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Micronutrients in pregnancy in low- and middle-income countries.
Nutrients 2015; 7(3):1744-68N

Abstract

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.

Authors+Show Affiliations

The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, NSW 2006, Australia. ian.darnton-hill@sydney.edu.au. The Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA 021111, USA. ian.darnton-hill@sydney.edu.au.Columbia University Medical Center, Institute of Human Nutrition, New York, NY 10027, USA. ucm2103@columbia.edu.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

25763532

Citation

Darnton-Hill, Ian, and Uzonna C. Mkparu. "Micronutrients in Pregnancy in Low- and Middle-income Countries." Nutrients, vol. 7, no. 3, 2015, pp. 1744-68.
Darnton-Hill I, Mkparu UC. Micronutrients in pregnancy in low- and middle-income countries. Nutrients. 2015;7(3):1744-68.
Darnton-Hill, I., & Mkparu, U. C. (2015). Micronutrients in pregnancy in low- and middle-income countries. Nutrients, 7(3), pp. 1744-68. doi:10.3390/nu7031744.
Darnton-Hill I, Mkparu UC. Micronutrients in Pregnancy in Low- and Middle-income Countries. Nutrients. 2015 Mar 10;7(3):1744-68. PubMed PMID: 25763532.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Micronutrients in pregnancy in low- and middle-income countries. AU - Darnton-Hill,Ian, AU - Mkparu,Uzonna C, Y1 - 2015/03/10/ PY - 2014/08/23/received PY - 2015/02/09/revised PY - 2015/02/26/accepted PY - 2015/3/13/entrez PY - 2015/3/13/pubmed PY - 2015/11/11/medline SP - 1744 EP - 68 JF - Nutrients JO - Nutrients VL - 7 IS - 3 N2 - 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. SN - 2072-6643 UR - https://www.unboundmedicine.com/medline/citation/25763532/Micronutrients_in_pregnancy_in_low__and_middle_income_countries_ L2 - http://www.mdpi.com/resolver?pii=nu7031744 DB - PRIME DP - Unbound Medicine ER -