Nutrition in pregnancy: mineral and vitamin supplements

Study on Impact of Iron and Folic Acid on the Plasma Trace Minerals in Pregnant Anemic Women

Iron deficiency anemia is one of the causes that lead to significant mortality and morbidity among pregnant women and fetus. The present study was undertaken to explore oral iron supplementation can modify the metal contents in pregnant anemic women. Iron and folic acid supplementations was given to 500 anemic women (mild = 200, moderate = 200, and severe = 100) and 100 age matched non-anemic controls daily for 100 days. Blood index values and plasma trace minerals were estimated as per standard protocols. Haemoglobin and ferritin levels were found significantly increased (p < 0.001) in anemic and control subjects after treatment. Moreover, the serum transferring receptor levels and total iron binding capacity were found significantly decreased in all treated groups. Iron (Fe), zinc (Zn) and copper (Cu) levels were found increased (p < 0.01) after oral iron supplementation groups. Moreover, selenium (Se) manganese (Mn) and were found to be decreased in all treated groups. Data provides the conclusion that iron and folic acid supplementation recovered the essential trace minerals, except manganese, which may lead to various complications including peroxidation of vital body molecules resulting in increased risk for pregnant women as well as fetus.

Foods tabooed for pregnant women in Abala district of Afar region, Ethiopia: an inductive qualitative study

Background

Food taboo is contributing substantially to malnutrition for pregnant women by restricting and limiting the frequency and variety of foods most of which are nutritious and easily accessible. The practice is common in developing countries and most of the food taboos in East Africa fall on the women and most unfortunately on the pregnant. Foods of animal products, which are the main sources dietary energy of pastoralist communities, are often prone to the practice of food taboos. Nonetheless, the existence of the practice in Ethiopian pastoralist communities, the communities whose way of life is mostly nomadic and based on tending of herds or flocks, is not investigated yet. Therefore, the current study aimed to explore foods tabooed for pregnant women and the reasons behind the practice if exists in Abala district of Afar region, Ethiopia.

Methods

Exploratory qualitative study was conducted inductively involving homogeneous participants in four focus group discussions and eight key informants in individual in-depth interview who were purposively selected in Aballa district from March 1 to 30, 2016. A semi-structured interview guide was used to collect the data. The investigators audiotaped focus group discussions and interviews and then transcribed them verbatim. Finally, the transcribed data were imported to Atlas.ti 7 software for coding. Analysis was done inductively. Triangulation and peer debriefing were applied to assure data quality.

Results

The study revealed that foods tabooed for pregnant women were 1) Eating a large amount of food of any type, 2) fatty foods like meat, milk and yoghurt, 3) Foods that are not in liquid form such as different types of bread and 4) cool/cold foods such as cold milk, cold meat and cold water. The reasons mentioned to adhere with the foods taboo for pregnant women were to avoid difficulty to deliver the fetus, to prevent disease like Gastritis, Diarrhea, Typhoid and skin discoloration of the fetus. Besides, inconveniences like abdominal cramp were reported as reasons to adhere the foods tabooed.

Conclusions

Pregnant women in Aballa district avoid eating numerous accessible foods because the foods are believed as tabooed for them. Further studies that focus on the extent of food taboo and uncovering the understanding on how it is being practiced were recommended.

Micronutrient Intake Is Inadequate for a Sample of Pregnant African-American Women

BACKGROUND

Micronutrient intake is critical for fetal development and positive pregnancy outcomes. Little is known about the adequacy of micronutrient intake in pregnant African-American women.

OBJECTIVE

To describe nutrient sufficiency and top food groups contributing to dietary intake of select micronutrients in low-income pregnant African-American women and determine whether micronutrient intake varies with early pregnancy body mass index (BMI) and/or gestational weight gain.

DESIGN

Secondary analysis of data collected in a cohort study of pregnant African-American women.

PARTICIPANTS/SETTING

A total of 93 women aged 18 to 36 years, <20 weeks pregnant, with early pregnancy BMIs ≥18.5 and <40.0. The study was conducted during 2008 to 2012 with participants from university-affiliated obstetrics clinics in an urban setting in the northeastern United States.

MAIN OUTCOME MEASURES

Proportion of women with dietary intakes below Estimated Average Requirement (EAR) or Adequate Intake (AI) for vitamin D, folate, iron, calcium, and choline throughout pregnancy. Top food groups from which women derived these micronutrients was also determined.

STATISTICAL ANALYSES PERFORMED

Descriptive statistics included means, standard deviations, and percentages. Percent of women reaching EAR or AI was calculated. The χ² test was used to assess micronutrient intake differences based on early pregnancy BMI and gestational weight gain.

RESULTS

A large percentage of pregnant women did not achieve the EAR or AI from dietary sources alone; EAR for folate (66%), vitamin D (100%), iron (89%), and AI for choline (100%). Mean micronutrient intake varied throughout pregnancy. Top food sources included reduced-fat milk, eggs, and mixed egg dishes, pasta dishes, and ready-to-eat cereal.

CONCLUSIONS

The majority of study participants had dietary micronutrient intake levels below EAR/AI throughout pregnancy. Findings suggest that practitioners should evaluate dietary adequacy in women to avoid deficits in micronutrient intake during pregnancy. Top food sources of these micronutrients can be considered when assisting women in improving dietary intake.

Human Placental Arterial Distensibility, Birth Weight, and Body Size Are Positively Related to Fetal Homocysteine Concentration

Methionine demethylation during metabolism generates homocysteine (Hcy) and its remethylation requires folate and cobalamin. Elevated Hcy concentrations are associated with vascular-related complications of pregnancy, including increased vascular stiffness, predictive of clinical vascular disease. Maternal and fetal total Hcy (tHcy) concentrations are positively related, yet the influence of Hcy on fetoplacental vascular function in normal pregnancy has not been examined. We hypothesized that Hcy alters fetoplacental vascular characteristics with influences on fetal growth outcomes. We investigated (1) placental chorionic plate artery distensibility and neonatal blood pressure in relation to umbilical plasma tHcy; (2) relationships between cord venous (CV) and cord arterial (CA) plasma tHcy, folate, and cobalamin concentrations; and (3) tHcy associations with birth weight and anthropometric measurements of body size as indices of fetal growth in normal pregnancies with appropriate weight-for-gestational age newborns. Maternal plasma tHcy, folate, and cobalamin concentrations were consistent with published data. Placental chorionic plate artery distensibility index (β; measure of vessel stiffness) was inversely related to CA tHcy, yet neonatal blood pressure was not significantly affected. CV and CA tHcy concentrations were positively related and CV tHcy negatively related to CV cobalamin but not folate. CV tHcy concentration positively related to birth weight, corrected birth weight percentile, length, head circumference, and mid-arm circumference of newborns. CV cobalamin was inversely related to fetal growth indices but not to folate concentration. Our study demonstrates a potential relationship between fetal tHcy and placental artery distensibility, placing clinical relevance to cobalamin in influencing Hcy concentration and maintaining low vascular resistance to facilitate nutrient exchange favorable to fetal growth.

Dietary iron and calcium intakes during pregnancy are associated with lower risk of prematurity, stillbirth and neonatal mortality among women in Tanzania

Objective

Prematurity, stillbirth and other adverse birth outcomes remain major concerns in resource-limited settings. Poor dietary intake of micronutrients during pregnancy has been associated with increased risk of adverse outcomes. We determined the relationships between dietary Fe and Ca intakes during pregnancy and risks of adverse birth outcomes among HIV-negative women.

Design

Women’s diet was assessed through repeated 24 h diet recalls in pregnancy. Mean intakes of total Fe, Fe from animal sources and Ca during pregnancy were examined in relation to adverse birth outcomes and neonatal mortality. Women were prescribed daily Fe supplements as per standard perinatal care.

