Introduction
Micronutrients or trace elements immensely influence the health of the mother and her child during pregnancy and lactation period. They are required in small amounts for the normal functioning, development, and growth of a human being at the early stages of his or her life (Allen 2005). Their deficiency during pregnancy may give rise to many complications such as anemia, hypertension, etc (Ravindra 2000).
The main purpose of this article is to discuss the role of various micronutrients before and after the birth of the child because much attention has been given only to a few micronutrients such as iron and folate with less regard to other trace elements, which are no less important. In particular, we must ascertain the consequences of micronutrient shortage or surplus. Furthermore, we need to determine their dosage, basing our argument on evidence-based practice.
On the whole, deficiency in these micronutrients happens when a pregnant mother has a poor quality diet with less intake of animal protein, milk, meat, eggs (Allen, 2005). Apart from that, even if a pregnant woman has a well-balanced diet there might be certain problems with the absorption of the necessary vitamins, namely, it can be limited by gene polymorphisms, diseases like malaria, and intestinal parasites (Institute of Medicine, 1991). This example shows that the shortage of vital microelements may also be caused by the peculiarities of the human organism, and dietitians have to take into consideration this factor while developing a nutrition plan for the woman and the infant.
Micronutrients required during pregnancy
Iron
Iron is one of the major trace elements, required during pregnancy (Langley-Evans et al 2003). Some scholars maintain that the lack of this micronutrient can result in preterm delivery and anemic condition (Dawson et al, 1997, p 480). It is required from conception, through the pregnancy to lactation (Casanueva et al. 2003). In this regard, we should point out that the effects of iron surplus have yet to be thoroughly studied, however, the overwhelming majority of scholars concur with the dosage of 3 or 4 mg per day (O Scholl,2004). It is believed that the excess of this nutrient can hinder the absorption of other vitamins, though, this hypothesis has yet to be fully substantiated (Scholl, 2004).
B-Vitamins
The group of B vitamins includes folate, riboflavin, vitamin B- 6, thiamine, and B-12. The most positive effect of these micronutrients is that they stimulate metabolism and enable pregnant women to accumulate strength (Herbert, 1988). Furthermore, they are essential for the functioning of the immune system. As for the risk of vitamin B, we should first pay attention to the concentration of plasma homocysteine in the body of the mother, which may lead to premature birth (Bondevik et al. 2001). Additionally, a high level of homocysteine in the body of the mother may lead to low birth weight, placenta disorders, preeclampsia, club foot, and neural tube defect affect their infants (Langley-Evans et al, 2003, p 216). Therefore, pregnant women should be given B –Vitamins supplements.
For instance, in Spain, pregnant women were given Folic acid as a supplement in their 2nd and 3rd trimesters, and this reduced the level of homocysteine in their body Murphy et al. 2002). They must also cut down their intake of coffee and nicotine (Allen, 2005). It is rather difficult to determine the most adequate intake of this trace element because much depends upon a particular substance, we may tell only the most approximate amount, which is 0.1 mg. As for the negative effects, it should be borne in mind that a woman, who consumes it in excessive quantities, may considerably gain weight, and this will complicate labor (Lammi-Keefe, et al 2008, p 44).
Vitamin A
Vitamin A must an inseparable part of every womans diet, especially if she is pregnant because it strengths her immune system. Deficiency in Vitamin A has been associated with increase deaths of the mother, intrauterine growth retardation, preterm births, low birth weight of the child, and placenta abruption (Christian et al, 2001, p 1049). Thus, the provision of Vitamin A during pregnancy will diminish the risk and also increase the hemoglobin level in the bodies of the mother and the infant.
According to the Institute of Medicine (1991), supplementation of pregnant women with Vitamin A minimizes their mortality rate by 40% while supplementing with beta–carotene reduces the mortality rate by 49% for women who were provided with this micronutrient within the 3rd trimester (Allen, 2005). Moreover, vitamin A avers the danger of having the anemic condition, for instance, scientists ascertained that the risk of iron deficiency in pregnant women was lowered by 10% among the women, who received Vitamin A supplements
(Allen 2005). The adequate intake ranges from 2800 -3000 ug per day, the amount depends on the age of the mother (Flodin, 1988, p 134).
