Physiology of pregnancy and nutrient metabolism

Pregnancy increases urinary loss of carnitine and reduces plasma carnitine in Korean women

This study compared plasma and urinary carnitine concentrations in pregnant and non-pregnant Korean women. The subjects were fifty pregnant women and thirty non-pregnant women aged 24-28 years. During the first trimester, dietary carnitine intakes in the pregnant women were much lower than in non-pregnant women (70.00 (SD 29.22) micromol/d), but over the course of pregnancy carnitine intake increased from 44.64 (SD 24.84) micromol/d during the first trimester to 96.11 (SD 36.56) micromol/d during the third trimester. Pregnant women had a significantly lower plasma carnitine concentration than non-pregnant women. Plasma concentrations of non-esterified carnitine, acid-soluble acylcarnitine and total carnitine were significantly lower during the second and third trimesters than the first. Plasma acid-insoluble acylcarnitine levels, which tended to be higher in the non-pregnant women compared with the pregnant women, increased significantly as gestation proceeded. The urinary excretion of non-esterified carnitine, acid-soluble acylcarnitine and total carnitine was significantly higher in the pregnant women during the first and second trimesters than in non-pregnant women and decreased significantly as gestation proceeded. We found that there was a significant decrease in plasma carnitine level even though dietary carnitine intake increased as gestation proceeded. The low urinary excretion of carnitine in late pregnancy may be caused by an increased demand during pregnancy.

Maternal--neonatal serum selenium and copper levels in Greeks and Albanians

AIM

To evaluate selenium (Se) and copper (Cu) concentrations in Greek and Albanian immigrant mothers and in the cord blood of their newborns.

SUBJECTS AND METHODS

From 1118 Greek and 820 Albanian mothers and from the cord blood of their neonates blood was obtained for Se and Cu measurement. Se and Cu concentrations were determined in sera with graphite furnace atomic absorption spectroscopy (GFAAAS) and atomic absorption spectrometry, respectively. In all, 30 days' nutrient intakes were evaluated in both groups.

RESULTS

Animal protein, Se and Cu intakes were poor in the Albanians vs the Greeks (P < 0.001). Se concentrations in the Greek mothers (68.3 +/- 8.5 microg/l) and in their newborns (37.02 +/- 8.9 microg/l) were found higher as compared with those in Albanian mothers (37.4 +/- 9.9 microg/l) and in their newborns (34.3 +/- 9.1 microg/l) (P < 0.001). Cu levels were also found higher (P < 0.001) in the Greek mothers (1687 +/- 353 microg/l) and in their neonates (449 +/- 87 microg/l) compared with those in the Albanian mothers (959 +/- 318 microg/l) and in their newborns (229 +/- 67 microg/l). Additionally, 31.5% of neonates born to Albanian women with Se concentrations less than 28 microg/l had higher Se levels (P < 0.01) than their mothers.

CONCLUSIONS

The low Se and Cu levels evaluated in the Albanian mothers and their newborns could be related to their poor animal protein intake which could be the consequence of their low socioeconomic status. As an effective preventive measure, accurate dietetic strategies to assess the requirements of pregnant immigrant women for trace elements may be planned in Greece.

Status of plasma folate after folic acid fortification of the food supply in pregnant African American women and the influences of diet, smoking, and alcohol consumption

BACKGROUND

African American women and socioeconomically challenged women are at risk of compromised folate status and, thus, of folate-related birth defects. Data are limited on circulating folate concentrations in pregnant African American women after folic acid fortification of the food supply was implemented.

OBJECTIVE

The objective was to determine the influence of smoking and alcohol consumption on plasma 5-methyltetrahydrofolic acid (5-MTHFA) concentrations in pregnant African American women.

DESIGN

Alcohol consumption, smoking exposure, and other characteristics of pregnant African American women reporting to an inner-city antenatal clinic were assessed. At 24 wk of gestation, blood samples and food-frequency intake data were collected. Plasma 5-MTHFA concentrations were determined by liquid chromatography-mass spectrometry for 116 subjects and examined in a correlational study design.