Setting

Dar es Salaam, Tanzania.

Subjects

A cohort of 7634 pregnant women.

Results

Median (interquartile range) daily dietary intake of total Fe, animal Fe and Ca was 11·9 (9·3–14·7), 0·5 (0–1·1) and 383·9 (187·4–741·2) mg, respectively. Total Fe intake was significantly associated with reduced risk of stillbirth (trend over quartiles, P=0·010). Animal Fe intake was significantly associated with reduced risk of preterm birth and extreme preterm birth. Animal Fe intake was inversely related to neonatal mortality risk; compared with women in the lowest intake quartile, those in the top quartile were 0·51 times as likely to have neonatal death (95 % CI 0·33, 0·77). Higher Ca intake was associated with reduced risk of preterm birth (relative risk; 95 % CI: 0·76; 0·65, 0·88) and extreme preterm birth (0·63; 0·47, 0·86). Women in the highest Ca intake quartile had reduced risk of neonatal mortality (0·59; 0·37, 0·92).

Conclusions

Daily dietary Fe and Ca intakes among pregnant women are very low. Improvement of women’s diet quality during gestation is likely to improve the risks of adverse birth outcomes.

The impact of nutrients on the aging rate: A complex interaction of demographic, environmental and genetic factors

Nutrition has a strong influence on the health status of the elderly, with many dietary components associated to either an increased risk of disease or to an improvement of the quality of life and to a delay of age-related pathologies. A direct effect of a reduced caloric intake on the delay of aging phenotypes is documented in several organisms. The role of nutrients in the regulation of human lifespan is not easy to disentangle, influenced by a complex interaction of nutrition with environmental and genetic factors. The individual genetic background is fundamental for mediating the effects of nutritional components on aging. Classical genetic factors able to influence nutrient metabolism are considered those belonging to insulin/insulin growth factor (INS/IGF-1) signaling, TOR signaling and Sirtuins, but also genes involved in inflammatory/immune response and antioxidant activity can have a major role. Considering the worldwide increasing interest in nutrition to prevent age related diseases and achieve a healthy aging, in this review we will discuss this complex interaction, in the light of metabolic changes occurring with aging, with the aim of shedding a light on the enormous complexity of the metabolic scenario underlying longevity phenotype.

Perinatal nutrition in maternal mental health and child development: Birth of a pregnancy cohort

BACKGROUND

Mental disorders are one of the leading contributors to the global burden of disease. The Alberta Pregnancy Outcomes and Nutrition (APrON) study was initiated in 2008 to better understand perinatal environmental impacts on maternal mental health and child development.

AIMS

This pregnancy cohort was established to investigate the relationship between the maternal environment (e.g. nutritional status), maternal mental health status, birth outcomes, and child development. The purpose of this paper is to describe the creation of this longitudinal cohort, the data collection tools and procedures, and the background characteristics of the participants.

SUBJECTS

Participants were pregnant women age 16 or older, their infants and the biological fathers.

OUTCOME MEASURES

For the women, data were collected during each trimester of pregnancy and at 3, 6, 12, 24, and 36months after the birth of their infant. Maternal measures included diet, stress, current mental and physical health, health history, and lifestyle. In addition, maternal biological samples (DNA, blood, urine, and spot breast milk samples) were banked. Paternal data included current mental and physical health, health history, lifestyle, and banked DNA samples. For infants, DNA and blood were collected as well as information on health, development and feeding behavior.

RESULTS

At the end of recruitment in 2012, the APrON cohort included 2140 women, 2172 infants, and 1417 biological fathers. Descriptive statistics of the cohort, and comparison of women who stayed in the study and those who dropped out are discussed.

CONCLUSION

Findings from the longitudinal cohort may have important implications for health policy and clinical practice.

Impact of Food Rations and Supplements on Micronutrient Status by Trimester of Pregnancy: Cross-Sectional Studies in the Maela Refugee Camp in Thailand

Micronutrient fortified flour (MFF), supplementary food rations and micronutrient (MN) supplements may prevent deficiencies among pregnant women. Objectives of cross-sectional surveys in 2004 (n = 533) and 2006 (n = 515) were to assess the impact of new food rations (flour, oil) and supplements on MN status by trimester of pregnancy in the Maela refugee camp. Hemoglobin, iron status, zinc, retinol, β-carotene and tryptophan decreased, while α-/γ-tocopherol and 5-methyltetrahydrofolate (5-MTHF) increased from first to third trimester. In 2006, mean zinc and α-tocopherol for each trimester was significantly higher than in 2004. The weeks of supplemented thiamine and folic acid were positively correlated with thiamine diphosphate (TDP) and 5-MTHF, but not for ferrous sulfate as iron deficiency was observed in 38.5% of third-trimester women. Frequent consumption of fish paste and owning a garden or animal were associated with significantly higher iron status, retinol, β-carotene, and 5-MTHF. In conclusion, MFF and supplementary oil were most likely to explain improved zinc and α-tocopherol status, while thiamine and folate supplements ensured high TDP and 5-MTHF in late pregnancy. MN supplements, MN-rich staple food, small gardens, and programs to improve iron compliance are promising strategies to prevent MN deficiencies during pregnancy in vulnerable populations.

Gastrointestinal Complications of Ferrous Sulfate in Pregnant Women: A Randomized Double-Blind Placebo-Controlled Trial

Background:

Some pregnant women discontinue iron supplements consumption due to Gastrointestinal (GI) complications, whereas pregnancy induces the same complications physiologically.

Objectives:

The aim of the present study was to assess GI complications of ferrous sulfate in pregnant women.

Patients and Methods:

This randomized, double-blind, placebo-controlled clinical trial was performed on 176 pregnant women referred to prenatal care clinic of Maryam Hospital from April 2011 to February 2012. Pregnant women with Hb ≥ 13.2 gr/dL at 13^th - 18^th weeks of gestation were selected based on the inclusion criteria and were randomly assigned to the ferrous sulfate and placebo groups. The ferrous sulfate group (n = 90) received a 50-mg ferrous sulfate tablet daily from the 20^th week to the end of pregnancy and the placebo group (n = 89) received one placebo tablet in the same way. All participants were visited twice at 24^th - 28^th and 32^nd - 36^th weeks to assess the GI complications as well as Hb level to determine the Hb changes in two groups. Chi-square test, t-test and Kolmogorov-Smirnov test were used to analyze the data. P value of < 0.05 and confidence level of 95% were considered as statistically significant.

Results:

None of the GI complications were significantly different between the ferrous sulfate and placebo groups at 24^th - 28^th and 32^nd - 36^th weeks. Hemoglobin drop lower than 10.5 gr/dL at 24^th - 28^th weeks or lower than 11 g/dL at 32^nd - 36^th weeks was not observed in any cases.

Conclusions:

It can be concluded that GI complications in pregnant women using ferrous sulfate are mostly caused by physiologic changes of pregnancy rather than ferrous sulfate; therefore, it is not reasonable to stop using ferrous sulfate due to GI complications.

