Nebojša Zečević

HOW TO CHOOSE SUPPLEMENTS IN PREGNANCY

Date 03.11.2018 07:26 Author: Asst. Nebojša Zečević, MD, PhD

Diet during pregnancy should provide energy and all the necessary nutritional and non-nutritional components that are necessary for a healthy pregnancy outcome

Suplements in pregnancy

Nutritional components - proteins, carbohydrates, vitamins and minerals have a major impact on the pregnancy.

Nutrition and nutritional status before and during pregnancy affect the outcome of pregnancy, which makes the optimal diet very important.

During pregnancy, energy needs increase due to:

The energy needs of the mother whose metabolic needs increase during pregnancy by 15%.

The needs of the fetus accelerated development.

During pregnancy, energy needs increase

In the first trimester there is no need to increase energy input.

In the second trimester, an additional 340 kcal per day is required.

In the third trimester an additional 450 kcal per day is required.

PROTEINS

In pregnancy proteins have a primary role for the growth and development of fetal tissue, the placenta, the formation of amniotic fluid ...

Protein needs increase from the second trimester, from 45 g / day in the first trimester to 71 g / day in the second and 90 g / day in the third trimester. This is particularly important in twin pregnancies.

CARBOHYDRATES

In 2002, for the first time, recommendations for carbohydrate intake during pregnancy were given and amounted to about 175 g / day.

This amount is sufficient to provide energy during pregnancy, to avoid ketoacidosis and maintain adequate blood glucose levels.

FATS

For now, there are no clear recommendations on the daily fat intake in pregnancy.

It is recommended that the intake of saturated and trans fatty acids be reduced, while the intake of unsaturated fatty acids (consumption of vegetable oils and fish of the northern seas) be increased.

Estimated average intake for omega 3 fatty acids is 1.4 g / day, and for omega 6 fatty acids 13 g / day.

Vitamins and minerals

VITAMINS AND MINERALS

During pregnancy, the need for all vitamins is increased.

Vitamin A and Vitamin C are important for tissue growth.

B vitamins are key coenzymes for energy production and metabolism.

Folic acid is essential for the development of nerve embryonic tissue.

MINERALS

A particular care should be taken on the intake of iron, calcium and iodine.

Iron is essential for increasing hemoglobin synthesis.

Due to poor resorption, the required quantities are often not supplied with food.

The recommended daily intake is 18 mg / day, while in pregnancy it is 27 mg/day.

SUPPLEMENTS IN PREGNANCY

Dietary supplements are concentrated sources of nutrients with a physiological or nutritional effect in the dosage form.

Studies in the United States indicate that the nutritional intake in pregnant women is lower for the following 8 nutrients: vitamins B6, D, E, folates, iron, zinc, magnesium and calcium.

Supplements for pregnant women contain a combination of a large number of vitamins and minerals, and there is a high likelihood of their interaction during absorption and metabolism.

FOLIC ACID

Folic acid requirements increase in pregnancy.

Insufficient folic acid intake is associated with the risk of spontaneous abortion, rupture of the placenta and the neural tube defects.

Women who consume alcohol or smoke, and those who are on anti-colitis treatment or oral contraceptives have increased risk of developing folate deficiency.

The recommended daily intake of folic acid before conception is 400 mcg, while in pregnancy it is 600 mcg.

The national guide for women healthcare in pregnancy recommends supplements of 400 mcg of folic acid during pregnancy planning, up to 12 weeks of pregnancy (reduction of risk for anencephaly and bony defects in the spine).

USA Canada and Chile went a step further and established national strategies for the fortification of certain foods (flour, cereals).

VITAMIN A

The need for vitamin A increases by 10% in pregnancy.

The biggest needs for vitamin A are in the III trimester when the fetus has the fastest development.

Low vitamin A is associated with premature birth, low body weight, and stagnation in growth.

Supplementation of vitamin A reduces the 40% postpartum death of the mother, but does not affect the percentage of pregnancy loss and neonatal mortality.

Excessive amounts of vitamin A can be teratogenic.

Women who use retinoic acid for acne treatments as well as women who use excessive liver foods that contain a lot of vitamin A are particularly at risk.

