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Nutrition in pregnancy
Abstract
The pivotal role of nutrition in pregnancy is well established and has important implications on subsequent maternal and offspring health, including outcomes in later adult life. Optimal nutrition periconception, if maintained throughout pregnancy, promotes optimal foetal growth and development. Growth trajectories in utero and size at birth are related to the offspring's risk of developing disease in later life, especially chronic non-communicable diseases such as hypertension, diabetes and coronary heart disease (the Barker hypothesis). This article aims to review nutritional requirements in pregnancy, describe their transport mechanisms and highlight the implications of inadequate or inappropriate intake. Nutritional requirements are broadly divided into issues surrounding quality (macronutrients and micronutrients) and quantity of intake with a final summary of current International Federation of Gynaecology and Obstetrics (FIGO) and Royal College of Obstetricians and Gynaecologists (RCOG) recommendations.
... Dietary diversity is recognized as a measure of diet quality (consumed variety of food from different food groups per day or week), nutrient adequacy, and Micro-Nutrient (MN) utilization with a prominent effect on adverse birth outcomes like LBW, Small for Gestational Age (SGA) and Pre Term Delivery (PTD) [11][12][13]. Though it is important to evaluate individual MN, it is challenging due to the complex behavior of food consumption and nutrient interactions as micronutrients are consumed naturally as a combination of nutrients and fibers [14]. ...
... The sample was collected based on the proportion of pregnant women in the randomly selected Woredas and continued follow-up until birth. The data were collected using a structured questionnaire about participants' socio-economic-demographic factors, a daily and weekly dietary intake questionnaire [2,13,14], and translated into the Amharic language. The tool for collecting data was pretested with 5% of the respondents that were not included in the study and trained midwives working in the antenatal clinic of the corresponding health institutions have collected the data. ...
... Population groups that are most affected by MN deficiencies are those that subsist on refined cereal grain or tuber-based diets. Such diets provide energy and protein but often lack some critical MN, and essential amino acids [13,21]. Low DDSg indicated a proportional deficiency of MMN ranging from five to eleven including riboflavin, niacin, folate, vitamin B 12 , calcium, and iron as indicated in previous studies [18,23] which could explain the LBW associated with this low DDS and FCS. ...
Introduction
Low birth weight is a global public health problem, with 15–20% of all births globally, described by weight at birth of less than 2500 g ensuing fetal and neonatal mortality and morbidity, poor cognitive growth, and an increased risk of chronic diseases later in life. The prevalence is critical in East Africa where about 11% have low birth weight out of 54% of neonates whose weight was measured at birth. There are many causes of low birth weight, including early induction of labor or cesarean birth, multiple pregnancies, infections, diabetes, and high blood pressure. Moreover, socioeconomic factors and unhealthy dietary habits could contribute to low birth weight in areas with poor intake of a diversified diet. This study has indicated the association between poor dietary diversity and low birth weight in the study area for the first time.
Methods
An institutional-based cross-sectional study was conducted on eligible 423 pregnant women recruited from Gestational Age of less than 17 weeks until delivery where the birth outcomes were recorded in health institutions in randomly selected five Woredas in East Gojjam Zone, Amhara, Ethiopia from June 2019 to December 2020. Questionnaires were used to collect data on socio-economic-demographic, dietary diversity scores, and food consumption scores.
Results
The study found a prevalence of low birth weight of 9.6%, low dietary diversity score of 53.2%, low food consumption score of 19.7%, and preterm delivery of 9.1%. Ever attended school and a higher level of education (diploma and above) decreased the risk of low birth weight with an Adjusted Odds Ratio (AOR) of 0.149 (0.024, 0.973) P ≤ 0.042; 0.059 (0.007, 0.513) P ≤ 0.007; whereas low dietary diversity score group and low food consumption group increased the risk of low birth weight with AOR 2.425 (1.342, 6.192) P ≤ 0.011and 2.983 (1.956, 9.084) P ≤ 0.044 respectively.
Conclusion and recommendation
Participants with no formal education, no diploma, and above (no college or university training/degree), low diversity score group, and low food consumption group had an increased risk of low birth weight. Therefore the use of a diversified diet, educating women to a higher educational level, and health education on the intake of a diversified food rich in multiple micronutrients are recommended as strategies that will ameliorate the occurrence of low birth weight.
... High fat diet [26][27][28][29][30][31][32][33][34][35][36][37][38] Obesity [12][13][14]29,30,[39][40][41][42][43][44][45] Ketogenic diet [15] Undernutrition Maternal malnutrition/famine [10,11,25,26,[46][47][48][49][50][51][52][53][54][55][56][57] Vitamins Folate [5,[58][59][60][61][62] B12 [9,11,58,63] Vitamin D [46,62,[64][65][66] Vitamin A [10,44,67] Vitamin E Vitamin K ...
... High fat diet [26][27][28][29][30][31][32][33][34][35][36][37][38] Obesity [12][13][14]29,30,[39][40][41][42][43][44][45] Ketogenic diet [15] Undernutrition Maternal malnutrition/famine [10,11,25,26,[46][47][48][49][50][51][52][53][54][55][56][57] Vitamins Folate [5,[58][59][60][61][62] B12 [9,11,58,63] Vitamin D [46,62,[64][65][66] Vitamin A [10,44,67] Vitamin E Vitamin K ...
... Iron [5,26,58,[68][69][70] Iodine [9,10,[71][72][73][74] Choline [25,46,[75][76][77][78] Zinc [11,79] Copper [71,[80][81][82] Creatine [76,83] Other Caffeine [5,[84][85][86][87] Gangliosides [88][89][90][91][92][93] ...
In this scoping review, we examined the association between maternal nutrition during pregnancy and neurodevelopment in offspring. We searched the Pubmed and ScienceDirect databases for articles published from 2000 to 2020 on inadequate intake of vitamins (B12, folate, vitamin D, vitamin A, vitamin E, vitamin K), micronutrients (cooper, iron, creatine, choline, zinc, iodine), macronutrients (fatty acids, proteins), high fat diets, ketogenic diets, hypercaloric diets, and maternal undernutrition. Some older relevant articles were included. The search produced a total of 3590 articles, and 84 studies were included in the qualitative synthesis. Data were extracted and analyzed using charts and the frequency of terms used. We concluded that inadequate nutrient intake during pregnancy was associated with brain defects (diminished cerebral volume, spina bifida, alteration of hypothalamic and hippocampal pathways), an increased risk of abnormal behavior, neuropsychiatric disorders (ASD, ADHD, schizophrenia, anxiety, depression), altered cognition, visual impairment, and motor deficits. Future studies should establish and quantify the benefits of maternal nutrition during pregnancy on neurodevelopment and recommend adequate supplementation.
... A healthy lifestyle, including a healthy diet, is one of the important factors responsible for the correct course of pregnancy and childbirth. It also has a beneficial effect on the health of the mother and child both during childhood and in adulthood (Fowella, 2004;Ho et al., 2016;Ghahremani et al., 2017). Antenatal classes effectively promote more favorable health-related behaviors in preparation for childbirth and parenthood (Ferguson et al., 2013;O'Sullivan et al., 2014;Krysa et al., 2016;Suto et al., 2017). ...
... To cover high demand, a pregnant woman should drink 3-4 glasses of milk or fermented milk drinks during the day. More than half of a pregnant woman's protein requirement should be obtained from protein of animal origin from milk and its products as well as meat, poultry and fish which have adequate proportions of amino acids to human requirements (Ho et al., 2016). In this research, 60 percent of the women from the attendee group and only 28 percent of the non-attendees declared drinking milk and yoghurt type milk drinks every day. ...
... Fruit and vegetables and their products are important foods and at the same time are important contributors of vitamins (C, folate), minerals (potassium, magnesium) and dietary fiber to the overall diet (EFSA, 2008;Ho et al., 2016). According to Polish recommendations, in the first trimester pregnant women should include vegetables and fruit in the amount of 400 g and 300 g per day and in the second and third trimester -500 g and 400 per day, respectively. ...
Purpose
The purpose of this study was to assess the nutritional behavior regarding the frequency of consumption of the main types of food by pregnant women attending antenatal classes in comparison to non-attendees.
Design/methodology/approach
A questionnaire survey was conducted in Poland among 200 women in the first pregnancy, 100 of whom were attending antenatal classes and 100 were non-attendees.
Findings
Women attending antenatal classes exhibited more favorable health-related nutritional behaviors in comparison with those not attending. Attendees eat more vegetables and milk products whereas non-attendees declared more processed meat and sweets consumption. Three-fourth of non-attendees and two-fourth of attendees considered their diet as good. It was also found that the level of physical activity of pregnant women attending antenatal classes was significantly higher than among those who did not attend such classes.
Research limitations/implications
A limitation of the study was that it took place in Poland and voices from women of other European countries as well as diverse ethnicities were not represented. In addition, women were interviewed only during their pregnancy, and therefore it was not possible to investigate women's nutritional behaviors after delivery.
Practical implications
This research shows clearly that attending antenatal classes may involve with a beneficial effect on the nutritional behavior of pregnant women. It is expected that once established healthy nutritional habits should be practiced further.
Originality/value
This research is the indication of the important role of antenatal classes in developing more favorable health-related dietary behavior expressed by the participants. To our knowledge in Poland, it is the first time that the nutritional behavior of pregnant women attending and not attending antenatal classes were examined and compared. So far in Poland, the extent and type of nutritional education received by pregnant women across antenatal care has not been examined. This research can contribute to a broader recognition of nutritional knowledge and practice of pregnant women important for the health of mother and her baby.
... In addition, the recommended diet for pregnant women is to eat nutritious food by regulating the food intake to small but frequent (5-6 times a day) portions to prevent indigestion. Impaired nutritional status of pregnant women has a direct effect on the fetus, such as on infant birth weight [7][8][9][10]. ...
... Infant birth weight is one predictor of infant growth and survival [8,10]. In addition, to maternal nutrition, several factors affect the infant birth weight: sex, genetics, race, placental state, maternal age, parity, height, weight before pregnancy and weight gain, socioeconomic status, infection, physical, health services, maternal nutrition, and smoking or alcohol consumption [8][9][10][11][12][13][14][15][16][17][18]. ...
... Infant birth weight is one predictor of infant growth and survival [8,10]. In addition, to maternal nutrition, several factors affect the infant birth weight: sex, genetics, race, placental state, maternal age, parity, height, weight before pregnancy and weight gain, socioeconomic status, infection, physical, health services, maternal nutrition, and smoking or alcohol consumption [8][9][10][11][12][13][14][15][16][17][18]. ...
Objective:
To analyze the relationships between infant birth weight and maternal mastication ability, caloric intake, and body mass index (BMI) of women with posterior tooth loss.
