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Thakur GK, Shankar H, Arora TK, Kulkarni B. Role of mineral nutrients other than iron in pregnancy: under recognized opportunities to improve maternal/fetal outcomes: a literature review. Arch Gynecol Obstet 2024; 309:895-905. [PMID: 37698602 DOI: 10.1007/s00404-023-07183-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/02/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Anemia during pregnancy is an important global health concern, affecting 40% of women worldwide, and iron deficiency shares a significant proportion of the burden. From conception to birth, pregnancy is a period when women undergo metabolic and physiological changes. The nutritional needs are higher during pregnancy; thus, adequate nutrition is essential to maintain fetal growth and development. However, adverse effects due to deficiency in nutrition during pregnancy can result in maternal, fetal and neonatal complications. Despite the multifactorial etiology of anemia, iron deficiency is assumed as the primary cause of anemia during pregnancy and hence, mitigation strategy pivots around it for anemia management. Therefore, excluding other contributors, a single-micronutrient approach with iron supplements remains a myopic approach and this can exacerbate iron deficiency anemia. Micronutrient deficiencies are of particular concern as they may pose a silent threat to the survival and well-being of reproductive-age women and their infants. AIM Micronutrients, especially trace minerals, play a myriad of roles in pregnancy, and the lack of each one causes adverse complications to both the mother and the fetus. In this review paper, we attempt to piece together available information regarding the adverse effects of abnormal trace mineral levels along with iron deficiency on the mother and the fetus. METHOD A non-systematic literature search in PubMed, Google Scholar, and the Cochrane databases, for publications on minerals and vitamins during pregnancy and the possible influence of supplements on pregnancy outcomes. CONCLUSION Micronutrient deficiency exacerbates the pregnancy-induced anemia and other adverse birth outcomes. Micronutrient supplementation during pregnancy can combat anemia as well as reduce a number of adverse pregnancy outcomes in a comprehensive manner.
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Affiliation(s)
- Gaurav Kr Thakur
- RBMCH Division, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India
| | - Hari Shankar
- Central Procurement Cell, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India.
| | - Taruna K Arora
- RBMCH Division, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India.
| | - Bharati Kulkarni
- RBMCH Division, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India
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Santoso DPJ, Nugrahani AD, Siddiq A, Pramatirta AY, Aziz MA, Irianti S, Pribadi A, Anwar AD, Effendi JS. Effect of maternal serum magnesium and calcium levels on umbilical glial fibrillary acidic protein levels in preterm labor. Sci Rep 2023; 13:13337. [PMID: 37587163 PMCID: PMC10432514 DOI: 10.1038/s41598-023-40022-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023] Open
Abstract
Magnesium can prevent astrocyte cell death and Glial Fibrillary Acidic Protein (GFAP) secretion as inflammatory marker in preterm delivery. This study was performed to analyze differences in umbilical cord GFAP levels in preterm labor given magnesium sulfate (MgSO4) as treatment group and control group and analyze the correlation between magnesium and calcium levels with umbilical GFAP levels. This quasi-experimental study was performed on 68 patients at Dr. Hasan Sadikin General Hospital from February-June 2021 consisting of 34 patients in each group. Maternal-umbilical cord magnesium levels, calcium levels, and GFAP levels were examined using ELISA test. The result was statistically measured by IBM SPSS 24.0. We found that there was a significant difference between maternal and umbilical magnesium levels and GFAP umbilical cord blood levels between the treatment and the control group (P < 0.05) in which GFAP level was higher in the control group. The multivariate analysis showed no significant relevance between mother magnesium and calcium level to umbilical cord GFAP level in the MgSO4 group. As conclusions, umbilical cord blood GFAP levels in preterm labor given MgSO4 were lower than in preterm deliveries who were not given MgSO4. There was no correlation between magnesium, calcium, and GFAP levels in the treatment group.
