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NUTRITIONAL REQUIREMENTS DURING PREGNANCY AND LACTATION FREE

BERTHA S. BURKE, M.A.; HAROLD C. STUART, M.D.
[+] Author Affiliations

This paper, prepared at the request of the Council of Foods and Nutrition, is one of a series which will appear in THE JOURNAL. The entire series will appear later in book form as the Council's Handbook of Nutrition.


Boston

From the Department of Maternal and Child Health, School of Public Health, Harvard University. Assistant Professor of Maternal and Child Nutrition (Mrs. Burke) and Professor of Maternal and Child Health (Dr. Stuart).


JAMA. 1948;137(2):119-128. doi:10.1001/jama.1948.02890360001001
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The normal physiologic processes of the body are greatly altered during pregnancy and lactation, and additional demands are imposed on the maternal organism during each period. Digestion and absorption from the intestinal tract are frequently impaired, especially during the early months of pregnancy, and nutritional requirements are considerably elevated during the latter half of pregnancy and during lactation. It is not strange, therefore, that evidences of nutritional deficiencies are more likely to appear at these times, and it is obvious that the diets of pregnant and lactating women deserve special consideration. Since considerable evidence has accumulated in recent years which indicates that faulty nutrition during pregnancy may affect the pregnant woman or her fetus in ways not usually considered to be signs of malnutrition, someof the studies from which this evidence has come will be reviewed. They provide a background for understanding the special requirements of this period and the

REFERENCES

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Burke, B. S.:  Nutrition During Pregnancy: A Review , J. Am. Dietet. A. 20: 735-741 ( (Dec.) ) 1944;.
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Ebbs, J. H.; Tisdall, F. F., and Scott, W. A.:  The Influence of Prenatal Diet on the Mother and Child , J. Nutrition 22: 515-526 ( (Nov.) ) 1941;
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 Nutrition of Expectant and Nursing Mothers, Interim Report of the People's League of Health , Lancet 2: 10-12 ( (July 4) ) 1942;.
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Balfour, M. I.:  Supplementary Feeding in Pregnancy , Lancet 1: 208-211 ( (Feb. 12) ) 1944;.
Burke, B. S.; Beal, V. A.; Kirkwood, S. B., and Stuart, H. C.:  Nutrition Studies During Pregnancy: I. Problem, Methods of Study and Group Studied; II. Relation of Prenatal Nutrition to Condition of Infant at Birth and During First Two Weeks of Life; III. Relation of Prenatal Nutrition to Pregnancy, Labor, Delivery and the Postpartum Period , Am. J. Obst. & Gynec. 46: 38-52 ( (July) ) 1943;
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Burke, B. S.; Harding,V. V., and Stuart,. H. C.:  Nutrition Studies During Pregnancy: IV. Relation of Protein Content of Mother's Diet During Pregnancy to Birth Length, Birth Weight and Condition of Infant at Birth , J. Pediat. 23: 506-515 ( (Nov.) ) 1943;.
Cameron, C. S., and Graham, S.:  Antenatal Diet and Its Influence on Stillbirths and Prematurity , Glasgow M. J. 24: 1-7 ( (July) ) 1944;.
McCance, R. A.; Widdowson, E. M., and Verdon-Roe, C. M.,  A Study of English Diets by the Individual Method: III. Pregnant Women at Different Economic Levels , J. Hyg. 38: 596-622 ( (Sept.) ) 1938;.
Sutherland, I.:  The Stillbirth-Rate in England and Wales in Relation to Social Influences , Lancet 2: 953-956 ( (Dec. 28) ) 1946;.
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Warkany, J., and Schraffenberger, E.:  Congenital Malformations Induced in Rats by Maternal Vitamin A Deficiency: I. Defects of the Eye. Arch. Ophth. 35: 150-169 ( (Feb.) ) 1946;.
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Carpenter, T. M., and Murlin, J. R.:  The Energy Metabolism of Mother and Child Just Before and Just After Birth , Arch. Int. Med. 7: 184-222 ( (Feb.) ) 1911;.
Rowe, A. W., and Boyd, W. C.:  The Metabolism in Pregnancy: IX. The Foetal Influence on the Basal Rate , J. Nutrition 5: 551-569 ( (Nov.) ) 1932;.
Johnston, J. A.; Hunscher, H. A.; Hummel, F.; Bates, M. F.; Bonner, P., and Macy, I. G.:  The Basal Metabolism in Pregnancy . J. Nutrition 15: 513-524 ( (May) ) 1938;.
