conducted by Agrahar –Murugkar .D 2004 on the intake of nutrients and food sources of
nutrients among the Khasi tribal women of India using questionnaire method and the result of this study is
consumption of energy in lactating women in whom energy levels were significantly lower than the recommended
daily allowances.
11
According to Udipi .S.A , Ghugre.P,Antony 2000 , nutrition in pregnancy and lactation place an
important role, because the maternal nutrition is very important for the course and outcome of pregnancy and he
states that lactation represents a stage where in health and nutrition status of the infant are dependent on mother.
12
As per the study conducted by Manocha .S , regarding the knowledge amongst
adolescent girls about nutritive value of food, diet during diseases and antenatal and post natal period was assessed
amongst 152 adolescent school girls. In that a total of 26.69% and 55.93% students are having incorrect knowledge
that pulses and Non-Vegetarian foods should be avoided during later half of the pregnancy.
Chaudhuri R.N. Ghosh.B.N. 198913 investigated and found that common food items avoided by mothers
during lactation were vegetables (93%), fruits (81%), Pulses (59%) and roots and tubers (54%).
Kuhimann.A.K., Dietz.P.M., 200814 investigated and found that, these studies indicate that interventions
can help pregnant and post partum women manage their weight, many questions remained unanswered. Several
research gaps for weight management interventions in this important population have been identified.
Piers.LS, Diggari.SN, Thangam.S, VanRaaij.JM 15 had done a study on changes in energy expendicture,
anthropometry and energy intake during the course of pregnancy and lactation in well nourished Indian women.
Results indicated that the basal metabolic rate [BMR]and thermic effect of a meal[TEM]were not associated with
any energy saving either during pregnancy or lactation .Mean weight gain from 12 weeks gestation to term was
11.4+/-3.7kg mean birth weight of the infants was 3.06+/-3.6and 2.5+/-2.9kg respectively.Energy cost of pregnancy
was estimated to be 303+/-171mj.The cumulative increase in energy intake over the last two trimesters of pregnancy
was 290+/-280mj meeting a large part of the total estimated cost of pregnancy.
16
Sakamoto .S 2007 , Hayashi .T. have investigated. Pre germinated brown rice could enhance maternal
mental health and immunity during lactation and had concluded that the rice may have beneficial effects on
psychosomatic health.
Caire.Juvera.G 200717 had conducted a study on food components and dietary patterns of two different
groups of Mexican lactating woman and he concluded that the energy and nutrient in take of woman were different
by regional hospital and not by age. Education about the importance of the maternal diet during lactation should be
directed towards increasing consumption of foods rich in micronutrients.
Somwanshi.M, Tripath .A, Singh.B, Bajaj.P 199518 had conduct a study on effect of preoperative oral
fluids on gastric volume and pH in postpartum patients. Forty consecutive postpartum patients and twenty non
pregnant patients scheduled for sterilization procedure were selected for the study. All patients were fasted
overweight. Twenty postpartum patients were randomly allocated to receive 150ml of plain water two and half hours
before surgery [group-1],while the remaining postpartum patients[group-2]and non pregnant patients [group-3]
continued their overnight fast as usual. After induction of anesthesia, gastric volume and pH was measured in all
the patients. The mean gastric was found to be 21.9+/-8.49ml in group 1,22.55+/-8.30ml in group 2 and 22.65+/8.17ml in group 3.The mean pH was found to be 2.2 1+/-1.02 in group 3.The difference in the volume and pH in all
three groups w as statistically in significant. The author concluded that ingestion of 150ml of plain water
approximately two and half hours before scheduled time of surgery in overnight fasted postpartum patients does not
increase the risk of aspiration syndrome.
6.2 REVIEW OF LITERATURE
Review of literature is an essential activity of scientific research project, helps to familiarize with
the practical issue related to the problem and enable the researcher to avoid unintentional duplication of studies. The
typical purpose for analyzing or reviewing existing literature is to generate research question to identify conceptual
or theoretical tradition with in the bodies of Literature. Hence the Investigator tends to review the literature available
on postnatal diet and its importance using both research and non-research materials.
Review of literature done for this study is arranged under the following headings :1. REVIEW OF LITERATURE RELATED TO DIET FOR POSTNATAL MOTHERS WITH COMPLICATIONS.
2. REVIEW OF LITERATURE RELATED TO DIET FOR POSTNATAL MOTHERS WITHOUT
COMPLICATIONS.
1. REVIEW OF LITERATURE RELATED TO DIET FOR POSTNATAL MOTHERS WITH
COMPLICATIONS
According to Sundara raj R.Pereira.SM197519,the diets of women, studied at regular intervals in the first
year of lactation, showed that food taboos adversely affected the daily intake of energy, protein , and some nutrients
in the first month .Despite the poor intakes, the women breastfed their babies successfully and the weight gained by
the babies in the early months was satisfactory. Breast feeding continued until the next pregnancy. Most women
believed lactation prevented conception.
