Vitamin use during pregnancy

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vitamins; Growth, development, blood production, functions of enzymes are essential substances for cells to function properly. The amount of vitamins and minerals that should be taken daily generally increases during pregnancy and lactation. Since the gestational week is calculated according to the last menstrual period (SAT), the fetus is at least 1 month old when the woman learns that she is pregnant. Since some vitamins must have certain blood values ​​during and after fertilization, this support cannot be provided under the supervision of a doctor and in unconscious pregnancies. For example, it is observed at a rate of 30/1000 in this population in families with a history of a baby with a neural tube defect (NTD) in a previous pregnancy. Because the first 3 months is the period of organ development (organogenesis) of the fetus, it has been shown that having enough folic acid in the environment during this period can prevent neural tube defects by 70%. For this reason, ideally, this support should be provided after the pregnancy decision is made, at least 8 weeks before pregnancy and during the first 3 months of pregnancy. It is even more important to provide this support, especially in societies or individuals who are underdeveloped and have a low socioeconomic level. Now let’s try to talk about the use of some vitamins, minerals and foods.

Multivitamin use: According to the American National Academy of Sciences (IOM) and CDC, it has determined and published the vitamin and mineral supplements that should be used in pregnancy and breastfeeding. Accordingly, in pregnant women, folic acid (0.4-0.6 mg/day), iron (30-60 mg/day), vitamin B6 (2 mg/day), zinc (15 mg/day), copper (2 mg/day), C recommends using or taking vitamin D (50 mg/day), calcium (250 mg/day), and vitamin D (5µg/day). For this purpose, multivitamin supplementation in pregnant women is frequently used in the USA. The information we have shows that the replacement of folic acid, iron and vitamin B6 is beneficial during pregnancy.

Meanwhile, the risks and benefits of routine multivitamin supplementation are still unclear today. The most important concern about this is whether there will be interactions such as increase or decrease in absorption or bioavailability of minerals and vitamins presented together in multivitamins when taken with food. For example, calcium and magnesium inhibit iron absorption. In an observational study conducted with low-income pregnant women, it was shown that the risk of preterm birth decreased in pregnant women who took vitamin preparations in the 1st and 2nd trimesters of pregnancy. So much so that the risk of early pregnancy before 33 weeks is reduced by 4 times with the use of vitamins in the first 3 months. Vitamin A is a vitamin that can cause injury (teratogenicity) if it is taken in excess. It is effective in epithelial tissue, growth, development, bones, vision and reproduction. It is found in egg yolks, butter, milk, margarine, vegetables and fruits. It should never be used in doses over 10,000 IU per day during pregnancy.

Vitamin E, on the other hand, is an antioxidant vitamin that is effective in maintaining the cell membrane and internal integrity. There is a requirement of 5-30 mg per day, and pregnancy does not increase this need much. It is available in soybean oil, hazelnuts, walnuts, eggs. Like vitamin E, there is no increased need for vitamin K during pregnancy, and excessive intake is toxic on the contrary. For the daily need of vitamin C, approximately 1 orange is sufficient by natural means. The World Health Organization recommends iodine intake as 250 mcg in both pregnancy and lactation, while the American Thyroid Association recommends 150 mcg. Those who drink fluorid-free water or consume non-fluoridated drinking water need 3 mg of fluoride daily whether they are pregnant or not. Except for these special cases, fluoride supplementation is not routinely recommended for pregnant women. There are no randomized controlled studies on the benefit of using multivitamins before pregnancy.

Iron usage: In large-scale studies with the use of iron in pregnancy, it has been shown that the risks such as low birth weight baby delivery, prematurity, maternal and infant death are increased in patients with low blood values. A total of 1000 mg of iron is lost in all pregnancy and lactation. Therefore, daily iron intake of 27-30 mg if there is no anemia, and 30-120 mg if anemia is present, should definitely be provided to pregnant women. According to Cochrane data, the risk of anemia is reduced by administering iron and folic acid together (when hemoglobin is below 10-10.5 g/L). known to be required.

