Nutrition in pregnancy: mineral and vitamin supplements

Abstract

Pregnancy is associated with physiologic changes that result in increased plasma volume and red blood cells and decreased concentrations of circulating nutrient-binding proteins and micronutrients. In many developing countries, these physiologic changes can be aggravated by undernutrition, leading to micronutrient deficiency states, such as anemia, that can have disastrous consequences for both mothers and newborn infants. Multiple micronutrients are often taken by pregnant women in developed countries, but their benefits are limited, except for prophylactic folic acid taken during the periconceptional period. Women in developing countries may benefit from multiple-micronutrient prophylaxis in pregnancy, but the underlying basis and rationale for changing from supplementation with iron and folate to supplementation with multiple micronutrients has not been debated in the context of existing program objectives. There is an urgent need for this discussion so that both program effectiveness and program efficacy can be improved. Am J Clin Nutr 2000;72(suppl):280S-90S. KEY WORDSNutrition, vitamins, trace elements, minerals, pregnancy, requirements INTRODUCTIONThe demand for both energy and nutrients is increased during pregnancy (1). For well-nourished women, only a small amount of additional energy is required because the body adapts to the increased energy requirements and becomes more energy efficient through reduced physical activity and a lowered metabolic rate. Although the average-sized, well-nourished woman requires Ϸ10 460 kJ/d (2000 kcal/d) during the last trimester of pregnancy (2), many women in developing countries restrict their food intake during pregnancy to have smaller infants, on the premise that smaller infants will carry a lower risk of delivery complications (3). Recent evidence suggests, however, that infants who are small or disproportionate at birth have increased health risks later in life (4-6). The hypothesis is that such infants have had to adapt to a limited supply of nutrients and that in so doing their physiology and metabolism are permanently changed, although the rationale for this hypothesis has been challenged (7).Requirements for many, but not all, micronutrients increase during pregnancy. Deficiencies can exist because of losses or malabsorption associated with disease or inadequate intakes, lack of knowledge about adequate prenatal nutrition, or dietary taboos associated with pregnancy (8), with potential adverse consequences for both mothers and newborn infants. Rush (9) notes that anemia in pregnancy and pregnancy-induced hypertension are common and thought to contribute significantly to maternal mortality and morbidity in developing countries. Maine (10), however, shows there is little evidence that nutrition plays a role in pregnancy-induced hypertension.This paper discusses minerals and trace elements as well as fat-and water-soluble vitamins in pregnancy-their concentrations, the requirements for them, the consequences of their deficiency, and the functional eff...

Correlations of adherence to iron supplements and prevalence of anemia in antenatal women

“…Most cases of anaemia during pregnancy are caused by iron deficiency; however, it is also associated with folate deficiency. 3 Oral iron supplement treatment resulted into a significant progressive improvement in iron level in the pregnant women. The treatment with oral iron preparations improves availability of elemental iron for that improves anemia.…”

Folate, vitamin B12 and total homocysteine levels in neonates from Brazil

“…The demand for nutrients increase during pregnancy (Ladipo, 2000) and approximately 20% of women show deficiency of vitamin B12 and/or folate (Bruinse and van den Berg, 1995;Pardo et al, 2000;Mathews et al, 2004). Several environmental risk factors such as poor nutritional status, parasitosis and lifestyle may conduct to serious health problems in pre-or pregnant women.…”

Multivitamins : Use or Misuse?

“…The use of folate supplement in preconceptional stage is important to reduce the number of births with neural tube defects and in later part of pregnancy along with iron to prevent dimorphic anemia. There is some evidence that supplementation of calcium may decrease the incidence of pregnancy associated hypertension, pre-eclampsia and depression in population with low calcium intake [21].…”