How Nutrition before and during Early Pregnancy Affects Birth Outcome - Assignment Example

INTRODUCTION Proper and balanced diet is always important more so in pregnant women. Although the diet of pregnant women is the same as that in adult but with some restrictions and supplementations. Studies showed that fetal growth is associated with maternal diet, however, there is no epidemiological evidence how maternal growth is influenced by the diet. During pregnancy itself it is important to consider the well-being and maternal health, the health of the newborn baby, and the welfare of the mother’s ability to provide adequate care and proper nutrients. One study showed that maternal diet is an important determinant in the fetal growth and placental weight. But other study reveals that the effects of maternal diet are not much appreciated in industrialized countries than it is in developing countries. The fetal weight of 3.1 – 3.6 kg serves as the basis of having optimum maternal and fetal outcomes. A lower birth weight can be associated with higher mortality and morbidity, as well as increased of risk diseases later in life. While the effects of some micronutrients such as iodine in pregnancy has been long recognized other vitamins and minerals have just become recently appreciated. It is the objective of this paper to bring about and compare different micronutrients taken before and during pregnancy and how can these affect the outcome of birth based on several studies. DIFFERENT VITAMINS AND MINERALS AND ITS EFFECTS IN THE OUTCOME OF BIRTH Iron International and national bodies have recommended the use of iron in pregnant women. It seemed that it has been made a part of the standard of care during pregnancy. Lack of iron results in anemia which could be very fatal if there are complications in giving birth such as hemorrhage. Supplemental intake of iron shows an increase in iron reserves and reduces anemia. A trial study for the use of iron as supplemental during pregnancy in a developing country showed a marked reduction in fetal loss and neonatal mortality. Folic acid Folic acid has been recommended by most obstetricians and gynecologists as a supplement for women who want to have a baby. It is said to have an important effect in preparing a woman’s reproductive organs by preventing congenital malformations as well as complications during pregnancy. It is usually taken in combination with iron. From a study in a developing country, limited data showed that folic acid reduces the incidence of low birth weight and improve fetal growth. It is also established that folic acid supplementation prevents neural tube defects in the fetus. When not prevented or there is a deficiency in folate the most common neural tube defects include anencephaly which could result in stillbirth and spina bifida which has a wide range of physical disorders including but not limited to partial or complete paralysis. The mechanism on how folate supplementation reduces the risk on neural tube defects was not clearly established, but it was emphasized in the recent study conducted by Wald (2000) that it is very important to take folate supplementation before pregnancy otherwise it will be too late if it is taken during early pregnancy and it will not be that effective. Zinc According to (Caulfield et. al 1998), “zinc deficiency has been associated with complications of pregnancy and delivery, such as pre-eclampsia, premature rupture of membranes, and pre-term delivery, and with fetal growth retardation and congenital abnormalities”. In developed countries there are some effects of zinc in some population but significant results of zinc supplementation are seen in developing countries. In some trials made in developing countries there are other beneficial effects of zinc but needs further investigation. One trial also reveals an enhanced neurobehavioral development when taken during pregnancy as compared to pregnant women who have not taken zinc supplement. In animal models, the absence of zinc at the time of conception resulted to congenital defects and during pregnancy the development of fetal immune system has adverse effects. (Osendarp et. al 2000) contends that, “trials in developing countries have found that babies mothers were given zinc supplementation during pregnancy have improved immune function and a reduction in diarrhea and respiratory illnesses in infancy, suggesting effects on immune competence that persist beyond birth”. Iodine Iodine has something to do with the thyroid function not only of pregnant women but others also as part of healthy well being. But in pregnancy there is a clear link that iodine deficiency results in endemic cretinism, congenital anomalies, deficits in intellectual and motor function, and possibly fetal wastage and pre-term delivery. Iodine supplementation helps reduce the risk of these disorders. In developing countries iodine deficiency is minimized by administering iodized oil before and during pregnancy and providing iodized salt to others in iodine deficient area. Magnesium In a trial made in developed countries, the supplementation of magnesium during pregnancy showed fewer pre-term births and less intrauterine growth retardation. Magnesium deficiency is closely linked with pre-eclampsia, pre-term delivery, and possibly low birth weight. In most trials magnesium has shown positive effects in birth weight when taken during early pregnancy. But other trials revealed that a 15 mmol/ daily of magnesium showed no effect to improve pregnancy outcome. Selenium and Copper Deficiencies in selenium and copper before and during pregnancy have also its adverse effects and reduced fetal growth; however, there is still a need to support it with further investigations and trials in developing countries where deficiencies are common. Calcium Calcium