Anand.S.Mittal.R, Bhargava.U, Vir.SC 198120 had conducted study on copper status of Indian pregnant
women of low socio economic group and its effect on the outcome of pregnancy, copper status of 109
women,[36non pregnant, 17 in the first trimester ,17 in the second trimester of pregnancy and 39 in the postpartum
period] and its effects on the outcome of pregnancy were evaluated by a cross-sectional study. The results
documented a low intake of copper 1.2mg-1.5mg, by a women and a statistically significant correlation[p less than
0.01] between the intake of copper and the intake of calories and proteins. Serum copper levels rose with the
progress of pregnancy and the increase was statistically significant [p less than 0.005] in the second trimester.
Thereafter, a slight decline was noted. No correlation was found between serum copper and serum total proteins,
albumins or globulins in either the pregnant or the non pregnant women. The correlation between the dietary intake
of copper and serum copper concentration was also not significant.
According to AmorimA.R. 2007 21Weight retention after pregnancy may contribute to obesity. For women
who are breast feeding, more evidences required to confirm whether diet or exercise, or both is not detrimental for
either mother or baby.
Kjos .S.L. 2007 22 from department of obstetrics and gynecology, Torrance, U.S.A. had investigated and
found that after pregnancy the mother may be complicated by diabetes, or pre gestational or gestational diabetes
allows the physician and mother to switch from intensive medical and obstetric management in to a pro-active and
preventive mode, and to jointly develop a reproductive health plan.
Oken .E 2007 23 in a obesity prevention program. U.S.A. have done prospective cohort study of 902
women post partum television viewing, walking and trans fat intake for associated with weight management.
Interventions to modify these behaviors may help reduce excess post partum weight gain and prevent obesity among
women.
Derbyshire .E 2006 24 has investigated and found that diet, physical activity and prevalence of
constipation through out and after pregnancy using a prospective 4-7 days weighed food dairy, international physical
activity, questionnaire and seven day bowel have it dairy dietary factors and bowel habit parameters were assessed
and examined concurrently at weeks 13; 25; 35 of pregnancy and 6 weeks post partum.
Ali.M.S. 200425 had done study on women’s believes and practices regarding food restrictions during
pregnancy and lactation and this was done in department of family medicine Karachi, Pakistan. A cross sectional
survey was conducted at community health centre 2000 Four Hundred adult female respondents was interviewed
after verbal consent. A self administered pre coded and pre tested questionnaire filled by the respondent. 12%
believed in restricting some food items during pregnancy and about 25% believed the same during lactation.
review of literature related to diet for postnatal mothers without complications.
Penney d.s. – 2008 26as per he studied vegetarian and vegan diets may present with unique nutrient
deficiencies that can be addressed during pre natal nutritional counseling.
Theobald H.E. 200727 says that women planning a pregnancy should follow a balanced nutrient which diet
and consumed a daily folic acid supplement up until the end of first trimester
Glenbille.M 200628 conducted a study on importance of nutritional supplements in pregnancy. And in his
study he says that emphasis must always be on eating a good diet, but given the limitations of the 24 century life
styles and the nutritional content of the food, good quality nutritional supplements should be used during pregnancy
in combination rather than isolated single nutrients.
Rush.E , Puniani .N, Snowling.N, Paterson.J 200729 conducted a study on food security ,selection and
healthy eating in a pacific community . Auckland New Zealand, questions about food security were asked of 1376
pacific island mothers approximately six weeks after the birth of their baby. Due to lack of money food sometimes
ran out in 39.8%of households and in a further 3.8% food often ran out . Variety of foods was limited by jack of
money in 39.3% food that were still bought when money was limited included bread [97%]milk[95%] meat and
chicken [91%] vegetables and fruits [83%]rice or pasta [82%],breakfast cereals [69%] , fish or shell fish[50%] and
biscuits or chips [44%]alcohol [1%] soft drinks [11%]ice creams[12%]and fruit juice [21%]were the east often
bought. The best protein value for money was from minced beef, chicken and tinned tuna and the most fibre rich
foods included baked beans and mixed vegetables .Food security is a major problem for pacific families .The
environment of food availability, choices and cost requires attention to help close the health gap.
Ayatollahi S.N. 200430 had conducted a study and women were interviewed at home in 1998 an nutrient
intake was calculated from a food frequency questionnaire and 24 hours dietary recall. Estimated average daily
energy intake was 2,250 Kcal iron and calcium intakes were significantly lower. Protein intake was insufficient
among 9% of women, calcium in 35.7%, iron in 18.8% and vitamin C in 15%.