Calcium usage: In general, it is recommended to take 1000 mg of calcium daily for women aged 19-39 (whether pregnant or not). Between the ages of 14 and 18, this should be 1300 mg. Adequate doses of vitamin D and magnesium are also essential to obtain optimal benefit from calcium intake. In low-income pregnant women with insufficient calcium intake, calcium replacement is beneficial for reducing the risk of gestational hypertension (preeclampsia) and osteoporosis, leg cramps. It also prevents lead poisoning in the unborn baby (fetus) and some conditions such as neonatal hypocalcemia that can cause seizures in the baby. This is because lead accumulates in the bone, increasing bone turnover and can cause lead to be released into the bloodstream. Likewise, insufficient intake of magnesium can cause leg cramps in the mother. Pregnant women who do not receive sunlight or receive daily calcium below 600 mg should be advised to take additional 600 mg of calcium, exposure to sunlight or 10 µg of vitamin D.

Vegetarian pregnancies: In vegetarian pregnant women who do not consume any animal products, additionally 400 IU (10 µg) vitamin D and 2 µg vitamin B12 should be given. The main source of vitamin B12 is animal foods.

Fish Oil Usage: In 2004, the US government restricted the intake of excess seafood due to the risk of heavy metals, industrial chemicals, and methylmercury poisoning in some seafood. Because mercury is toxic to the nervous tissue of the newly developing, vulnerable fetus. However, the only source of omega 3 fatty acids, which are very beneficial for health, is fish consumption. And it has been shown by studies that the rates of preterm birth, low birth weight baby delivery and preeclampsia decrease with consumption. With low consumption, a decrease in verbal intelligence and behavioral quality was observed in children aged 6 months to 8 years. Despite all this, it is still not clear what the optimal fish intake should be during pregnancy. Recommended fish with low mercury content are salmon, shrimp, tuna, cod, catfish. The use of fish oil or Omega 3 preparations can prevent the uptake and toxicity of mercury and other chemicals. However, there is no study on its routine use.

Pregnancy nausea and vomiting: Excessive nausea and vomiting during pregnancy is called hyperemesis gravidarum. It is found in 0.5-2% of pregnant women. Severe nausea, vomiting, weight loss of at least 5%, urinary ketonuria (as a sign of hunger) without an obvious cause. 10-25 mg of vitamin B6 should be given 3-4 times a day as the first-line treatment in these pregnant women. It is known that vitamins B1 and B6 reduce nausea and vomiting up to 74% in pregnant women.

It is appropriate to take balanced and specially produced multivitamin / multimineral combinations during pregnancy, especially in cases of malnutrition, smoking & alcohol use, vegetarians, multiple pregnancies, adolescents. The storage, cooking and preparation processes of foods can affect their vitamin content. In countries such as our country, where iron deficiency anemia is encountered at a high rate of 75% in the female population, vitamin, mineral and iron supplementation should only be under the supervision of a doctor and in recommended doses, and it should be known that it cannot replace nutrition. These balanced combinations should also contain special minerals such as selenium, copper, biotin, which can only be obtained from the diet. There is still no accepted evidence and opinions on the routine use of vitamins during pregnancy. It should not be forgotten that in excessive and uncontrolled use, fat-soluble vitamins such as vitamins A, D, E, and K can accumulate in the body, causing harm on the contrary to the benefit.

References:

1-Yetley EA: Multivitamin and multimineral dietary supplements: Definitions, characterization, bioviability, and drug interactions. Am J Clin Nutr 85:269 S-276,2007

2-School TO, Hediger ML, Bendich A et al: Use of multivitamin/mineral prenatal supplements: Influence on the outcome of pregnancy. Am J Epidemiol 146:134-141,1997

3-Insttue of Medicine (US) Subcomitee on Nutritional Status and Weight Gain during Pregnancy: Nutrition during pregnancy: I. Weight gain. II.Nutrient supplements. Washington, DC, National Academy Press, 1990.

4-Siega –Riz AM, Hartzema AG, Turnbull C et al.: The effects of prophylactic iron given in prenatal supplements on iron status and birth outcomes: A randomized controlled trial. Am J Obstet Gynecol 194:512-519,2006.

5- Hibbeln JR, Davis JM, Steer C, et al.: maternal seafoodconsumption in pregnancy and neurodevelopmental outcomes in c hildhood(ALSPAC study): An observational cohort study. Lancet 369:578-585,2007.

Kind regards…
Assist. Assoc. Dr. Ilker Gunyeli

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