Zinc
Zinc stimulates the development of the fetus and affects the infant’s weight for the first six months (Haider et al, 2009). According to research carried out on pregnant women in Peru, Zinc supplements helped to reduce the risk of preterm delivery and hypertension (Tatala et al. 2003). It was found out this trace element helped to keep the muscles of the woman in tone, which minimizes the risk of difficult labor and Caesarian section (Tatala et al. 2003). Some researchers believe that zinc deficiency causes the deceleration of child growth. (Caulfield et al. 1999).
Vitamin D
Vitamin D belongs to the group of soluble fats that help to absorb calcium and phosphorous from food intakes (Chames et al. 2002.). According to Allen (2005.), the absorbed calcium and phosphorous stimulate the skeleton formation of the fetus and the infants. The deficiency of vitamin D has been attributed to a low intake of well-prepared breakfast grains and milk. Vitamin D deficiency has also been associated with rickets, type 1 diabetes in the infants born to mothers with a deficiency (Chames et al, 2002, pg 190). The adequate status of Vitamin D is approximately 400 ug per day particularly during pregnancy; however, abundant supplementation may be rather detrimental, because it brings fatigue and loss of appetite (Ravindra, 2000, p 67).
Vitamin C and Vitamin E
Vitamin C should be included in the diet of any pregnant woman, because it stimulates better absorption of iron, and helps reduce the risk of anemic condition (Haider et al 2009, p 4) As an oxidant it guards the body against injurious free radicals. The negative effects of its shortage have not been fully examined but some researchers claim that the deficiency, combined with other factors may result in difficult labor (Haider et al 2009, p 4). Nevertheless, it is impermissible to consume more than 500 mg per day because there is a risk of cardiovascular disturbances (Haider et al 2009, p 4). In turn, vitamin E helps to prevent preeclampsia (Christian et al, 2006). Its most optimal intake varies according to the age of the patient, but on average, it is 10 mg (Christian, et al, 2006, p 173).
Iodine
Iodine is a chemical element, needed for the growth and development of the fetus and the child The major source of iodine is the stable salt that we consume, however, it is found in small amounts in fruits and vegetables (Allen 2005). The lack of this micronutrient results in subsequent mental retardation of the infant (Haider et al, 2006 p 4). The mother should consume no less than 150 mg of iodine, overconsumption is dangerous to the child because is rather toxic (Francois et al, 2003, p 155).
To conclude, each of these above-mentioned trace elements constitutes a diet of the would-be mother. Adequate intake of micronutrients contributes to safe delivery and helps to minimize possible complications. If a mother does not obtain sufficient quantities of the micronutrients, she may experience problems during and after delivery (Allen, 2005). Yet, as we have noted previously, the surplus of each vitamin may also produce negative effects.
Micronutrients during the lactation period
The amount of micronutrients in breast milk is supposed to be sufficient for the normal development of the child if the mother adheres to a well-balanced diet(Allen, 2006). It is recommended World wide that all mothers breastfeed for up to six months without giving the child any other food (Francois 2003). This is because all the nutrients that a child wants are present in breast milk. However, if the diet of the mother is a deficiency in some major macro and micro-nutrients, there will be a reduction in the total amount of nutrients found in the breast milk and this affects the infant in one way or other (Bodnar et al. 2001). This may subsequently pose threat to the normal development of the child.
Below are some of the micronutrients that are found in breast milk and their role:
Vitamin A
Breast milk is the best source of vitamin A for the newborn baby. After birth, the level of vitamin A in breast milk is very high but it starts to drop in about 6 weeks (Allen, 2005, p 1209). It is essential for the development of good vision and for upholding epithelial composition and its deficiency may lead to blindness by injuring the corneal epithelium and add to morbidity through transmissible diseases to the infant (Christian et al. 2001).
