Micronutrients In Pregnancy Research Articles

Supplementation with antioxidant micronutrients in pregnant women with obesity: a randomized controlled trial.

Obesity increases maternal morbidity and adversely affects child health. Maternal inflammation may play a role in adverse outcomes. The objective of this study was to determine whether providing a higher dose of antioxidant micronutrients to pregnant women with obesity would raise concentrations of key antioxidant vitamins and impact inflammation and oxidative stress during pregnancy. This was a double-blind, randomized controlled trial. We recruited pregnant women with a body mass index (BMI) ≥ 30 kg/m2 at their initial prenatal visit ( < 13 weeks gestation) and collected blood and urine samples at baseline, 24-28 weeks, and 32-36 weeks to measure micronutrient concentrations (vitamin C, E, B6 and folate), markers of inflammation (C-reactive protein, interleukin-6, 8, and 1β) and oxidative stress (8-epi-PGF2α and malondialdehyde). We collected maternal and infant health data from enrollment to delivery as secondary outcomes. We enrolled 128 participants (64 in each arm), and 98 (49 in each arm) completed follow-up through delivery. Both groups received a standard prenatal vitamin containing the recommended daily allowance of micronutrients in pregnancy. In addition, the intervention group received a supplement with 90 mg vitamin C, 30 αTU vitamin E, 18 mg vitamin B6, and 800 μg folic acid, and the control group received a placebo. The intervention group had higher vit B6 (log transformed (ln), β 24-28 weeks: 0.76 nmol/L (95% CI: 0.40, 1.12); β 32-36 weeks: 0.52 nmol/L (95% CI: 0.17, 0.88)) than the control group. Vitamins C, E, erythrocyte RBC folate concentrations did not differ by randomization group. The intervention did not impact biomarkers of inflammation or oxidative stress. There were no differences in maternal or neonatal clinical outcomes by randomization group. Higher concentrations of antioxidant vitamins during pregnancy increased specific micronutrients and did not impact maternal inflammation and oxidative stress, which may be related to dosing or type of supplementation provided. Clinical Trial Identification Number: NCT02802566; URL of the Registration Site: www. gov .

Recommendation and intake of dietary supplements periconceptional and during pregnancy: results of a nationwide survey of gynaecologists

BackgroundMicronutrient supplementation during pregnancy is a controversial issue. For some micronutrients, for example folic acid or iodine, the evidence regarding supplementation is clear, whereas for others, such as zinc or vitamin E, it is not. Studies show that a large number of pregnant women have deficient levels of folic acid and iodine. However, especially with folic acid, starting supplementation during the preconception period is crucial. It is, therefore, important that gynaecologists explain this to their pregnant or preconceptional patients. Our goal was to find out how gynaecologists make their recommendations on this topic, how they assess the compliance of their patients and which micronutrients they consider to be important before/during pregnancy and during breastfeeding.Method and ResultsWe sent about 12,000 questionnaires to all registered resident gynaecologists in Germany, with a response rate of 12.2%. Regarding which micronutrients gynaecologists consider to be particularly important during pregnancy, there was a broad agreement for both folic acid and iodine (> 88% answered yes). According to the questionnaire, doctors rate other micronutrients, such as vitamin D and omega-3 fatty acids, as less essential. The controversial evidence level for many micronutrients certainly plays a role here. Overall, the intake rate, especially for preconceptional women, is classified as rather low (< 60%). The most widely valued reason is the high price of dietary supplements. It was also noticeable that doctors consider certain micronutrients to be particularly important but then do not include them in the products they recommend.ConclusionOverall, there seems to be uncertainty about micronutrients in pregnancy and their supplementation. The study situation is often ambiguous and there are no official guidelines, leading to ambiguous recommendations from doctors and therefore low intake rates for pregnant or preconceptional women.

Micronutrients in Pregnancy after Bariatric Surgery: A Narrative Review.