RESULTS

Dietary folate and markers of alcohol consumption were positively associated, whereas exposure to smoke was negatively associated with plasma 5-MTHFA. More than one-half of the participants in this population failed to meet the recommended dietary allowance for dietary folate equivalents of 600 microg/d during pregnancy.

CONCLUSIONS

Most inner-city African American women are not meeting the recommended dietary allowance for dietary folate during pregnancy, and smoking may further compromise their folate status. Programs to reduce smoking and raise awareness about the importance of folate and multivitamin supplementation during pregnancy need to target this population.

Comparison of bloodstream fatty acid composition from African-American women at gestation, delivery, and postpartum

Our aim was to examine the docosahexaenoic acid (DHA; 22:6n-3) status of pregnant African-American women reporting to the antenatal clinic at Wayne State University in a longitudinal study design. Fatty acid compositions of plasma and erythrocyte total lipid extracts were determined and food frequency surveys were administered at 24 weeks of gestation, delivery, and 3 months postpartum for participants (n = 157). DHA (mean +/- SD) in the estimated total circulating plasma was similar at gestation (384 +/- 162 mg) and delivery (372 +/- 155 mg) but was significantly lower at 3 months postpartum (178 +/- 81 mg). The relative weight percentage of DHA and docosapentaenoic acid n-6 (DPAn-6; 22:5n-6) decreased postpartum, whereas their respective metabolic precursors, eicosapentaenoic acid (EPA; 20:5n-3) and arachidonic acid (AA; 20:4n-6), increased. Similar results were found in erythrocytes. Dietary intake of DHA throughout the study was estimated at 68 +/- 75 mg/day. The relative amounts of circulating DHA and DPAn-6 were increased during pregnancy compared with 3 months postpartum, possibly via increased synthesis from EPA and AA. The low dietary intake and blood levels of DHA in this population compared with others may not support optimal fetal DHA accretion and subsequent neural development.

Gestational diabetes and nutritional recommendations

The goals of medical nutrition therapy for gestational diabetes mellitus (GDM) are to meet the maternal and fetal nutritional needs, as well as to achieve and maintain optimal glycemic control. Nutrition requirements during pregnancy are similar for women with and without GDM. The American Diabetes Association and the American College of Obstetrics and Gynecology recommend nutrition therapy for GDM that emphasizes food choices to promote appropriate weight gain and normoglycemia without ketonuria, and moderate energy restriction for obese women. Current controversies in GDM nutrition therapy involve manipulation of dietary composition (amounts and types of carbohydrates and fats), gestational weight gain, and energy and carbohydrate restriction. Randomized controlled trials are needed to determine which dietary compositions and patterns promote normoglycemia as well as optimal maternal and infant outcomes. Until better evidence is available, nutrition therapy will remain a cornerstone of GDM management with potential benefits that cannot be fully realized in clinical practice.

Pregnancy and lactation

Pregnancy results in physiologic changes in almost all organ systems in the body mediated mainly by female sex hormones. Physiologic changes of pregnancy influence the dental management of women during pregnancy. Understanding these normal changes is essential for providing quality care for pregnant women. This review article briefly discusses the cardiovascular, respiratory, gastrointestinal, urogenital, endocrine, and oral physiologic changes that occur during normal gestation. A summary of current scientific knowledge of ionizing radiation is presented. Information about the compatibility, complications, and excretion of the common drugs during pregnancy is provided. Drugs and their usage during breast-feeding are also discussed. Guidelines for the management of a pregnant patient in the dental office are summarized.

A supply–demand model of fetal energy sufficiency predicts lipid profiles in male but not female Filipino adolescents

OBJECTIVE

To test the hypothesis that the balance between fetal nutritional demand and maternal nutritional supply during pregnancy will predict lipid profiles in offspring measured in adolescence.