Wohlleb.J.C. 198331 had studied on maternal supplementation and post natal physical growth. In contrast
to studies where in children were supplemented, in addition to or exclusive of mothers, the trials under review
generally failed to demonstrate any effect on physical growth.
Wilson .P.R. 200532 had conducted study on promoting nutrition in breast feeding woman and discussed to
the nutritional requirements for breast feeding woman in terms of micro nutrients, macro nutrients and minerals.
STATEMENT OF THE PROBLEM
A Study To Assess The Effectiveness Of Structured Teaching Programme Regarding Importance Of Post
Natal Diet Among Post natal Mothers Attending The O.P.D. Of Vanivilas Hospital, Bangalore, Karnataka.
6.3 OBJECTIVES OF THE STUDY
1. To assess the level of knowledge about post natal diet of mothers.
2. To evaluate the effectiveness of the structure teaching program on the postnatal mothers
3. To determine the co-relation between pre and post test knowledge on Post natal diet among post natal mothers.
4. To Associate the demographic variables with the post test knowledge of the postnatal mothers .
6.4 OPERATIONAL DEFINITIONS
1. Assessment : - It refers to the evaluation of the level of knowledge regarding postnatal mothers.
2. Effectiveness :- It refers to the outcome of structured teaching programme assessed by difference in pre and post
text scores.
3. Structured Teaching Programme :- It refers to the systematically developed information and imparting those
information regarding post natal diet and its importance to the postnatal mother.
4. Postnatal :- Occurring after birth, with reference to the new born.
5. Postnatal Diet : - Diet which should be taken by mother after her delivery. The Customary amount and kind of
food and drink taken by a person from day to day, more nervously, a diet planned to meet specific requirements of
the individual including or excluding certain foods.
6.5 ASSUMPTIONS
1. Knowledge is minimal for the mother’s attending the selected maternity O.P.D. of Vanivilas Hospital.
2. People would explore their knowledge regarding postnatal diet and its importance during postnatal period
3. Relevant health education is necessary to save the mother’s from intake of less diet during postnatal mothers.
4. Nurse has an important role in educating the mother regarding postnatal diet and its importance.
5. Group teaching will provide an opportunity for active learning among participants.
6.6 HYPOTHESIS
H1: The mean post test knowledge score of maternity O.P.D. Postnatal mothers who received Teaching Programme
will be significantly higher than the pre test knowledge score.
H2: There will be a significant association between knowledge and selected demographic variables.
6.7 VARIABLES UNDER STUDY
6.7.1 Dependent variables :- knowledge regarding postnatal diet.
6.7.2 Independent variables :- Structured Teaching Programme.
6.7.3 Attributed variables :- Age, sex, education, income, occupation, dietary, habits, religion.
7. MATERIALS AND METHODS :7.1 Sources of data : - Postnatal mothers attending the O.P.D. of Vanivilas Hospital, Bangalore.
7.2 Methods of data collection :7.2.1 Research design :- Pre experimental design (one group pre and post test design).
7.2.2 Setting :The study will be conducted in vanivilas Hospital, Bangalore district of Karnataka which is a
bedded hospital
5-7
km
7.2.3 Population :Post natal mothers
7.2.4 Sample size :50-60
7.2.5 Sample Technique:-
350
Convenient sample technique will be used to select the samples depending on the availability.
7.2.6. Sampling criteria :1. Inclusion criteria : -.
 The study will includes postnatal mother attending the O.P.D. of Vanivilas Hospital Bangalore
 The study includes postnatal mothers who know English & Kannada.
2. Exclusive Criteria: Study will not include the postnatal mother of other hospitals.
 Study will not include postnatal mothers who do not know English or kannada.
 Study will not include the patients who are not willing to participate in the study.
7.2.7 Tools of data collection :Structured Questionnaire will consists of two parts:
 Part one consists of objective questions related to demographic data.
 Part two consists of questions regarding postnatal diet and its importance.
The researcher prior to data collection will establish the validity and reliability of the tool by doing
highlights study obtaining expert’s opinion.
7.2.8 Methods of data collection :The structure questionnaire will be distributed to the subjects or interviewed by the investigator. Prior to
the study the purpose of the study will be explained and consent of the participants will be obtained to involve in the
study. Before the original study a pilot study will be conducted and then necessary modifications and further
refinement of the tools will be done. Researcher herself will collect the data.
7.2.9 Data analysis and interpretation :Descriptive and inferential statistical techniques such as frequency distribution, central measures (mean,
median and mode) standard derivation. Chi square and co relation co efficient will be used for data analysis and
presented in the form of tables, graphs and diagrams.