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Affiliation(s)
- Dhanny Primantara Johari Santoso
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynaecology, Slamet General District Hospital Garut, Faculty of Medicine, Padjadjaran University - Dr. Hasan Sadikin General Hospital, Pasteur No. 38, Bandung, 40161, West Java, Indonesia.
| | - Annisa Dewi Nugrahani
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynaecology, Slamet General District Hospital Garut, Faculty of Medicine, Padjadjaran University - Dr. Hasan Sadikin General Hospital, Pasteur No. 38, Bandung, 40161, West Java, Indonesia
| | - Amillia Siddiq
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynaecology, Faculty of Medicine, Padjadjaran University - Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Akhmad Yogi Pramatirta
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynaecology, Faculty of Medicine, Padjadjaran University - Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Muhammad Alamsyah Aziz
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynaecology, Faculty of Medicine, Padjadjaran University - Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Setyorini Irianti
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynaecology, Faculty of Medicine, Padjadjaran University - Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Adhi Pribadi
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynaecology, Faculty of Medicine, Padjadjaran University - Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Anita Deborah Anwar
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynaecology, Faculty of Medicine, Padjadjaran University - Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Jusuf Sulaeman Effendi
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynaecology, Faculty of Medicine, Padjadjaran University - Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
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Yarsilikal Guleroglu F, Balkan Ozmen A, Ekmez M, Cetin A. Relationship between Maternal Serum Calcium and Magnesium Levels and Isolated Fetal Echogenic Intracardiac Focus Encountered During Second-trimester Ultrasound Screening. HASEKI TIP BÜLTENI 2022. [DOI: 10.4274/haseki.galenos.2021.7841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Wang JJ, Wang O, Wang YB, Yang J, Song A, Jiang Y, Li M, Xia WB, Xing XP. Changes in Serum Calcium and Treatment of Hypoparathyroidism During Pregnancy and Lactation: A Single-center Case Series. J Clin Endocrinol Metab 2021; 106:e5054-e5063. [PMID: 34279662 DOI: 10.1210/clinem/dgab530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hypoparathyroidism (hypo-PT) is rare, and studies on hypo-PT, especially during pregnancy and lactation, are limited. DESIGN AND SETTING This was a retrospective study on a relatively large case series in a single center from mainland China. METHODS A total of 19 patients with 25 pregnancies, diagnosed with hypo-PT before pregnancy, were enrolled. Data on clinical characteristics and treatment strategies at onset time and around pregnancy period were collected. RESULTS During pregnancy, except for 2 patients with missing data, 5 patients with 6 pregnancies (6/23, 26.1%) experienced improved hypo-PT condition, defined as an increased serum calcium level; 4 patients with 4 pregnancies (4/23, 17.4%) experienced worsened hypo-PT condition, defined as a more than 0.2 mmol/L decline in the serum calcium level; and 3 patients with 3 pregnancies (3/23, 13.0%) remained in stable hypo-PT condition. The prevalence of adverse pregnancy outcomes was 30.4% (4/23 for preterm delivery; 3/23 for miscarriage). The serum calcium and 24-hour urine calcium levels significantly increased during lactation compared with pregnancy (2.57 ± 0.34 vs 1.99 ± 0.11 mmol/L, P < 0.001; 12.28 ± 5.41 vs 8.63 ± 3.22 mmol/L, P = 0.013), and 5 patients with 5 lactations (5/12, 41.7%) developed hypercalcemia in the first 2 months after delivery. CONCLUSIONS Female patients with hypo-PT had different changes in calcium homeostasis and a high prevalence of adverse outcomes during pregnancy. Thus, they should be monitored closely to maintain the optimal serum calcium level. Decreasing drug dosage during the lactation period should be considered to avoid hypercalcemia.
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Affiliation(s)
- Jia-Jia Wang
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, China
| | - Ou Wang
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, China
| | - Ya-Bing Wang
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, China
| | - Jing Yang
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, China
| | - An Song
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, China
| | - Yan Jiang
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, China
| | - Mei Li
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, China
| | - Wei-Bo Xia
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, China
| | - Xiao-Ping Xing
- Department of Endocrinology, Key Laboratory of Endocrinology, National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, China
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Zubero MB, Llop S, Irizar A, Murcia M, Molinuevo A, Ballester F, Levi M, Lozano M, Ayerdi M, Santa-Marina L. Serum metal levels in a population of Spanish pregnant women. GACETA SANITARIA 2021; 36:468-476. [PMID: 34627659 DOI: 10.1016/j.gaceta.2021.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe serum levels of calcium, copper, selenium, magnesium, iron and zinc and evaluate their relationship with maternal socio-demographic characteristics and dietary variables in women in the first trimester of pregnancy. METHOD Cross-sectional study with 1279 participants from the INMA cohorts. RESULTS The concentrations of the elements analyzed were within the normal range. Associations with higher levels of these metals were found for calcium with white meat intake (p=0.026), for copper with excess body weight (p <0.01), low social class (p=0.03) and being multipara (p <0.01), for magnesium with being over 35 years old (p=0.001), high social class (p=0.044), primiparous status (p=0.002) and low daily intake of bread (p=0.009) and legumes (p=0.020); for zinc with university education (p=0.039) and residence in Gipuzkoa (p <0.01), and for selenium with residence in Valencia (p <0.01), university education (p=0.001), vitamin B6 supplementation (p=0.006), fish intake (> 71g/day) (p=0.014) and having been born in Spain (p=0.001). Further, lower iron levels were associated with being overweight (p=0.021) or obese (p <0.001) and vitamin B12 supplementation (p=0.006). CONCLUSIONS Our results suggest that trace elements in the analyzed cohorts are adequate for this stage of pregnancy. The variability in these elements is mainly linked to socio-demographic and anthropometric variables.