Material and Methods:
A cross-sectional study was conducted in 52 females aged 20–35 years who gave birth recently and had one or more unreplaced missing posterior teeth. The number and locations of the missing teeth were grouped on the basis of the Eichner Index. Prepregnancy BMI, caloric intake, and subjective mastication ability were recorded
Results:
A significant difference was observed in the mean infant birth weights between the subjects with good and poor mastication in Eichner A2 (p<0.001), B1 (p=0.039), and B2 groups (p=0.039), that mean infant birth weight was lower in the group of women with poor mastication. The Pearson correlation test revealed a significant relationship between maternal caloric intake and infant birth weight (p<0.001). Mean infant birth weights differed between BMI categories, i.e., underweight, normal and overweight women subjects (2.59 ± 0.18 Kg, 2.99 ± 0.15 Kg, 3.58 ± 0.30 Kg) (p<0.001). The Kruskal-Wallis test revealed significant differences between the prepregnancy BMIs of pregnant women with posterior tooth loss and infant birth weights (p<0.001)
Conclusion:
We found that decreased subjective mastication ability in pregnant women who lost posterior teeth was associated with decreased infant birth weight, whereas higher mean caloric intake and higher prepregnancy BMI in pregnant mothers who lost posterior teeth were associated with increased infant birth weight.
... The mother's contribution is also crucial in enhancing nutrition during the early stages of a child's life (Heckert et al., 2019). Consequently, the mother's role in preventing stunting should encompass reproductive, productive, and social domains (Saputri et al., 2020) In the early stages of pregnancy, it is essential for mothers to consume healthy and balanced foods to get adequate nutrition to optimize fetal growth and development (Ho et al., 2016). Existing intake must be able to meet the essential nutritional requirements, such as protein, iron, calcium, vitamin B12, vitamin A, vitamin D, minerals, and folic acid (Cruz-Rodr� ıguez et al., 2023;Ho et al., 2016;Tsakiridis et al., 2020). ...
... Consequently, the mother's role in preventing stunting should encompass reproductive, productive, and social domains (Saputri et al., 2020) In the early stages of pregnancy, it is essential for mothers to consume healthy and balanced foods to get adequate nutrition to optimize fetal growth and development (Ho et al., 2016). Existing intake must be able to meet the essential nutritional requirements, such as protein, iron, calcium, vitamin B12, vitamin A, vitamin D, minerals, and folic acid (Cruz-Rodr� ıguez et al., 2023;Ho et al., 2016;Tsakiridis et al., 2020). The needs of maternal nutritional continue to increase as gestational age increases. ...
... Women of reproductive age are at greater risk of under nutrition (protein-energy malnutrition and micronutrient deficiencies) than other adults because they are saddled with responsibilities such as child bearing and care, home keeping as well as income generation. Recurrent pregnancies, blood loss during menstruation also increase their nutritional and energy needs [1,2]. Other causes of maternal under nutrition can be attributed to poverty levels, limited diversity in diets, longer methods of food preparation and lack of fuel for adequate food preparation [3]. ...
... Aroma Texture Consistency Taste After taste Overall appearance Overall acceptability 1 6.1 ± 1.54b 6.8 ± 1.1abc 6.9 ± 1.1ab 7.0 ± 1.0a 7.2 ± 1.1ab 7.0 ± 1.4ab 6.8 ± 0.8abc 6.8 ± 0.9bc 2 6.6 ± 1.9ab 6.2 ± 1.9bc 6.5 ± 1.5b 6.5 ± 1.7a 6.2 ± 2.0c 6.2 ± 1.9b 6.4 ± 1.8c 6.6 ± 1.7c 3 ...
Aim: This study was aimed to develop nutrient dense instant grain amaranth-based soup with high protein, vitamin A, iron, zinc and dietary fibre contents for women of child bearing age using locally available crops in Uganda. Study Design: Six soups were produced from blends of extruded grain amaranth, groundnut, ROBA beans, pumpkin, orange fleshed sweet potato, carrot and maize flours in different proportions. The six formulations (soups) were tested for acceptability by panelists (n = 30) using the Original Research Article 796 9-point hedonic scale to obtain the most acceptable formulation. The most acceptable formulation was developed into an instant soup using extrusion cooking at barrel temperature of 169 •C and feed moisture of 14% to obtain an instant flour. Place and Duration of Study: Methodology: Sautéed and oven dried tomatoes, green pepper, ginger, garlic and other seasonings were milled coarsely and then incorporated into the instant powder to obtain the instant soup. The nutritional, physicochemical properties and consumers' acceptability of the instant soup were evaluated and compared with commonly used commercial soup. Results: The formulated soup had a significantly higher nutrient density than the commercial soup. The instant soup had 11.83% protein, 4.9 mg/100g iron, 5.61 mg/100g zinc and 621.29 µgRAE/100g vitamin A. The sensory properties of the amaranth based instant soup revealed the soup was more liked over the commercial soup. Pasting properties showed that the amaranth based soup has better stability against retrogradation than the commercial soup. Conclusion: Nutritious instant soup can be developed from amaranth-based flours.
... In addition, an unbalanced diet during pregnancy has been associated with serious pregnancy complications [14]. Although the role of nutrition in pregnancy has been investigated in several studies, the results have been inconclusive [15]. A healthy and varied diet during pregnancy can provide adequate energy and nutrients for both the mother and the growing fetus [5]. ...
... In addition, diet can influence embryonic development through biochemical signals in the environment of uterus. It has been shown that optimal nutrition during periconception promotes fetal growth and development [15]. Studies in animals and humans have shown that epigenetic events expressed later in adulthood are related to early embryonic stages and the quality of maternal periconceptional nutrition [7]. ...
During pregnancy, rapid and subtle physiological changes are observed from conception to birth. Nutrition and other lifestyle factors before and during pregnancy have been shown in the literature to influence the health of both mother and child. A healthy and varied diet during pregnancy can provide adequate energy and nutrients for both the mother and the growing fetus. Current research focuses on the periconceptional phase, which includes the early processes of gametogenesis, embryogenesis and placentation. A variety of abnormalities and pregnancy-related problems occur during this period, including congenital defects, fetal loss, miscarriage and preterm birth. A varied and balanced diet during periconception is important to maintain fetal development and growth. To date, numerous studies have been conducted to investigate the effects of consuming different nutrients, foods or food groups during pregnancy on the health of mother and child. For example, the Mediterranean diet is considered as a balanced, nutrient-rich diet due to the low consumption of meat products and fatty foods and the high consumption of vegetables, cheese, olive oil, fish, shellfish and little meat. While many studies have been conducted in the literature to investigate the effects of a Mediterranean diet during pregnancy on fetal health, the results have been inconclusive. The aim of this article is to review the current literature on the Mediterranean diet during pregnancy.
... with key dietary sources including eggs, oily fish, fortified spreads, milk, and yogurt. Due to the teratogenic effects of vitamin A, high dosage should be avoided (54). In vitamin A-deficient rats, studies have highlighted the variability in both the intensity and distribution of nervous system lesions (55). ...
Maternal nutrition reflects the health and well-being of the fetus, making it one of the most critical and controllable factors in ensuring healthy growth and development throughout pregnancy. Therefore, deficiencies in certain nutrients during gestation could result in neurodevelopmental disorders like hydrocephalus. Hydrocephalus (HC) is a diverse condition marked by the accumulation of abnormal volumes of CSF within the brain's ventricles and subarachnoid space, contributing to approximately 276,000 neonatal deaths annually worldwide. Therefore, this review aims to analyze the role of maternal nutrition in the development and potential management of hydrocephalus during pregnancy. The search protocol involves searching these primary databases: PubMed, Cochrane Library, Google Scholar, and Research Rabbit supplemented by a manual search of references from selected relevant articles. Relevant articles that studied the relationship between maternal nutrition and congenital anomalies, multivitamin supplementation in pregnancy, the use of animal models to detect the development of hydrocephalus, and so on were reviewed. Relevant older articles were also included. It is concluded that maternal folic acid-fortified multivitamin supplementation during the periconceptional period is effective against the development of hydrocephalus. Multivitamin folic acid supplementation is recommended for women of childbearing age, whether or not, they are planning to get pregnant. Further research on the mechanism of how folic acid prevents congenital hydrocephalus should be explored.
... Macrosomia and its adverse perinatal outcomes are associated with excessive weight gain during pregnancy by the mother [6,7]. During pregnancy, the need for macronutrients, calories, and supplementation of minerals and vitamins, namely vitamin D, increases, providing optimal quality and quantity of the diet for the mother and fetus [8]. ...
Background: The aim is to assess the association between the level of vitamin D, maternal diseases, and macrosomia in newborns. Methods: This study included 258 full-term newborns (86 newborns with macrosomia; and 172 newborns with normal weight). Enzyme immunoassays for the determination of vitamin D were performed. Results: Newborns with macrosomia were statistically significantly more likely to have severe vitamin D deficiency compared with control (13.5 ± 6.7 ng/mL vs. 21.3 ± 12.1 ng/mL; p < 0.05). In the main group, severe deficiency was found in 40.7% of newborns, in the control group this rate was 5.8% (χ2 = 71,788, df = 3, p < 0.001). Multiple regression analysis shows that statistically significant risk factors for the development of macrosomia were vitamin D deficiency in the cord blood (OR = 2.29), maternal age over 36 years old (OR = 19.54), and hypothyroidism (OR = 9.35). Conclusion: the results of our study demonstrate relationship between macrosomia in newborns and vitamin D deficiency in the cord blood, maternal overweight and obesity, maternal age and thyroid disease.
... It is estimated that over half of the maternal energy Frontiers in Nutrition 05 frontiersin.org available to the growing fetus during pregnancy is allocated to brain development (71). The brain health, quality of life, and overall wellbeing of offspring are critically dependent on the trajectory of their neurodevelopment, which begins prenatally (72,73). ...
The human brain remains one of the greatest challenges for modern medicine, yet it is one of the most integral and sometimes overlooked aspects of medicine. The human brain consists of roughly 100 billion neurons, 100 trillion neuronal connections and consumes about 20–25% of the body’s energy. Emerging evidence highlights that insufficient or inadequate nutrition is linked to an increased risk of brain health, mental health, and psychological functioning compromise. A core component of this relationship includes the intricate dynamics of the brain-gut-microbiota (BGM) system, which is a progressively recognized factor in the sphere of mental/brain health. The bidirectional relationship between the brain, gut, and gut microbiota along the BGM system not only affects nutrient absorption and utilization, but also it exerts substantial influence on cognitive processes, mood regulation, neuroplasticity, and other indices of mental/brain health. Neuroplasticity is the brain’s capacity for adaptation and neural regeneration in response to stimuli. Understanding neuroplasticity and considering interventions that enhance the remarkable ability of the brain to change through experience constitutes a burgeoning area of research that has substantial potential for improving well-being, resilience, and overall brain health through optimal nutrition and lifestyle interventions. The nexus of lifestyle interventions and both academic and clinical perspectives of nutritional neuroscience emerges as a potent tool to enhance patient outcomes, proactively mitigate mental/brain health challenges, and improve the management and treatment of existing mental/brain health conditions by championing health-promoting dietary patterns, rectifying nutritional deficiencies, and seamlessly integrating nutrition-centered strategies into clinical care.
... Therefore, it is recommended that pregnant women consume 400 mcg/day of folic acid from preconception until 13 weeks of gestation. (Ho et al., 2016) In Table 4, information on sun exposure is also provided. Of all the pregnant women, 58 (89.2%) received sun exposure. ...