Bariatric surgery is increasingly used in women of childbearing age due to the rising prevalence of obesity and the effectiveness and availability of this treatment. Pregnancy in women with previous bariatric surgery deserves special attention. Weight loss induced by surgery reduces the risks that obesity poses to pregnancy. But on the other hand, decreased intake and malabsorption may increase the risk of malnutrition and micronutrient deficiency and negatively affect maternal and foetal health. The aim of this narrative review is to provide an updated analysis of the impact of different bariatric surgery techniques on mineral and micronutrient nutritional status during pregnancy and the possible effect on maternal-foetal health.

Correlation between Selected Micronutrient Status in Maternal Blood and Cord Blood of Newborn from a Tertiary Care Hospital in West Bengal, India: A Cross-sectional Study

Introduction: The demand for most micronutrients increases during pregnancy for obvious reasons. Micronutrients like copper and zinc are indispensable co-factors for various enzymes in metabolism. The reduction in the concentration of serum iron and ferritin is a common phenomenon in pregnancy, and early diagnosis is crucial for favourable maternal and foetal outcomes. However, there is a dearth of studies on the metabolism of micronutrients in pregnancy. Aim: The aim of this cross-sectional study, conducted from July 2018 to February 2019 in the Department of Gynaecology and Obstetrics and the Department of Biochemistry, College of Medicine and Sagore Dutta Hospital, West Bengal, India, was to assess the serum levels of copper, zinc, and iron in maternal serum and foetal cord blood. Additionally, the study aimed to correlate the concentrations of these micronutrients between maternal serum and foetal cord blood. Materials and Methods: A total of 336 pregnant women of childbearing age, irrespective of gravida, were included in the study. Blood samples were collected from the pregnant women, and cord blood samples were collected from the foetal end in clot vials for the estimation of copper, zinc, and iron levels. Correlation was assessed between the concentration of these micronutrients in maternal serum and cord blood of the newborn. Data normality was determined using the Shapiro-Wilk normality tests, and the significance level was set at p-value ≤0.05. Results: The study included a total of 336 pregnant women in the age group of 18-33 years, with a mean age of 29.72±4.39 years. In maternal serum, the mean concentration of copper was 122.79±33.67 μg/dL, zinc was 78.47±27.62 μg/dL, and iron was 114.5±45.05 μg/dL. In foetal cord blood, the mean concentration of copper was 48.02±16.37 μg/dL, zinc was 75.82±27.64 μg/dL, and iron was 185.30±52.74 μg/dL. The correlation coefficients between maternal serum and foetal cord blood concentrations were statistically significant for zinc and iron (p-value&lt;0.05). Additionally, the correlation was statistically significant for copper (p-value=0.030). The mean concentration of haemoglobin in maternal serum was 10.9±1.96 g/dL, compared to 14.05±2.13 g/dL in cord blood. The mean maternal serum ferritin was 73.53±56.15 μg/L, and the mean cord blood ferritin was 147.21±61.13 μg/L. Conclusion: The study demonstrated a positive correlation between the concentrations of iron and zinc in maternal serum and foetal cord blood, while a negative correlation was observed for copper concentration.

Dietary Intakes of Folate, Vitamin D and Iodine during the First Trimester of Pregnancy and the Association between Supplement Use and Demographic Characteristics amongst White Caucasian Women Living with Obesity in the UK

Folate, vitamin D and iodine are key micronutrients in pregnancy, with deficiency associated with poor maternal and infant outcomes. For folate and vitamin D especially, deficiency is more common amongst women with obesity and recommended intakes and guidance on supplementation varies worldwide. The present study aims to investigate dietary and supplementary intakes of these micronutrients amongst a population of pregnant women with obesity in the United Kingdom, alongside key maternal demographic characteristics. Expectant women (n = 75) with a body mass index ≥ 30 kg/m2 at first antenatal appointment were recruited at 12 weeks gestation. Participants were asked about their supplement use preconception and during trimester one in a baseline questionnaire which also asked about demographic characteristics. Women also completed a four day diet diary from which dietary and supplemental intakes of micronutrients intakes were estimated. Folic acid was taken by 96% of women at any point in trimester 1, whilst only 26% of women took the higher 5 mg dose recommended for women with obesity in the UK. For vitamin D and iodine, 56% and 44% of women met the UK RNI, respectively. Maternal age was positively associated with taking supplements of any kind and the 5 mg folic acid supplement, whilst parity was inversely associated with both outcomes. This study strengthens the rationale for further work to be done raising awareness of the need for women with obesity to supplement both with a higher dose of folic acid and vitamin D and to be aware of the role of iodine during pregnancy.