SUBJECTS AND METHODS

A total of 296 male and 307 female Filipino offspring (aged 14-16 y) and mothers enrolled in a longitudinal birth cohort study (begun in 1983-84) had lipid profiles measured. Data on maternal height (as a proxy for offspring growth potential and thus fetal nutritional demand) and third trimester maternal arm fat area (as a proxy for maternal supply) were used to create four groups hypothesized to reflect a gradient of fetal energy sufficiency.

RESULTS

As fetal energy sufficiency increased among males, there was a decrease in total cholesterol (TC) (P<0.05 for trend), low-density lipoprotein cholesterol (LDL-C), and the ratios of TC/HDL-C cholesterol and LDL-C/HDL-C (all P<0.001), while HDL-C increased (P<0.05). Similar associations were identified when lipid levels were modeled as dichotomous 'high-risk' cut-points used in cardiovascular disease prevention in adolescents. These relationships were stronger, or only present, among offspring of mothers in the lower half of the third trimester energy intake distribution, and were independent of the child's current adiposity, dietary energy and fat intake, maturity, household income, and birth weight. In females, the supply-demand model did not predict any lipid outcome or clinical risk criteria.

CONCLUSIONS

Our findings in males support the hypothesis that the balance between fetal nutritional demand and maternal nutritional supply has implications for future lipid profiles. The lack of significant associations in females adds to mounting evidence for sex differences in lipid metabolism programming, and may reflect sex differences in fetal nutritional demand.

SPONSORSHIP

The National Science Foundation, the Mellon Foundation, the Nestle Foundation, and the Emory University Internationalization Program.

Nitrogen balance and delta15N: why you're not what you eat during pregnancy

Carbon (13C/12C) and nitrogen (15N/14N) stable isotope ratios were longitudinally measured in human hair that reflected the period from pre-conception to delivery in 10 pregnant women. There was no significant change in the delta13C results, but all subjects showed a decrease in delta15N values (-0.3 to -1.1 per thousand) during gestation. The mechanisms causing this decrease in hair delta15N have not been fully elucidated. However, since the delta15N values of dietary nitrogen and urea nitrogen are significantly lower compared to maternal tissues, it is hypothesized that the increased utilization of dietary and urea nitrogen for tissue synthesis during pregnancy resulted in a reduction of the steady state diet to a body trophic level effect by approximately 0.5-1 per thousand. An inverse correlation (R2 = 0.67) between hair delta15N and weight gain was also found, suggesting that positive nitrogen balance results in a reduction of delta15N values independent of diet. These results indicate that delta15N measurements have the ability to monitor not only dietary inputs, but also the nitrogen balance of an organism. A potential application of this technique is the detection of fertility patterns in modern and ancient species that have tissues that linearly record stable isotope ratios through time.

Effects of a combined micronutrient supplementation on maternal biological status and newborn anthropometrics measurements: a randomized double-blind, placebo-controlled trial in apparently healthy pregnant women

OBJECTIVE

To investigate the possible beneficial effects of a micronutrient supplementation to apparently healthy pregnant women on maternal biological status and new born anthropometric characteristics.

SETTING

Departments of Obstetric of the University Hospital of Grenoble (France) and Lyon (France), Laboratoire of Biology of Oxidative Stress, UFR de Pharmacie. Grenoble (France).

STUDY DESIGN

Double-blind, randomized placebo-controlled intervention trial.

SUBJECTS

A total of 100 apparently healthy pregnant women were recruited at 14+/-2 weeks of gestation to delivery. At the end, they were 65 women to follow out the study.

INTERVENTIONS

Daily consumption over gestation of a micronutrients supplement or placebo.

MAIN OUTCOME MEASURES

Plasma micronutrient levels and oxidative stress parameters were measured in mothers at 14 and 38 weeks of gestation. New born's anthropometric characteristics were measured at delivery.

RESULTS

In the supplemented group, folic acid, vitamin C, E, B2, B6 and beta-carotene levels were higher than in the placebo group. Oxidative stress parameters were not different between the groups. Birth weights were increased by 10% and the number of low newborn weights (<2700 g) decreased significantly when the mother received the supplementation. Maternal plasma Zn levels were positively correlated to the newborn heights.