Latar Belakang: Gizi dalam kehamilan mempunyai implikasi penting terhadap kesehatan ibu dan anak. Gizi selama kehamilan yang optimal, akan mendorong pertumbuhan dan perkembangan janin yang optimal.Tujuan: Mengidentifikasi kecukupan zat gizi pada ibu hamil di Puskemas Kota Sukabumi dan mengidentifikasi kelompok ibu hamil yang beresiko mengalami masalah giziMetode : Desain penelitian analitik observasional dengan pendekatan cross sectional menggunakan data primer dengan mengukur kecukupan gizi ibu hamil dengan instrumen FIGO Nutrition Checklist. Sampel dalam penelitian ini sebanyak 65 orang dengan teknik pengambilan sampel menggunakan consecutive sampling. Penelitian dilaksanakan di Puskesmas PONED Sukabumi pada bulan Juli – September 2022. Analisis data menggunakan Chi Square.Hasil: Masih terdapat ibu hamil dengan status gizi kurang (7,7%) dan status gizi lebih (30,8%). Hanya 20% ibu hamil dengan kualitas diet memenuhi indikator instrumen FIGO Nutrition Checklist. Variasi jenis makanan yang dikonsumsi ibu hamil belum memenuhi kebutuhan diet yang disarankan. Faktor demografi yang berhubungan dengan kualitas diet adalah pendidikan ibu (p<0,05). Kesimpulan: Kebutuhan gizi selama kehamilan belum memenuhi indikator FIGO Nutrition Checklist, terdapat ibu hamil dengan gangguan nutrisi.Saran: Perlu dilakukan edukasi gizi terhadap ibu hamil melalui pelayanan antenatal. Kata Kunci: FIGO,Nutrition, Checklist ABSTRACT Background: A balanced diet during pregnancy is crucial for optimal fetal growth and development.Objective: This study aims to assess the nutritional adequacy of pregnant women attending the Sukabumi Public Health Center and identify groups of pregnant women at risk of nutritional problems.Methods: This observational study used the FIGO Nutrition Checklist to measure the nutritional adequacy of 65 pregnant women at the Sukabumi Public Health Center from July to September 2022, using chi-square for data analysis.Results: The study found that some pregnant women suffered from undernutrition (7.7%) and overnutrition (30.8%). Only 20% of pregnant women met the indicators of the FIGO Nutrition Checklist instrument, indicating that their diet quality was appropriate. The study also revealed that the variety of foods consumed by pregnant women did not meet the recommended dietary needs. Maternal education was found to be associated with diet quality (p<0.05).Conclusion: The results suggest that pregnant women's nutritional needs are not being met according to the FIGO Nutrition Checklist indicators, and some women are experiencing nutritional disorders.Suggestion: It is recommended that antenatal care should include nutrition education for pregnant women to ensure that they receive adequate nutrition during pregnancy. Keywords: FIGO, Nutrition,Checklist
... A potential advantage of the broad-spectrum micronutrient approach was that all essential vitamins and minerals required for optimal brain health were provided [26]. Good nutrition is becoming more widely recognised as important for maternal mental health, and adequate nutrition during pregnancy lays the foundation for development of cognitive, motor and socio-emotional skills for the infant [48,49]. Improving the nutritional environment through micronutrient supplementation during critical periods of fetal development could provide more optimal conditions for brain development, thus impacting the cognitive and behavioral functioning of the infants. ...
... Yiyecekler ağır metal (civa, kurşun) ve patojen (listeriosis, salmonella, toksoplazmoz) taşıyabilir, bu riske dikkat edilmelidir. Sigara, alkol ve uyuşturucu kullanımından kaçınılmalıdır(37).Gebelikte egzersiz konusunda, özel durumlarda egzersiz için bir otorite ve rehber olan Amerikan Spor Hekimliği Koleji (ACSM)'nin önerileri şu şekildedir: Haftanın çoğu, tercihen tüm günlerinde 30 dakikalık orta yoğunlukta fiziksel aktivite, komplike olmayan gebelikler sırasında çoğu kadın için uygundur. Morfolojik ve fizyolojik değişiklikleri hesaba katan çeşitli düzenlemelerle birlikte ACSM'nin genel sağlıklı popülasyon için önerdiği direnç ve esneklik antrenmanı ilkeleri gebe ve postpartum dönemdeki kadınlar için geçerlidir. ...
z Sedanter yaşam tarzındaki artış daha fazla kadının hamileliğe aşırı kilolu veya obez olarak girmesine yol açmakta ve birçoğu hamilelik sırasında da aşırı kilo almaktadır. 2011-2014 yılları arasında yapılan bir araştırmada doğurganlık çağındaki (20-39 yaş arası) ABD'li kadınların %34,4'ünün fazla kilolu veya obez olduğu görülmüştür. 2016 yılında doğum yapan 18-24 yaşları arasındaki kadınların %21'i, 25-34 yaşları arasındaki kadınların %23'ü ve 35-44 yaşları arasındaki kadınların %24'ünün obez olduğu bildirilmiştir. Gebelikte aşırı kilo alımı kronik hastalık yükünü artırırken anne ve bebek sağlığını riske atmaktadır. Bu potansiyel risklerden bazıları; gestasyonel hipertansiyon, preeklampsi, gestasyonel diyabet ve erken doğumdur. 2009 IOM yönergelerine göre; düşük kilolu kadınlar için önerilen gestasyonel ağırlık kazanımı (BMI <18.5 kg/m2) 12,5-18 kg, normal kilolu kadınlar için (BMI:18,5-24,9 kg / m2) 11,5-16 kg, fazla kilolu kadınlar için (BMI: 25,0-29,9 kg/m2) 7-11,5 kg ve obez kadınlar için (BMI >30,0 kg/m2) 5-9 kg'dır. Literatürde gebelikte aşırı kilo alımını önlemek için yalnızca beslenme, yalnızca egzersiz veya beslenme ile eş zamanlı egzersiz müdahalesi çalışmaları olduğu görülmektedir. Gebelerde yalnızca beslenme müdahalesi çalışmaları istatistiksel olarak anlamlı derecede düşük gestasyonel ağırlık kazanımı ile ilişkilendirilmiştir. Kılavuzlardaki gestasyonel ağırlık kazanımı oranlarına ulaşmaya yardımcı olma olasılığı en yüksek yöntemin beslenme olduğu bildirilmiştir (p = 0,013). Sadece egzersiz (p = 0,069) ve beslenme ve egzersiz (p = 0,056) müdahaleleri gestasyonel ağırlık kazanımını kontrol etme potansiyeline sahiptir ancak birçok çalışmada sonuçlar istatistiksel anlamlılığa ulaşamamıştır. Çalışmalardaki farklı beslenme stratejilerine rağmen müdahaleler evrensel olarak; meyve ve sebze tüketiminin artırılmasını, yüksek yağ ve şeker tüketiminin azaltılmasını önermektedir.
... Yiyecekler ağır metal (civa, kurşun) ve patojen (listeriosis, salmonella, toksoplazmoz) taşıyabilir, bu riske dikkat edilmelidir. Sigara, alkol ve uyuşturucu kullanımından kaçınılmalıdır(37).Gebelikte egzersiz konusunda, özel durumlarda egzersiz için bir otorite ve rehber olan Amerikan Spor Hekimliği Koleji (ACSM)'nin önerileri şu şekildedir: Haftanın çoğu, tercihen tüm günlerinde 30 dakikalık orta yoğunlukta fiziksel aktivite, komplike olmayan gebelikler sırasında çoğu kadın için uygundur. Morfolojik ve fizyolojik değişiklikleri hesaba katan çeşitli düzenlemelerle birlikte ACSM'nin genel sağlıklı popülasyon için önerdiği direnç ve esneklik antrenmanı ilkeleri gebe ve postpartum dönemdeki kadınlar için geçerlidir. ...
Sedanter yaşam tarzındaki artış daha fazla kadının hamileliğe aşırı kilolu veya obez olarak girmesine yol açmakta ve birçoğu hamilelik sırasında da aşırı kilo almaktadır. 2011-2014 yılları arasında yapılan bir araştırmada doğurganlık çağındaki (20-39 yaş arası) ABD’li kadınların %34,4’ünün fazla kilolu veya obez olduğu görülmüştür. 2016 yılında doğum yapan 18 - 24 yaşları arasındaki kadınların %21’i, 25 -34 yaşları arasındaki kadınların %23’ü ve 35 - 44 yaşları arasındaki kadınların %24’ünün obez olduğu bildirilmiştir. Gebelikte aşırı kilo alımı kronik hastalık yükünü artırırken anne ve bebek sağlığını riske atmaktadır. Bu potansiyel risklerden bazıları; gestasyonel hipertansiyon, preeklampsi, gestasyonel diyabet ve erken doğumdur. 2009 IOM yönergelerine göre; düşük kilolu kadınlar için önerilen gestasyonel ağırlık kazanımı (BMI 30,0 kg/m2) 5-9 kg’dır. Literatürde gebelikte aşırı kilo alımını önlemek için yalnızca beslenme, yalnızca egzersiz veya beslenme ile eş zamanlı egzersiz müdahalesi çalışmaları olduğu görülmektedir. Gebelerde yalnızca beslenme müdahalesi çalışmaları istatistiksel olarak anlamlı derecede düşük gestasyonel ağırlık kazanımı ile ilişkilendirilmiştir. Kılavuzlardaki gestasyonel ağırlık kazanımı oranlarına ulaşmaya yardımcı olma olasılığı en yüksek yöntemin beslenme olduğu bildirilmiştir (p = 0,013). Sadece egzersiz (p = 0,069) ve beslenme ve egzersiz (p = 0,056) müdahaleleri gestasyonel ağırlık kazanımını kontrol etme potansiyeline sahiptir ancak birçok çalışmada sonuçlar istatistiksel anlamlılığa ulaşamamıştır. Çalışmalardaki farklı beslenme stratejilerine rağmen müdahaleler evrensel olarak; meyve ve sebze tüketiminin artırılmasını, yüksek yağ ve şeker tüketiminin azaltılmasını önermektedir.
... Few studies have reported the added benefits of this novel technology as it offers better absorption, bioavailability, and tolerability profiles compared to available iron formulas, thus enhancing patient compliance [37,38] The panel of experts also recommended Omega-3 supplementation in the preconception period and during all three trimesters of pregnancy based on the benefits it provides. Available literature supports the potential role of omega-3 in reducing the risk of pre-term birth and low birth weight [39,40]. Adequate DHA is believed to be necessary for fetal and early-life brain development [40]. ...
Purpose
To reach a consensus among obstetrics and gynecology experts on the effects of micronutrient supplementation on fertility and pregnancy to aid clinicians in decision-making and create a unified approach to managing micronutrient deficiencies in women, by performing a modified Delphi study.
Methods
A three-round modified Delphi process was conducted among a Delphi panel of 38 Egyptian experts to define recommendations regarding the role of supplementation on fertility and pregnancy in women of reproductive age. A literature review was performed and supporting evidence was graded to help guide the recommendations based on available evidence.
Results
A total of 62 statements were developed for discussion and voting. Out of the 62 statements, 60 statements reached expert consensus. Statements were divided into two domains. The first domain discussed the role of supplementation in fertility: optimizing natural fertility, polycystic ovary syndrome (PCOS), in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), unexplained infertility, and endometriosis, whereas the second domain was concerned with the role of supplementation in pregnancy during the prenatal, antenatal, and postnatal periods.