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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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Garry, R. C., and Stiven, D.:  A Review of Recent Work on Dietary Requirements in Pregnancy and Lactation, with an Attempt to Assess Human Requirements , Nutrition Abstr. & Rev. 5: 855-887 ( (April) ) 1936;.
Garry, R. C., and Wood, H. O.:  Dietary Requirements in Human Pregnancy and Lactation: A Review of Recent Work , Nutrition Abstr. & Rev. 15: 591-621 ( (April) ) 1946;.
Burke, B. S.:  Nutrition During Pregnancy: A Review , J. Am. Dietet. A. 20: 735-741 ( (Dec.) ) 1944;.
Warkany, J.:  Manifestations of Prenatal Nutritional Deficiency , in Harris, R. S., and Thimann, K. V.: Vitamins and Hormones: Advances in Research and Applications , New York, Academic Press, Inc., 1945;, vol. 3, pp. 73-103.
Ebbs, J. H.; Tisdall, F. F., and Scott, W. A.:  The Influence of Prenatal Diet on the Mother and Child , J. Nutrition 22: 515-526 ( (Nov.) ) 1941;
Milbank Mem. Fund Quart. 20: 35-46 ( (Jan.) ) 1942;.
Ebbs, J. H., and Kelly, H.:  The Relation of Maternal Diet to Breast Feeding , Arch. Dis. Childhood 17: 212-216 ( (Dec.) ) 1942;.
 Nutrition of Expectant and Nursing Mothers, Interim Report of the People's League of Health , Lancet 2: 10-12 ( (July 4) ) 1942;.
 The Nutrition of Expectant and Nursing Mothers in Relation to Maternal and Infant Mortality and Morbidity, The People's League of Health , J. Obst. & Gynaec. Brit. Emp. 53: 498-509 ( (Dec.) ) 1946;.
Balfour, M. I.:  Supplementary Feeding in Pregnancy , Lancet 1: 208-211 ( (Feb. 12) ) 1944;.
Burke, B. S.; Beal, V. A.; Kirkwood, S. B., and Stuart, H. C.:  Nutrition Studies During Pregnancy: I. Problem, Methods of Study and Group Studied; II. Relation of Prenatal Nutrition to Condition of Infant at Birth and During First Two Weeks of Life; III. Relation of Prenatal Nutrition to Pregnancy, Labor, Delivery and the Postpartum Period , Am. J. Obst. & Gynec. 46: 38-52 ( (July) ) 1943;
 The Influence of Nutrition During Pregnancy upon the Condition of the Infant at Birth , J. Nutrition 26: 569-583 ( (Dec.) ) 1943;.
Burke, B. S.; Harding,V. V., and Stuart,. H. C.:  Nutrition Studies During Pregnancy: IV. Relation of Protein Content of Mother's Diet During Pregnancy to Birth Length, Birth Weight and Condition of Infant at Birth , J. Pediat. 23: 506-515 ( (Nov.) ) 1943;.
Cameron, C. S., and Graham, S.:  Antenatal Diet and Its Influence on Stillbirths and Prematurity , Glasgow M. J. 24: 1-7 ( (July) ) 1944;.
McCance, R. A.; Widdowson, E. M., and Verdon-Roe, C. M.,  A Study of English Diets by the Individual Method: III. Pregnant Women at Different Economic Levels , J. Hyg. 38: 596-622 ( (Sept.) ) 1938;.
Sutherland, I.:  The Stillbirth-Rate in England and Wales in Relation to Social Influences , Lancet 2: 953-956 ( (Dec. 28) ) 1946;.
Baird, D.:  The Influence of Social and Economic Factors on Still births and Neonatal Deaths , J. Obst. & Gynaec. Brit. Emp. 52: 217-234, ( (June) ); 339-366 (Aug.) 1945;.
Smith, C. A.:  Effects of Maternal Undernutrition upon the Newborn Infant in Holland (1944-1945) , J. Pediat. 30: 229-243 ( (March) ) 1947;.
Antonov, A. N.:  Children Born During the Siege of Leningrad in 1942 , J. Pediat. 30: 250-259 ( (March) ) 1947;.
Toverud, K. U.: Beretning om de Første 6 ars arbeid ved Oslo kommunes helsestasjon for mor og barn pa Sagene (1939-1944) , Oslo, Fabritius and Sønner, 1945;, pp. 1-158.
Warkany, J.:  Congenital Malformations Induced by Maternal Nutritional Deficiency , J. Pediat. 25: 476-480 ( (Dec.) ) 1944;.