Maternal micronutrient deficiencies and related adverse neonatal outcomes after bariatric surgery: a systematic review

Pregnant and postpartum women with a history of bariatric surgery are at risk of micronutrient deficiencies as a result of the combination of physiologic changes related to pregnancy and iatrogenic postoperative alterations in the absorption and metabolism of crucial nutrients. This systematic review investigates micronutrient deficiencies and related adverse clinical outcomes in pregnant and postpartum women after bariatric surgery. A systematic approach involving critical appraisal was conducted independently by 2 researchers to examine deficiencies of phylloquinone, folate, iron, calcium, zinc, magnesium, iodide, copper, and vitamins A, D, and B-12 in pregnant and postpartum women after bariatric surgery, together with subsequent outcomes in the neonates. The search identified 29 relevant cases and 8 cohort studies. The quality of reporting among the case reports was weak according to the criteria based on the CARE (CAse REporting) guidelines as was that for the cohort studies based on the criteria from the Cohort Study Quality Assessment list of the Dutch Cochrane Center. The most common adverse neonatal outcomes related to maternal micronutrient deficiencies include visual complications (vitamin A), intracranial hemorrhage (phylloquinone), neurological and developmental impairment (vitamin B-12), and neural tube defects (folate). On the basis of the systematically collected information, we conclude that the evidence on micronutrient deficiencies in pregnant and postpartum women after bariatric surgery and subsequent adverse neonatal outcomes remains weak and inconclusive.

Micronutrients in pregnancy in low- and middle-income countries

Pregnancy is one of the more important periods in life when increased micronutrients, and macronutrients are most needed by the body; both for the health and well-being of the mother and for the growing foetus and newborn child. This brief review aims to identify the micronutrients (vitamins and minerals) likely to be deficient in women of reproductive age in Low- and Middle-Income Countries (LMIC), especially during pregnancy, and the impact of such deficiencies. A global prevalence of some two billion people at risk of micronutrient deficiencies, and multiple micronutrient deficiencies of many pregnant women in LMIC underline the urgency to establishing the optimal recommendations, including for delivery. It has long been recognized that adequate iron is important for best reproductive outcomes, including gestational cognitive development. Similarly, iodine and calcium have been recognized for their roles in development of the foetus/neonate. Less clear effects of deficiencies of zinc, copper, magnesium and selenium have been reported. Folate sufficiency periconceptionally is recognized both by the practice of providing folic acid in antenatal iron/folic acid supplementation and by increasing numbers of countries fortifying flours with folic acid. Other vitamins likely to be important include vitamins B12, D and A with the water-soluble vitamins generally less likely to be a problem. Epigenetic influences and the likely influence of micronutrient deficiencies on foetal origins of adult chronic diseases are currently being clarified. Micronutrients may have other more subtle, unrecognized effects. The necessity for improved diets and health and sanitation are consistently recommended, although these are not always available to many of the world's pregnant women. Consequently, supplementation programmes, fortification of staples and condiments, and nutrition and health support need to be scaled-up, supported by social and cultural measures. Because of the life-long influences on reproductive outcomes, including inter-generational ones, both clinical and public health measures need to ensure adequate micronutrient intakes during pregnancy, but also during adolescence, the first few years of life, and during lactation. Many antenatal programmes are not currently achieving this. We aim to address the need for micronutrients during pregnancy, the importance of micronutrient deficiencies during gestation and before, and propose the scaling-up of clinical and public health approaches that achieve healthier pregnancies and improved pregnancy outcomes.

Micronutrient levels and supplement intake in pregnancy after bariatric surgery: a prospective cohort study

Background

Studies report frequent micronutrient deficiencies after bariatric surgery, but less is known about micronutrient levels of pregnant women after bariatric surgery.

Objective

To prospectively evaluate micronutrient levels and supplement intake in pregnancy following bariatric surgery.

Design

A multicenter prospective cohort study including women with restrictive or malabsorptive types of bariatric surgery. Nutritional deficiencies, together with supplement intake, were screened during pregnancy.

Results

The total population included 18 women in the restrictive and 31 in the malabsorptive group. Most micronutrients were depleted and declined significantly during pregnancy. The proportion of women with low vitamin A and B-1 levels increased to respectively 58 and 17% at delivery (P = 0.005 and 0.002). The proportion of women with vitamin D deficiency decreased from 14% at trimester 1 to 6% at delivery (P = 0.030). Mild anemia was found in respectively 22 and 40% of the women at trimester 1 and delivery. In the first trimester, most women took a multivitamin (57.1%). In the second and third trimester, the majority took additional supplements (69.4 and 73.5%). No associations were found between supplement intake and micronutrient deficiencies.

Conclusion

Pregnant women with bariatric surgery show frequent low micronutrient levels. Supplementation partially normalizes low levels of micronutrients.

Greek pregnant women demonstrate inadequate micronutrient intake despite supplement use

BACKGROUND/AIM

Maternal diet is important in the outcome of pregnancy and the health of the children. The present cross-sectional study aimed to assess the use of dietary supplements during pregnancy and define the maternal characteristics associated with supplement use.

METHODS

The diet of 100 childbearing women was recorded for three consecutive days and micronutrient supplementation was added to the dietary intake and the median values were used in the analyses.

RESULTS

The majority of the participants (92%) consumed at least one supplement. Supplementation of folic acid (FA) was significantly lower during the third trimester compared to the second (p ≤ .007). Higher intake of Ca and Fe supplements was observed in the second trimester (p ≤ .001). The use of supplements contributed to an attenuated consumption of all reported micronutrients (Mg, Ca, FA, and Fe, p ≤ .001). The principal components analysis revealed that the most important factor contributing to supplementation was primiparity.

CONCLUSIONS

Overall, a high prevalence of micronutrient supplementation during pregnancy was observed without ensuring adequacy in the micronutrient intake. The increased rates of supplement users might be the result of an act for balancing diet in unplanned pregnancies.

Levels of Serum Calcium and Magnesium in Pre-eclamptic and Normal Pregnancy: A Study from Coastal India

BACKGROUND

Pre-eclampsia is one of the major causes of maternal and fetal morbidity and mortality. Though the aetiology is obscure, recent studies indicate that serum levels of calcium and magnesium may have a role in pre-eclampsia.

AIM

The aim of this study was to find out the relationship of serum levels of calcium and magnesium in pre-eclamptic pregnancies compared to normal pregnancies in women from southern coastal India.

SETTINGS AND DESIGN

This study was done in a medical college hospital in southern coastal India.

MATERIALS AND METHODS

The blood samples from 60 pre-eclamptic women and an equal number of controls were analysed for calcium and magnesium levels. Data on Body Mass Index, maternal and gestational ages, serum calcium and magnesium were compared between the two groups. Outcome of pregnancy was analysed in both the groups and compared.

STATISTICAL ANALYSIS

Data was expressed as Mean ± Standard Deviation. Data analysis was done by SPSS version 20. Comparison of serum levels of the elements between the two groups was performed by Independent t-test and Chi-square test and P-value of < 0.05 was considered as statistically significant.

RESULTS

The serum calcium concentration was significantly lower in the pre-eclamptic group compared to normotensives (7.84 ± 0.87 mg/dl Vs 8.97± 0.69 mg/dl, p<0.001) whereas the levels of serum magnesium showed a marginal difference in both the groups. (1.43± 0.55 mg/dl Vs, 1.57 ± 0.72 mg/dl P 0.257) The study also showed that pre-eclamptic women were older, their BMI was higher and birth weight of babies lower compared to normotensives.

CONCLUSION

According to the results of our research, intake of supplements, mainly calcium may help in the reduction of incidence of pre-eclampsia especially in a population of a developing country like ours where the nutrition is poor. Not many studies have been done in developing countries to assess the role of these elements in pre-eclampsia. The actual role of magnesium and calcium supplements needs further investigation.