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Affiliation(s)
- Miren Begoña Zubero
- Preventive Medicine and Public Health Department, University of the Basque Country, Leioa, Bizkaia, Spain; Biodonostia, Health Research Institute, Donostia, Gipuzkoa, Spain
| | - Sabrina Llop
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I, Valencia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
| | - Amaia Irizar
- Biodonostia, Health Research Institute, Donostia, Gipuzkoa, Spain
| | - Mario Murcia
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I, Valencia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Amaia Molinuevo
- Biodonostia, Health Research Institute, Donostia, Gipuzkoa, Spain
| | - Ferrán Ballester
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I, Valencia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Department of Nursing and Chiropody, Universitat de València, València, Spain
| | - Michael Levi
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Manuel Lozano
- Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I, Valencia, Spain; Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine Department, Universitat de València, València, Spain
| | - Mikel Ayerdi
- Biodonostia, Health Research Institute, Donostia, Gipuzkoa, Spain; Department of Health of the Basque Government, Public Health Division of Gipuzkoa, Donostia, Gipuzkoa, Spain
| | - Loreto Santa-Marina
- Biodonostia, Health Research Institute, Donostia, Gipuzkoa, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Department of Health of the Basque Government, Public Health Division of Gipuzkoa, Donostia, Gipuzkoa, Spain
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Beluska-Turkan K, Korczak R, Hartell B, Moskal K, Maukonen J, Alexander DE, Salem N, Harkness L, Ayad W, Szaro J, Zhang K, Siriwardhana N. Nutritional Gaps and Supplementation in the First 1000 Days. Nutrients 2019; 11:E2891. [PMID: 31783636 PMCID: PMC6949907 DOI: 10.3390/nu11122891] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/13/2019] [Accepted: 11/19/2019] [Indexed: 12/23/2022] Open
Abstract
Optimized nutrition during the first 1000 days (from conception through the 2nd birthday) is critical for healthy development and a healthy life for the newborn. Pregnancy and the postpartum period are accompanied by physiological changes, increased energy needs, and changing requirements in the nutrients critical for optimal growth and development. Infants and toddlers also experience physiological changes and have specific nutritional needs. Food and nutrition experts can provide women of childbearing age with adequate dietary advice to optimize nutrition, as well as guidance on selecting appropriate dietary supplements. Considering the approaching 2020-2025 Dietary Guidelines for Americans (DGA) will be making specific recommendations for children, it is important to provide accurate scientific information to support health influencers in the field of nutrition. The purpose of this review is to summarize the nutrition and supplementation literature for the first 1000 days; to highlight nutritional and knowledge gaps; and to educate nutrition influencers to provide thoughtful guidance to mothers and families. Optimal nutrition during pregnancy through early childhood is critical for supporting a healthy life. Nutrition influencers, such as dietitians, obstetricians/gynecologists, and other relevant health professionals, should continue guiding supplement and food intake and work closely with expectant families and nutrition gatekeepers.
