Untitled Quiz

The Need for Vitamins and Minerals During Pregnancy

• Inadequate folate intake is associated with anemia and reduced fetal growth.
• Folate functions in metabolic reactions.
• Folate deficiencies can lead to congenital abnormalities.
• Folate status can be assessed by serum and red cell folate levels.
• Dietary sources of folate include vegetables and fruits.
• The recommended intake of folate during pregnancy is 600 mcg DFE (Dietary Folate Equivalents).

Dietary Folate Equivalents (DFE)

• 1 mcg DFE comes from food folate.
• 0.6 mcg DFE comes from folic acid consumed in fortified food or with a supplement taken with food.
• 0.5 mcg DFE comes from folic acid taken as a supplement on an empty stomach.

Neural Tube Defects (NTDs)

• NTDs occur due to the failure of the neural tube to close early in gestation.
• Worldwide, 300,000 cases of NTDs occur, with 3,000 cases in the United States.
• NTDs are diagnosed using alpha-fetoprotein and fetal ultrasound.
• NTDs involve the interaction of genetic and environmental factors.
• Folic acid has a protective effect against NTDs when taken at 4mg per day.
• NTDs include Anencephaly and Spina Bifida.
• Neural tube closes between days 22-29 of gestation
• Lack of folic acid or other nutrients (vitamin B12, magnesium, zinc, etc.) may cause NTDs.
• Other causes of NTDs include obesity and glucose intolerance/diabetes.
• Genetic factors, such as the MTHFR genotype, also contribute to NTDs.
• Hispanic Americans present a remaining risk group for neural tube defects.
• Women taking the anti-seizure drug valproate without appropriate folic acid supplementation are a risk group for neural tube defects.
• Women who have previously delivered an infant with a neural tube defect also present a remaining risk group.

Effect of Increased Folate Fortification

• A study published in JAMA in 2001 (285:2981) examined live births and NTDs per 100,000 live births.
• From 1990-1999, there were 37.8 NTDs per 100,000 live births.
• From 1998-2001, this number decreased to 30.5.
• Increased folate fortification resulted in a 19% reduction of NTDs.

The Need for Vitamins and Minerals During Pregnancy: Choline

• Choline is a B-complex vitamin.
• The Recommended Daily Allowance (RDA) for choline is 450 mg.

The Need for Vitamins and Minerals During Pregnancy: Vitamin A

• Vitamin A supports the baby's embryonic growth, including the heart, lungs, kidneys, eyes, and bones, as well as the circulatory, respiratory, and central nervous systems.
• Vitamin A helps with postpartum tissue repair.
• Vitamin A helps maintain eyesight, fights infections, supports the immune system, and helps with fat metabolism.
• A healthy daily intake of vitamin A for pregnant women is approximately 4000 IUs, and should not exceed 8000 IUs.
• Vitamin A deficiency and high vitamin A intake can lead to birth defects.

The Need for Vitamins and Minerals During Pregnancy: Vitamin D

• Vitamin D supports fetal growth.
• The RDA for Vitamin D is 15 mcg (600 IU).
• The upper limit for Vitamin D intake during pregnancy is 4000 IU.
• Calcium is needed for fetal skeletal and maternal bones mineralization
• Consuming three cups of milk or calcium-fortified soymilk can meet calcium needs.
• Vitamin D deficiency during pregnancy could cause smaller size, poorly calcified bones and abnormal enamel, dental cavities.
• Higher risk for miscarriage, preeclampsia, preterm birth, maternal infection is associated with vitamin D deficiency.
• Vitamin D deficiency difference exists in different racial and ethnic groups.
• Obese women have an increased risk of Vitamin D deficiency.
• Vegan women have an increased risk for Vitamin D deficiency.

The Need for Vitamins and Minerals During Pregnancy: Iron

• Iron need increases substantially during pregnancy: 300 mg for fetus and placenta, 250 mg lost at delivery, and 450 mg for increased red blood cell mass.
• Iron deficiency is marked by depleted iron stores and characterized by weakness, fatigue, short attention span, poor appetite, increased susceptibility to infection, and irritability.
• Iron-deficiency anemia is marked by low hemoglobin and characterized by signs of iron deficiency plus paleness, exhaustion, and rapid heart rate.
• Iron-deficiency anemia increases the risk of preterm delivery and low birth weight, and related to lower scores on intelligence, language, gross motor, and attention tests
• Women who take iron supplements have, on average, 40 percent less risk of ovulatory infertility than those who do not.
• Regular consumption of vitamin C can improve iron status.
• The amount of iron needed during pregnancy is 18 to 27 milligrams (mg) per day
• A 30 mg daily supplement of elemental iron as a preventive dose is recommended.
• Iron deficiency can cause Mild anemia which may not have any effect on pregnancy and labor.
• Moderate anemia may cause increased weakness, lack of energy, fatigue and poor work performance.
• Severe anemia, palpitations, tachycardia, breathlessness, increased cardiac output leading on to cardiac stress which can cause de-compensation and cardiac failure which may be fetal
• Iron deficiencies can cause an increased risk of preterm delivery and low birth weight.
• Higher risk of stillbirth or newborn death can result from iron deficiencies.
• Maternal anemia can affect a baby's iron stores at birth, increasing his risk for future anemia

Recommendations for Iron Supplementation in Pregnancy

• A 30-mg iron supplement daily to prevent deficiencies

The Need for Vitamins and Minerals During Pregnancy: Iodine

• Iodine is required for thyroid function, energy production, and fetal brain development.

The Need for Vitamins and Minerals During Pregnancy: Sodium

• Sodium plays a critical role in maintaining the body's water balance.
• Restriction of sodium intake is not typically indicated in normal pregnancy or for the control of edema or high blood pressure.

Energy and Nutrient Needs During Pregnancy

• Moderate amounts of coffee intake, such as three cups daily, do not appear to pose a risk.
• Water needs during pregnancy may be met by increased levels of thirst, with an average consumption of nine cups of fluid per day.