Micronutrient Supplementation for Pregnant and Lactating Women to Improve Maternal and Infant Nutritional Status in Low- and Middle-Income Countries: Protocol for a Systematic Review and Meta-analysis.

BackgroundTwo billion people in low- and middle-income countries (LMICs) are deficient in key nutrients. Nutritional deficiencies worsen during pregnancy, causing adverse outcomes for the mother and the fetus, with consequences after pregnancy. These effects may be mitigated by providing micronutrient supplementation to women during pregnancy and lactation. However, the effects of micronutrient supplementation on the nutritional status of pregnant and lactating women and that of their infants remain largely unclear in LMICs. ObjectiveThe purpose of this systematic review and meta-analysis is to determine the effects of single, double, or multiple micronutrient supplements during pregnancy or lactation on maternal and infant nutritional status in LMICs.MethodsRandomized controlled trials of single, double, or combinations of micronutrients assessing effects on the maternal (serum, plasma, and breastmilk) and infant (serum and plasma) nutritional status will be included. MEDLINE (through PubMed), EMBASE, CENTRAL (through Cochrane Library), and the World Health Organization (WHO) library database will be used to identify relevant published studies, starting from the inception of each database until February 28, 2022. The Cochrane Risk of Bias Tool will be used to assess the risk of bias in the included studies. The selection of studies, data extraction, and risk of bias assessment will be carried out independently by 2 reviewers. A narrative summary will be provided of all the included studies. Meta-analyses will be performed whenever possible, and the heterogeneity of effects will be evaluated using I2, subgroup analyses, and metaregression. The certainty of the evidence for each outcome will be assessed using the GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach.ResultsWe will conduct meta-analyses using Stata software (version 16, StataCorp) and present both a narrative and systematic summary of all studies included in this review in text and table form. For continuous outcomes, effect estimates will be expressed as mean differences and standardized mean differences, while for binary outcomes, they will be expressed as risk ratios, rate ratios, hazards ratios, or odds ratios, all with 95% CIs and comparing the intervention group with the control group. When studies for an outcome are adequately consistent with respect to intervention, comparator, and definition of the outcome, a random-effects, inverse variance-weighted meta-analysis will be conducted. We will provide a narrative synthesis for outcomes with insufficient data or extreme heterogeneity.ConclusionsThis review will provide evidence upon which to base policy and programming for women in LMICs to supplement micronutrients in pregnancy and lactation. Detailed results disaggregated by variables such as maternal age, sex of infant, duration, and dose of intervention may also help policy makers, researchers, practitioners, and government agencies to adopt more effective maternal and child health policies and programs in LMICs. The review will also identify any gaps in the existing evidence.Trial RegistrationPROSPERO CRD42022308715; https://tinyurl.com/y33cxekr.International Registered Report Identifier (IRRID)PRR1-10.2196/40134

Cross Sectional Study of Zinc, Copper and Magnesium Levels in Preeclampsia and Normal Pregnancy

Preeclampsia is a pregnancy related high blood pressure disorder. It involves defective trophoblast invasion and decreased spiral artery remodelling. Alterations in micronutrients have been identified as one of the risk factor of preeclampsia. In this study we have estimated the levels of zinc, copper, iron and magnesium in preeclampsia and normal pregnant women. Our study revealed a significant decrease of zinc, copper and magnesium levels and significant increase of iron levels in preeclampsia compared to normal pregnant women. Thus assessment of micronutrients in pregnancy helps in decreasing the incidence of preeclampsia. Keywords: Preeclampsia, Zinc, Copper, Iron, Magnesium.

Disparities in Risks of Inadequate and Excessive Intake of Micronutrients during Pregnancy.