Warkany, J.:  Effect of Maternal Rachitogenic Diet on Skeletal Development of Young Rat . Am. J. Dis. Child. 66: 511-516 ( (Nov.) ) 1943;.
Warkany, J., and Schraffenberger, E.:  Congenital Malformations Induced in Rats by Maternal Vitamin A Deficiency: I. Defects of the Eye. Arch. Ophth. 35: 150-169 ( (Feb.) ) 1946;.
Warkany, J., and Schraffenberger, E.:  Congenital Malformations Induced in Rats by Maternal Nutritional Deficiency: VI. The Preventive Factor. J. Nutrition 27: 477-484 ( (June) ) 1944;.
Recommended Dietary Allowances, Food and Nutrition Board, National Research Council, Reprint and Circular Series no. 122, revised 1945. pp. 1-18.
Root, H. F., and Root, H. K.:  The Basal Metabolism During Pregnancy and the Puerperium , Arch. Int. Med. 32: 411-424 ( (Sept.) ) 1923;.
Carpenter, T. M., and Murlin, J. R.:  The Energy Metabolism of Mother and Child Just Before and Just After Birth , Arch. Int. Med. 7: 184-222 ( (Feb.) ) 1911;.
Rowe, A. W., and Boyd, W. C.:  The Metabolism in Pregnancy: IX. The Foetal Influence on the Basal Rate , J. Nutrition 5: 551-569 ( (Nov.) ) 1932;.
Johnston, J. A.; Hunscher, H. A.; Hummel, F.; Bates, M. F.; Bonner, P., and Macy, I. G.:  The Basal Metabolism in Pregnancy . J. Nutrition 15: 513-524 ( (May) ) 1938;.
Sontag, L. W.; Reynolds, E. L., and Torbet, V.:  The Relation of Basal Metabolic Gain During Pregnancy to Nonpregnant Basal Metabolism , Am. J. Obst. & Gynec. 48: 315-320 ( (Sept.) ) 1944;.
Kerr, A., Jr.:  Weight Gain in Pregnancy and Its Rotation to Weight of Infants and to Length of Labor , Am. J. Obst. & Gynec. 45: 950-960 ( (June) ) 1943;.
Hunscher, H. A.; Donelson, E.; Nims, B.; Kenyon, F.; and Macy, I. G.:  Metabolism of Women During the Reproductive Cycle: V. Nitrogen Utilization , J. Biol. Chem. 99: 507-520 ( (Jan.) ) 1933;.
Coons, C. M.; Schiefelbusch, A. T.; Marshall, G. B., and Coons, R. R.: Studies in Metabolism During Pregnancy , Bulletin 223, Oklahoma Agricultural and Mechanical College, Agricultural Experiment Station, (March) 1935;, pp. 1-113.
Adair, F. L.; Dieckmann, W. J.; Michel, H.; Dunkle, F.; Kramer, S., and Lorang, E.:  Calcium, Phosphorus, Iron and Nitrogen Balances in Pregnant Women , Am. J. Obst. & Gynec. 46: 116-121 ( (July) ) 1943;.
Oberst, F. W., and Plass, E. D.:  Calcium, Phosphorus and Nitrogen Metabolism in Women During the Second Half of Pregnancy and in Early Lactation , Am. J. Obst. & Gynec. 40: 399-413 ( (Sept.) ) 1940;.
Macy, I. G., and Hunscher, H. A.:  Evaluation of Maternal Nitrogen and Mineral Needs During Embryonic and Infant Development , Am. J. Obst. & Gynec. 27: 878-888 ( (June) ) 1934;.
Williams, P. F.:  Importance of Adequate Nutrition in Pregnancy , J. A. M. A. 127: 1052-1055 ( (April 21) ) 1945;.
Arnell, R. E.; Goldman, D. W., and Bertucci, F. J.:  Protein Deficiencies in Pregnancy , J. A. M. A. 127:1101-1107 ( (April 28) ) 1945;.
Williams, P. F., and Fralin, F. G.:  Nutrition Study in Pregnancy: Dietary Analyses of Seven-Day Food Intake Records of Five Hundred Fourteen Pregnant Women; Comparison of Actual Food Intakes with Variously Stated Requirements, and Relationship of Food Intake to Various Obstetric Factors . Am. J. Obst. & Gynec. 43: 1-20 ( (Jan.) ) 1942;.
