Multiple Micronutrient Needs in Pregnancy in Industrialized Countries

Abstract

Background: As nutritional deficiencies are known to lead to adverse pregnancy outcomes, a woman's nutritional status should be assessed preconceptionally with the goal of optimizing maternal, fetal and infant health. Worldwide micronutrient intakes do not fit pregnancy requirements, so that their supplementation is recommended from the beginning of pregnancy in most of the low- and middle-income countries. Conversely, data on multiple supplementation in developed countries appear few and controversial. Key Message: Although a balanced diet is generally accessible in industrialized countries, a switch to a high-fat and low-quality diet has led to an inadequate vitamin and mineral intake during pregnancy, so that recent data show the micronutrient intake and supplementation to be lower than recommended even in high-income countries, particularly for iron, folic acid, calcium and vitamin D. Conclusions: Currently, even if there is insufficient evidence to support routine supplementation at the population level, except for periconceptional folate supplementation, these results need to be evaluated at an individual level in order to avoid nutritional deficiencies and to encourage women to establish healthful dietary practices prior to conception. The new goal in industrialized countries needs to be an individualized approach that takes account of the phenotypic, genotypic and metabolic differences among individuals of the same population.

Impact of Micronutrient Status during Pregnancy on Early Nutrition Programming

“…2) [6,17,33]. Even in developed countries, where a balanced diet is accessible, micronutrient inadequacies are common due to a general switch to high-fat and low-quality diets (e.g., in highly processed products rich in salt, sugar and saturated fats), with frequently suboptimal intake particularly of iron, iodine, folate, vitamin D, vitamin B 12 and docosahexaenoic acid (DHA) [33,34].…”

“…2) [6,17,33]. Even in developed countries, where a balanced diet is accessible, micronutrient inadequacies are common due to a general switch to high-fat and low-quality diets (e.g., in highly processed products rich in salt, sugar and saturated fats), with frequently suboptimal intake particularly of iron, iodine, folate, vitamin D, vitamin B 12 and docosahexaenoic acid (DHA) [33,34]. It is known that low intakes of these micronutrients are of significant clinical relevance in pregnant women because they can lead to health problems in the mother and foetus/newborn [6,28,35].…”

The Impact of Kidney Development on the Life Course: A Consensus Document for Action

“…2 Appropriate maternal nutrition should consider intake not only of macronutrients (e.g., proteins, carbohydrates, and fats) but also of micronutrients (e.g., iron, folate, and iodine), for which it may be easier to incur deficiencies or inadequacies [3,99,310]. Importantly, obese women may have important nutritional deficiencies [3].…”

“…Maternal health and nutrition are important determinants of healthy pregnancies and impact kidney development [15,99]. These factors are strongly impacted by socioeconomic and structural factors [65,100] (Table 5).…”

Preface

“…However, in medium- to high-income countries, it is indicated that there is currently insufficient evidence to support a routine supplementation at the population level, except for periconception folate supplementation, and for most pregnant women, a more individualised approach is recommended with a specific focus on iron, calcium and vitamin D status [3]. …”