Conclusion
In this work, a modified Delphi methodology was implemented to reach a consensus on the use of micronutrient supplementation in women of reproductive age. These recommendations can help clinicians in their practice, guide future research, and identify gaps in the market for the pharmaceutical industry. This clinical guidance can be extrapolated to similar communities.
... This impairment can lead to decreased embryonic cell development and underdevelopment of the hippocampus, a crucial brain region responsible for learning and memory [110]. Excessive intake of n-6 PUFA, such as linoleic acid, may result in altered stress response and thigmotactic behavior or avoidance of open spaces [111]. ...
Brain development, a complex process, consisting of several phases, starting as early as two weeks after conception, and continuing through childhood till early adolescence, is crucial for the development of properly functioning body systems, behavioral traits, and neurocognitive abilities. Infancy and childhood are recognized as important periods for initial brain formation, however in later stages of life, such as childhood and adulthood, experiences, together with environmental exposures, can still influence brain physiology. The developing brain is particularly susceptible to epigenetic changes with many factors being proposed as modifiers by directly impacting DNA methylation as well as histone and chromatin modifications within genes implicated in development. These factors include: maternal stress and diet, exposure to pollutants, sleep quality, as well as dietary habits. Evidence indicates exposures to environmental threats can lead to inappropriate neurological, metabolic, and endocrine functioning often mediated by epigenetic mechanisms with symptoms manifesting themselves as early as childhood or in later stages of life. Therefore, the main aim of this review is to evaluate the current studies focused on negative environmental exposures and their consequences on the developing brain directed by epigenetic mechanisms.
... This should include a variety of vegetables, fruits, whole grains, nuts, legumes, fish, and oils high in monounsaturated fat. Intake of red meat and refined grains, simple sugars, processed foods, and trans and saturated fats should be restricted.(84,165,166) A dietitian should be consulted about any special dietary considerations or food intolerances to ensure adequate dietary and nutritional intake. ...
Background and Aims
Patients with inflammatory bowel disease [IBD] are often affected during their reproductive years and may have many perinatal queries that require the comprehensive perspectives of a multidisciplinary team [MDT]. The purpose of this topical review is to assess the scientific evidence and provide expert opinion related to nutritional, psychological, and supportive care of women and their infants throughout the prenatal, antenatal, and infant periods.
Methods
A consensus expert panel of a paediatrician, gastroenterologists, nurses, and dietitians was convened by the European Crohn’s and Colitis Organisation. This panel critically reviewed literature related to the non-medical management of patients with IBD during preconception, pregnancy, the postnatal period, and the first years of the infant’s life. Statements were developed using an e-Delphi process over two rounds and were confirmed when ≥80% of experts agreed with the statements.
Results
A total of 19 current practice positions were developed that cover the preconception period, pregnancy and lactation, and early life exposures associated with risk of IBD. Development of the infant microbiome and its role in the immune system and topics including nutritional optimization, psychological support, and education relating to early life were reviewed.
Conclusions
Patients with IBD have unique nutritional and psychosocial needs that may affect fertility and pregnancy outcomes. The early life environment of infants born to parents with IBD may be associated with subsequent development of IBD in offspring. A MDT is the optimal setting to support and counsel patients throughout the perinatal period.
... Kehamilan merupakan suatu kondisi fisiologis yang akan terjadi pada perempuan setelah menikah sesuai dengan perkembangannya (Ho et al., 2016). Kehamilan yang baik adalah kehamilan yang tumbuh dan berkembang tanpa disertai dengan komplikasi atau penyakit penyerta (Koenig, 2017). ...
Vegetables are one of the sources of nutrition that are cheap and easy to obtain, especially in Jember Regency. Most of the people of Jember have jobs as capital in diversifying nutritional sources made from vegetables and are able to support the health status of the community. Complications of pregnant women is one of the health problems experienced by many pregnant women. Complications of pregnant women can be done by consuming healthy and diverse nutrition. However, hopefully people still don't know how to make processed food so that nutrition is maintained and more attractive. One effort that can be done is to empower mothers who are members of the posyandu to become the main pillar in helping prevent complications in pregnant women through the vegetable-eating movement program. Processed vegetable products are one of the creations to increase public support in consuming vegetables. The methods applied include the stages of preparation, implementation and evaluation. This stimulus community partnership program (PKMS) activity was carried out at the Posyandu Dusun Tgil, Kemiri Village, Panti District, Jember Regency, which was attended by 42 posyandu mothers consisting of 10 cadres, 2 midwives, and 30 posyandu members. Activities that have been carried out are in the form of counseling about the movement to eat vegetables, the benefits of vegetables for health and how to process vegetables so that the nutrients contained in them are not lost as well as healthy vegetable processing competitions by pregnant women. Based on the activities that have been carried out, there has been an increase in both the knowledge and skills of partners in processing vegetable-based foods as well as understanding the benefits of vegetables for pregnant women.
... The role of education and nutrition is important in pregnancy because it has implications for the health of mothers and children in later life. Optimal nutrition, if maintained throughout pregnancy, promotes optimal fetal growth and development [8]. Calorie intake should increase by about 300 kcal/day during pregnancy. ...
Background : Stunting is a major nutritional problem in children under five years old which has an impact on slowing growth by reducing the number and development of body cells, including brain cells and other organs. Pregnant women are one of the groups who are vulnerable to nutritional problems, related to the process of growth and development of the fetus in the womb. The role of education and nutrition is important during pregnancy because it has implications for the health of mothers and children in later life. The aimed of this review was to identify research about effect stunting prevention and education and nutrition to pregnant women. Methods : A database review undertaken using Pubmed, CHINAHL and Google Scholar from 2011-2021 to collect focused study on education and nutrition research on pregnant women to prevent stunting. A total of 1788 articles were identified. These were scaned and 18 articles were retrieved with 13 articles shortlisted for to in depth review. Results : Education with using audiovisual media, moringa leaf ice cream and early nutrition has proved effective in increasing pregnant women knowledge regarding stunting prevention. Providing nutritional supplements/nutrients for moringa oliefera, folic acid and iron, specific nutrition, LNS, PM2A PROCOMIDA, nutrition before pregnancy, supplements antenatal iron and folic acid, prenatal micronutrients have an effect on reducing children stunting. Conclusion: Audio visual education can convery health knowledge because easily to facilitate the reception of health message for pregnant women. Continuous education and monitoring of the of pregnant women diet every month during pregnancy classes at the posyandu are needed to prevent stunting in children.
... Pregnancy is a physiological condition in women after fertilization (Ho, Flynn, and Pasupathy, 2016). A good pregnancy is a pregnancy that grows and develops without being accompanied by certain complications or diseases (Koenig, 2017). ...
Fish is a source of nutrition that is cheap and easy to get, especially in Jember Regency. One of the health problems experienced by teenage girls and pregnant women is anemia. Anemia can be prevented by consuming adequate and diverse nutrients. However, the society at Darungan Dusun (Dusun is lower than the village in Indonesia's administrational hierarchy) did not know how to make exciting and not boring processed food. Fish nugget is creations from tuna or catfish to increase fish consumption coverage in society. This activity was carried out in the Integrated Health Post at Darungan Dusun Kemuning Lor Village, Jember Regency. There were fourteen of the integrated health post cadres and pregnant women who participated in this activity. Community service methods used demonstrations and counseling. The counseling and demonstration of fish nugget processing improve knowledge in Integrated Health Post cadres and pregnant women. Furthermore, it can prevent anemia in pregnant women. There should be support and participation from the local government for the sustainability of this activity.
... The literature shows that the gestational period in all women is a complex process that involves multiple changes in their lives, so it is very important that HE includes a healthy lifestyle [50][51][52][53] and diet [54][55][56][57][58][59]. The study warns that pregnant women tend to have an inadequate diet due to excessive consumption of convenience foods and pastries, with a low intake of dairy products, legumes, fruits, vegetables, meat and fish [54][55][56][57][58][59]. ...
The dietary behaviour of pregnant women, as well as the socio-cultural conditions in which pregnancy takes place, influence obstetric outcomes. To analyse the influence of socioeconomic factors and dietary habits on obstetric outcomes in Spanish and foreign pregnant women living in a rural environment, a population-based, prospective-observational study in a cohort of Spanish and foreign pregnant women in the town of Yepes, in the province of Toledo, Spain was conducted. Foreign pregnant women are ecodependent on their partners, have secondary education and low socioeconomic level. Spanish pregnant women have secondary education, a medium socio-economic level, live with their partners and are economically independent. Moreover, 85% of Spanish pregnant women gave birth at term and reached a gestational age of 40 ± 1.83 weeks. However, only 55% of foreign pregnant women reached a gestational age of 39.72 ± 2.28 weeks. Through health education, pregnant women in this geographical area of Castilla la Mancha, Spain, adopted bicultural dietary patterns, thus reaching the prescribed diet of 2000 Kcal. Through this diet, both Spanish and foreign pregnant women maintained albumin and plasma protein levels within the established range, with no significant differences in obstetric outcomes among pregnant women in the study.
... Overweight and obesity are prevalent among women of reproductive ages, and maternal obesity influences a multitude of current and potential future health issues. 19 Lactation education has been a priority of the World Health Organization (WHO) for decades because of its association with proper growth and development, with an objective of 50% of mothers exclusively breastfeeding by 2025. 20 In the US, 2017 rates of exclusive breastfeeding at 6 months of age were at 25.6% nationally and 23.3% in North Carolina, significantly behind WHO goals. ...
Objective:
Nutrition education during pregnancy is associated with improved maternal and fetal outcomes. This study explored nutrition practitioner perceptions of providing nutrition education to this population and examined gaps in current practices.
Methods:
North Carolina nutrition practitioners (n = 73) working with pregnant women were asked to complete a survey about their provision of nutrition services to pregnant clients. Data were analyzed for descriptive statistics.
Results:
Cost (91%) and lack of time to cook (83%) were perceived as the largest barriers for clients to making dietary changes. Topics most requested by clients paralleled those practitioners identified as needs: weight gain (69%), lactation (63%), and general nutrition information (57%). Pamphlets (97%), posters (66%), telehealth (42%), and texting (38%) were accepted education methods.
Conclusions and implications:
Evidence-based education on weight, lactation, and general nutrition, using time and cost-efficient approaches, and embracing technology were desired by pregnant clients when receiving nutrition education from nutrition and other health care practitioners and may result in improved maternal and fetal outcomes.
... It also implied dietary adequacy (Rathnayake et al., 2012), and a well-balanced diet is very crucial for pregnant and lactating women as they support two lives, the mother and their fetus or infants (Koletzko et al., 2019;Kominiarek & Rajan, 2016;Thorne-Lyman et al., 2010). During pregnancy, women are recommended to have adequate dietary diversity that can assure adequate energy, macronutrient and micronutrient to support fertility, pregnancy, and positive birth outcomes and future health of the offspring (Caut et al., 2019;Ho et al., 2016). Lactating women are also in need of appropriate diet for their healthiest life and for growth and development of their infants (Kominiarek & Rajan, 2016). ...