Sydenham, A.:  Amenorrhoea at Stanley Camp, Hong Kong, During Internment , Brit. M. J. 2: 159 ( (Aug. 3) ) 1946;.
Holmes, O. M.:  Protein Diet in Pregnancy , West. J. Surg. 49: 56-60 ( (Jan.) ) 1941;.
Strauss, M. B.:  Observations on Etiology of Toxemias of Pregnancy: IV. Primary Role of Plasma Proteins in Conditioning Water Retention and Edema Formation in Normal and "Toxemic" Pregnancy , Am. J. M. Sc. 195: 723-728 ( (June) ) 1938;.
Dieckmann, W. J.:  Edema in Pre-Eclampsia and Eclampsia , Am. J. Obst. & Gynec. 41: 1-16 ( (Jan.) ) 1941;.
Smith, C. A.:  The Effect of Wartime Starvation in Holland upon Pregnancy and Its Product , Am. J. Obst. & Gynec. 53: 599-608 ( (April) ) 1947;.
Stuart, H. C.:  Effects of Protein Deficiency on the Pregnant Woman and Fetus and on the Infant and Child , New England J. Med. 236: 507-513 ( (April 3) ): 537-541 (April 10) 1947;.
Swanson, W. W., and Iob, L. V.:  The Growth of Fetus and Infant as Related to Mineral Intake During Pregnancy , Am. J. Obst. & Gynec. 38: 382-391 ( (Sept.) ) 1939;.
Liu, S. H.; Chu, H. I.; Hsu, H. C.; Chao, H. C., and Cheu, S. H.:  Calcium and Phosphorus Metabolism in Osteomalacia: XI. The Pathogenic Role of Pregnancy and Relative Importance of. Calcium and Vitamin D Supply , J. Clin. Investigation 20: 255-271 ( (May) ) 1941;.
McCance, R. A.; Widdowson, E. M., and Lehmann, H.:  Effect of Protein Intake on Absorption of Calcium and Magnesium , Biochem. J. 36: 686-691 ( (Sept.) ) 1942;
Maxwell, J. P.:  Further Studies in Adult Rickets (Osteomalacia) and Foetal Rickets . Proc. Rov. Soc. Med. 28: 265-300 ( (Jan.) ) 1935;.
Dunham, E. C.:  Rickets in an Infant of Thirty-Four Days , Am. J. Dis. Child. 26: 155-163 ( (Aug.) ) 1923;.
Rector, J. M.:  Prenatal Influence in Rickets. I. Fetal Rickets; II. Early Postnatal Rickets and Florid Rickets with Multiple Fractures , J. Pediat. 6: 161-177 ( (Feb.) ) 1935;.
Stuart, H. C.:  Findings on Examinations of Newborn Infants and Infants During the Neo-Natal Period Which Appear to Have a Relationship to the Diets of Their Mothers During Pregnancy , Federation Proc. 4: 271-281 ( (Sept.) ) 1945;.
Toverud, G.:  Preventive Dentistry in the Preschool Period and Particularly During Foetal Life , Dent. Mag. & Oral Topics 55: 299-310 ( (April) ) 1938;.
Mellanby, M., and Coumoulos, H.:  The Improved Dentition of Five-Year Old London School Children: A Comparison Between 1943 and 1929 , Brit. M. J. 1: 837-840 ( (June 24) ) 1944;.
Toverud, K. U., and Toverud, G.:  Studies on the Mineral Metabolism During Pregnancy and Lactation and Its Special Bearing on the Disposition to Rickets and Dental Caries , Acta Pædiat. ( (supp. 2) ) 12: 1-116, 1931;.
Burke, B. S.:  Study of the Nutrition of Groups of Children Selected on the Basis of No Defective Deciduous Teeth and High Incidence of Defective Deciduous Teeth , Child Development 11: 327-334 ( (Dec.) ) 1940;.
Berk, H.:  Some Factors Concerned with the Incidence of Dental Caries in Children: Multiple Pregnancy and Nutrition During Prenatal, Postnatal and Childhood Periods , J. Am. Dent. A. 30: 1749-1754 ( (Nov.) ) 1943;.
Massler, M.; Schour, I., and Poncher, H. G.:  Devolopmental Pattern of the Child as Reflected in the Calcification Pattern of the Teeth , Am. J. Dis. Child. 62: 33-67 ( (July) ) 1941;.
Coons, C. M.:  Iron Retention by Women During Pregnancy , J. Biol. Chem. 97:215-226 ( (July) ) 1932;.