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Affiliation(s)
- Katrina Beluska-Turkan
- Church & Dwight, Co., Inc., Product Development Nutritional Sciences, Princeton, NJ 08540, USA; (K.B.-T.); (K.M.); (L.H.); (W.A.); (J.S.); (K.Z.)
| | - Renee Korczak
- Premier Nutrition, LLC, Bernardsville, NJ 07924, USA;
| | - Beth Hartell
- PearTree Nutrition, LLC, Seattle, WA 98115, USA;
| | - Kristin Moskal
- Church & Dwight, Co., Inc., Product Development Nutritional Sciences, Princeton, NJ 08540, USA; (K.B.-T.); (K.M.); (L.H.); (W.A.); (J.S.); (K.Z.)
| | | | | | - Norman Salem
- DSM Nutritional Products, Columbia, MD 21045, USA;
| | - Laura Harkness
- Church & Dwight, Co., Inc., Product Development Nutritional Sciences, Princeton, NJ 08540, USA; (K.B.-T.); (K.M.); (L.H.); (W.A.); (J.S.); (K.Z.)
| | - Wafaa Ayad
- Church & Dwight, Co., Inc., Product Development Nutritional Sciences, Princeton, NJ 08540, USA; (K.B.-T.); (K.M.); (L.H.); (W.A.); (J.S.); (K.Z.)
| | - Jacalyn Szaro
- Church & Dwight, Co., Inc., Product Development Nutritional Sciences, Princeton, NJ 08540, USA; (K.B.-T.); (K.M.); (L.H.); (W.A.); (J.S.); (K.Z.)
| | - Kelly Zhang
- Church & Dwight, Co., Inc., Product Development Nutritional Sciences, Princeton, NJ 08540, USA; (K.B.-T.); (K.M.); (L.H.); (W.A.); (J.S.); (K.Z.)
| | - Nalin Siriwardhana
- Church & Dwight, Co., Inc., Product Development Nutritional Sciences, Princeton, NJ 08540, USA; (K.B.-T.); (K.M.); (L.H.); (W.A.); (J.S.); (K.Z.)
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Anto EO, Roberts P, Coall D, Turpin CA, Adua E, Wang Y, Wang W. Integration of suboptimal health status evaluation as a criterion for prediction of preeclampsia is strongly recommended for healthcare management in pregnancy: a prospective cohort study in a Ghanaian population. EPMA J 2019; 10:211-226. [PMID: 31462939 DOI: 10.1007/s13167-019-00183-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/18/2019] [Indexed: 12/14/2022]
Abstract
Background Normotensive pregnancy may develop into preeclampsia (PE) and other adverse pregnancy complications (APCs), for which the causes are still unknown. Suboptimal health status (SHS), a physical state between health and disease, might contribute to the development and progression of PE. By integration of a routine health measure in this Ghanaian Suboptimal Health Cohort Study, we explored the usefulness of a 25-question item SHS questionnaire (SHSQ-25) for early screening and prediction of normotensive pregnant women (NTN-PW) likely to develop PE. Methods We assessed the overall health status among a cohort of 593 NTN-PW at baseline (10-20 weeks gestation) and followed them at 21-31 weeks until 32-42 weeks. After an average of 20 weeks follow-up, 498 participants returned and were included in the final analysis. Hematobiochemical, clinical and sociodemographic data were obtained. Results Of the 498 participants, 49.8% (248/498) had 'high SHS' at baseline (61.7% (153/248) later developed PE) and 38.3% (95/248) were NTN-PW, whereas 50.2% (250/498) had 'optimal health' (17.6% (44/250) later developed PE) and 82.4% (206/250) were NTN-PW. At baseline, high SHS score yielded a significantly (p < 0.05) increased adjusted odds ratio, a wider area under the curve (AUC) and a higher sensitivity and specificity for the prediction of PE (3.67; 0.898; 91.9% and 87.8%), PE coexisting with intrauterine growth restriction (2.86, 0.838; 91.5% and 75.9%), stillbirth (2.52; 0.783; 96.6% and 60.0%), hemolysis elevated liver enzymes and low platelet count (HELLP) syndrome (2.08; 0.800; 97.2% and 63.8%), acute kidney injury (2.20; 0.825; 95.3% and 70.0%) and dyslipidaemia (2.80; 0.8205; 95.7% and 68.4%) at 32-42 weeks gestation. Conclusions High SHS score is associated with increased incidence of PE; hence, SHSQ-25 can be used independently as a risk stratification tool for adverse pregnancy outcomes thereby creating an opportunity for predictive, preventive and personalized medicine.
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Affiliation(s)
- Enoch Odame Anto
- 1School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia.,2Department of Molecular Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Peter Roberts
- 1School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
| | - David Coall
- 1School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
| | | | - Eric Adua
- 1School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
| | - Youxin Wang
- 4Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Wei Wang
- 1School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia.,4Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China.,5School of Public Health, Taishan Medical University, Taian, China
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