Vitamin D
The normal intake of vitamin D during the lactation period is supposed to be 11 mg per day. It is believed that deficiency of this micronutrient may lead to liver disorders when the child is two or three years old (Institute of Medicine, 1991). At the same time, the overdose of vitamin D hinders the absorption of other micronutrients, namely, vitamin K (Institute of Medicine, 1991).
Vitamin E
The effects of vitamin E deficiency have not been fully identified, but some scholars suggest that it slower metabolism in the body of the child. The average intake of this nutrient constitutes approximately 5 mg per day (Langley-Evans, 2003). Apart from that, this micronutrient helps to restore the mothers health after delivery especially, if we are speaking about her digestion (Langley-Evans, 2003).
Vitamin K
Adequate status of Vitamin K ensures normal bone formation in the body of the child because it helps to absorb calcium. Secondly, this micronutrient is conducive to blood coagulation during the postpartum period (Haider, 2009, p 14). Its normal intake is 65 ug per day, which is about 3 mg. A mother may suffer from excessive bleeding if her body lacks vitamin K (Bodnar, 2001, p 440).
Iron
According to Lindsay Allen, the lack of iron after the delivery is associated with the so-cold postpartum depression (Allen, 2005, p 1207). Furthermore, the shortage is believed to worsen the childs appetite (Lammi-Keefe, et al 2008, p 79. Iron performs several functions at the early stages of development. First, it improves the work of neurotransmitters and this stimulates the mental activity of the infant. Iron deficiency during the lactation period is often associated with mental retardation, but this theory still requires thorough analysis (Dawson et al, 1987, p 478). During the postpartum period, the intake of this substance should be approximately 3,4 mg per day (O Scholl, 2006).
Calcium
Calcium is one of the essential vitamins, ensures bone formation in the body of the child. The effects of calcium deficiency are not always noticeable during the lactation period, some researchers believe that they manifest themselves at pre-school age or even earlier, for example, many scientists emphasize the dangers of rickets (Chames, 2002, pg 187). Many experts suggest that the adequate dosage of this micronutrient should constitute 600 mg per day (Herbert, 1988, p 111)
Zinc
Recent studies, dedicated to the role of zinc, indicate that it contributes to the cognitive development of the child. Additionally, it is essential for the immune system of the infant (Riordan, 2005). However, it should be borne in mind that at the moment scientists have not identified the correlation between the lack of zinc and mental disorders. Moreover, the shortage of this trace element contributes to several liver diseases (Christian et al, 2001, p 1049).
Conclusion
A well-balanced diet during pregnancy is very essential for the mother, fetus, and child to be born. In this article, we have analyzed the role of various trace elements in the development of the fetus and the child when born. Micronutrients help to avoid complications during pregnancy and delivery. A pregnant woman should pay special attention to her daily ratio and, it is of crucial importance that she is not deficient in any of micronutrients. Nonetheless, as we have pointed out earlier, there should be no surplus, because, excessive amounts of any substance in the organism may disrupt the normal functioning of the body.
During the postpartum period, micronutrients serve two major purposes, first; they help the mother to recover her health after birth; secondly, they contribute to the development of the childs organism. A woman should pay much attention to the status of trace elements in her diet. If she is not taking food rich in micronutrients then she should take on supplements for these micronutrients. This will help to replenish the depleted stores of vitamins in her body system, particularly after delivery. Apart from that, the breast milk must contain the necessary norm of the vitamins to promote the health of the child during the lactation period and in the long-term, because the effects of deficiency may manifest themselves after a considerable amount of time as it is the case with vitamin D. But, again, we should emphasize the idea that the surplus may also be harmful.
References
Allen, H 2005, Multiple Micronutrients in Pregnancy and Lactation, American Journal on Clinical Nutrition, vol. 81, no. 5, pp 1206S- 1216S.
Batool A Haider1, Zulfiqar A Bhutta1 “Multiple-micronutrient supplementation for women during pregnancy” JohnWiley & Sons, Ltd.
Beazley, D, Livingston, J, Kao, L & Sibai B 2002, Vitamin C and E supplementation in women at high risk for preeclampsia: a double blind placebo controlled trial. American Journal of Obstetrics and Gynecology, vol. 187.