The role of gangliosides in brain development and the potential benefits of perinatal supplementation

The maternal diet provides critical nutrients that can influence fetal and infant brain development and function. This review highlights the potential benefits of maternal dietary ganglioside supplementation on fetal and infant brain development. English-language systematic reviews, preclinical studies, and clinical studies were obtained through searches on PubMed. Reports were selected if they included benefits and harms of maternal ganglioside supplementation during pregnancy or ganglioside-supplemented formula after pregnancy. The potential benefits of ganglioside supplementation were explored by investigating the following: (1) their role in neural development, (2) their therapeutic use in neural injury and disease, (3) their presence in human breast milk, and (4) their use as a dietary supplement during or after pregnancy. Preclinical studies indicate that ganglioside supplementation at high doses (1% of total dietary intake) can significantly increase cognitive development and body weight when given prenatally. However, lower ganglioside supplementation doses have no beneficial cognitive effects, even when given throughout pregnancy and lactation. In human clinical trials, infants given formula supplemented with gangliosides showed increased cognitive development and an increase in ganglioside content. Ganglioside supplementation may promote brain development and function in offspring when administered at the optimum dosage. We propose that prenatal maternal dietary supplementation with gangliosides throughout pregnancy may promote greater long-term effects on brain development and function. Before this concept can be encouraged in preconception clinics, future research and clinical trials are needed to confirm the ability of dietary gangliosides to improve cognitive development, but available results already encourage this area of research.

Maternal iron and folic acid supplementation is associated with lower risk of low birth weight in India

Improving maternal nutrition is an important step toward reducing low birth weight (LBW) and its sequelae. In India, an estimated 7.5 million babies are born each year with LBW, which accounts for more than one-third of the global burden. In this context, little is known about the population-level association of iron and folic acid supplementation (IFA) during pregnancy and reducing the outcome of LBW. Using pooled data from the nationally representative 1998/1999 and 2005/2006 National Family Health Surveys of India, we examined the association of IFA with LBW and birth weight using multivariable logistic and linear regression models, respectively (n = 22,648). We found that IFA during pregnancy was negatively associated with LBW after adjustment for socioeconomic status [OR = 0.77 (95% CI: 0.68, 0.87); P < 0.001] and further adjustment for antenatal care (ANC) utilization [OR = 0.82 (95% CI: 0.72, 0.94); P < 0.001]. This corresponded to a 41-g [(95% CI: 2 g, 80 g); P < 0.05] increase in birth weight, which attenuated to 28 g [(95% CI: -12 g, 68 g); P = 0.71] after additional adjustment for ANC. At the population level in a context where the burden of anemia is severe (prevalence ≥40%), IFA during pregnancy was significantly associated with decreased LBW. Measures to improve the implementation of this simple intervention should help to address India's burden of LBW.

Multiple-micronutrient supplementation for women during pregnancy

BACKGROUND

Multiple-micronutrient deficiencies often coexist in low- to middle-income countries. They are exacerbated in pregnancy due to the increased demands, leading to potentially adverse effects on the mother. Substantive evidence regarding the effectiveness of multiple-micronutrient supplements (MMS) during pregnancy is not available.

OBJECTIVES

To evaluate the benefits to both mother and infant of multiple-micronutrient supplements in pregnancy and to assess the risk of adverse events as a result of supplementation.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (17 February 2012) and reference lists of retrieved articles and key reviews. We also contacted experts in the field for additional and ongoing trials.

SELECTION CRITERIA

All prospective randomised controlled trials evaluating multiple-micronutrient supplementation during pregnancy and its effects on the pregnancy outcome, irrespective of language or publication status of the trials. We included cluster-randomised trials but quasi-randomised trials were excluded.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trials for inclusion and trial quality. Two review authors independently extracted the data. Data were checked for accuracy.

MAIN RESULTS

Twenty-three trials (involving 76,532 women) were identified as eligible for inclusion in this review but only 21 trials (involving 75,785 women) contributed data to the review.When compared with iron and folate supplementation, MMS resulted in a statistically significant decrease in the number of low birthweight babies (risk ratio (RR) 0.89; 95% confidence interval (CI) 0.83 to 0.94) and small-for-gestational age (SGA) babies (RR 0.87; 95% CI 0.81 to 0.95). No statistically significant differences were shown for other maternal and pregnancy outcomes: preterm births RR 0.99 (95% CI 0.96 to 1.02), miscarriage RR 0.90 (95% CI 0.79 to 1.02), maternal mortality RR 0.97 (95% CI 0.63 to 1.48), perinatal mortality RR 0.99 (95% CI 0.84 to 1.16), stillbirths RR 0.96 (95% CI 0.86 to 1.07) and neonatal mortality RR 1.01 (95% CI 0.89 to 1.15).A number of prespecified clinically important outcomes could not be assessed due to insufficient or non-available data. These include placental abruption, congenital anomalies including neural tube defects, premature rupture of membranes, neurodevelopmental delay, very preterm births, cost of supplementation, side-effects of supplements, maternal well being or satisfaction, and nutritional status of children.

AUTHORS' CONCLUSIONS

Though multiple micronutrients have been found to have a significant beneficial impact on SGA and low birthweight babies, we still need more evidence to guide a universal policy change and to suggest replacement of routine iron and folate supplementation with a MMS. Future trials should be adequately powered to evaluate the effects on mortality and other morbidity outcomes. Trials should also assess the effect of variability between different combinations and dosages of micronutrients, keeping within the safe recommended levels. In regions with deficiency of a single micronutrient, evaluation of each micronutrient against a placebo in women already receiving iron with folic acid would be especially useful in justifying the inclusion of that micronutrient in routine antenatal care.

Trace elements and oxidative stress in hypertensive disorders of pregnancy

PURPOSE

Due to increased metabolic requests, pregnancy can be considered as metabolic stress, especially if associated with oxidative stress triggered by disbalance of pro/antioxidants. The aim of the study was to determine serum concentrations of the trace elements iron (Fe), zinc (Zn) and copper (Cu) important in growth regulation and pro/anti-oxidant homeostasis, in relation to the total serum oxidant capacity (TOC) and total serum antioxidant capacity (TAC) in pregnant women with preeclampsia (n = 30) or with gestational hypertension (n = 30) and in healthy pregnant women (n = 37) and non-pregnant women (n = 30) as control groups expecting common differences between all pregnant women and controls and between preeclampsia and the other pregnancies indicating specific disbalance of the oxidative stress and analyzed trace elements.

METHODS

Serum Fe was determined by spectrophotometric method, Cu and Zn were determined by atomic absorption spectrometry, TOC was determined by Enzymatic ANTIOX-CAP assay and TAC by Peroxide-activity assay.

RESULTS

Serum Cu and TOC were significantly higher while Zn was lower in all pregnant groups regardless of hypertensive disorders. Serum Fe and TAC concentrations were found to be significantly higher in pregnant women with preeclampsia compared to pregnant controls.

CONCLUSION

Increase of TOC in all pregnant women our study points to latent oxidative stress in pregnancy. Fe might have a role in etiopathogenesis of preeclampsia while the increase of TAC in the very beginning of preeclampsia might represent a stressdefence mechanism of the body. It has still to be revealed whether significantly higher serum Fe levels are associated with preeclampsia as a cause or as a consequence of this disorder.

Socioeconomic status and intake of energy and sodium are associated with calcium intake among pregnant women in Rafsanjan city, Iran

AIM

Calcium intake in developing countries is lower than that in developed countries. In Iran, inadequate calcium intake in the general population, especially among women, is a public health concern. This cross-sectional study examined the correlation between sociodemographic, obstetrical and lifestyle factors with calcium intake among pregnant women in Rafsanjan city, southeast Iran.

MATERIAL AND METHODS

A sample of 308 healthy pregnant women aged 18-35 years from seven urban health-care centers participated in the study. All women were measured for height and weight and interviewed for demographic and socioeconomic, obstetrical, lifestyle and dietary intake information while pre-pregnancy weight was obtained from prenatal record. Stepwise multiple regression was used to assess factors associated with calcium intake.

