Relationships between Dietary Patterns and Erythropoiesis-Associated Micronutrient Deficiencies (Iron, Folate, and Vitamin B12) among Pregnant Women in Taiwan

Abstract

Globally, anemia affects 56 million pregnant women, especially women with a low household income. Functional erythropoiesis requires a constant supply of micronutrients, and the demands significantly increase during fetal development. This study aims to identify dietary patterns for preventing gestational erythropoiesis-associated micronutrient deficiencies (e.g., iron, folic acid, and vitamin B12). A Nationwide Nutrition and Health Survey in Pregnant Women, Taiwan (NAHSIT-PW), was conducted between 2017 and 2019. Data on baseline information, diet, anthropometrics, and blood biochemistry were collected during a prenatal visit. Dietary patterns were identified using a reduced rank regression (RRR). Erythropoiesis-related micronutrient deficiencies were defined as single, double, and triple micronutrient deficiencies of an iron deficiency, folate depletion, and a vitamin B12 deficiency. In total, 1437 singleton pregnancies aged ≥20–48 years were included in the analysis. Prevalences of normal nutrition, and single, double, and triple erythropoiesis-related micronutrient deficiencies were 35.7%, 38.2%, 18.6%, and 7.5%, respectively. Anemic pregnant women with a low household income had the highest prevalence rates of double (32.5%) and triple (15.8%) erythropoiesis-related micronutrient deficiencies. Dietary pattern scores were positively correlated with nuts and seeds, fresh fruits, total vegetables, breakfast cereals/oats and related products, soybean products, and dairy products but negatively correlated with processed meat products and liver, organs, and blood products. After adjusting for covariates, the dietary pattern had 29% (odds ratio (OR): 0.71; 95% confidence interval (CI): 0.055–0.091, p = 0.006)) and 43% (OR: 0.57; 95% CI: 0.41–0.80, p = 0.001)) reduced odds of having double and triple erythropoiesis-related micronutrient deficiencies for those pregnant women with a low household income. For those women with anemia, dietary patterns had 54% (OR: 046, 95% CI: 0.27–0.78) and 67% (OR: 0.33; 95% CI: 0.170.64) reduced odds of double and triple erythropoiesis-related micronutrient deficiencies. In conclusion, increased consumption of breakfast cereals and oats, nuts, and seeds, fresh fruits and vegetables, soybean products, and dairy products may protect women against erythropoiesis-related micronutrient deficiencies during pregnancy.

Factors Associated with Anemia and Iron Deficiency during Pregnancy: A Prospective Observational Study in Japan

“…Healthcare professionals need to consider nutritional advice that can prevent GA by focusing on overall micronutrients and not merely energy intake. Specifically, healthcare professionals should promote the consumption of animal foods, such as red meat, which is rich in heme iron [12], and fruits and green vegetables, which are rich in vitamin C [13,42,49]. Pregnant women should also avoid coffee and tea, as caffeine inhibits iron absorption [42].…”

“…One significant risk factor for iron-deficiency anemia is a lack of iron intake from food [12]. Additionally, deficiencies in erythropoiesis-related micronutrients (folic acid and vitamin B12), inadequate nutrient intakes of protein, carbohydrates, fats, minerals, and other vitamins, and inadequate energy intake may lead to the development of GA [7,13]. GA is globally associated with poverty and often results from insufficient iron intake because of inadequate dietary intake.…”

Ideal Dietary Intakes of Vitamin B12 and Vitamin E Prevent Anemia during Pregnancy

“…A deficiency of vitamin B12 also has a role in the occurrence of Anemia; this is because vitamin B12 has a role as an enzyme and also a cofactor and mediates the formation of mitochondrial succinyl-CoA and cytosolic methionine synthesis and is very important for haemoglobin formation (Cortés-Albornoz et al, 2021). Vitamin B12 also has a role in folic acid activation and all cell's metabolic functions, especially bone marrow, digestive tract, and nervous tissue (Mayasari et al, 2023). Vitamin E is a vitamin that has some functions for maintaining the Insufficiency in the intake of vitamins also affects ferritin levels (Soppi, 2018).…”

“…Decreased ferritin levels are an early sign to predict low haemoglobin levels as a marker of Anemia in the future (Fitriani and Pamungkasari, 2020). Deficiency in vitamin B12 and E intake can contribute to morbidity and even mortality in mothers and children (Chen et al, 2018;Mayasari et al, 2023).…”

Nutritional deficiency anemia and post‐acute sequelae in patients with severe acute respiratory syndrome coronavirus 2 infection: A six‐month retrospective cohort analysis of 30 892 patients

“…[5][6][7] Therefore, the WHO has set a global nutrition target aimed at achieving a 50% reduction in anemia rates in women by 2025. 8 Among the subtypes of anemia, NDA is classified as iron deficiency anemia (IDA), folate deficiency anemia (FDA), or cobalamin deficiency anemia (CDA), 9 which can be mitigated by changes in dietary patterns or intake of supplements. [10][11][12] This distinguishes NDA from other forms of anemia as it can be managed through personalized behavioral modifications.…”