Bodnar, DL, Scanlon, KS, Freedman, DS, Siega-Riz, MA & Cogswell, ME 2001, High prevalence of postpartum anemia among low-income women in the United States. American Journal Obstetric Gynecology, vol. 185, pp 438–443.
Bondevik, GT, Schneede, J, Refsum, H, Lie RT, Ulstein, M. & Kvale G 2001, Homocysteine and methylmalonic acid levels in pregnant Nepali women. Should cobalamin supplementation be considered? European Journal on Clinical Nutrition, vol. 55, no. 10, pp 856-864.
Casanueva, E, Pfeffer, F, Drijanski, A, et al 2003, Iron and folate status before pregnancy and anemia during pregnancy. Ann Nutrition Metabolism, vol. 47, pp 60-63.
Caulfield, LE, Zavaleta, N, Figueroa, A, Leon, Z 1999, Maternal zinc supplementation does not affect birth size or pregnancy duration in Peru. Journal of Nutrition, no. 129, pp. 1563–1568.
Chames, M, Liu, H, Bendich, A, Bogden, J, Siabi, B & Prada J 2002, A randomized trial of calcium supplementation: effects on blood lead levels in pregnancy. American Journal of Obstetrics and Gynecology, vol. 187, no. 6.
Christian, P, Khatry, SK, Yamini, S, Stallings, R, LeClerq, SC, Shrestha ,SR, et al 2001, Zinc supplementation might potentate the effect of vitamin A in restoring night vision in pregnant Nepalese women. American Journal of Clinical Nutrition, vol. 73, pp 1045–1051.
Dawson, EB, McGanity, WJ 1987, Protection of maternal iron stores in pregnancy. Journal of Reproductive Medicine, vol. 32, pp 478–487.
Flodin, NW 1988, Pharmacology of Micronutrients, A. R. Liss.
Francois, MD, & Keith, PW 2003, Micronutrients in the First Month of Life, Karger.
Herbert, B 1988, Vitamin and Minerals in Pregnancy and Lactation, Raven Press.
Institute of Medicine (U.S) 1991, Nutrition during Lactation, National Academies Press, Washington.
Lammi-Keefe, CJ, Couch, SC & Elliot, P 2008, Hand book of Nutrition and Pregnancy. Karger.
Murphy, MM., Scott MJ, McPartlin JM & Fernandez-Ballart JD 2002, The pregnancy-related decrease in fasting plasma homocysteine is not explained by folic acid supplementation, hemodilution, or a decrease in albumin in a longitudinal study. American Journal of Clinical Nutrition, Vol. 76, No. 3, pp. 614-619.
O Scholl (2005). “Iron status during pregnancy: setting the stage for mother and infant”. American Journal of Clinical Nutrition, Vol. 81, No. 5, 1218S-1222S.
Preziosi, P, Prual, A, Galan, P, Daouda, H, Boureima, H & Hercberg, S 1997, Effect of iron supplementation on the iron status of pregnant women: consequences for newborns, American Journal Clinical Nutrition, vol. 66, pp 1178–1182.
Ravindra, N 2000, Health and Diseases; Role of Micronutrients and Trace Elements, APH.
Riordan, J 2005, Breastfeeding and Human Lactation, Jones & Bartlett Publishers.
Siekmann JH., Allen, LH, Bwibo, NO, Demment MW, Murphy, SP& Neumann, CG 2003, Kenyan School children have multiple micronutrient deficiencies, but increased plasma vitamin B-12 is the only detectable micronutrient response to meat or milk supplementation. Journal on Nutrition, vol.133, pp 3972S– 3980S.
Takumi, Y, Franklyn, F & Velimer, B 2008, Micronutrients and Health Research, Nova Publishers.
Tatala, SR, Ash, D, Makola, D, Latham, M, Ndosi, G & Grohn, Y 2002, Effect of micronutrient fortified beverage on nutritional anemia during pregnancy. East African Medical, vol. 79, no. 11, pp 598-603.