The dietary diversity of pregnant and lactating women remains unacceptably poor in resource‐limited countries such as Ethiopia. Despite the presence of inconsistent and inconclusive small‐scale studies, it is difficult to portray an actual picture of dietary diversity and dietary practices of women in Ethiopia. This study aimed to identify the prevalence of dietary diversity, dietary practice, and dietary patterns of pregnant and lactating women in Ethiopia. Electronic and gray literature sources were explored. A total of 3,256 articles were found, of which 38 were included in the final analysis. The data were analyzed by using STATA version 15. The pooled estimates were presented using random‐effects models due to considerable heterogeneities among studies. In this study, 16,412 pregnant and lactating women were included. The pooled prevalence of low, medium, and high dietary diversity scores of pregnant women was 37.1%, 41.55%, and 39.3%, respectively. Likewise, low, medium, and high dietary diversity scores of lactating women were 50.31%, 41.22%, and 9.1%, respectively. The mean dietary diversity of pregnant and lactating women was 3.99 ± 0.20. Regarding the minimum dietary diversity, 56.6% of pregnant women and 50.21% of lactating women were found to have inadequate dietary diversities. Two‐third (65.7%) of pregnant women were found to have poor dietary practice. Starchy foods were the main staple foods of study subjects, whereas organ meats were least consumed food types. The dietary diversity score, minimum dietary diversity, and dietary practices of women are suboptimal and below WHO and FAO recommendations. This could lead to both macro‐ and micronutrient deficiencies. Policymakers, program managers, healthcare workers, and stakeholders need to redesign nutrition promotion and intervention programs to alleviate this issue. The abstract is about the pooled prevalence of dietary diversity and practice of pregnant and lactating women in Ethiopia.
... Prekonsepsiyonel veya prenatal maternal mikro besin ögesi eksiklikleri, yalnızca olumsuz gebelik sonuçlarıyla yakından ilişkili olmakla kalmayıp; aynı zamanda kronik hastalıkların gelişimsel kökeninde de rol alabilmektedir (4,5). Fetal gelişim sürecinde önemli besin ögelerinin yetersizliği fetal dokuların yeniden programlanmasına yol açarak bebeğin sonraki yaşamını da etkileyebilir (6). ...
Gebelik sürecinde artan gereksinimler dolayısıyla; özellikle bazı mikro besin ögelerinin besin desteği olarak alınması ve böylece yetersizlik ile ilişkili risklerinin en aza indirilmesi, maternal ve fetal sağlığın korunmasında büyük öneme sahiptir. Gebelikte, besin ögelerinin ciddi veya orta düzeyde yetersizliğinde, hayat kurtarıcı nitelikte olan destekler; hafif yetersizlik veya maternal depoların yeterli olduğu koşullarda, çeşitli riskleri de beraberinde getirmektedir. Doğumsal anomalilerin önlenmesinde etkisi kanıtlanmış olan folik asitin maternal dönemde fazla alımı durumunda kanserojeniteyi tetikleyebileceği, çinko emilimini olumsuz etkileyebileceği, B12 vitamini eksikliğinin tanısında ve tedavisinde gecikmelere yol açabileceği, çocukluk çağı astım, alerji riski ile ilişkili olabileceği görülmüştür. Eksikliği fetal anomaliler ile ilişkilendirilen bir diğer vitamin olan B12’nin toksik etkisi bildirilmemekle birlikte literatür taramasında fazla alımı durumunda alerjik reaksiyonlar gösteren bir vaka raporuna rastlanmıştır. Yenidoğan hipokalsemisi ve raşitizmin önlenmesinde etkili D vitamini desteğinin fazla alımı teratojen etki gösterebilir. İyot yetersizliği ile ilişkili kretenizm gibi hastalıkların önlenmesinde etkili olan iyot desteğinin fazla alımının gebenin tiroid disfonksiyonuna, gebelikteki subklinik ve aşikâr hipotiroidizm prevalansında artışa yol açabileceği ve bebeğin psikomotor gelişimini olumsuz etkileyebileceği belirtilmiştir. Gebelikte önerilen dozlarda besin desteklerinin kullanımı uygundur ancak yetersizliğin önlenmesi kadar fazla alım konusunda da dikkatli olunmalıdır. Bu derlemede; gebelikte yaygın olarak kullanılan folik asit, B12 vitamini, D vitamini ve iyot besin desteklerinin fazla alımına ilişkin riskler tartışılmıştır.
... The phenomenon is referred to as "early metabolic programming of long-term health and disease " [191]. The most common diseases associated with poor nutrition during pregnancy, infancy and early life are cardiovascular diseases and neural tube defects (NTD's), which are characterized by severe defects of the brain and spine, clubfoot, diabetes, obesity and hypertension [192,193]. Nutrition requirements for pregnant women and mothers vary across countries, depending on the guidelines recommended and used. In order for these guidelines to be understood and followed, pregnant women and mothers need to have an adequate level of health literacy and nutrition literacy. ...
Nutrition in early life is of extreme important due to direct correlation with long-term increased risk of non-communicable diseases (NCDs). The fetal and postnatal level of micronutrients and polyunsaturated fatty acids (PUFAs) may alter metabolism, organ growth, development and function leading to increased risk of cardio metabolic diseases, obesity, renal disorders, respiratory disorders, metabolic syndrome, and, eventually to type 2 diabetes and cardiovascular diseases. This chapter is focused on the complexed effects of micronutrients (vitamins and minerals) and PUFAs deficiencies on the health and discuss the importance of supplementation and education programs as a health policy strategy.
... A good diet before and during pregnancy (1) is important because suboptimal maternal nutrition can result in poor infant outcomes such as neural tube defects, low birth weight and infant hypovitaminosis D (2) . Managing weight gain in pregnancy reduces the risk of adverse short and long term maternal and neonatal outcomes, including high maternal postpartum weight retention and the development of obesity in mothers and children (3) . ...
To assess the accuracy and readability of internet prenatal nutrition advice. Between August and December 2018, 130 internet pages returned from Google searches on foods to avoid, foods to eat, and supplements use were compared to UK government advice for pregnant women. Readability was assessed using the Flesch Readability Ease (FRE) tool. Descriptive and non-parametric tests were used. Spearman’s Correlation explored associations between accuracy and readability. Kruskal-Wallis tests with Bonferroni correction were used for multiple pairwise tests and Mann-Whitney U tests for two-sample differences in medians. One hundred and thirty internet pages were examined: 48% from publishers, 27% from other commercial organisations, 22% from charities and 3% from governments. Eighty-three (64%) pages contained inaccurate and accurate advice, 23 (18%) were accurate and complete, 21 (16%) were inaccurate, and three (2%) lacked any relevant advice. The median percentage accuracy of all advice was 83 (LQ, UQ) (48,100). Median FRE was 55 (46, 61) ‘fairly difficult’. Eighty-seven pages (67%) scored below the recommended FRE for public internet pages. There was a weak positive correlation between accuracy and readability of internet pages rho = 0.241, p=0.006. Accuracy of internet pages did not differ by dietary theme. Pages on supplements were the most difficult to read. Internet pages from publishers and other commercial organisations were significantly less accurate than those from not-for-profit organisations, median percent difference -8 (-29, 0.00), p=0.019. Much pregnancy-related dietary advice online is inaccurate and difficult to read. Advice should be developed in consultation with qualified nutritionists and dietitians.
... The diet of a woman during pregnancy is one of the most important factors affecting the health of the mother and child. Epidemiological studies have shown that the prenatal period of development largely determines the occurrence of lifestyle and civilization diseases in later life [1][2][3][4]. Proper preparation of a woman for pregnancy has a significant impact on embryo genesis. ...
A woman’s diet during pregnancy can significantly affect her health, as well as her child’s future development and well-being. Unfortunately, many pregnant women do not follow the recommended nutritional guidelines. The reason could be that they have insufficient knowledge about nutritional best practice. Accordingly, the purpose of this study is to investigate the nutritional behaviour of pregnant women in Poland. The research was conducted using a questionnaire to survey a sample of N = 815 pregnant women in first pregnancy. Among the findings were that the subjects ate an excessive amount of sweets, and white bread, and consumed insufficient quantities of fish, milk and fermented milk drinks. Subjects chose white bread more often than wholemeal bread, and fruit rather than vegetables. The study showed that the nutritional behaviour of pregnant women was characterised by many bad practices.
... Nutrition in pregnancy requires a careful balance of both the quality and quantity of fat intake to optimize fetal growth and development, also reducing maternal morbidity [121]. The maternal nutritional status and dietary FA composition during gestation and/or lactation shape offspring development with high fat programming conferring cardiovascular risk to offspring that may present at any time over the life course. ...
Programming is triggered through events during critical developmental phases that alter offspring health outcomes. High fat programming is defined as the maintenance on a high fat diet during fetal and/or early postnatal life that induces metabolic and physiological alterations that compromise health. The maternal nutritional status, including the dietary fatty acid composition, during gestation and/or lactation, are key determinants of fetal and postnatal development. A maternal high fat diet and obesity during gestation compromises the maternal metabolic state and, through high fat programming, presents an unfavorable intrauterine milieu for fetal growth and development thereby conferring adverse cardiac outcomes to offspring. Stressors on the heart, such as a maternal high fat diet and obesity, alter the expression of cardiac-specific factors that alter cardiac structure and function. The proper nutritional balance, including the fatty acid balance, particularly during developmental windows, are critical for maintaining cardiac structure, preserving cardiac function and enhancing the cardiac response to metabolic challenges.
... The preconception period represents a crucial time when dietary and PA behaviours could help prepare the body and ensure the accumulation of sufficient nutrient stores for healthy pregnancies in the future [1]. Maternal nutrition during pregnancy influences foetal growth and development and sets a foundation for long-term health for both mother and child [2]. Pregnant women are particularly vulnerable to inadequate nutrition due to the high nutrient and energy demands of pregnancy [3,4]. ...
Dietary and physical activity behaviours during preconception and in pregnancy are important determinants of maternal and child health. This review synthesised the available evidence on dietary and physical activity behaviours in pregnant women and women of childbearing age who have migrated from African countries to live in high income countries. Searches were conducted on Medline, Embase, PsycInfo, Pubmed, CINAHL, Scopus, Proquest, Web of Science, and the Cochrane library. Searches were restricted to studies conducted in high income countries and published in English. Data extraction and quality assessment were carried out in duplicate. Findings were synthesised using a framework approach, which included both a priori and emergent themes. Fourteen studies were identified; ten quantitative and four qualitative. Four studies included pregnant women. Data on nutrient intakes included macro- and micro-nutrients; and were suggestive of inadequacies in iron, folate, and calcium; and excessive sodium intakes. Dietary patterns were bicultural, including both Westernised and African dietary practices. Findings on physical activity behaviours were conflicting. Dietary and physical activity behaviours were influenced by post-migration environments, culture, religion, and food or physical activity-related beliefs and perceptions. Further studies are required to understand the influence of sociodemographic and other migration-related factors on behaviour changes after migration.
... The preconception period represents a crucial time when dietary and PA behaviours could help prepare the body and ensure the accumulation of sufficient nutrient stores for healthy pregnancies in the future [1]. Maternal nutrition during pregnancy influences foetal growth and development and sets a foundation for long-term health for both mother and child [2]. Pregnant women are particularly vulnerable to inadequate nutrition due to the high nutrient and energy demands of pregnancy [3,4]. ...