deficiency is also associated with abnormal fetal development, pregnancy induced hypertension, and pre-term delivery (Ritchie & King, 2000; Villar & Belizen, 2000). Several trials resulted to a beneficial effect on gestational hypertension and women with low calcium intake. Vitamins Vitamin A deficiency also leads to fetal wastage during pregnancy; however, higher doses can also be teratogenic (Azais-Braesco & Pasca, 2000). Weekly supplement of vitamin A and beta- carotene reduced maternal mortality by 50% in a trial conducted in Nepal. Deficiencies of vitamins C and E are associated with complications with pregnancy but recent trial reveals that provision of vitamin C and E resulted in 60% lower in pre-eclampsia. There was no concrete epidemiological evidence of the effects of vitamin D in the weight of birth but it surely has benefits in reducing hypocalcaemia in neonates. Energy It is important that women who entered pregnancy must be in good nutritional status and a healthy weight. Study revealed that pregnant women must include in their diet sufficient energy in order to ensure full term delivery of a healthy infant. Supplemental energy during pregnancy greatly affects the condition of pregnant women who are nutritionally at risk as well as the outcome of birth. According to Goldberg (2002) the following brought about the need for additional energy requirement: 1. The need to deposit energy in the form of new tissue; this includes the fetus, placenta, and amniotic fluid; 2. The growth of existing maternal tissues, including breast and uterus; 3. Extra maternal fat deposition; 4. Increased energy requirements for tissue synthesis; 5. Increased oxygen consumption by maternal organs; 6. The energy needs of the products of conception (fetus and placenta), particularly in the later stages of pregnancy. Protein The protein daily intake increases as the pregnancy progresses. The reason for the variation in the amount of protein is for the development of placental, fetal, and maternal tissues. Most trials conducted in underprivileged women population showed that supplementation of higher protein density resulted in increased incidence of SGA, hence, there should be a balanced supplementation of protein-energy to significantly reduced the incidence of SGA. Essential Fatty Acids There are no clear effects of fish oil supplementation in birth weight however, epidemiological evidence revealed a close association of between fish intake and birth weight. No specific dietary amount of fatty acids required during pregnancy, however, essential fatty acids are needed for the development of the brain and nervous system of the fetus. A good neurodevelopment can be attributed to an improved docosahexaenoic acid content in infants at birth. Carbohydrates There are no changes in the carbohydrate requirement during pregnancy but other pregnant women who suffered difficulty in bowel movement must increase their dietary fiber intake. Alcohol The reproductive capability of the women is affected by excessive intake of alcohol. Likewise, when taken during early pregnancy it has a damaging effect on the embryo. Excessive drinking before and during pregnancy has a lower birth weight and will likely result to a variety of congenital abnormalities, stunted growth, and mental retardation. Caffeine Caffeine is not only found in coffee other beverages and some pill or medicine is said to contain amount of caffeine. The effect of daily consumption of caffeine before and during pregnancy is inconclusive. There is no concrete evidence yet that could lead caffeine consumption to lower birth weight. Smoking Smoking before and during pregnancy could have an adverse effects on the baby. It surely leads to low birth weight, premature birth, or babies die before birth. Overweight and Underweight The dietary intake of women which also affects the body composition has something to do with the outcome of birth. Being underweight or overweight before conception affects birth weight. It is evidenced in a study that taller and fat or short but of appropriate weight women have a good outcome of birth as compared to women who are short and fat. There is also a strong relationship between the body mass index and fertility. CONCLUSION Many trials and studies were conducted to determine how macro and micro nutrients before and during pregnancy affect the outcome of birth. Majority of which pointed out that these nutrients in one way or another have contributed to the welfare of both the mother and the baby. Some of these nutrients are needed even before the onset of pregnancy to have optimum protection during childbirth. Comparatively, studies were also made in developed and developing countries. Some of the beneficial effects of these nutrients are not much appreciated in developed countries. However, a marked increase on the effects of these essential nutrients is commonly manifested in women in developing countries. Nevertheless, there is no sufficient evidence that the same holds true to women coming from developing countries and have lived in developed countries. As part of a healthy habit proper diet and nutrition is necessary as it has been established that a deficiency or an excess in proper nutrition has its consequences. More care must be observed especially in pregnant women since any deficiency has its adverse effects not only for the mothers but for the baby as well. References: AA Jackson & SM Robinson. Public Health Nutrition. Dietary Guidelines for Pregnancy: A Review of Current Evidence. 4(2B), 625-630. Black, R.E. 2001. British Journal of Nutrition. Micronutrients in Pregnancy. 85, Suppl. 2, S193-S197. Matthews, F.; Yudkin, P.; Neil, A. 1999. Influence of Maternal Nutrition on Outcome of Pregnancy: Prospective Cohort Study. Williamson, C.S. Briefing Paper: Nutrition in Pregnancy. Read More