Importance of breast feeding.

1. Influence of mineral and vitamin
supplements on pregnancy outcome
Presented by: Nabiilah Naraino Majie &
Joorawon Svenia
Date: 26/01/16

2. • Introduction
• Methods
• Minerals
– Iron, calcium, magnesium, zinc, selenium
• Vitamins
– Vitamin A, B-Complex (B1,B6), folate, B12,C,E &
D
• Multiple micronutrients
• Comments
• Conclusion
Table of Content

3. Introduction
• Nutrient metabolism and energy requirements should be
continuously and physiologically adjusted during pregnancy as
the pre-pregnancy nutritional status affects maternal health
and fetal growth.
• Fetal growth is mainly affected by low pre-pregnancy body
mass index and low gestational weight gain.
• Malnourished women have increased risk for fetal disorders
and nutrition of pregnant women is controlled.
• Mineral and vitamin supplements are usually given to prevent
fetal diseases.
• Since deficiencies in minerals and vitamins influence
pregnancy outcome, indications for nutritional support were
investigated.

4. Methodology
• Data was screened non-systematically
through
Journals about nutrition
Observational studies
Meta-analysis
Randomised controlled trials
Reviews

5. MINERALS
• Minerals are chemical elements required by humans’
body to maintain physical health and life functions.
• Classified into major (macrominerals) and trace
elements.
• Major minerals  sodium, chloride, potassium,
calcium, phosphorus and magnesium.
• Trace elements  iron, zinc, iodine, selenium, copper
and fluorine. These are needed in smaller amounts.

6. Iron
• Compulsory for haemoglobin synthesis and proper
functioning of organs.
• Being the most prevalent nutrient deficiency in the
world, lack of Fe affects more than 50% of pregnant
women.
• Major impact of this deficiency is the inhibition of fetal
growth as neonatal Fe depends on status of maternal
Fe.
• This leads to anaemia, intrauterine growth retardation,
neonates small for gestational age and oxidative
damage to fetal erythrocytes. Cortisol production as well
as maternal and fetal stress are increased.

7. Iron
• Prolonged gestational Fe deficiency leads to cognitive
and behavioural problems in childhood.
• Fe is supplemented in case of low haemoglobin and
plasma ferritin.
• Surplus of Fe increases the risk for gestational DM and
preterm delivery.
• Sources include red meats, dark green leafy
vegetables and dried fruits.

8. Calcium
• Essential for bone development, muscle and cell membrane
functions, nerve impulse transmission and blood coagulation.
• Ca demand is increased during pregnancy as it is needed for
mobilisation from skeleton and doubling of intestinal
absorption.
• Hypocalcaemia causes pre-eclampsia and intrauterine growth
retardation but it occurs rare in pregnant women.
• However, statistics reveals that low birth weight can be
associated with low intake of milk and vitamin D during
pregnancy.
• Sources: milk and dairy products.

9. Magnesium
• Common enzyme cofactor and activator, Mg is needed for
muscle contraction, nerve transmission and protein
manufacture.
• Mg deficiency during pregnancy interrupts fetal growth and
development which eventually causes haematological and
teratogenic harm.
• Diabetic pregnant women with hypomagnesaemia increases
the risk for both maternal and fetal hypoparathyroidism and
hypocalcaemia.
• Sources: nuts, green leafy vegetables and chocolates.

10. Zinc
• Required for the activity of about 100 enzymes, Zn has also
antioxidant properties, protects immune system and is involved
in embryogenesis and growth.
• Gestational Zn deficiency affects fetal growth which can lead to
severe teratogenic effects.
• Fetal demand for Zn occurs through absorption in intestine but
the transfer of Zn depends on the maintenance of maternal Zn
concentration.
• Zn absorption is altered by high intake of Fe, GI dysfunction
and cereal-based diets rich in phytate.
• Excess of Zn during pregnancy can increase birth weight of
neonates.
• Sources: meat, poultry, fish and whole grains.

11. Selenium
• Requested for its good antioxidant properties, Se protects the
immune and reproductive systems.
• Low level of Se during pregnancy is associated with pre-
eclampsia, intrauterine growth retardation and abortion.
• Studies have proved that Se supplementation decreases the
prevalence for pre-eclampsia.
• Sources: seafood, grains and meat.

12. VITAMINS
• Organic compounds
– Fat soluble or water soluble
• Required in small quantities
• Support of normal physiologic functions
• Humans do not biosynthesize enough to meet the needs of the
body
• 20-30% of pregnant women suffer from vitamin deficiency
• About 75% vitamin deficiency was observed without
prophylaxis
• In a study, despite vitamin supplementations, reduced level of
vit A, B6, B3, B1, and B12 was observed during all pregnancy
trimesters.

13. Vitamin A
• Fat soluble vitamin essential for the following:
– Gene regulation, cell differentiation, proliferation and growth, innate and
adaptive immune system, maintenance of mucosal surfaces, intestinal iron
uptake, haematopoiesis, vision and reproduction.
• Vit A deficiency is prevalent in developing countries while
overdose is mostly common in developed countries.
• Vit A is beneficial in right amount while teratogenic in high
amount
– The recommended dose is 5000 IU/day;
– High doses (8000-10000 IU/day) may not result in malformations
• Vit A supplementation lead to improvement in birth weight and
growth is observed among infants born to HIV-infected women
due to enhanced immunity.