Inadequate or excessive intake of micronutrients in pregnancy has potential to negatively impact maternal/offspring health outcomes. The aim was to compare risks of inadequate or excessive micronutrient intake in diverse females with singleton pregnancies by strata of maternal age, race/ethnicity, education, and prepregnancy BMI. Fifteen observational cohorts in the US Environmental influences on Child Health Outcomes (ECHO) Consortium assessed participant dietary intake with 24-h dietary recalls (n=1910) or food-frequency questionnaires (n=7891) from 1999-2019. We compared the distributions of usual intake of 19 micronutrients from food alone (15 cohorts; n=9801) and food plus dietary supplements (10 cohorts with supplement data; n=7082) to estimate the proportion with usual daily intakes below their age-specific daily Estimated Average Requirement (EAR), above their Adequate Intake (AI), and above their Tolerable Upper Intake Level (UL), overall and within sociodemographic and anthropometric subgroups. Risk of inadequate intake from food alone ranged from 0% to 87%, depending on the micronutrient and assessment methodology. When dietary supplements were included, some women were below the EAR for vitamin D (20-38%), vitamin E (17-22%), and magnesium (39-41%); some women were above the AI for vitamin K (63-75%), choline (7%), and potassium (37-53%); and some were above the UL for folic acid (32-51%), iron (39-40%), and zinc (19-20%). Highest risks for inadequate intakes were observed among participants with age 14-18 y (6nutrients), non-White race or Hispanic ethnicity (10 nutrients), less than a high school education (9 nutrients), or obesity (9 nutrients). Improved diet quality is needed for most pregnant females. Even with dietary supplement use, >20% of participants were at risk of inadequate intake of ≥1 micronutrients, especially in some population subgroups. Pregnancy may be a window of opportunity to address disparities in micronutrient intake that could contribute to intergenerational health inequalities.

Sociodemographic and Obesity-Related Disparities in Risks of Inadequate and Excessive Intake of Micronutrients During Pregnancy: The National ECHO Consortium

ObjectivesBoth inadequate and excessive intake of micronutrients in pregnancy have the potential to negatively impact child health outcomes. We examined micronutrient intake in a large, diverse sample of women with singleton pregnancies across the United States, including intake by maternal age, race/ethnicity, education, and pre-pregnancy body mass index (BMI). MethodsFifteen observational cohorts in the Environmental influences on Child Health Outcomes (ECHO) consortium assessed prenatal food intake and dietary supplement use with 24-hour dietary recalls (5 cohorts; 1859 women) or food frequency questionnaires (10 cohorts; 8064 women) from 1999–2019. We compared mean daily intake of 19 micronutrients to the age-specific estimated average requirement (EAR), adequate intake (AI), and tolerable upper intake level (UL) for pregnancy, overall and within sociodemographic and anthropometric subgroups. For recall data, we used a measurement error method to estimate distributions of usual intake, proportion below the EAR/AI, and above the UL. For FFQ data, we calculated the proportion below the EAR/AI and above the UL. ResultsRisk of inadequate intake from foods alone ranged from 0–93%, depending on the micronutrient or assessment method. With dietary supplements, more than 1 in 5 women remained at risk for inadequate intake of choline, magnesium, and vitamins D, E, and K; or excessive intake of folic acid, iron, and zinc. Higher risks for inadequate intakes were observed among women with obesity (magnesium, vitamin K), who were <18 years (magnesium, vitamin K), Hispanic (vitamin E), non-Hispanic Black (vitamin K), non-Hispanic White (choline) or less educated (magnesium, vitamin E) when compared to counterparts. ConclusionsImproved diet quality is needed for most pregnant women. Even with a high prevalence of dietary supplement use, at least 1 in 5 pregnant women were at risk of inadequate intake of ≥ 1 micronutrients, especially in some population subgroups. Pregnancy may be a window of opportunity to address disparities in micronutrient intake that could contribute to intergenerational health inequalities. Funding SourcesNational Institutes of Health, Environmental Protection Agency, Autism Speaks.