CONCLUSION

A regular intake of a micronutrient supplement at nutritional dose may be sufficient to improve micronutrient status of apparently healthy pregnant women and could prevent low birth weight of newborn.

Role of the small intestine in postpartum weight retention in mice

BACKGROUND

Approximately 25% of women retain 5 kg of the weight gained during pregnancy, but the physiologic factors underlying excessive postpartum weight gain are not known.

OBJECTIVE

The objective of the study was to determine whether pregnancy-related adaptive increases in intestinal nutrient transport are retained after parturition and therefore contribute to postpartum weight gain.

DESIGN

We measured body weight and intestinal nutrient transport in virgin (V, control), primiparous (P, one pregnancy), and multiparous (M, 3 pregnancies) mice at parturition (day 1), during lactation (days 14 and 21), at weaning (day 28), after weaning (day 40), and during aging (days 70, 120, 200, and 300).

RESULTS

In M and P mice, body weight and the weight and length of the small intestine were greatest during lactation; they then decreased but did not return to prepregnancy values until 300 d after parturition. Intestinal villus heights were maximal at lactation and remained high < or = 200 d after parturition. Total intestinal transport capacity for D-glucose, D-fructose, and L-proline was also greatest during lactation, and the lactation-enhanced transport capacity was retained < or = 70 d after parturition. M mice retained more body weight and intestinal transport capacity postpartum than did P mice. Aging per se had little or no effect on body weight or intestinal weight, length, and nutrient transport. The dramatic, lactation-related increases in intestinal nutrient transport capacity were due mainly to increases in intestinal mass.

CONCLUSIONS

Postpartum retention of pregnancy- and lactation-related increases in intestinal nutrient uptake capacity may play a significant role in postpartum body weight retention. These adaptive increases may be cumulative and may result in greater weight retention in mice with multiple pregnancies.

Atividade física e gestação: saúde da gestante não atleta e crescimento fetal

São reconhecidos os benefícios da prática de atividade física sobre o ciclo vital, sem consenso quanto à gestação. Este artigo reviu considerações e efeitos da prática da atividade física durante a gestação sobre a saúde da gestante não-atleta e o feto. Foram utilizados os bancos de dados Medline e Pubmed referentes ao período 1992-2002. Dentre os benefícios, os artigos destacam: prevenção e redução de lombalgias, de dores das mãos e pés e estresse cardiovascular, fortalecimento da musculatura pélvica, redução de partos prematuros e cesáreas, maior flexibilidade e tolerância à dor, controle do ganho ponderal e elevação da auto-estima da gestante. No feto, observou-se aumento do peso ao nascer e melhoria da condição nutricional. Não se encontraram recomendações de necessidades nutricionais para a gestante não-atleta. Não existiu consenso quanto às necessidades nutricionais e o tipo de atividade física dessa gestante, sendo o exercício na água o mais indicado. Porém destacaram-se diversas contra-indicações da prática de exercícios na gestação. Concluiu-se que a atividade física, sendo regular, moderada e controlada desde o início da gestação, promove benefícios para a saúde materna e fetal.

Homocysteine and other plasma amino acids in preeclampsia and in pregnancies without complications

OBJECTIVES

To evaluate a). the plasma amino acid changes observed in pregnant women (n = 124) and b). the homocysteine and other amino acid changes in preeclampsic patients (n = 18), and to determine c) whether these changes were also evident in nonpregnant women with a prior history of preeclampsia (n = 18).

DESIGN AND METHODS

Case-control study. Plasma total homocysteine (tHcy): HPLC with fluorescence detection, and amino acids (AA): ion exchange chromatography.

RESULTS

a). Significantly lower absolute AA values were observed in the pregnant controls for homocysteine, total, essential, and nonessential AA compared with nonpregnant controls. b. In preeclampsia, significantly higher absolute values of tHcy, total, essential and nonessential AA were observed, but relative values referred to total AA were not different. These changes corrected after delivery.