RESULTS

The mean daily calcium intake of women was 968.51±363.05mg/day and only 46.4% of the pregnant women met the dietary reference intakes of 1000 mg for calcium. Milk and milk products showed the greatest contribution to calcium intake (75.11%). Energy-adjusted calcium intake was positively associated with years of schooling (P<0.01), calorie (P<0.01) and energy-adjusted sodium (P<0.01) intakes.

CONCLUSION

This information would be useful in planning and developing appropriate strategies to improve calcium intake in pregnant women. Efforts to increase calcium intake in pregnant women should focus on promoting nutrient-dense food and making these foods available and accessible, particularly to socioeconomically deprived women.

Associations of Dietary Intake Levels with Ante-natal Depression in Pregnant Women

PURPOSE

This study was conducted to identify the association of dietary intake levels with ante-natal depression among pregnant women.

METHODS

Secondary data analysis was done using Can Pro software (version 3.0) to evaluate the diet intake levels with 24 hour recall diary method with 130 pregnant women visiting a general hospital. Statistical analysis included descriptive statistics, t-test, Mann-Whitney U test and adjusted logistic regression using the SPSS/WIN program.

RESULTS

Whole dietary intake levels of pregnant women were insufficient according to Recommended Nutrient Intake (RI) with the except of phosphorus intake. There were significant differences in RI by gestation period and high risk pregnancies. Non-depressed women showed more intake in niacin (z=1.33, p=.018) and zinc (t=3.99, p=.048) than depressed women did. Niacin was a significant determinant of ante-natal depression (Exp (B)=5.88, p=.47, 95% CI [1.02~23.83]).

CONCLUSION

Dietary intake assessment would be necessary during pregnancies for the screening of ante-natal depression. For ante-natal depression care, a tailored dietary intervention should be applied for women with insufficient nutrient intake.

Critical issues in setting micronutrient recommendations for pregnant women: an insight

The European Micronutrient Recommendations Aligned (EURRECA) Network aims to provide standardized approaches to reveal and beneficially influence variability within the European Union in micronutrient recommendations for vulnerable population groups. Characterization of the 'vulnerability' together with the 'variability' of micronutrient needs represents the first step to creating guidelines for setting micronutrient recommendations within target populations. This paper describes some of the key factors and characteristics relevant to assess micronutrient requirements and formulate recommendations of micronutrients in pregnancy. Nutritional requirements during pregnancy increase to support fetal growth and development as well as maternal metabolism and tissue accretion. Micronutrients are involved in both embryonal and fetal organ development and overall pregnancy outcomes. Several factors may affect directly or indirectly fetal nourishment and the overall pregnancy outcomes, such as the quality of diet including intakes and bioavailability of micronutrients, maternal age, and the overall environment. The bioavailability of micronutrients during pregnancy varies depending on specific metabolic mechanisms because pregnancy is an anabolic and dynamic state orchestrated via hormones acting for both redirection of nutrients to highly specialized maternal tissues and transfer of nutrients to the developing fetus. The timing of prenatal intakes or supplementations of specific micronutrients is also crucial as pregnancy is characterized by different stages that represent a continuum, up to lactation and beyond. Consequently, nutrition during pregnancy might have long-lasting effects on the well-being of the mother and the fetus, and may further influence the health of the baby at a later age.

Serum reference levels of selenium, zinc and copper in healthy pregnant women at a prenatal screening program in southeastern Mediterranean region of Turkey

PROJECT

The aim of the study was to investigate the serum reference range for Selenium (Se), Zinc (Zn) and Copper (Cu) levels in women of 10-14 (group I) and 16-20 (group II) weeks of gestation and compare them with those in non-pregnant healthy women and healthy men.

PROCEDURE

This cross-sectional study was performed in 351 pregnant women [group I (n: 177) and group II (n: 174)], 30 non-pregnant women and 30 men as controls. The levels of Se, Zn and Cu levels were determined on flame and furnace atomic absorption spectrophotometer using Zeeman background correction.

RESULTS

In the 10-14 weeks of gestation Se, Zn and Cu serum levels were 44.85+/-9.23, 81.30+/-31.94 and 132.33+/-38.24 microg/dl, in 16-20 weeks of gestation were 47.18+/-10.92, 74.25+/-22.47 and 164.86+/-39.69 microg/dl, in non-pregnant women were 55.38+/-8.81, 121.41+/-29.22 and 104.75+/-39.14 microg/dl also in men 72.24+/-9.28, 134.85+/-15.95 and 78.29+/-20.90 microg/dl, respectively.

CONCLUSION

A significant low level of serum Se, Zn and a high level of Cu in the pregnant women in the 10-14 and 16-20 weeks of gestation were detected when compared with that of non-pregnant women and men.

Assessment of dietary intake among pregnant women in a rural area of western China

BACKGROUND

Adequate maternal nutrient intake during pregnancy is important to ensure satisfactory birth outcomes. There are no data available on the usual dietary intake among pregnant women in rural China. The present study describes and evaluates the dietary intake in a cohort of pregnant women living in two counties of rural Shaanxi, western China.

METHODS

1420 pregnant women were recruited from a trial that examined the effects of micronutrient supplementation on birth outcomes. Dietary information was collected at the end of their trimester or after delivery with an interviewed-administrated semi-quantitative food frequency questionnaire (FFQ). Nutrients intake was calculated from the FFQ and compared to the Estimated Average Requirements (EAR). The EAR cut-offs based on the Chinese Nutrition Society Dietary Reference Intakes (DRIs) were used to assess the prevalence of inadequate dietary intakes of energy, protein, calcium, zinc, riboflavin, vitamin C and folate. Mann-Whitney U and Kruskal Wallis tests were used to compare nutrient intakes across subgroups.

RESULTS

The mean nutrient intakes assessed by the FFQ was similar to those reported in the 2002 Chinese National Nutrition and Health Survey from women living in rural areas except for low intakes of protein, fat, iron and zinc. Of the participants, 54% were at risk of inadequate intake of energy. There were high proportions of pregnant women who did not have adequate intakes of folate (97%) and zinc (91%). Using the "probability approach", 64% of subjects had an inadequate consumption of iron.

CONCLUSION

These results reveal that the majority of pregnant women in these two counties had low intakes of nutrients that are essential for pregnancy such as iron and folate.

TRIAL REGISTRATION

ISRCTN08850194.

Regulation of folate receptor 1 gene expression in the visceral endoderm

BACKGROUND

Nutrient supply to the developing mammalian embryo is a fundamental requirement. Before completion of the chorioallantoic placenta, the visceral endoderm plays a crucial role in nurturing the embryo. We have found that visceral endoderm cells express folate receptor 1, a high-affinity receptor for the essential micronutrient folic acid, suggesting that the visceral endoderm has an important function for folate transport to the embryo. The mechanisms that direct expression of FOLR1 in the visceral endoderm are unknown.

METHODS

Sequences were tested for transcriptional activation capabilities in the visceral endoderm utilizing reporter gene assays in a cell model for extraembryonic endoderm in vitro, and in transgenic mice in vivo.

RESULTS

With F9 embryo carcinoma cells as a model for extraembryonic endoderm, we demonstrate that the P4 promoter of the human FOLR1 gene is active during differentiation of the cells towards visceral endoderm. However, transgenic mouse experiments show that promoter sequences alone are insufficient to elicit reporter gene transcription in vivo. Using sequence conservation as guide to choose genomic sequences from the human FOLR1 gene locus, we demonstrate that the sequence termed F1CE2 exhibits specific enhancer activity in F9 cells in vitro, in the visceral endoderm, and later the yolk sac in transgenic mouse embryos in vivo. We further show that the transcription factor HNF4-alpha can activate this enhancer sequence.