Roles of Micronutrients in Pregnancy

This study assessed the roles of micronutrients in pregnancy. Micronutrients play a central part in the metabolism and maintenance of tissue functions in human beings. Sources of micronutrients include vegetables and fruits and, as such, categorized under vitamins and minerals. These are required in small amounts in the body but greatly impact healthy growth and development. In pregnancy, these micronutrients' adequate requirements are necessary as inadequate intake could result in adverse maternal conditions such as anemia, hypertension, labor complications, and even death. These could, in turn, affect the fetus resulting in stillbirth, premature delivery, intrauterine growth retardation, congenital malformations, reduced immune competence, and abnormal organ development. The micronutrients include vitamins (such as water-soluble vitamins and fat-soluble) and minerals, classified into micro and macro. Strategies for correcting deficiency of these micronutrients in pregnant women can improve pregnancy outcomes. However, it is more beneficial to consume an adequate micronutrient level before conception to minimize the likely risks associated with their mother and fetus deficiencies.

The Relationship Between Magnesium Level in Pregnancy with Gestational Diabetes Mellitus

Introduction : Magnesium is one of important micronutrients in pregnancy. Pregnant women needs higher magnesium intake than non-pregnant women at similar age. Decreased blood and cellular magnesium level was related to insulin resistance.Objective : To determine relationship between mean magnesium level in pregnant women with incidence of gestational diabetes mellitus.Methods : This was quantitative analytic study using cross sectional comparative design conducted in 8 Primary Health Care in Padang and 5 General Hospital in West Sumatra. This study was done from December 2019 until March 2020. Total sample collected was 36 samples consisted of 18 pregnant mother with gestational diabetes mellitus and 18 control sample with normal pregnancy, both were in gestational age between 24-28 weeks. Statistical analysis was done using independent sample T-test.Results : Mean magnesium level of pregnant mother with gestational diabetes mellitus was 1.85 ± 0.12 mg/dL, while in control sample was 2.10 ± 0.15 mg/dL. Statistical result using independent sample T-test showed significant correlation between mean magnesium level and incidence of gestational diabetes mellitus with p &lt;0.001 (p value &lt;0.05)Conclusion : Magnesium level during pregnancy is related to gestational diabetes mellitus incidence.Keywords: magnesium level, pregnant women, gestational diabetes mellitus

Maternal selenium deficiency during pregnancy in mice increases thyroid hormone concentrations, alters placental function and reduces fetal growth.

Inappropriate intake of key micronutrients in pregnancy is known to alter maternal endocrine status, impair placental development and induce fetal growth restriction. Selenium is an essential micronutrient required for the function of approximately 25 important proteins. However, the specific effects of selenium deficiency during pregnancy on maternal, placental and fetal outcomes are poorly understood. The present study demonstrates that maternal selenium deficiency increases maternal triiodothyronine and tetraiodothyronine concentrations, reduces fetal blood glucose concentrations, and induces fetal growth restriction. Placental expression of key selenium-dependent thyroid hormone converting enzymes were reduced, whereas the expression of key placental nutrient transporters was dysregulated. Selenium deficiency had minimal impact on selenium-dependent anti-oxidants but increased placental copper concentrations and expression of superoxide dismutase 1. These results highlight the idea that selenium deficiency during pregnancy may contribute to thyroid dysfunction, causing reduced fetal growth, that may precede programmed disease outcomes in offspring. Selenium is a trace element fundamental to diverse homeostatic processes, including anti-oxidant regulation and thyroid hormone metabolism. Selenium deficiency in pregnancy is common and increases the risk of pregnancy complications including fetal growth restriction. Although altered placental formation may contribute to these poor outcomes, the mechanism by which selenium deficiency contributes to complications in pregnancy is poorly understood. Female C57BL/6mice were randomly allocated to control (>190µgkg-1 , n=8) or low selenium (<50µgkg-1 , n=8) diets 4weeks prior to mating and throughout gestation. Pregnant mice were killed at embryonic day 18.5 followed by collection of maternal and fetal tissue. Maternal and fetal plasma thyroid hormone concentrations were analysed, as was placental expression of key selenoproteins involved in thyroid metabolism and anti-oxidant defences. Selenium deficiency increased plasma tetraiodothyronine and triiodothyronine concentrations. This was associated with a reduction in placental expression of key selenodependent deiodinases, DIO2 and DIO3. Placental expression of selenium-dependent anti-oxidants was unaffected by selenium deficiency. Selenium deficiency reduced fetal glucose concentrations, leading to reduced fetal weight. Placental glycogen content was increased within the placenta, as was Slc2a3mRNA expression. This is the first study to demonstrate that selenium deficiency may reduce fetal weight through increased maternal thyroid hormone concentrations, impaired placental thyroid hormone metabolism and dysregulated placental nutrient transporter expression. The study suggests that the magnitude of selenium deficiency commonly reported in pregnant women may be sufficient to impair thyroid metabolism but not placental anti-oxidant concentrations.

