Women's Health Issues

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Pregnancy
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The rapid cell division characteristic of a growing fetus represents a nutrient drain, especially of B vitamins, minerals, and antioxidants, on a pregnant woman. One study demonstrated that the levels of retinal, thiamin, vitamin B6, folic acid and vitamin B12 decreased significantly as pregnancy advanced. Another study found that mean intakes of iron, zinc, calcium, magnesium, folic acid, vitamin D and vitamin E were below recommended standards for pregnant women. Yet another series of studies found that a marginal degree of biotin deficiency developed in a substantial number of women during normal pregnancy, and that this deficiency was severe enough to produce metabolic derangements capable of causing fetal malformations. In light of these and many other observations, evidence of the impact of maternal nutritional status on pregnancy outcomes is becoming overwhelming, especially with the recognition that neural tube defects can be prevented by assuring a sufficient intake of folic acid for the mother from the time of conception. The increased need for folate appears to be due to it increased usage for fetal nucleic acid synthesis and cell division. Folic acid supplementation is especially critical if the mother is taking any of the common drugs which act as folic acid antagonists, such as trimethoprim, triampterne, carbamazapine, phenytoin, phenobarbitol, or primidone. Although serum folic acid determinations remain the method of choice for pregnant women to monitor their folic acid levels, it would be prudent of every woman of child bearing age to assure herself of a sufficient amount of folic acid through diet and/or supplementation, as advised by her health care provider.

Numerous studies are now revealing that folic acid is not the only critical nutrient required for the development of a healthy fetus and birth of a normal baby. Maintenance of sufficient antioxidant levels with a multivitamin/mineral supplement prevented the increased amount of DNA damage and the reduction in plasma retinal, beta-carotene, and ascorbic acid levels observed in non-supplemented women. Antioxidants were found to be especially important for prevention of diabetes-induced congenital deformations. Numerous investigations have shown that hyperglycemia can be teratogenic during organogenisis, and nutritional supplementation was found to reduce the incidence of diabetes-related malformations in offspring of diabetic pregnant animals. In addition, specific supplementation with either calcium or zinc reduced maternal and newborn morbidity/mortality, respectively. Finally, prenatal multivitamin supplementation was found to reduce the incidence of low birth weight. Thus, because of the strenuous nutritional demands of a growing fetus, pregnancy represents a nutritionally perilous state for every pregnant woman, as she provides nutrients to support her child's rapid growth in addition to supplying her own metabolic needs. Therefore, testing for nutritional deficiencies and supplying appropriate nutrient cocktails are first line defenses in promoting healthy outcomes for both mother and child.

REFERENCES

1. Longitudinal vitamin and homocysteine levels in normal pregnancy. Cikot RJ et al. Br J Nutr. 2001:85:49-58
2. Pregnant adolescent and adult women have similarly low intakes of selected nutrients. Giddnes JB et al. J Am Diet Assoc.
3. Marginal biotin deficiency is teatogenic. Zemplini J and Mock DM. Proc Soc Exp Biol Med. 2000;223:14-21
4. Thiamin suplementation to prevent induction of low birth weight by conventional therapy for gestational diabetes mellitus. Med. Hypotheses. 2000;55:88-90.
5. The realtionship between increased folate catabolism and the increased requirement for folate in pregnancy. Higgens JR et al. BJOG 2000;107:1149-1154.
6. Folic acid antagonists during pregnancy and the risk of birth defects. Hernanadez-Diaz S et al. N Engl J Med. 2000;343:1608-1614.

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