Dietary and physical activity behaviours during preconception and in pregnancy are important determinants of maternal and child health. This review synthesised the available evidence on dietary and physical activity behaviours in pregnant women and women of childbearing age women who have migrated from African countries to live in high income countries. Searches were conducted on Medline, Embase, PsycInfo, Pubmed, CINAHL, Scopus, Proquest, Web of Science, and the Cochrane library. Searches were restricted to studies conducted in high income countries and published in English. Data extraction and quality assessment were carried out in duplicate. Findings were synthesised using a framework approach, which included both a priori and emergent themes. Fourteen studies were identified; ten quantitative and four qualitative. Four studies included pregnant women. Data on nutrient intakes included macro- and micro-nutrients; and were suggestive of inadequacies in iron, folate, and calcium; and excessive sodium intakes. Dietary patterns were bicultural, including both Westernised and African dietary practices. Findings on physical activity behaviours were conflicting. Dietary and physical activity behaviours were influenced by post-migration environments, culture, religion, and food or physical activity-related beliefs and perceptions. Further studies are required to understand the influence of sociodemographic and other migration-related factors on behaviour changes after migration.
... Ancak randomize kontrollü çalışmaların yer aldığı sistematik derlemelerde gebelikte besin desteği olarak alınan n-3 PUFA'nın bilişsel gelişim, doğum ağırlığı, gestasyonel diyabet ve preeklempsi üzerine çok az etkisinin olduğu ya da hiç etkisinin olmadığını göstermektedir. Ancak n-3 desteğinin gebelik süresini uzatmada ve prematüre doğum riskini azaltmada yararlı olduğu bildirilmektedir (Ho et al., 2016). Tablo 1. Ulusal Gıda Kompozisyon Veri Tabanı'nda (TürKomp) yer alan balık türlerinin yaklaşık 1 porsiyonunun (150 g) enerji, makro ve mikro besin öğeleri kompozisyonu (TürKomp, 2014) ...
... It is now well-demonstrated that nutrition and other lifestyle behaviours during pregnancy have an impact on pregnancy outcomes for both mother and neonate health, including risk of gestational diabetes mellitus (GDM) and hypertension, preterm delivery, low birth weight, perinatal survival and risk of developing noncommunicable diseases (NCDs) in later life [1,2]. Moreover, recent researches demonstrate that nutrition can also influence germ cells through hormone changes and epigenetic mechanisms both in women and males, and thus further modify embryo and fetus development [3]. ...
Adopting pregnancy-specific mobile health applications has increased access to critical prenatal information and help. These apps include a variety of features for monitoring pregnancy development, tracking maternal health indicators, and accessing evidence-based diet, exercise, and delivery preparation materials. By allowing women to communicate directly with healthcare providers and delivering interactive educational information, these applications empower them to actively manage their pregnancy experience and make educated decisions about their health and well-being. Mobile health applications can help pregnant women manage their symptoms, relieve stress, and get mental healthcare. These applications promote a sense of connection and empowerment among pregnant women by offering symptom monitoring, meditation sessions, and community forums, improving their entire maternity care experience.The chapter aims to give an overview of different aspects of mobile health apps (mhealth) apps for expectant mothers.
Background
Optimal maternal nutrition is associated with better pregnancy and infant outcomes. Culinary nutrition programmes have potential to improve diet quality during pregnancy. Therefore, this research aimed to understand the experiences of cooking and the wants and needs of pregnant women regarding a cooking and food skills programme in the United Kingdom (UK) and Republic of Ireland (ROI).
Methods
Online focus group discussions with pregnant women and those who had experienced a pregnancy in the UK or ROI were conducted between February and April 2022. Two researchers conducted a thematic analysis. Seven focus groups with ROI participants ( n = 24) and six with UK participants ( n = 28) were completed.
Results
Five themes were generated. These were (1) cooking during pregnancy: barriers, motivators and solutions; (2) food safety, stress and guilt; (3) need for cooking and food skills programmes and desired content; (4) programme structure; (5) barriers and facilitators to programme participation. Overall, there was support for a programme focusing on broad food skills, including planning, food storage, using leftovers and to manage pregnancy‐specific physiological symptoms such as food aversions. Participants emphasised the importance of inclusivity for a diverse range of people and lifestyles for programme design and content.
Conclusions
Current findings support the use of digital technologies for culinary nutrition interventions, potentially combined with in‐person sessions using a hybrid structure to enable the development of a support network.
Background: Nutrition in pregnancy is a component of the Council on Resident Education in obstetrics and gynecology core curriculum; however, no studies currently examine adherence to this goal. Objectives: Our objective was to assess obstetrics and gynecology (Ob/Gyn) residents' education and knowledge surrounding nutrition in pregnancy, including (1) amount of dedicated didactic time to and attitudes toward, (2) subjective comfort in counseling patients on, and (3) objective knowledge of pregnancy-related nutrition. Materials and Methods: This is a cross-sectional electronic survey-based study. A 28-item questionnaire was distributed to residents enrolled in Ob/Gyn training programs across the United States in 2022. Results: From 247 Ob/Gyn residency programs, 218 residents across postgraduate years and from geographically diverse locations consented to participation and completed all survey questions. Almost half (48%) of participants reported 0 hours per year of dedicated nutrition-related education, 49% reported 1-2 hours, and 3% reported >2 hours. Most residents (92%) strongly agreed or agreed that education regarding pregnancy-related nutrition guidelines would be useful for clinical practice. However, less than one-third (31%) of residents reported feeling comfortable counseling patients on nutrition in pregnancy. On assessment of residents' objective knowledge of pregnancy-related nutrition, mean percentage of correct responses was 74%. Conclusions: This study identifies a gap in graduate medical education, specifically a disconnect between the recognized impact of nutrition on pregnancy outcomes and residents' ability to confidently and effectively counsel patients on nutrition in pregnancy. Results demonstrate a need to develop curriculum and interventions to educate Ob/Gyn residents about pregnancy-related nutrition.
Background: Food frequency questionnaire (FFQ) is the most frequently used dietary assessment method in estimating dietary intakes in epidemiological studies. Aim: This study aimed to assess the relative validity of a semiquantitative FFQ in evaluating dietary intake among pregnant women in the United Arab Emirates. Methods: Within the Mutaba'ah study, a subsample of 111 pregnant women completed a semiquantitative FFQ and a single 24-hour dietary recall (24-HDR) regarded as the reference method. Absolute and energy-adjusted nutrient and food intakes between the FFQ and 24-HDR were compared using the Wilcoxon signed ranks test, correlations, Bland–Altman analysis, cross-classification, and weighted kappa analysis. Results: There were no significant differences in reported absolute intakes between the FFQ and 24-HDR for carbohydrates, whole grains, white meat, beta-carotene, vitamin K, sodium, and selenium. Spearman's correlation coefficients between the FFQ and 24-HDR ranged from 0.09 (trans fatty acids) to 0.5 (potassium) for absolute intakes. Correlation decreased after energy adjustment. Bland–Altman analysis showed that the FFQ overestimated intakes compared with 24-HDR and that the limits of agreement were wide. The average percentage of pregnant women classified into the same or adjacent quartile of intake by both methods was 73%. Weighted kappa values ranged from −0.02 (white meat) to 0.33 (magnesium). Conclusion: Our findings showed that the semi-quantitative FFQ is a useful tool in ranking pregnant women from the Emirati population according to their dietary intake. However, the validity of some estimated intakes was poor; hence, certain intakes should be interpreted with caution.
Background: During pregnancy, adequate energy, nutrient intake, and food safety are important. Aims: This study aimed to examine the presence of aflatoxin, which has toxigenic properties, in nuts and dried fruits consumed during pregnancy. Subjects and Methods: Forty-five pregnant women living in Istanbul and Balikesir cities provinces, who were selected using the convenience sampling method, were applied face-to-face interview method on their attitudes and behaviors regarding their preferences for consuming nuts and dried fruits and storage conditions between February and April 2022. For aflatoxin analysis, the samples were taken from the nuts and dried fruits consumed by the pregnant women. The total aflatoxin content in the samples was analyzed by the ELISA method with a quantitative aflatoxin high-sensitivity test kit. Results: The most commonly consumed nuts by pregnant women during pregnancy; were walnuts and hazelnuts, respectively. It was determined that pregnant women buy nuts and dried fruits first from the nut shop and second from the market. Regarding storage preferences, it was seen that the participants mostly stored the nuts in the closed kitchen cabinet or refrigerator cabinet. For the storage material preferences, glass, porcelain, and packaging were preferred. For aflatoxin results, no detectable level of aflatoxin was found in 35 samples, and the presence of aflatoxin in 3 samples (1.43 ppb, 1.523 ppb, and 1.804 ppb, respectively) was detected. Conclusion: Nuts and dried fruit consumption preferences of pregnant women differed according to the products. No aflatoxin was found in the nuts and dried fruits at a level that could threaten the health of pregnant women. Keywords: Aflatoxin, Nuts, Dried Fruits, Pregnancy, ELISA method
Resumen
Objetivo
Conocer la influencia del índice de masa corporal (IMC) materno al inicio del embarazo en los resultados obstétricos-perinatales.
Material y métodos
Estudio observacional-ambispectivo. Se incluyeron 1.407 pacientes con gestaciones únicas y partos de fetos > 24 semanas entre el 01/12/2017 y el 31/07/2019. La muestra fue estratificada según su IMC según la clasificación de la OMS. Se analizaron variables sobre: enfermedad pregestacional, gestacional, asistencia obstétrica y resultados maternos-perinatales y se compararon entre los grupos estudiados. El programa estadístico utilizado ha sido R Core Team 2020, versión 3.6.3. Un valor de p ≤ 0,05 se consideró significativo.
Resultados
Las obesas ii-iii (IMC 35-39 e IMC ≥ 40, respectivamente) tienen mayor riesgo de hipertensión arterial crónica (OR 53,54, IC95% 18,21-229,02), diabetes gestacional (OR 5,24, IC95% 2,87-9,51) y preeclampsia (OR 2,38, IC95% 0,95-5,51; p = 0,049). Las de bajo peso tuvieron más fetos con crecimiento intrauterino restringido (OR 3,09, IC95% 1,46-6,17). Las inducciones del parto y las cesáreas aumentan conforme lo hace el IMC (p = 0,006). Las pacientes con bajo peso también tuvieron mayor riesgo de cesárea (OR 2,46, IC95% 1,06-5,20). Los ingresos neonatales fueron más frecuentes en mujeres obesas y con bajo peso (OR 2,68, IC95% 1,39-5,00, y OR 2,56, IC95% 1,10-5,44, respectivamente). Las obesas tuvieron más riesgo de peso neonatal > 4.000 g (OR 3,06, IC95% 1,57-5,77) y las gestantes de bajo peso más riesgo de peso neonatal < 2.500 g (OR 2,94, IC95% 1,54-5,41).
Conclusión
Los valores extremos del IMC materno al inicio de la gestación son factores determinantes para un desenlace obstétrico-perinatal adverso.
