Table 1.

Recommended daily micronutrient intake during pregnancy and lactation.

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•• Comprehensive review of interventions of different micronutrients to reduce the burden of maternal and child undernutrition, including a series of systematic reviews on micronutrients such as iodine in the web appendices.
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•• Very useful latest paper of the impact of multiple-micronutrient supplements MMS on birthweight and length of gestation. Also shows that MMS are more effective in women with a higher BMI.
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Author(s)

Mohammad Yawar Yakoob, MBBS

Research Fellow, Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan

Disclosures

Disclosure: Mohammad Yawar Yakoob, MBBS, has disclosed no relevant financial relationships.

Yasir Pervez Khan, MBBS

Research Fellow, Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan

Disclosures

Disclosure: Yasir Pervez Khan, MBBS, has disclosed no relevant financial relationships.

Zulfiqar Ahmed Bhutta, MB, BS, PhD, FRCP, FRCPCH, FCPS, FAAP

Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan

Disclosures

Disclosure: Zulfiqar Ahmed Bhutta, MB, BS, PhD, FRCP, FRCPCH, FCPS, FAAP, has disclosed no relevant financial relationships.

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Elisa Manzotti

Editorial Director, Future Science Group, London, United Kingdom

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Disclosure: Elisa Manzotti has disclosed no relevant financial relationships.

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Désirée Lie, MD, MSEd

Clinical Professor, Family Medicine, University of California, Irvine, Orange, California; Director of Research and Patient Development, Family Medicine, University of California, Irvine, Medical Center, Rossmoor, California

Disclosures

Disclosure: Désirée Lie, MD, MSEd, has disclosed the following relevant financial relationship:
Served as a nonproduct speaker for: "Topics in Health" for Merck Speaker Services

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Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

CME

Maternal Mineral and Vitamin Supplementation in Pregnancy

Authors: Mohammad Yawar Yakoob, MBBS; Yasir Pervez Khan, MBBS; Zulfiqar Ahmed Bhutta, MB, BS, PhD, FRCP, FRCPCH, FCPS, FAAP
CME Released: 3/3/2010
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 3/3/2011, 11:59 PM EST

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Target Audience and Goal Statement

This activity is intended for primary care clinicians, obstetricians and gynecologists, neonatologists, and other specialists who care for pregnant women.

The goal of this activity is to review the burden of maternal micronutrient deficiencies and their effects on the mother and infant.

Upon completion of this activity, participants will be able to:

Describe the effects of iron deficiency and the effect of iron supplementation during pregnancy
Describe the effect of zinc supplementation during pregnancy
Identify the benefits of vitamin A supplementation during pregnancy
List the effect of folate supplementation during pregnancy
Describe the effects of vitamin D, calcium, and magnesium deficiency and supplementation during pregnancy

Disclosures

Author(s)

Mohammad Yawar Yakoob, MBBS

Research Fellow, Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan

Disclosures

Disclosure: Mohammad Yawar Yakoob, MBBS, has disclosed no relevant financial relationships.

Yasir Pervez Khan, MBBS

Research Fellow, Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan

Disclosures

Disclosure: Yasir Pervez Khan, MBBS, has disclosed no relevant financial relationships.

Zulfiqar Ahmed Bhutta, MB, BS, PhD, FRCP, FRCPCH, FCPS, FAAP

Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan

Disclosures

Disclosure: Zulfiqar Ahmed Bhutta, MB, BS, PhD, FRCP, FRCPCH, FCPS, FAAP, has disclosed no relevant financial relationships.

Editor(s)

Elisa Manzotti

Editorial Director, Future Science Group, London, United Kingdom

Disclosures

Disclosure: Elisa Manzotti has disclosed no relevant financial relationships.

CME Author(s)

Désirée Lie, MD, MSEd

Clinical Professor, Family Medicine, University of California, Irvine, Orange, California; Director of Research and Patient Development, Family Medicine, University of California, Irvine, Medical Center, Rossmoor, California

Disclosures

Disclosure: Désirée Lie, MD, MSEd, has disclosed the following relevant financial relationship:
Served as a nonproduct speaker for: "Topics in Health" for Merck Speaker Services

CME Reviewer(s)

Sarah Fleischman

CME Program Manager, Medscape, LLC

Disclosures

Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

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From Expert Review of Obstetrics & Gynecology

CME

Maternal Mineral and Vitamin Supplementation in Pregnancy

Authors: Mohammad Yawar Yakoob, MBBS; Yasir Pervez Khan, MBBS; Zulfiqar Ahmed Bhutta, MB, BS, PhD, FRCP, FRCPCH, FCPS, FAAPFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME Released: 3/3/2010