CONCLUSIONS

Hyperhomocysteinemia and an increase in most AA levels were observed in preeclampsia. Relative AA values suggested that these changes might be explained by fluctuations in plasma volume. Abnormal AA levels corrected after delivery.

Position of the American Dietetic Association: nutrition and lifestyle for a healthy pregnancy outcome

It is the position of the American Dietetic Association that women of childbearing potential should maintain good nutritional status through a lifestyle that optimizes maternal health and reduces the risk of birth defects, suboptimal fetal growth and development, and chronic health problems in their children. The key components of a health-promoting lifestyle during pregnancy include appropriate weight gain; consumption of a variety of foods in accordance with the Food Guide Pyramid; appropriate and timely vitamin and mineral supplementation; avoidance of alcohol, tobacco, and other harmful substances; and safe food-handling. Prenatal weight gain within the Institute of Medicine (IOM) recommended ranges is associated with better pregnancy outcomes. The total energy needs during pregnancy range between 2,500 to 2,700 kcal a day for most women, but prepregnancy body mass index, rate of weight gain, maternal age, and physiological appetite must be considered in tailoring this recommendation to the individual. The consumption of more food to meet energy needs and the increased absorption and efficiency of nutrient utilization that occurs in pregnancy are generally adequate to meet the needs for most nutrients. However, vitamin and mineral supplementation is appropriate for some nutrients and situations. This statement also includes recommendations pertaining to use of alcohol, tobacco, caffeine, street drugs, and other substances during pregnancy; food safety; and management of common complaints during pregnancy and specific health problems. In particular for medical nutrition therapy, pregnant women with inappropriate weight gain, hyperemesis, poor dietary patterns, phenylketonuria (PKU), certain chronic health problems, or a history of substance abuse should be referred to a qualified dietetics professional.

Anesthetic considerations for a patient with compound heterozygous medium-chain Acyl-CoA dehydrogenase deficiency

IMPLICATIONS

We describe the anesthetic management of a parturient with compound heterozygous medium chain acyl-CoA dehydrogenase deficiency, the most common disorder of fatty acid metabolism.

Nitrogen balance of healthy Dutch women before and during pregnancy

BACKGROUND

Experimental studies including longitudinal nitrogen balance studies could provide insight into protein metabolism in pregnancy.

OBJECTIVE

Our aim was to determine the development of nitrogen balance during pregnancy compared with nitrogen balance before pregnancy in women consuming imposed constant diets. We also tracked changes in muscle mass and lean body mass by measuring urinary 3-methylhistidine (3-MeH) and urinary creatinine.

DESIGN

Nitrogen balance was determined over 8 d in 12 healthy Dutch women before pregnancy and at weeks 12, 23, and 34 of gestation. Complete daily diets were supplied during each balance period so that each subject's energy, protein, and macronutrient intakes were similar in amount and composition in all 4 balance periods.

RESULTS

Throughout pregnancy there was no significant change in loss of nitrogen in feces and therefore no change in protein digestibility. The amount of nitrogen excreted in urine in late pregnancy (11.0 +/- 1.4 g/d) was significantly (P < 0.01) less than in early pregnancy (12.6 +/- 1.3 g/d). Nitrogen retention increased toward term, even though energy balance became progressively negative. The difference between the first (-0.4 +/- 1.7 g N/d) and third (1.2 +/- 1.6 g N/d) trimester was significant (P < 0.05). No differences were found in either 3-MeH or creatinine excretion between trimesters.

CONCLUSIONS

These urinary nitrogen excretion and nitrogen retention data show that when the dietary supply remains constant, nitrogen balance increases toward the end of pregnancy, suggesting a more efficient use of dietary protein later in pregnancy. Urinary 3-MeH and creatinine excretion indicated no change in protein metabolism.