7.3 Does the study require any investigation or interventions to be conducted on patients / sample population/
other humans or animals?
The study will be conducted on the clients of age between 20 and 40 years attending the O.P.D. of the Vani
vilas Hospital, Bangalore. Since the study is a pre experimental study, it requires an intervention (Structured
teaching Programme).
7.4 Has ethical clearance been obtained from your institutes?
Prior permission will be obtained from the concerned authorities of vanivilas Hospital of Bangalore district
to conduct a study and also from research committee of Bangalore City College of nursing, Bangalore. The purpose
of the study will be explained to the patients attending the O.P.D. of the Govt. Hospital. Scientific objectivity of the
study will be maintained with honesty and impartiality.
8. LIST OF REFERENCES
1. Margarette S. Myles Text Book for Midwife With Modern Concepts of Obstretrics and Neonatal Care 9th Edition
1981
2.Agarwal K.N., “Prevalence of Anaemia in Pregnant & Locating Women in INDIA” Journal of INDIAN J.Med.res
(2007) Jan; 125 (1):99-101.
3.Kapil .U “Knowledge amongst Adolescent Girls about Nutritive Value of Foods and Diet during Diseases,
Pregnancy and Location, Journal of Indian Paediatrics Act 1991, 28(10) 1135-9
4.Baig Ansari .N “Anemia Prevalence and Risk Factors in Pregnant Women in the Urban Area of Pakistan; Journal
of Food Nutr. Bull – Jun 2008 ; 29 (2) : 132-9.
5.Pinheiro .J ; Seabra . D “ Changes of Food Habits During Pregnancy and Breast – Feeding, Journal of Act a
Med.port Mar-Apr 2008; 21(2) :149-60.
6.Hermann DR “ Effect of a Targeted Subsidy on Intake of Fruits and Vegetables among Low-Income Women in
the Special Supplemental Nutrition Program for Women, Infants and Children” Journal of AM. J. Public Health Jan2008; 98(1): 98-105.
7.Koletzko.B “Dietary for Mistakes for Pregnant and Lactating Women” Journal of Br. J.. Nutr. Nov-2007; 98(5):
873-7.
8. D.C. Dutta Text Book of Obstretrics Including Perinatology and Contraception, 6th Edition 2004
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Jan2007 128(1):99-101.
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Pregnancy and Lactation Journal of Indian Pediatrics – Oct 1991 :28 607:1135-9.
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Pregnancy and Lactation ,Indian Journal of Public Health -1989April-Jun;33(2)82-3
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Course of Pregnancy and Lactation in Well Nourished Indian Women .Am Journal Clinical Nutria 1995
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Women”,Journal of Am Coll Nutria.2007 Apr ;26(2):156-62
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the out come of Pregnancy”,Journal of Vitam Nutria.Res1981;51(4);410-5
21.Amorium A.R “Diet or Exercise on Both for Weight Reduction in Women after Child Birth; Journal of Cochrane
Data Base Syst. Ref. Jul-2007 18 :( 3): CD005627.
22.Kjos .S.L., “After Pregnancy Complicated by Diabetes “Journal of Obstet. Gynecol. Clin. North Am. Jun – 2007
84(2): 335-49.
23.Oken E “Television: Walking and Diet Association with Post Partum Weight Retention, Journal of Am.J. Prer.
Med April-2007 32(4): 356-7.
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Journal of Maternal Child, Nutr. Jul-2006 2(3): 127 -34.
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Based Study. Of J.Ayub. Med. College. Abborabad July – Sep – 2004 16(3):29-31.
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Mid Wifelly Women’s Health Jan-Feb-2008: 53 (1): 37-44.
27.TheobaldH.E “Eating for Pregnancy and Breastfeeding”, Journal of Fam Health Care.2007;17(2);45-9
28.Glenrille .M “ Nutritional Supplements in Pregnancy, Commercial Push or Evidence Based, Curer Opin
Obstet.Gynecol Dec.2006; 18(6);624-7.
29.Rush.E,Puniani.N, “Food Security ,Selection and Healthy Eating in a Pacific Community in Auckland
NewZealand”,Asia Pac Journal Clin.Nutri.2007;16(3);448-54
30.Ayatollahi .SM “ Nutritional Assessment of Lactating Women in Shiraz in Relation Recommended Daily
Allowances, Journal of East Mediterr. Health Nov-2004 : 10(6) ; 822 – 7.
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642-8.
32.Wilson .PR. “ Promoting Nutrition in Breast Feeding Women, Journal of Obi Stet. Gynecol. Neonatal Nurs –
Jan-Feb 2005 34(1):120 – 4.