Toverud, K. U.:  Investigation on the Ironstore of Newborn Infants , Acta Pædiat. ( (supp. 1) ) 17: 136-140, 1935;.
Napier, L. E., and Neal-Edwards, M. I.:  Anaemia in Pregnancy in Calcutta: An Analysis of Haematological and Other Data from Five Hundred and Twenty-Nine Pregnant Women , Indian M. Research Mem. , December 1941;, no. (33) , pp. 1-135.
Bethell, F. H.; Blecha, E., and Van Sant, J. G.:  Nutritional Inadequacies in Pregnancy Correlated with the Incidence of Anemia , J. Am. Dietet. A. 19: 165-172 ( (March) ) 1943;.
Spies, T. D.:  Effect of Folic Acid on Persons with Macrocytic Anemia in Relapse , J. A. M. A. 130: 474-476 ( (Feb. 23) ) 1946;.
Byrn, J. N., and Eastman, N. J.:  Vitamin A Levels in Maternal and Fetal Blood Plasma , Bull. Johns Hopkins Hosp. 73: 132-137 ( (Aug.) ) 1943;.
Bodansky, O.; Lewis, J. M., and Lillienfeld, M. C. C.:  The Concentration of Vitamin A in the Blood Plasma During Pregnancy , J. Clin. Investigation 22: 643-647 ( (Sept.) ) 1943;.
Lund, C. J., and Kimble, M. S.:  Vitamin A During Pregnancy, Labor and the Puerperium , Am. J. Obst. & Gynec. 46: 486-501 ( (Oct.) ) 1943;.
Lund. C. J., and Kimble, M. S.:  Plasma Vitamin A and Carotene of the Newborn Infant with Consideration of Fetal-Maternal Relationships , Am. J. Obst. & Gynec. 46: 207-221 ( (Aug.) ) 1943;.
Lewis, J. M.; Bodansky, O.; Lillienfeld, M. C. C., and Schneider, H.:  Supplements of Vitamin A and of Carotene During Pregnancy: Their Effect on the Levels of Vitamin A and Carotene in the Blood of Mother and of Newborn Infant , Am. J. Dis. Child. 73: 143-150 ( (Feb.) ) 1947;.
Maxwell, J. P.:  Vitamin Deficiency in the Antenatal Period: Its Effects on the Mother and Infant , J. Obst. & Gynaec. Brit. Emp. 39: 764-776, 1932;.
Lockhart, H. S.; Kirkwood, S. B., and Harris, R. S.:  The Effect of Pregnancy and Puerperium on the Thiamine Status of Women , Am. J. Obst. & Gynec. 46: 358-365 ( (Sept.) ) 1943;.
McGoogan, L. S.:  Severe Polyneuritis Due to Vitamin B Deficiency in Pregnancy , Am. J. Obst. & Gynec. 43: 752-762 ( (May) ) 1942;.
Van Gelder, D. W., and Darby, F. U.:  Congenital and Infantile Beriberi , J. Pediat. 25:226-235 ( (Sept.) ) 1944;.
Braun, K.; Bromberg, Y. M., and Brzezinski. A.:  Riboflavin Deficiency in Pregnancy , J. Obst. & Gynaec. Brit. Emp. 52: 1-12 ( (Feb.) ) 1945;.
Krehl. W. A., Sarma, P. S.; Teply, L. J., and Elvehjem, C. A.:  Factors Affecting the Dietary Niacin and Tryptophane Requirement of the Growing Rat , J. Nutrition 31: 85-106 ( (Jan.) ) 1946;.
Weinstein, B. B.; Wohl, Z.; Mitchell, G. J., and Sustendal, G. F.:  Oral Administration of Pyridoxine Hydrochloride in the Treatment of Nausea and Vomiting of Pregnancy , Am. J. Obst. & Gynec. 47: 389-394 ( (March) ) 1944;.
Hart, B. F.; McConnell, W. T., and Pickett. A. N.:  Vitamin and Endocrine Therapy in Nausea and Vomiting of Pregnancy , Am. J. Obst. & Gynec. 48: 251-253 ( (Aug.) ) 1944;.
Lund, C. J., and Kimble, M. S.:  Some Determinants of Maternal and Fetal Plasma Vitamin C Levels , Am. J. Obst. & Gynec. 46: 635-647 ( (Nov.) ) 1943;.
Teel, H. M.; Burke, B. S., and Draper, R.:  Vitamin C in Human Pregnancy and Lactation: I. Studies During Pregnancy , Am. J. Dis. Child. 56: 1004-1010 ( (Nov.) ) 1938;.