CONCLUSIONS

We have identified a transcriptional enhancer sequence from the FOLR1 locus with specific activity in vitro and in vivo, and suggest that FOLR1 is a target for regulation by HNF4-alpha.

Effects of prenatal multimicronutrient supplementation on pregnancy outcomes: a meta-analysis

BACKGROUND

Reduced intake of micronutrients during pregnancy exposes women to nutritional deficiencies and may affect fetal growth. We conducted a systematic review to examine the efficacy of prenatal supplementation with multimicronutrients on pregnancy outcomes.

METHODS

We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library for relevant articles published in English up to December 2008. We also searched the bibliographies of selected articles as well as clinical trial registries. The primary outcome was low birth weight; secondary outcomes were preterm birth, small-for-gestational-age infants, birth weight and gestational age.

RESULTS

We observed a significant reduction in the risk of low birth weight among infants born to women who received multimicronutrients during pregnancy compared with placebo (relative risk [RR] 0.81, 95% confidence interval [CI] 0.73-0.91) or iron-folic acid supplementation (RR 0.83, 95% CI 0.74-0.93). Birth weight was significantly higher among infants whose mothers were in the multimicronutrient group than among those whose mothers received iron-folic acid supplementation (weighted mean difference 54 g, 95% CI 36 g-72 g). There was no significant differences in the risk of preterm birth or small-for-gestational-age infants between the 3 study groups.

INTERPRETATION

Prenatal multimicronutrient supplementation was associated with a significantly reduced risk of low birth weight and with improved birth weight when compared with iron-folic acid supplementation. There was no significant effect of multimicronutrient supplementation on the risk of preterm birth or small-for-gestational-age infants.

Determinants of compliance to antenatal micronutrient supplementation and women's perceptions of supplement use in rural Nepal

OBJECTIVE

We examined factors affecting compliance to antenatal micronutrient supplementation and women's perceptions of supplement use.

DESIGN

Randomized controlled supplementation trial of four alternative combinations of micronutrients given during pregnancy through to 3 months postpartum. Women were visited twice weekly to monitor compliance and to replenish tablets by female study workers. At 6 weeks postpartum women with live births (n 4096) were interviewed regarding their perceptions of the supplement. Median compliance calculated as percentage of total eligible doses received by women was high (84 %).

SETTING

Rural southern Nepal.

SUBJECTS

Pregnant women.

RESULTS

Women with high compliance (above the median of 84 %) were likely to be older, less educated, poorer, undernourished, belong to lower caste and of Pahadi (hill) ethnicity compared with women with low compliance (at or below the median of 84 %). Smoking and drinking alcohol in the past week during pregnancy were strongly associated with low compliance. The major reason for irregular intake was forgetting to take supplements. A higher proportion of the high compliers liked taking the supplements but only half of them were willing to purchase them in the future. A large proportion of women (91 %) perceived a benefit from taking the supplement such as improved strength and health, whereas only about 10 % perceived any side-effects which were not a major barrier to compliance.

CONCLUSIONS

The present analysis highlights that poor, undernourished, uneducated women can have high compliance to antenatal supplementation if they are supplied with the tablets and reminded to take them regularly, and counselled about side-effects.

Effects of maternal multimicronutrient supplementation on the mental development of infants in rural western China: follow-up evaluation of a double-blind, randomized, controlled trial

OBJECTIVE

We investigated the benefits of maternal multimicronutrient supplementation during gestation on the mental and psychomotor development of infants.

METHODS

In a double-blind, randomized, controlled trial, pregnant women (N = 5828) in 2 rural counties in western China were assigned randomly to receive multimicronutrient (5 minerals and 10 vitamins at levels approximating the recommended daily allowance), folic acid plus iron, or folic acid supplementation daily from approximately 14 weeks of gestation until delivery. We assessed a subset of the newborns (N = 1305) from the 3 supplementation groups by measuring their mental and psychomotor development with the Bayley Scales of Infant Development, at 3, 6, and 12 months of age. Multilevel analyses were used to compare the mental development and psychomotor development raw scores at 3, 6, and 12 months.

RESULTS

Multimicronutrient supplementation was associated with mean increases in mental development raw scores for infants at 1 year of age of 1.00 and 1.22 points, compared with folic acid only and folic acid plus iron supplementation, respectively. However, supplementation did not increase significantly the psychomotor development raw scores up to 1 year of age.

CONCLUSION

Compared with iron and folic acid supplementation, the administration of multimicronutrients to pregnant women improved the mental development of their children at 1 year of age.

Impact of micronutrient supplementation during pregnancy on birth weight, duration of gestation, and perinatal mortality in rural western China: double blind cluster randomised controlled trial

OBJECTIVE

To examine the impact of antenatal supplementation with multiple micronutrients or iron and folic acid compared with folic acid alone on birth weight, duration of gestation, and maternal haemoglobin concentration in the third trimester.

DESIGN

Cluster randomised double blind controlled trial.

SETTING

Two rural counties in north west China.

PARTICIPANTS

5828 pregnant women and 4697 live births.

INTERVENTIONS

Villages were randomised for all pregnant women to take either daily folic acid (control), iron with folic acid, or multiple micronutrients with a recommended allowance of 15 vitamins and minerals.

MAIN OUTCOME MEASURES

Birth weight, length, and head circumference measured within 72 hours after delivery. Neonatal survival assessed at the six week follow-up visit.

RESULTS

Birth weight was 42 g (95% confidence interval 7 to 78 g) higher in the multiple micronutrients group compared with the folic acid group. Duration of gestation was 0.23 weeks (0.10 to 0.36 weeks) longer in the iron-folic acid group and 0.19 weeks (0.06 to 0.32 weeks) longer in the multiple micronutrients group. Iron-folic acid was associated with a significantly reduced risk of early preterm delivery (<34 weeks) (relative risk 0.50, 0.27 to 0.94, P=0.031). There was a significant increase in haemoglobin concentration in both iron-folic acid (5.0 g/l, 2.0 to 8.0 g/l, P=0.001) and multiple micronutrients (6.9 g/l, 4.1 to 9.6 g/l, P<0.001) groups compared with folic acid alone. In post hoc analyses there were no significant differences for perinatal mortality, but iron-folic acid was associated with a significantly reduced early neonatal mortality by 54% (relative risk 0.46, 0.21 to 0.98).

CONCLUSION

In rural populations in China antenatal supplementation with iron-folic acid was associated with longer gestation and a reduction in early neonatal mortality compared with folic acid. Multiple micronutrients were associated with modestly increased birth weight compared with folic acid, but, despite this weight gain, there was no significant reduction in early neonatal mortality. Pregnant women in developing countries need sufficient doses of iron in nutrient supplements to maximise reductions in neonatal mortality. Trial registration ISRCTN08850194.

Evaluation of the microelement profile of Turkish hazelnut (Corylus avellana L.) varieties for human nutrition and health

In this study, the levels of boron (B), cobalt (Co), copper (Cu), chromium (Cr), iron (Fe), lithium (Li), nickel (Ni), selenium (Se) and zinc (Zn) microelements in 16 hazelnut samples were determined by inductively coupled plasma mass spectrometry and atomic absorption spectroscopy after microwave digestion, and are discussed for human nutrition and health. Significant differences were observed between the microelement contents of the 16 varieties (P < 0.01). The average microelements concentrations in the varieties varied in the following ranges: B, 13.63-23.87; Co, 0.47-0.82; Cr, 0.22-0.52; Cu, 16.23-32.23; Fe, 31.60-51.60; Li, 0.035-0.042; Ni, 0.58-2.58; Se, 0.96-1.39; and Zn, 22.03-44.03 mg/kg. These results showed that hazelnuts can be an important microelement source for human nutrition and health. According to our trace element data, a daily consumption of 50 g hazelnut can supply easily about 6% for B, 9% for Co, 19% for Fe, 9% for Ni and 16% for Zn of the recommended daily allowance. On the other hand, Se, Cu and Cr levels of 50 g hazelnuts are higher than the respective daily requirements, but slight overdoses of these elements are non-toxic for human health.