Valid for credit through: 3/3/2011, 11:59 PM EST

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Abstract and Introduction

Abstract

Deficiency of vitamins and minerals, collectively known as micronutrients, during pregnancy can have important adverse effects on maternal and birth outcomes. Evidence-based nutrition interventions can make a difference and potentially avert these outcomes. Iron supplementation has been shown to improve maternal mean hemoglobin concentration at term and reduce the risk of anemia. Zinc supplementation has been shown to result in a small but significant reduction in preterm births. A cluster-randomized study in Nepal showed a 40% reduction in maternal mortality up to 12 weeks postpartum with weekly vitamin A and 49% biweekly β-carotene supplementation but subsequent large studies in Bangladesh and Ghana have failed to demonstrate any impact on mortality. Maternal vitamin A supplementation has no role in preventing mother-to-child transmission of HIV in HIV-infected pregnant women. Periconceptional folic acid supplementation reduces the risk of neural tube defects, while supplementation with vitamin D reduces the incidence of neonatal hypocalcemia with no impact on craniotabes. Iodine supplementation during pregnancy has also been suggested to reduce the risk of perinatal and infant mortality, and the risk of endemic cretinism at 4 years of age. Calcium supplementation reduced the risk of preeclampsia in women with low baseline calcium dietary intake, while magnesium supplementation has been associated with a lower frequency of preterm births and adverse neurodevelopmental outcomes in childhood. Other vitamins and minerals, such as vitamins B, C and E, copper and selenium, have been associated with fetal development, but their impact on pregnancy outcomes is not clear. Given such widespread maternal vitamin and mineral deficiencies, it is logical to consider supplementation with multiple micronutrient preparations in pregnancy. The clinical benefits of such an approach over single-nutrient supplements are unclear, and this article explores the current concepts, evidence and limitations of maternal multiple-micronutrient supplementation.

Introduction

Undernutrition during the reproductive age group and pregnancy remains a major problem in countries where women usually do not have equitable access to food, education and healthcare.^[101] Many women are undernourished at birth, stunted during childhood, become pregnant at adolescence, and are underfed and overworked during pregnancy and lactation, resulting in nutritional deficiencies.^[102] Most women living in developing countries experience various biological and social stresses that, combined with other factors, increase the risk of malnutrition throughout life. These include: poverty, lack of purchasing power, food insecurity and inadequate diets, recurrent infections, poor healthcare, heavy work burdens, gender inequities and limited general knowledge about appropriate nutritional practices. These factors are compounded by high fertility rates, repeated pregnancies and short intervals between pregnancies.^[1] Undernutrition undermines the woman's ability to survive childbirth and give birth to healthy children, translating into lost lives of mothers and their infants.^[102] Nutrient deficiencies, whether clinical or subclinical, can also potentially affect fetal growth, cognition and future reproductive performance.^[2] In the developing world, maternal and fetal undernutrition impairs their contribution to their families and communities, as well as their productivity and income-generating capacity.^[102] It has been shown that maternal undernutrition reduces placental-fetal blood flow and retards fetal growth in both domestic animals and humans.^[3,4] An altered intrauterine nutritional environment affects expression of the fetal genome, a phenomenon termed 'fetal programming'.^[5] This impact of maternal nutritional status on fetal programming and genetic imprinting is associated with disease in later life, such as coronary heart disease and stroke, and the associated conditions such as hypertension and non-insulin-dependent diabetes. People who have low growth rates in utero also cannot withstand the stress of becoming obese as adults.^[4]

Page 1 of 8

Burden of Maternal Micronutrient Deficiencies and Evidence Base for Interventions

CME Information

Abstract and Introduction
Burden of Maternal Micronutrient Deficiencies and Evidence Base for Interventions
Suggested Interventional Strategies
Dosage and Potential Interactions
Conclusion
Expert Commentary
Five-year View
Key Issues

References

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References

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The material presented here does not necessarily reflect the views of Medscape, LLC, or companies that support educational programming on www.medscapecme.com. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

Table 1.

References

Faculty and Disclosures

Author(s)

Mohammad Yawar Yakoob, MBBS

Yasir Pervez Khan, MBBS

Zulfiqar Ahmed Bhutta, MB, BS, PhD, FRCP, FRCPCH, FCPS, FAAP

Editor(s)

Elisa Manzotti

CME Author(s)

Désirée Lie, MD, MSEd

CME Reviewer(s)

Sarah Fleischman

CME

Maternal Mineral and Vitamin Supplementation in Pregnancy

Target Audience and Goal Statement

Disclosures

Author(s)

Mohammad Yawar Yakoob, MBBS

Yasir Pervez Khan, MBBS

Zulfiqar Ahmed Bhutta, MB, BS, PhD, FRCP, FRCPCH, FCPS, FAAP

Editor(s)

Elisa Manzotti

CME Author(s)

Désirée Lie, MD, MSEd

CME Reviewer(s)

Sarah Fleischman

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Maternal Mineral and Vitamin Supplementation in Pregnancy

Abstract and Introduction

Abstract

Introduction

Table of Contents