Iron, iodine and vitamin D deficiencies during pregnancy: epidemiology, risk factors and developmental impacts

Abstract

Micronutrient deficiency persists throughout the world, and although the burden is higher in low-resource settings, it is also prevalent in wealthy countries, a phenomenon termed ‘hidden hunger’. Due to their high requirements for vitamins and minerals relative to their energy intake, young women and children are particularly vulnerable to hidden hunger. As they share several risk factors and impact on overlapping outcomes, we consider how deficiency of iron, iodine and vitamin D can have profound impacts on perinatal health and infant development. We review the epidemiology of these micronutrient deficiencies during pregnancy, including social, environmental and dietary risk factors. We identify the main challenges in defining nutritional status of these nutrients using validated diagnostic criteria linked with meaningful clinical outcomes. Public health strategies are urgently required to improve the overall health and nutritional status of women of reproductive age. Obesity prevention and early detection of malnutrition with standardised screening methods would detect pregnant women at increased risk of iron deficiency. Development of sensitive, individual biomarkers of iodine status is required to protect maternal health and fetal/infant brain development. Risk assessments of vitamin D requirements during pregnancy need to be revisited from the perspective of fetal and neonatal requirements. International consensus on standardised approaches to micronutrient assessment, analysis and reporting as well as sensitive, clinically validated infant and child neuro-behavioural outcomes will enable progression of useful observational and intervention studies.

An Evaluation of Probability of Adequate Nutrient Intake (PANDiet) Scores as a Diet Quality Metric in Irish National Food Consumption Data

“…In Ireland, females between the ages of 18 and 35 years had the lowest probability of meeting recommendations, followed by females aged between 36 and 50, and older males between the ages of 65 and 90. These population sub-groups have been highlighted as concerns for nutrient deficiencies in the Irish population in previous research [ 36 , 37 ]. Though males were found to have higher PANDiet scores in Ireland, this was not found in France, where older participants were found to have higher scores, and no relationship was found with gender, or in the US, where females were found to have higher scores, but no relationship with age was found.…”

“…As nutritional value can significantly vary within food groups, the use of a combination of food- and nutrient-based DQIs has been recommended in order to prevent the oversight of important nutrients [ 12 ]. As dietary patterns have not shown to be static in Ireland [ 35 ], and micronutrient deficiencies in sub-groups of the population remain concerning [ 36 , 37 ], the use of the PANDiet scoring system may be useful for monitoring changes in nutrient adequacy over time across food consumption databases [ 21 , 22 , 23 , 24 , 26 , 27 ], and may facilitate the assessment of additional factors, such as environmental impact or dietary cost [ 14 , 16 , 17 , 18 , 19 , 20 , 22 ]. The current study aimed to apply an expanded PANDiet score to individuals in the Irish National Adult Nutrition Survey (NANS), and to evaluate these scores for use as a measure of diet quality.…”

Biofortification of iron and zinc in rice and wheat

“…This malnutrition is also known as hidden hunger (Kiely et al, 2021;Satyavathi et al, 2021). The average iron concentration in current popular cultivars is 2 µg/g in polished rice and 30 µg/g in wheat grain.…”

“…For many people, rice and wheat provide sufficient dietary carbohydrates but not enough iron and zinc, resulting in malnutrition. This malnutrition is also known as hidden hunger (Kiely et al, 2021; Satyavathi et al, 2021). The average iron concentration in current popular cultivars is 2 µg/g in polished rice and 30 µg/g in wheat grain.…”

“…Rice ( Oryza sativa ) and wheat ( Triticum aestivum ) are the dominant staple foods, feeding more than half of the human population of the world (Fitzgerald et al, 2009). Coincidentally, they are also the staple foods of most people who have iron and zinc deficiencies (Kiely et al, 2021; Satyavathi et al, 2021).…”