Iodine requirements during pregnancy, lactation and the neonatal period and indicators of optimal iodine nutrition

OBJECTIVE

This paper re-evaluates the requirements for iodine during pregnancy, lactation and the neonatal period, and formulates original proposals for the median concentrations of urinary iodine (UI) that indicate optimal iodine nutrition during these three critical periods of life. This paper also discusses the measurements that are used to explore thyroid functions during the same periods.

DESIGN

An extensive and critical review of the literature on thyroid physiopathology during the perinatal period.

SETTING

Human studies conducted in various regions throughout the world.

SUBJECTS

Pregnant women, lactating women, and newborns.

RESULTS

The following proposals are made after extensive review of the literature: the requirement for iodine by the mother during pregnancy is 250-300 microg day-1; during lactation the requirement is 225-350 microg day-1; and during the neonatal period the requirement of the infant is 90 microg day-1. The median UI that indicates an optimal iodine nutrition during these three periods should be in the range of 150-230 microg day-1. These figures are higher than recommended to date by the international agencies.

CONCLUSIONS

Pregnant women and young infants, but especially the second group, are more sensitive to the effects of an iodine deficiency (ID) than the general population because their serum thyroid-stimulating hormone (TSH) and thyroxine are increased and decreased, respectively, for degrees of ID that do not seem to affect thyroid function in the general population. Systematic neonatal thyroid screening using primary TSH could be the most sensitive indicator to monitor the process of ID control.

Effect of maternal multiple micronutrient supplementation on fetal loss and infant death in Indonesia: a double-blind cluster-randomised trial

BACKGROUND

Maternal nutrient supplementation in developing countries is generally restricted to provision of iron and folic acid (IFA). Change in practice toward supplementation with multiple micronutrients (MMN) has been hindered by little evidence of the effects of MMN on fetal loss and infant death. We assessed the effect of maternal supplementation with MMN, compared with IFA, on fetal loss and infant death in the setting of routine prenatal care services.

METHODS

In a double-blind cluster-randomised trial in Lombok, Indonesia, we randomly assigned 262 midwives to distribute IFA (n=15 ,86) or MMN (n=15,804) supplements to 31 290 pregnant women through government prenatal care services that were strengthened by training and community-based advocacy. Women obtained supplements, to be taken daily, every month from enrolment to 90 days post partum. The primary outcome was early infant mortality (deaths until 90 days post partum). Secondary outcomes were neonatal mortality, fetal loss (abortions and stillbirths), and low birthweight. Analysis was by intention to treat. The study is registered as an International Standard Randomised Controlled Trial, number ISRCTN34151616.

FINDINGS

Infants of women consuming MMN supplements had an 18% reduction in early infant mortality compared with those of women given IFA (35.5 deaths per 1000 livebirths vs 43 per 1000; relative risk [RR] 0.82, 95% CI 0.70-0.95, p=0.010). Infants whose mothers were undernourished (mid upper arm circumference <23.5 cm) or anaemic (haemoglobin <110 g/L) at enrolment had a reduction in early infant mortality of 25% (RR 0.75, 0.62-0.90, p=0.0021) and 38% (RR 0.62, 0.49-0.78, p<0.0001), respectively. Combined fetal loss and neonatal deaths were reduced by 11% (RR 0.89, 0.81-1.00, p=0.045), with significant effects in undernourished (RR 0.85, 0.73-0.98, p=0.022) or anaemic (RR 0.71, 0.58-0.87, p=0.0010) women. A cohort of 11 101 infants weighed within 1 h of birth showed a 14% (RR 0.86, 0.73-1.01, p=0.060) decreased risk of low birthweight for those in the MMN group, with a 33% (RR 0.67, 0.51-0.89, p=0.0062) decrease for infants of women anaemic at enrolment.

INTERPRETATION

Maternal MMN supplementation, as compared with IFA, can reduce early infant mortality, especially in undernourished and anaemic women. Maternal MMN supplementation might therefore be an important part of overall strengthening of prenatal-care programmes.

Mercury exposure from fish consumption within the Japanese and Korean communities

Public health guidance pertaining to fish consumption requires that we be cognizant of the health concerns associated with eating contaminated fish and the nutritional benefits obtained from fish consumption. In doing so, a need exists for an improved understanding of the extent of contamination within various fish species consumed by populations of concern and the extent of exposure to contamination by these populations. As part of the Arsenic Mercury Intake Biometric Study involving the Japanese and Korean communities, it was possible to obtain fish intake data, determine mercury (Hg) fish tissue concentrations for various species consumed, and examine hair for Hg levels of study participants. This longitudinal study (n = 214) included 106 Japanese and 108 Korean women of childbearing age. Hair Hg levels for the two populations and weight-normalized, species-specific, individual-consumption pattern data that estimated Hg intake levels were compared with published National Health and Nutrition Examination Survey (NHANES) data. Sensitivity analyses and population-specific probabilistic assessments of exposure were conducted. The estimated Hg intake levels for the Japanese (0.09 microg/kg/d) and Koreans (0.05 microg/kg/d) were above the NHANES estimates (0.02 microg/kg/d), as were the hair Hg levels (1.23, 0.61, 0.2 ppm, respectively). Results indicate that (1) there are significant differences between the fish-species-consumption behavior of these two populations; (2) even when fish-consumption rates are equal between two populations, Hg intakes between them can vary significantly; and (3) these population and Hg intake differences present public health challenges when attempting to provide fish consumption guidance.

Is cooking food in iron pots an appropriate solution for the control of anaemia in developing countries? A randomised clinical trial in Benin

OBJECTIVE

To evaluate the effect of two types of iron pots on haemoglobin (Hb) and serum ferritin (SF) concentrations in young children (6-24 months), adolescent girls (11-15 years) and women of reproductive age (15-44 years), whose households were provided with iron pots for cooking food over a period of 6 months, compared with controls.

DESIGN AND METHODS

We randomly assigned 161 households including 339 individuals from the three subgroups to cast iron pots, blue steel pots or oral iron supplements (control). In the control group, children received micronutrient Sprinkles, and adolescent girls and women received iron tablets daily for 6 months. We measured Hb, SF and C-reactive protein concentrations at baseline and 6 months, and compared groups using regression models.

RESULTS

Anaemia prevalence (Hb < 110 g l(-1) in infants, Hb < 120 g l(-1) in girls or women) was 47% (cast iron group), 50% (blue steel group) and 50% (control) at baseline. At 6 months, there were no significant differences in Hb concentrations among groups; however, differences in SF concentrations were significant (P < 0.0001)--the control group had higher SF concentrations compared with the groups using iron pots. Also, differences in the prevalence of iron-deficiency anaemia (IDA; anaemia plus SF < 15 microg l(-1)) were almost significant between cast iron and control groups (P = 0.08), and blue steel and control groups (P = 0.05).

CONCLUSION

There is no evidence that iron cooking pots are effective against IDA. Further research is warranted to determine whether the iron leached from the pots is bioavailable.