Psychosocial thriving during late pregnancy: relationship to ethnicity, gestational weight gain, and birth weight

OBJECTIVE

To test the relationships between psychosocial thriving (depressive symptoms, health-related lifestyle) and gestational weight gain and birth weight. To test the influences of ethnicity on the relationships between psychosocial thriving and gestational weight gain and birth weight.

DESIGN

Baseline data taken from the Austin New Mothers Study.

SETTING

A community hospital in Texas.

PARTICIPANTS

305 low-risk African American, Hispanic, and White women with full-term pregnancies, singleton births, and Medicaid coverage.

MAIN MEASURES

Center for Epidemiologic Studies Depression Scale, Self Care Inventory, Food Habits Questionnaire, gestational weight gain, and birth weight.

RESULTS

Newborns of African American women had lower birth weights (3,240 g) than newborns of Hispanic (3,422 g) or White women (3,472 g), even though no ethnic differences were found among the mothers on psychosocial variables. Late in pregnancy, women had high levels and prevalence (> 70%) of depressive symptoms regardless of ethnicity, and 50% exceeded recommended gestational weight gains. In full regression models, psychosocial variables were not significant predictors of gestational weight gain or birth weight. Ethnicity also was not a significant moderator of weight outcomes.

CONCLUSIONS

Psychosocial thriving late in pregnancy was unrelated to gestational weight gain or birth weight. Ethnicity did not moderate psychosocial-weight relationships. Although ethnic differences were not found on psychosocial variables, high levels of depressive symptoms and greater than recommended gestational weight gains were prevalent. These findings have implications for maternal health during and beyond pregnancy.

Low-abundance plasma and urinary [(15)N]urea enrichments analyzed by gas chromatography/combustion/isotope ratio mass spectrometry

We report a method for determining plasma und urinary [(15)N]urea enrichments in an abundance range between 0.37 and 0.52 (15)N atom% (0-0.15 atom% excess (APE) (15)N) using a dimethylaminomethylene derivative. Compared with conventional off-line preparation and (15)N analysis of urea, this method requires only small sample volumes (0.5 ml of plasma and 25 microl of urine). The (15)N/(14)N ratio of urea derivatives was measured by gas chromatography/combustion/isotope ratio mass spectrometry (GC/C/IRMS). Two peaks were separated; one was identified by gas chromatography/mass spectrometry (GC/MS) as the complete derivatized urea. Calibration of the complete urea derivative was performed by linear regression of enrichment values of known standard mixtures. Replicate standard (6-465 per thousand delta(15)N) derivatizations showed a relative standard deviation ranging from 0.1 to 7%. In order to test the feasibility of the method, human subjects and rats ingested a single meal containing either 200 mg of [(15)N]glycine (95 AP (15)N) or 0.4 mg of [(15)N]-alpha-lysine (95 AP (15)N), respectively. Urine and plasma were collected at hourly intervals over 7 h after the meal intake. After (15)N glycine intake, maximum urinary urea (15)N enrichments were 330 and 430 per thousand delta(15)N (0.12 and 0.16 APE (15)N) measured by GC/C/IRMS, whereas plasma [(15)N]glycine enrichments were 2.5 and 3.3 APE (15)N in the two human subjects 2 h after the meal. (15)N enrichments of total urine and urine samples devoid of ammonia were higher enriched than urinary [(15)N]urea measured by GC/C/IRMS, reflecting the presence of other urinary N-containing substances (e.g. creatinine). In rats plasma urea (15)N enrichments were 15-20 times higher than those in urinary urea (10-20 per thousand delta(15)N). The different [(15)N]urea enrichments observed after ingestion of [(15)N]-labeled glycine and lysine confirm known differences in the metabolism of these amino acids.

Does dietary protein in early life affect the development of adiposity in mammals?