In developed countries, vitamin A deficiency is rare, so routine supplements are not recommended due to possible negative effects.

Vitamins

VITAMIN D

Pregnancy does not increase the need for vitamin D. However, additional amounts of calcium (Ca) are needed, as its metabolism is regulated by vitamin D.

The status of vitamin D is more conditioned by exposure to sunlight than diet.

Low vitamin D levels and calcium metabolism disorder lead to neonatal hypocalcaemia, tooth hypoplasia in the fetus and osteomalacia in the mother.

VITAMIN C

In pregnancy, the need for vitamin C increases by an additional 10 mg / day.

85 mg of vitamin C in pregnancy can be achieved by adding 5 fruit portions.

A low concentration of vitamin C leads to an increased risk of preeclampsia and premature rupture of membranes.

A 2014 study suggests that smokers who take 500 mg vitamin C daily, in a cheap and easy way reduce the effects of smoking on lung function of the baby.

IRON (Fe)

Additional amounts of iron are necessary due to an increase in the volume of the blood of the mother, which goes up to 50% at the end of the III trimester.

Iron requirements increase rapidly after 20 weeks of gestation.

The recommended daily intake is 27 mg / day.

Supplementation of iron in pregnancy has a positive outcome on the weight and length of the newborn, reducing the risk of premature labour.

Milk, tea and coffee can interfere with the absorption of iron.

The WHO recommends the supplementation of 60 mg Fe to all women throughout the entire pregnancy and three months after delivery.

The 2004 National Guide does not recommend the supplementation of Fe to all women as there is no solid evidence of a beneficial effect.

The indication for supplementation is Hgb


CALCIUM (Ca)

Though the need for calcium is increased in pregnancy, hormones increase the resorption of Ca from food. Therefore, it is considered that the calcium supplements in pregnancy are not needed.

Pregnant women in the adolescent age (with bone mineralization in progress) and pregnant women on a special diet (vegetarians, lactose intolerant persons) must have foods rich in Ca (fortified soy milk, soybean products, nuts, dry fruit).

JODINE (I)

The lack of iodine adversely affects the development of the fetus and leads to hypothyroidism of newborn infants with lower IQ and mental retardation.

The WHO estimates that 20 million people worldwide have cognitive impairment due to the lack of iodine in pregnancy.

Given that iodine is routinely added to table salt in our country, there are no recommendations for iodine supplements in pregnancy.

In the United States there is a recommendation for supplementation of 150mcg / day.

OMEGA 3 FATTY ACIDS

Women planning pregnancy and pregnant women should consume adequate amounts of essential fatty acids, especially omega 3 fatty acids, which are necessary for intrauterine brain and nervous system development.

The best source of omega 3 fatty acids are oils and fish from cold, northern seas.

Some clinical studies suggest a beneficial effect of omega 3 fatty acid supplements in pregnancy on visual acuity, fetal brain development as well as cognitive skills of the child.

VITAMIN-MINERAL SUPPLEMENTS (VMS)

Many studies have been conducted to prove the justification of supplements in pregnancy.

According to some VMS in pregnancy can result in weight gain at birth and prevention of premature birth, while others state that the same effect is achieved only by using the Fe-supplement.

In general, there is no official recommendation in the world or in our country for the routine use of VMS.

In the United States, the use of VMS is recommended only in high-risk categories of pregnant women (multiple gestations, alcohol and tobacco consumers).

Doctors advice

Supplements are very popular in our market, but the question of justification, even security, is raised.

According to the national guide for women"s health during pregnancy in 2004, there are only recommendations for the supplementation of folic acid during pregnancy planning, up to 12 weeks of pregnancy (reducing the risk of damage to the nervous system) and the therapeutic use of Fe supplements when indicated with low hemoglobin levels in the blood.

The access should be individual with the constant education of pregnant women on the importance of proper nutrition during pregnancy.

Tags: supplements iron vitamin c vitamin A vitamin D vitamin B omega 3 calcium iodine folic acid

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Asst. Nebojša Zečević, MD, PhD, a specialist in Gynecology and Obstetrics and doctors of other medical specialties, advise on how to protect health, deal with medical problems and diseases and have healthy offspring.

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