Micronutrientes na gestação e lactação

Vitamina A, ferro e zinco são micronutrientes essenciais ao pleno funcionamento do organismo humano. Durante o período gestacional, seus requerimentos encontram-se aumentados devido ao intenso crescimento e proliferação celular e, durante a lactação, o leite materno constitui a mais importante fonte destes nutrientes para o recém-nascido e lactente. O atendimento às necessidades nutricionais do grupo materno-infantil, considerado como grupo de risco, para o desenvolvimento de carências nutricionais, deve ser uma preocupação dos profissionais de saúde, e a prevenção e o diagnóstico precoce da deficiência de micronutrientes reveste-se de extrema importância. Este trabalho objetiva revisar informações disponíveis na literatura acerca do papel da vitamina A, do ferro e do zinco na gestação e lactação, enfatizando os agravos à saúde decorrentes de sua deficiência e o papel da suplementação no combate ao estado carencial desses micronutrientes. Foram pesquisadas as bases de dados MEDLINE e LILACS, utilizando os decritores: "vitamin A", "iron", "zinc", "deficiency", "pregnancy", "lactation", "newborn", "anemia" e "micronutrient", no período 1966 a 2004. Sugerem-se medidas que concorram para a modificação das práticas alimentares e da qualidade da dieta como estratégia de combate à deficiência de micronutrientes e incluídas no elenco de ações universais da atenção pré-natal. Tais ações podem produzir benefícios para a saúde materno-infantil e contribuir para a redução dos níveis de morbi-mortalidade no binômio mãe-filho.

Contribution of selected vitamins and trace elements to immune function

Adequate intakes of vitamins and trace elements are required for the immune system to function efficiently. Micronutrient deficiency suppresses immune functions by affecting the innate T-cell-mediated immune response and adaptive antibody response, and leads to dysregulation of the balanced host response. This increases the susceptibility to infections, with increased morbidity and mortality. In turn, infections aggravate micronutrient deficiencies by reducing nutrient intake, increasing losses, and interfering with utilization by altering metabolic pathways. Insufficient intake of micronutrients occurs in people with eating disorders, in smokers (both active and passive), in individuals with chronic alcohol abuse, in patients with certain diseases, during pregnancy and lactation, and in the elderly. With aging a variety of changes are observed in the immune system, which translate into less effective innate and adaptive immune responses and increased susceptibility to infections. Antioxidant vitamins and trace elements (vitamins C, E, selenium, copper, and zinc) counteract potential damage caused by reactive oxygen species to cellular tissues and modulate immune cell function through regulation of redox-sensitive transcription factors and affect production of cytokines and prostaglandins. Adequate intake of vitamins B(6), folate, B(12), C, E, and of selenium, zinc, copper, and iron supports a Th1 cytokine-mediated immune response with sufficient production of proinflammatory cytokines, which maintains an effective immune response and avoids a shift to an anti-inflammatory Th2 cell-mediated immune response and an increased risk of extracellular infections. Supplementation with these micronutrients reverses the Th2 cell-mediated immune response to a proinflammatory Th1 cytokine-regulated response with enhanced innate immunity. Vitamins A and D play important roles in both cell-mediated and humoral antibody response and support a Th2-mediated anti-inflammatory cytokine profile. Vitamin A deficiency impairs both innate immunity (mucosal epithelial regeneration) and adaptive immune response to infection resulting in an impaired ability to counteract extracellular pathogens. Vitamin D deficiency is correlated with a higher susceptibility to infections due to impaired localized innate immunity and defects in antigen-specific cellular immune response. Overall, inadequate intake and status of these vitamins and minerals may lead to suppressed immunity, which predisposes to infections and aggravates malnutrition.

Effects of fish-oil and folate supplementation of pregnant women on maternal and fetal plasma concentrations of docosahexaenoic acid and eicosapentaenoic acid: a European randomized multicenter trial

BACKGROUND

Pregnant women usually meet their increased energy needs but do not always meet their increased micronutrient requirements. The supply of both folic acid and docosahexaenoic acid (DHA) has been related to positive pregnancy and infant outcomes.

OBJECTIVE

We aimed to assess whether fish-oil (FO) supplementation with or without folate from gestation week 22 to birth improves maternal and fetal n-3 long-chain polyunsaturated fatty acid (n-3 LC-PUFA) status.

DESIGN

We conducted a multicenter (Germany, Hungary, and Spain), randomized, double-blind, 2 x 2 factorial, placebo-controlled trial. From gestation week 22 until delivery, 311 pregnant women received daily a preparation with FO [0.5 g DHA and 0.15 g eicosapentaenoic acid (EPA)], 400 microg methyltetrahydrofolic acid (MTHF), FO with MTHF, or placebo. Outcome measures included maternal and cord plasma DHA and EPA contents at gestation weeks 20 and 30 and at delivery, indicators of pregnancy outcome, and fetal development.

RESULTS

FO significantly (P<0.001) increased maternal DHA and EPA (% by wt), as shown by 3-factor repeated-measures ANOVA (ie, MTHF, FO, and time) with adjustment for maternal baseline DHA and EPA. In addition, FO significantly (P<0.001) increased cord blood DHA (% by wt; 2-factor ANOVA). MTHF was significantly (P=0.046) associated with increased maternal DHA (% by wt). There was no FO x MTHF interaction for the time course of DHA or EPA (P=0.927 and 0.893). Pregnancy outcomes and fetal development did not differ significantly among the intervention groups.

CONCLUSIONS

FO supplementation from gestation week 22 until delivery improves fetal n-3 LC-PUFA status and attenuates depletion of maternal stores. MTHF may further enhance maternal n-3 LC-PUFA proportions.

Lactating Women Restricting Milk Are Low on Select Nutrients

OBJECTIVE

Currently there are no recommendations for vitamin/mineral supplementation for lactating women but supplementation may be important, particularly for those women who choose to restrict milk intake during lactation. The objective of this study was to assess nutrient adequacy for lactating women and compare their dietary intake, including supplements, between those who restrict milk and those who do not.

METHODS

A cohort of 175 healthy exclusively breast-feeding women (19-45 yrs) recruited from prenatal classes were divided into milk restrictors (RS) defined as milk intake < or = 250 ml/day and non-restrictors (NRS) (>250 ml/day) and followed for six months postpartum. Participants provided repeated 24-hr dietary recalls, detailed use of vitamin/mineral supplements and reasons for restricting milk.

STATISTICAL ANALYSES

Observed intakes were adjusted to remove day-to-day variability. Nutrient intakes were estimated for macronutrients and vitamins C, D, thiamin, riboflavin, niacin, and minerals, calcium and zinc, with and without vitamin/mineral supplements. Chi-square was used to compare the number of RS and NRS with intakes less than the Estimated Average Requirement (EAR).

RESULTS

Milk restriction was practiced by 23% of the sample. Sixty per cent of RS reported protein intakes <EAR compared to 38% of NRS (chi(2) = 6.22, p < 0.05). Prior to supplementation, mean levels of calcium and vitamin D intakes for RS were below the adequate intake level (AI) and lower than NRS estimated intakes (p < 0.05). Following supplementation, mean levels of these nutrients reached AI for both groups. RS remained lower than NRS. RS had lower energy intakes than NRS (p < 0.05) but no difference in weight loss at 6 months was noted. A higher proportion of RS were below the EAR for thiamin, riboflavin and zinc.

CONCLUSIONS

Milk restriction compromised protein and nutrient intakes in lactating women who restricted milk to <250 mL. Vitamin/mineral supplements helped exclusively breastfeeding milk restrictors improve their vitamin D and calcium intakes. Milk restriction is not recommended during lactation and where unavoidable, nutrients provided by milk should be compensated for by other foods or supplements.