Pregnancy is a vulnerable period of life for changes in physical and mental health, which could be exacerbated by COVID-19. The aim of this study was to assess the impact of COVID-19 on health behaviour and emotional well-being among pregnant women in Latvia. The cross-sectional study included 269 women: pregnant women in the third trimester and women until the 7th day post-partum. The study was conducted between July and October 2020, performed by a trained interviewer. Information regarding demographic, anthropometric data, self-assessment of changes in nutritional habits, daily physical activities, and emotional well-being due to the COVID-19 pandemic was collected. 31.6% reported cooking at home more often and only 10.4% reported eating more often and/or larger portions, 23.2% were going on walks outdoors more often, 32.9% were feeling anxious, insecure about health of themselves and relatives, and 24.8% were lacking communication with friends and family. Latvian women were emotionally more affected than other nationalities (p = 0.015). Overall, women 30+ years of age were more often affected then women aged up to 30 years (p = 0.014). These results suggest that the COVID-19 pandemic had notable impact on health behaviour and emotional well-being in pregnant women in Latvia, especially on women 30+ years of age, who may need more careful counselling.
Scientific evidence confers the utmost importance to nutrition, both in the preconceptional and the pregnancy stages, and has become more significant every day. It has been demonstrated that dietary deficiencies are related to congenital disabilities, and development and growth problems (folate deficiency and spina bifida, low levels of iodine and brain development deterioration, lack of iron and low birth weights, etc.). Similarly, maternal obesity situations or an excessive weight gain have been linked to a higher risk of adverse results in the pregnancy, including premature birth, macrosomia, cesarean section, and the medium and long-term metabolic programming of the child toward obesity. The woman must follow a healthy diet even before gestation. A healthy diet is understood as any eating plan that combines different foods in a well-balanced and varied way, provided in appropriate amounts, so that each individual, depending on their size, age, gender, physical activity, and physiologic and physiopathological condition, maintains an optimal state of health. Although it is evident that, in the case of the pregnant woman, her nutritional needs will be increased during a large part of pregnancy (especially in the second and third trimesters), this physiologic status does not mean “eating for two.” It is generally recommended that, compared to her energy needs before pregnancy, they should be increased by 340 kcal/day during the second trimester and by 452 kcal/day in the third. It is also advisable for carbohydrates to represent between 45% and 65% of the total energy of the intake, which signifies around 175 g daily (45 more than a nonpregnant woman), and highlighting the importance of eating approximately 35 g/day of fiber. About 30%–35% of the total daily caloric intake should come from lipids. Particular attention should be paid to maintaining a healthy ratio between w-6 and w-3 fatty acids (from 5:1 to 10:1 is considered to be acceptable), to ensure the necessary consumption of EFAs and their long-chain derivatives [eicosapentaenoic and docosahexaenoic (DHA)], and to evaluate the need for supplementation with DHA (through dietetic complements of fish oils or derivatives of microalgae plants). Concerning protein needs, an amount of 70–71 g of proteins per day (which equals 1.1 g/kg/day) is considered to be adequate, making sure of the quality of the protein (with all its essential amino acids). Generally, during gestation, the consumption of a more considerable amount of food to meet energy needs, and the greater absorption and efficacy in the use of nutrients occurring in pregnancy, are sufficient for fulfilling the micronutrient requirements provided that a right choice of food is made. However, supplementation with vitamins and minerals may be essential in those women with important requirements (folic acid, iron, and calcium), but it must be prescribed and monitored by medical doctors. Finally, it remains to be pointed out that the diet must be adjusted to the prior feeding habits of the mother, considering her race and religious beliefs. It is recommended to establishing regular meal times, avoiding long periods of fasting, and eating a larger number of meals (5–6/day) but lighter ones.
Micronutrients are vitamins, minerals and trace elements that are used in minute doses as cofactors, antioxidants and modulators of gene transcription homeostasis. MMNs may have a role in averting or treating adverse pregnancy outcomes and maternal complications. In 2016, WHO suggested the use of iron-folic acid (IFA) rather than multiple micro-nutrients (MMNs) during pregnancy owing to some feared adverse outcomes like perinatal mortalities. However, this effect is debatable as such complications could be also due to genetic or environmental factors. Therefore, this appraisal should provide appropriate information and guidance to health workers, scholars and policymakers. This review includes large sample-sized studies with a special focus on developing countries like Ethiopia. The articles were selected using systematic searching with Boolean operators, advanced search techniques, snowballing and search limits. Mendeley was used as a reference management tool where the source of databases and references were PubMed, AJOL, Google Scholar, IRIS, Summon, DOAJ, Cochrane Library, Oxford Medicine Online, WHO reproductive health libraries majorly from the Hinari program. Articles from BMC, American Society for Nutrition, Lancet, Elsevier, John Wiley and Sons LTD, PLoS One, Springer and Nature Publishing Groups were also used. The results showed that there are no variations in adverse effects between MMNs and IFA. Moreover, MMNs are valuable in anemic pregnant women with lower preconception weight as it increases maternal weight and reduces low birth weight and anemia more than IFA. Therefore, MMNs may have greater health benefits than IFA for the offspring by minimizing fetal complications and the cost of their treatment, resulting from the MMN deficiency state.
Objective
To determine recent trends in maternal prepregnancy body mass index (BMI) and to quantify its association with birth and maternal outcomes.
Methods
A population-based retrospective cohort study included resident women with singleton births in the California Birth Statistical Master Files (BSMF) database from 2007 to 2016. There were 4,621,082 women included out of 5,054,968 women registered in the database. 433,886 (8.6%) women were excluded due to invalid or missing information for BMI. Exposures were underweight (BMI < 18.5 kg/m²), normal weight (18.5–24.9 kg/m²), overweight (25.0–29.9 kg/m²), and obese (≥ 30 kg/m²) at the onset of pregnancy. Obesity was subcategorized into class I (30.0–34.9 kg/m²), class II (35.0–39.9 kg/m²), and class III (≥ 40 kg/m²), while adverse outcomes examined were low birth weight (LBW), very low birth weight (VLBW), macrosomic births, preterm birth (PTB), very preterm birth (VPTB), small-for-gestational-age birth (SGA), large-for-gestational-age birth (LGA), and cesarean delivery (CD). Descriptive analysis, simple linear regression, and multivariate logistic regression were performed, and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) for associations were estimated.
Results
Over the ten-year study period, the prevalence of underweight and normal weight women at time of birth declined by 10.6% and 9.7%, respectively, while the prevalence of overweight and obese increased by 4.3% and 22.9%, respectively. VLBW increased significantly with increasing BMI, by 24% in overweight women and by 76% in women with class III obesity from 2007 to 2016. Women with class III obesity also had a significant increase in macrosomic birth (170%) and were more likely to deliver PTB (33%), VPTB (66%), LGA (231%), and CD (208%) than women with a normal BMI. However, obese women were less likely to have SGA infants; underweight women were 51% more likely to have SGA infants than women with a normal BMI.
Conclusions
In California from 2007 to 2016, there was a declining trend in women with prepregnancy normal weight, and a rising trend in overweight and obese women, particularly obesity class III. Both extremes of prepregnancy BMI were associated with an increased incidence of adverse neonatal outcomes; however, the worse outcomes were prominent in those women classified as obese.
Objectives:
An optimal gestational weight gain is essential for maternal health and to reduce adverse birth outcomes. Current guidelines to monitor gestational weight gain are based on pre-pregnancy body mass index (BMI). However, middle-upper arm circumference (MUAC) is increasingly used as an alternative nutritional status measure for pregnant women. Hence, this study aimed to determine associations of MUAC and pre-pregnancy BMI with gestational weight gain rate among Malaysian pregnant women.
Study design:
A cross-sectional study was conducted among 444 pregnant women (≥20 weeks gestation).
Main outcomes measures:
Women completed questionnaires on sociodemographic data, maternal characteristics and pre-pregnancy weight. Height, current weight and MUAC were measured at study visit (from 1st February 2016 to 31st January 2017).
Results:
About a third (34.24%) of pregnant women were overweight or obese prior to pregnancy. MUAC was inversely associated with an inadequate rate of gestational weight gain (OR = 0.77; 95% CI: 0.68, 0.87) as compared to normal gestational weight gain. In contrast, a higher MUAC was associated with a higher odds ratio (OR = 1.28; 95% CI: 1.11, 1.49) of having excessive rate of gestational weight. No associations were found for pre-pregnancy BMI categories for gestational weight gain rate.
Conclusion:
Our findings revealed that women with low MUAC were more likely to have an inadequate gestational weight gain rate during pregnancy whereas higher MUAC was associated with an excessive gestational weight gain rate. MUAC may be a useful indicator of nutritional status associated with GWG. Routine measurement of MUAC in pregnant women may help health professionals, particularly in middle-income countries, to counsel women about gestational weight gain.
Iron requirements are greater in pregnancy than in the nonpregnant state. Although iron requirements are reduced in the first trimester because of the absence of menstruation, they rise steadily thereafter; the total requirement of a 55-kg woman is ≈1000 mg. Translated into daily needs, the requirement is ≈0.8 mg Fe in the first trimester, between 4 and 5 mg in the second trimester, and >6 mg in the third trimester. Absorptive behavior changes accordingly: a reduction in iron absorption in the first trimester is followed by a progressive rise in absorption throughout the remainder of pregnancy. The amounts that can be absorbed from even an optimal diet, however, are less than the iron requirements in later pregnancy and a woman must enter pregnancy with iron stores of ≥300 mg if she is to meet her requirements fully. This is more than most women possess, especially in developing countries. Results of controlled studies indicate that the deficit can be met by supplementation, but inadequacies in health care delivery systems have limited the effectiveness of larger-scale interventions. Attempts to improve compliance include the use of a supplement of ferrous sulfate in a hydrocolloid matrix (gastric delivery system, or GDS) and the use of intermittent supplementation. Another approach is intermittent, preventive supplementation aimed at improving the iron status of all women of childbearing age. Like all supplementation strategies, however, this approach has the drawback of depending on delivery systems and good compliance. On a long-term basis, iron fortification offers the most cost-effective option for the future.
Background:
Vitamin C supplementation may help reduce the risk of pregnancy complications such as pre-eclampsia, intrauterine growth restriction and maternal anaemia. There is a need to evaluate the efficacy and safety of vitamin C supplementation in pregnancy.
Objectives:
To evaluate the effects of vitamin C supplementation, alone or in combination with other separate supplements on pregnancy outcomes, adverse events, side effects and use of health resources.
Search methods:
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2015) and reference lists of retrieved studies.
Selection criteria:
All randomised or quasi-randomised controlled trials evaluating vitamin C supplementation in pregnant women. Interventions using a multivitamin supplement containing vitamin C or where the primary supplement was iron were excluded.
Data collection and analysis:
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.