This article examines the proposition that dietary protein in pre- and early postnatal life influences the development of adiposity in later life. In rodents, low protein intake during gestation can result in low birth weight and subsequently leads to various metabolic disturbances in adulthood, such as high blood pressure, impaired glucose tolerance and insulin resistance. The few controlled studies conducted in animals suggest that high protein or energy intake during gestation leads to low birth weights. Observational studies in humans have been inconclusive in establishing a relationship between dietary protein intake in pregnancy and effects on birth weight and adiposity of the offspring later in life. There is only weak epidemiological evidence linking high protein intake during early childhood and the development of obesity. By contrast, studies in domestic animals have found that higher levels of protein intake are often associated with lower rates of fat accretion. Additional studies are proposed to explore claims linking protein nutrition in early life to the postnatal development of obesity and disease in humans.

HIV and other predictors of serum beta-carotene and retinol in pregnancy: a cross-sectional study in Zimbabwe

BACKGROUND

Vitamin A status during pregnancy is important to maternal and infant health.

OBJECTIVE

Our goal was to identify predictors of serum beta-carotene and retinol.

DESIGN

This was a cross-sectional study of 1669 women (22-35 wk of gestation) in Harare, Zimbabwe, who were receiving prenatal care. The statistical effects of age, season, gestational age, gravidity, HIV-1 infection, malaria parasitemia, and serum alpha1-antichymotrypsin (ACT) on serum beta-carotene (log10 transformed) and retinol were estimated by using multiple linear regression analyses.

RESULTS

HIV infection was found in 31.5% of the women; 0.4% had malaria. Serum beta-carotene concentrations (geometric x: 0.19 micromol/L) were lower in HIV-infected women than in uninfected women (10beta = 0.78; 95% CI: 0.72, 0.84) and increased with age (10beta = 1.05; 1.02, 1.07) in gravida 1 but not in gravida > or =2 (P for interaction = 0.00002). Serum retinol (x: 0.92 micromol/L) increased with age (beta = 0.004; 0.0001, 0.008) in uninfected women but not in HIV-infected women (P for interaction = 0.02) and was 0.05-micromol/L (0.02, 0.09) lower in HIV-infected women than in uninfected women at 24 y of age. Furthermore, gestational age, season, use of prenatal supplements, and malaria were predictors of serum beta-carotene. Serum retinol was lower in women carrying male (beta = -0.04; -0.08, -0.00005) and multiple (beta = -0.21; -0.35, -0.08) fetuses. Serum ACT concentrations of 0.3-0.4, 0.4-0.5, and >0.5 g/L were associated with 3%, 11%, and 44% lower serum beta-carotene and 0.04-, 0.15-, and 0.41-micromol/L lower serum retinol. Serum ACT (g/L) was higher in women with malaria than in those without (beta = 0.10; 0.03, 0.16) and in gravida 1 than in gravida > or =2 (beta = 0.012; 0.003, 0.021), but was not higher in HIV-infected women than in uninfected women (beta = 0.001; -0.008, 0.011).

CONCLUSIONS

HIV infection, malaria, gravidity, and gestational age were predictors of serum beta-carotene and retinol. Serum ACT was an important predictor of both and was associated with gravidity and gestational age.

Micronutrients in pregnancy

Vitamins and minerals, referred to collectively as micronutrients, have important influences on the health of pregnant women and the growing fetus. Iron deficiency results in anemia which may increase the risk of death from hemorrhage during delivery, but its effects on fetal development and birth outcomes is still unclear. Folic acid deficiency can lead to hematological consequences, pregnancy complications and congenital malformations, but again the association with other birth outcomes is equivocal. Zinc deficiency has been associated in some, but not all studies with complications of pregnancy and delivery, as well as with growth retardation, congenital abnormalities and retarded neurobehavioral and immunological development in the fetus. Iodine deficiency during pregnancy results in cretinism and possible fetal wastage and preterm delivery. Deficiency of other minerals such as magnesium, selenium, copper, and calcium have also been associated with complications of pregnancy, childbirth or fetal development. Deficiencies of vitamins other than folate may likewise be related to such complications; and vitamin A or beta-carotene supplements in pregnancy reduced maternal mortality by 50 % in a controlled trial in Nepal. Additional research is need on the prevalence of such deficiencies and their consequences and on cost-effective public health interventions for their control.