Benefits of supplementation with multiple micronutrients in pregnancy.

A task force was convened by the New York Academy of Sciences to evaluate new evidence that was not available at the time of, and to help countries interpret, recent World Health Organization guidelines for nutrition interventions in pregnancy as they relate to multiple micronutrient supplementation. The report of the task force is published in a recent special issue of Annals of the New York Academy of Sciences. Here, we provide a short introduction to the special issue.

Low Vitamin B12 Levels in Early Pregnancy Are Associated with Fasting Glycemia—A Prospective Cohort Study

Background: The pathogenesis of gestational diabetes mellitus (GDM) is not fully understood and combining novel biomarkers with established risk factors could improve early prediction of GDM. Low vitamin B12 (B12) levels have been linked to obesity, insulin resistance and GDM but its predictive ability in early pregnancy as a risk factor for later GDM has not been proven. Methods: Micronutrients in Pregnancy as a Risk factor for gestational diabetes and Effects on mother and baby (PRiDE) is a cohort study of pregnant women at high risk of developing GDM (n=4751 recruited). GDM was diagnosed by a 2-hour 75g OGTT according to UK NICE criteria (fasting blood glucose, FBG ≥5.6mmol/l or 2-hour BG ≥7.8mmol/l). B12 and folate were measured by electrochemiluminescence and deficiency defined as ≤200pg/ml and ≤3ng/ml respectively. Multiple linear and logistic regression models were done with covariates including age, BMI, ethnicity, parity, smoking status, gestational weight gain and folate levels. Results: The data from the first 3412 women with complete B12/folate and OGTT results were analysed (median (range) gestational age 12+5(4+3, 16+0) and 26+4 (15+0, 32+1) weeks respectively). Mean (±SD) age was 30.7±5.2 years, BMI 30.8±7.3 kg/m2 and 56.0% were obese. 11.5% had GDM and B12 and folate deficiency rates were 10.2% and 0% respectively (p&amp;gt;0.05 in GDM vs. no-GDM). GDM women had similar B12 and folate values to no-GDM (346±151 vs. 357 ± 155 pg/ml and 19.8±12.6 vs. 18.8±12.1 ng/ml respectively, adjusted p&amp;gt;0.05). B12 was negatively correlated with BMI (Pearson’s r=-0.24, p&amp;lt;0.001) and inversely related to FBG, after adjustment for covariates including BMI (β=-0.03, p=0.003). There was no association with 2-hour BG. Low B12 values were more predictive of GDM among obese women (mean 314±119 vs. 328±134 pg/ml, adjusted p=0.06). Conclusions: Early pregnancy B12 values were predictive of high FBG in late gestation. Low B12 levels may be an independent risk factor for GDM, particularly in obese women. Disclosure N. Sukumar: None. A. Antonysunil: None. Y. Ghebremichael-Weldeselass: None. I. Goljan: None. C. Bagias: None.

Micronutrients in pregnancy: where physiology, psychology and commercial interests meet

Micronutrients in pregnancy: where physiology, psychology and commercial interests meet

Maternal Diet and Nutrient Requirements in Pregnancy and Breastfeeding. An Italian Consensus Document.