Main results:
Twenty-nine trials involving 24,300 women are included in this review. Overall, 11 trials were judged to be of low risk of bias, eight were high risk of bias and for 10 trials it was unclear. No clear differences were seen between women supplemented with vitamin C alone or in combination with other supplements compared with placebo or no control for the risk of stillbirth (risk ratio (RR) 1.15, 95% confidence intervals (CI) 0.89 to 1.49; 20,038 participants; 11 studies; I² = 0%; moderate quality evidence), neonatal death (RR 0.79, 95% CI 0.58 to 1.08; 19,575 participants; 11 studies; I² = 0%), perinatal death (average RR 1.07, 95% CI 0.77 to 1.49; 17,105 participants; seven studies; I² = 35%), birthweight (mean difference (MD) 26.88 g, 95% CI -18.81 to 72.58; 17,326 participants; 13 studies; I² = 69%), intrauterine growth restriction (RR 0.98, 95% CI 0.91 to 1.06; 20,361 participants; 12 studies; I² = 15%; high quality evidence), preterm birth (average RR 0.99, 95% CI 0.90 to 1.10; 22,250 participants; 16 studies; I² = 49%; high quality evidence), preterm PROM (prelabour rupture of membranes) (average RR 0.98, 95% CI 0.70 to 1.36; 16,825 participants; 10 studies; I² = 70%; low quality evidence), term PROM (average RR 1.26, 95% CI 0.62 to 2.56; 2674 participants; three studies; I² = 87%), and clinical pre-eclampsia (average RR 0.92, 95% CI 0.80 to 1.05; 21,956 participants; 16 studies; I² = 41%; high quality evidence).Women supplemented with vitamin C alone or in combination with other supplements compared with placebo or no control were at decreased risk of having a placental abruption (RR 0.64, 95% CI 0.44 to 0.92; 15,755 participants; eight studies; I² = 0%; high quality evidence) and had a small increase in gestational age at birth (MD 0.31, 95% CI 0.01 to 0.61; 14,062 participants; nine studies; I² = 65%), however they were also more likely to self-report abdominal pain (RR 1.66, 95% CI 1.16 to 2.37; 1877 participants; one study). In the subgroup analyses based on the type of supplement, vitamin C supplementation alone was associated with a reduced risk of preterm PROM (average RR 0.66, 95% CI 0.48 to 0.91; 1282 participants; five studies; I² = 0%) and term PROM (average RR 0.55, 95% CI 0.32 to 0.94; 170 participants; one study). Conversely, the risk of term PROM was increased when supplementation included vitamin C and vitamin E (average RR 1.73, 95% CI 1.34 to 2.23; 3060 participants; two studies; I² = 0%). There were no differences in the effects of vitamin C on other outcomes in the subgroup analyses examining the type of supplement. There were no differing patterns in other subgroups of women based on underlying risk of pregnancy complications, timing of commencement of supplementation or dietary intake of vitamin C prior to trial entry. The GRADE quality of the evidence was high for intrauterine growth restriction, preterm birth, and placental abruption, moderate for stillbirth and clinical pre-eclampsia, low for preterm PROM.
Authors' conclusions:
The data do not support routine vitamin C supplementation alone or in combination with other supplements for the prevention of fetal or neonatal death, poor fetal growth, preterm birth or pre-eclampsia. Further research is required to elucidate the possible role of vitamin C in the prevention of placental abruption and prelabour rupture of membranes. There was no convincing evidence that vitamin C supplementation alone or in combination with other supplements results in other important benefits or harms.
Background:
Vitamin E supplementation may help reduce the risk of pregnancy complications involving oxidative stress, such as pre-eclampsia. There is a need to evaluate the efficacy and safety of vitamin E supplementation in pregnancy.
Objectives:
To assess the effects of vitamin E supplementation, alone or in combination with other separate supplements, on pregnancy outcomes, adverse events, side effects and use of health services.
Search methods:
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2015) and reference lists of retrieved studies.
Selection criteria:
All randomised or quasi-randomised controlled trials evaluating vitamin E supplementation in pregnant women. We excluded interventions using a multivitamin supplement that contained vitamin E.
Data collection and analysis:
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.
Main results:
Twenty-one trials, involving 22,129 women were eligible for this review. Four trials did not contribute data. All of the remaining 17 trials assessed vitamin E in combination with vitamin C and/or other agents. Overall the risk of bias ranged from low to unclear to high; 10 trials were judged to be at low risk of bias, six trials to be at unclear risk of bias and five trials to be at high risk of bias. No clear difference was found between women supplemented with vitamin E in combination with other supplements during pregnancy compared with placebo for the risk of stillbirth (risk ratio (RR) 1.17, 95% confidence interval (CI) 0.88 to 1.56, nine studies, 19,023 participants, I² = 0%; moderate quality evidence), neonatal death (RR 0.81, 95% CI 0.58 to 1.13, nine trials, 18,617 participants, I² = 0%), pre-eclampsia (average RR 0.91, 95% CI 0.79 to 1.06; 14 trials, 20,878 participants; I² = 48%; moderate quality evidence), preterm birth (average RR 0.98, 95% CI 0.88 to 1.09, 11 trials, 20,565 participants, I² = 52%; high quality evidence) or intrauterine growth restriction (RR 0.98, 95% CI 0.91 to 1.06, 11 trials, 20,202 participants, I² = 17%; high quality evidence). Women supplemented with vitamin E in combination with other supplements compared with placebo were at decreased risk of having a placental abruption (RR 0.64, 95% CI 0.44 to 0.93, seven trials, 14,922 participants, I² = 0%; high quality evidence). Conversely, supplementation with vitamin E was associated with an increased risk of self-reported abdominal pain (RR 1.66, 95% CI 1.16 to 2.37, one trial, 1877 participants) and term prelabour rupture of membranes (PROM) (average RR 1.77, 95% CI 1.37 to 2.28, two trials, 2504 participants, I² = 0%); however, there was no corresponding increased risk for preterm PROM (average RR 1.27, 95% CI 0.93 to 1.75, five trials, 1999 participants, I² = 66%; low quality evidence). There were no clear differences between the vitamin E and placebo or control groups for any other maternal or infant outcomes. There were no clear differing patterns in subgroups of women based on the timing of commencement of supplementation or baseline risk of adverse pregnancy outcomes. The GRADE quality of the evidence was high for preterm birth, intrauterine growth restriction and placental abruption, moderate for stillbirth and clinical pre-eclampsia, and low for preterm PROM.
Authors' conclusions:
The data do not support routine vitamin E supplementation in combination with other supplements for the prevention of stillbirth, neonatal death, preterm birth, pre-eclampsia, preterm or term PROM or poor fetal growth. Further research is required to elucidate the possible role of vitamin E in the prevention of placental abruption. There was no convincing evidence that vitamin E supplementation in combination with other supplements results in other important benefits or harms.
It has been reported that neural tube defects can be prevented with periconceptional folic acid supplementation. The effects of different doses, forms and schemes of folate supplementation for the prevention of other birth defects and maternal and infant outcomes are unclear.
This review updates and expands a previous Cochrane Review assessing the effects of periconceptional supplementation with folic acid to reduce neural tube defects (NTDs). We examined whether folate supplementation before and during early pregnancy can reduce neural tube and other birth defects (including cleft palate) without causing adverse outcomes for mothers or babies.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2010). Additionally, we searched the international clinical trials registry platform and contacted relevant organisations to identify ongoing and unpublished studies.
We included all randomised or quasi-randomised trials evaluating the effect of periconceptional folate supplementation alone, or in combination with other vitamins and minerals, in women independent of age and parity.
We assessed trials for methodological quality using the standard Cochrane criteria. Two authors independently assessed the trials for inclusion, one author extracted data and a second checked for accuracy.
Five trials involving 6105 women (1949 with a history of a pregnancy affected by a NTD and 4156 with no history of NTDs) were included. Overall, the results are consistent in showing a protective effect of daily folic acid supplementation (alone or in combination with other vitamins and minerals) in preventing NTDs compared with no interventions/placebo or vitamins and minerals without folic acid (risk ratio (RR) 0.28, 95% confidence interval (CI) 0.15 to 0.52). Only one study assessed the incidence of NTDs and the effect was not statistically significant (RR 0.08, 95% CI 0.00 to 1.33) although no events were found in the group that received folic acid. Folic acid had a significant protective effect for reoccurrence (RR 0.32, 95% CI 0.17 to 0.60). There is no statistically significant evidence of any effects on prevention of cleft palate, cleft lip, congenital cardiovascular defects, miscarriages or any other birth defects. There were no included trials assessing the effects of this intervention on maternal blood folate or anaemia at term.We found no evidence of short-term side effects.
Folic acid, alone or in combination with vitamins and minerals, prevents NTDs but does not have a clear effect on other birth defects.
Recent findings suggest that many human fetuses have to adapt to a limited supply of nutrients and in doing so they permanently change their physiology and metabolism. These "programmed" changes may be the origins of a number of diseases in later life, including coronary heart disease and the related disorders stroke, diabetes, and hypertension.
Calcium supplementation may prevent high blood pressure through a number of mechanisms and may help to prevent preterm labour.
The objective of this review was to assess the effects of calcium supplementation during pregnancy on hypertensive disorders of pregnancy and related maternal and child adverse outcomes.
We searched the Cochrane Pregnancy and Childbirth Group trials register (October 2001) and the Cochrane Controlled Trials Register (Issue 3, 2001) and we contacted study authors.
Randomised trials comparing at least one gram daily of calcium during pregnancy with placebo.
Eligibility and trial quality were assessed. Data extraction was carried out and double entered.
Eleven studies were included, all of good quality. There was a modest reduction in high blood pressure with calcium supplementation (relative risk 0.81, 95% confidence interval 0.74 to 0.89). The effect was greatest for women at high risk of hypertension (relative risk 0.45, 95% confidence interval 0.31 to 0.66) and those with low baseline dietary calcium (relative risk 0.49, 95% confidence interval 0.38 to 0.62). There was also a modest reduction in the risk of pre-eclampsia with calcium supplementation (relative risk 0.68, 95% confidence interval 0.57 to 0.81). The effect was greatest for women at high risk of hypertension (relative risk 0.21, 95% confidence interval 0.11 to 0.39) and those with low baseline calcium intake (relative risk 0.32, 95% confidence interval 0.21 to 0.49). There was no overall effect on the risk of preterm delivery, although there was a reduction in risk amongst women at high risk of hypertension (relative risk 0.42, 95% confidence interval 0.23 to 0.78). There was no evidence of any effect of calcium supplementation on stillbirth or death before discharge from hospital. There were fewer babies with birthweight < 2500g (RR 0.83, 95% CI 0.71-0.98). In one study, childhood systolic blood pressure > 95th percentile was reduced (RR 0.59, 95% CI 0.39-0.91).
Calcium supplementation appears to be beneficial for women at high risk of gestational hypertension and in communities with low dietary calcium intake. Optimum dosage requires further investigation.
Weight management before, during and after pregnancy. NICE guidelines published PH27. https://www.nice.org.uk/guidance/ph27/resources. Royal College of Obstetricians &Gynaecologists. Nutrition in pregnancy (Scientific Impact Paper No. 18). RCOG published
- National Institute
- Care Health
- Excellence
National Institute for Health and Care Excellence. Weight management
before, during and after pregnancy. NICE guidelines published July
2010. PH27. https://www.nice.org.uk/guidance/ph27/resources.
Royal College of Obstetricians &Gynaecologists. Nutrition in pregnancy (Scientific Impact Paper No. 18). RCOG published 2010.
https://www.rcog.org.uk/en/guidelines-research-services/
guidelines/sip18/.
Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database Syst Rev
- L M De-Regil
- J P Pena-Rosas
- A C Fernandez-Gaxiola
- P Rayco-Solon
De-Regil LM, Pena-Rosas JP, Fernandez-Gaxiola AC, Rayco-Solon P.
Effects and safety of periconceptional oral folate supplementation
for preventing birth defects. Cochrane Database Syst Rev 2015 Dec
14. Issue 12. Art. No.:CD007950.