14. Vitamin B1-Thiamine
• Water soluble
• Acts as coenzyme essential in metabolism and lipid &
nucleotide synthesis
• Deficiency is more common in developing countries
especially during pregnancy which may result in impairment
of brain development and impair fetal growth
• Higher level are encountered in fetus than in maternal blood
due to specific active placental transport systems.
• However, there is lack of data on the role of Vit B1 in
pregnancy.

15. Vitamin B6
• Also known as pyridoxine, pyridoxal & pyridoxamine
• Water soluble- works as coenzyme in protein metabolism in
the development of CNS
• Deficiencies do not occur alone but with deficiencies of B-
Complex vitamins
– Pre-eclampsia, gestational carbohydrate intolerance, hyperemesia,
gravidarum, & neuronal disease of infants.
• Clinical benefits of Vit B6 supplementation in pregnancy has
not been detected
– One trial suggested protection against dental decay.

16. Folate
• Water soluble
• Co-enzymatic role in carbon metabolism and in synthesis of
DNA, RNA and certain amino acids.
• Deficiency is prevalent in developing countries
– 25% of pregnant women in India
– Lead to congenital malformations and complications in pregnancy
• Daily supplemental dose of 400ug/day is recommended
– Higher doses (5mg) is recommended in conditions such as obesity,
diabetes & epilepsy
• Study showed that folate supplementation in pregnancy
resulted in reduced congenital anomalies

17. Vitamin B12-Cobalamine
• Important support for erythropoiesis
• Increased prevalence in low plasma B12 during pregnancy
• Long term vegetarian pregnant women have an increased risk
of Vit B12 deficiency.
• Decline in plasma cobalamine despite an adequate diet
resulting in –ve fetal outcome
– Alterations in haptocorrin-bound cobalamine
– Impairment of intestinal absorption
• Strong association between fetal and maternal plasma at
delivery
– Maternal B12 levels affects fetal vitamin level at birth
– Low level  reduced fetal growth

18. Vitamins C & E
• Vit C (water-soluble; ascorbic acid) and Vit E (fat-soluble; a-
tocopherol) are powerful antioxidants for prevention & treatment
of pre-eclampsia (PE) caused by oxidative stress
• Increased Ox. markers and decreased in Vit C (<85mg) & E in
PE
• From a report Use of any antioxidants lead to 39% decreased
risk of PE
• From other survey
– Use of Vit C & E suppl. in pregnancy does not reduce risk of PE
– Vit E may increase incidence of PE due to ability to induce Th1 cytokines
(pro-inflammatory)
– Use of Vit E may cause gestational hypertension, LBW, placental ischemia
• Vit C may be advantageous but Vit E is not recommended

19. Vitamin D
• Fat-soluble; Important role in immune function, cell
differentiation, bone growth & reduction of inflammation.
• Essential for calcium homeostasis & reduction of chronic
diseases.
• Biologically inactive  metabolised to active form
– 25-hydroxyvitamin [25(OH)D]
• 40% African American women and 4% caucasian-non-hispanic
women have low plasma Vit D conc.
• Deficiency is associated with osteomalacia, poor fetal and
infant skeletal growth & tooth mineralisation.
• No evidence in general suppl. has been found except that it
improve neonatal handling of Ca in population at risk.

20. Multiple micronutrients (MMN)
• Micronutrient deficiencies are caused due to
– Unavailability of adequate food quality
– Cultural differences
– Seasonal variations
– Poverty & infection in a population
• Several studies showed improved pregnancy upon use of
MMN e.g. reduced LBW.
• Large scale blood tests are scarce thus little are known
about the range & extent of nutrient deficiencies
• Evidence from studies shows that prevalent deficiencies of
Ca, Fe, Vit D, A, Zn and folate are most common in
developing countries.

21. Comments
• Vitamin suppl. considered solely as health promoting
• Deficiencies may result in morbidity
– Negative consequences to fetus & child health
– Effect of vitamins in pregnancy is poorly understood but vit treatment can
be curative
• Quantification of individual food component are difficult and
unreliable
– Non-homogenous population
– MMN may contain unnecessary and harmful overdoses
– Nutrient interactions are numerous
– Despite antioxidant properties of vit C & E; may lead to complication
• MMN important to prevent adverse pregnancy outcome are:
folic acid, Zn, Fe.

22. Conclusion
• Substitution therapy and supplementation may be beneficial
during pregnancy but deficiencies should be sought
• Pre- and early pregnancy folate suppl. has been confirmed
via reliable studies
• Fe treatment in Fe deficiency also has beneficial effects
• Vegetarian pregnant women lacks Vit B12, thus suppl. is
needed.
• Vit D and C are beneficial in PE treatment but Vit E is not
recommended.

23. References
• ANON, 2014. Minerals: Their functions and sources-
Topic overview. WebMD [online]. Available from:
http://www.webmd.com/vitamins-and-
supplements/tc/minerals-their-functions-and-sources-
topic-overview [Accessed on 22 January 2016].
• HOVDENAK, N., HARAM, K., 2012. Influence of mineral
and vitamin supplements on pregnancy outcome.
European Journal of Obstetrics & Gynecology and
Reproductive Biology; 164(2012), 127-132.