The importance of lifestyle and dietary habits during pregnancy and breastfeeding, for health of mothers and their offspring, is widely supported by the most recent scientific literature. The consumption of a varied and balanced diet from the preconceptional period is essential to ensure both maternal well-being and pregnancy outcomes. However, the risk of inadequate intakes of specific micronutrients in pregnancy and lactation is high even in the most industrialized countries. This particularly applies to docosahexaenoic acid (DHA), iron, iodine, calcium, folic acid, and vitamin D, also in the Italian population. Moreover, the risk of not reaching the adequate nutrient supply is increased for selected groups of women of childbearing age: those following exclusion diets, underweight or overweight/obese, smokers, adolescents, mothers who have had multiple or close pregnancies, and those with previous unfavorable pregnancy outcomes.

Health Behaviours during Pregnancy in Women with Very Severe Obesity.

The health behaviours of pregnant women with very severe obesity are not known, though these women are at high risk of pregnancy complications. We carried out a prospective case-control study including 148 very severely obese (BMI >40 kg/m2) and 93 lean (BMI <25 kg/m2) pregnant women. Diet, physical activity, smoking, alcohol and folic acid consumption were assessed by questionnaire in early and late (16 and 28 weeks gestation) pregnancy. Circulating levels of iron, vitamin B12 and folate and other essential trace elements and minerals were measured in a subset at each time point. The findings biochemically confirmed that very severely obese women consumed diets that were energy-rich but poor in essential micronutrients. A third of all women met physical activity recommendations for pregnancy. A third of very severely obese women and two thirds of lean women took folic acid supplements prior to pregnancy. Very severely obese women were more likely to smoke but less likely to drink alcohol than lean women (all p < 0.05). Women with very severe obesity have low self-reported intakes and circulating levels of essential micronutrients in pregnancy and few follow current recommendations for pregnancy nutrition and lifestyle. These high-risk women represent a group to target for education about health behaviours prior to and during pregnancy.

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.

Association of serum copper level with fasting serum glucose in south Indian women with gestational diabetes mellitus

Background and Aim: Prevalence of gestational diabetes mellitus (GDM) is higher in southern region compared to other parts of India. Deficiency of certain trace elements has been indicated in the progression of type 2 diabetes mellitus. Therefore, an inadequate supply of micronutrients in pregnancy may compromise the health and growth of both mother and fetus. Though copper and magnesium have an important role in glucose tolerance, they are not routinely checked in pregnancy. Therefore, this study was designed to determine the serum level of copper and magnesium in GDM patients and compare it with that of euglycemic pregnant women with similar gestational age. Methods: Serum was collected at 0, 1 st and 2 nd h from the blood drawn from pregnant ladies as part of their screening test for oral glucose tolerance test (OGTT), after obtaining informed consent. Serum copper and magnesium was estimated from fasting serum sample. Results: This prospective study showed a significant increase in copper level without significant change in magnesium level in GDM patients compared with euglycemic pregnant women. The increase in serum copper level was positively correlated with the rise in fasting serum glucose. Linear regression demonstrated association of serum copper level to fasting blood glucose (beta = 0.265, P = 0.017). Conclusion: Rise in serum copper level in GDM is linked to the level of fasting blood glucose. Therefore, women, who are diagnosed with GDM and found to have higher copper level, should be monitored carefully for ill-effects of higher copper level as it is linked to their hyperglycemic status.

The importance of antioxidant micronutrients in pregnancy.

Pregnancy places increased demands on the mother to provide adequate nutrition to the growing conceptus. A number of micronutrients function as essential cofactors for or themselves acting as antioxidants. Oxidative stress is generated during normal placental development; however, when supply of antioxidant micronutrients is limited, exaggerated oxidative stress within both the placenta and maternal circulation occurs, resulting in adverse pregnancy outcomes. The present paper summarises the current understanding of selected micronutrient antioxidants selenium, copper, zinc, manganese, and vitamins C and E in pregnancy. To summarise antioxidant activity of selenium is via its incorporation into the glutathione peroxidase enzymes, levels of which have been shown to be reduced in miscarriage and preeclampsia. Copper, zinc, and manganese are all essential cofactors for superoxide dismutases, which has reduced activity in pathological pregnancy. Larger intervention trials are required to reinforce or refute a beneficial role of micronutrient supplementation in disorders of pregnancies.