Liu, K. B.:  Case of Infantile Scurvy in the Newborn , China M. J. 45: 995-996 ( (Oct.) ) 1931;.
Shute, E.:  Vitamin E in Habitual Abortion and Habitual Miscarriage , J. Obst. & Gynaec. Brit. Emp. 49: 534-541 ( (Oct.) ) 1942;
 Vitamin E" and Premature Labor , Am. J. Obst. & Gynec. 44: 271-279 ( (Aug.) ) 1942;
Shettles, L. B.; Delfs, E., and Hellman, L. M.:  Factors Influencing Plasma Prothrombin in the Newborn Infant: II. Antepartum and Neonatal Ingestion of Vitamin K Concentrates , Bull. Johns Hopkins Hosp. 65:419-426 ( (Nov.) ) 1939;.
Bruchsaler, F. S.:  Vitamin K and the Prenatal and Postnatal Prevention of Hemorrhagic Disease in Newborn Infants . J. Pediat. 18: 317-330 ( (March) ) 1941;.
Parks, J., and Sweet, L. K.:  Does the Antenatal Use of Vitamin K Prevent Hemorrhage in the Newborn Infant? Am. J. Obst. & Gynec. 44: 432-442 ( (Sept.) ) 1942;.
Warner, E. D.:  Vitamin K and Hemorrhagic Disease of the Newborn , in Brennemann, J.: Practice of Pediatrics , Hagerstown, Md., W. F. Prior Company, Inc., 1936;, vol. 1, chap. 32 A.
Burke, B. S., and Kirkwood, S. B.: Daily Diet During Pregnancy , Department of Maternal and Child Health, Harvard School of Public Health, Boston,revised 1946;.
Garry and Stiven.1 Garry and Wood.2 Ebbs and Kelly.3
Stearns, G.:  The Mineral Metabolism of Normal Infants , Physiol. Rev. 19: 415-438 ( (July) ) 1939;.
Lesher, M.; Brody, J. K.; Williams, H. H., and Macy, I. G.:  Human Milk Studies: XXVI. Vitamin A and Carotenoid Contents of Colostrum and Mature Human Milk , Am. J. Dis. Child. 70: 182-192 ( (Sept.) ) 1945;.
Roderuck, C. E.; Williams, H. H., and Macy, I. G.:  Human Milk Studies: XXIII. Free and Total Thiamine Contents of Colostrum and Mature Human Milk . Am. T. Dis. Child. 70: 162-170 ( (Sept.) ) 1945;.
Roderuck, C. E.; Coryell, M. N.; Williams, H. H., and Macy, I. G.:  Human Milk Studies: XXIV. Free and Total Riboflavin Contents of Colostrum and Mature Human Milk , Am. J. Dis. Child. 70: 171-175 ( (Sept.) ) 1945;.
Coryell, M. N.; Harris, M. E.; Miller, S.; Williams, H. H., and Macy, I. G.:  Human Milk Studies: XXII. Nicotinic Acid, Panto henic Acid and Biotin Contents of Colostrum and Mature Human Milk , Am. J. Dis. Child. 70: 150-161 ( (Sept.) ) 1945;.
Selleg, I., and King, C. G.:  The Vitamin C Content of Human Milk and Its Variation with Diet , J. Nutrition 11: 599-606 ( (June) ) 1936;.
Ingalls, T. H.; Draper, R., and Teel, H. M.:  Vitamin C in Human Pregnancy and Lactation: II. Studies During Lactation , Am. J. Dis. Child. 56: 1011-1019 ( (Nov.) ) 1938;.
Lawrence, J. M.; Herrington, B. L., and Maynard, L. A.:  Human Milk Studies: XXVII. Comparative Values of Bovine and Human Milks in Infant Feeding , Am. J. Dis. Child. 70: 193-199 ( (Sept.) ) 1945;.
Beach, E. F.; Bernstein, S. S.; Hoffman, O. D.; Teague, D. M., and Macy, I. G.:  Distribution of Nitrogen and Protein Amino Acids in Human and in Cow's Milk , J. Biol. Chem. 139: 57-63 ( (May) ) 1941;.
Munks, B.; Robinson, A.; Williams, H. H., and Macy, I. G.:  Human Milk Studies: XXV. Ascorbic Acid and Dehydroascorbic Acid in Colostrum and Mature Human Milk , Am. J. Dis. Child. 70: 176-181 ( (Sept.) ) 1945;.
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To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
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