LB2882MaternalNutriti+ - Mead Johnson Nutrition

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FIGURE 2. DIFFERENCES IN MINERAL INTAkE RECOMMENDATIONS 250% 200% 150% 100% Calcium Chromium Copper Fluoride Iodine Iron Magnesium Manganese Molybdenum Phosphorus Selenium Zinc 50% 0% Pregnancy, 19-30 years Lactation, 19-30 years Potassium Sodium Chloride 100% represents the DRI for nonpregnant and non-lactating women ages 19-30 years. The bar graphs illustrate the percentage of the non-pregnant/nonlactating DRI recommended for pregnant and lactating women. Specifi c recommendations for pregnancy and lactation are provided in Table 9. It is important for pregnant women to consume adequate amounts of all essential minerals. Some minerals that deserve special attention during pregnancy and/or lactation are highlighted below. TAbLE 9. RECOMMENDED MINERAL INTAkES FOR WOMEN DURING PREGNANCY AND LACTATION, AGES 19 TO 50 YEARS 21,79,80 Pregnancy Lactation Nutrient IOM WHO/FAO IOM WHO/FAO 1200 Calcium ac , mg 1000 1000 1000 3rd Trimester Chromium b , µg 30 - 45 - Copper a , µg 1000 - 1300 - Flouride b , mg 3 - 3 - Iodine ac , µg 220 200 290 200 Iron ac , mg 27 Not specified 9 10-30 Magnesium ac , mg 350-360 220 310-320 270 Manganese b , mg 2 - 2.6 - Molybdenum a , µg 50 - 50 - Phosphorus a , mg 700 - 700 - Selenium a , µg 60 - 70 - Zinc a , mg 11 4.2-20 12 4.3-17.5 Potassium b , g 4.7 - 5.1 - Sodium b , g 1.5 - 1.5 - Chloride b , g 2.3 - 2.3 - a Recommended Dietary Allowance (RDA) b Adequate Intake (AI) c Recommended Nutrient Intake (RNI) Intakes are per day, unless otherwise noted. MATERNAL NUTRITION 18
Iron Iron is vital to the production of hemoglobin, (which is necessary for oxygen transport), and energy production, fetal immunity, and development of the central nervous system. 106 Iron deficiency affects more than 2 billion people globally, making it the most common nutrient deficiency in the world. Iron deficiency is more common in developing countries but continues to be a significant problem in developed countries despite near elimination of other forms of malnutrition. 107 An estimated eight million women of childbearing age in the US have iron-deficiency anemia, 2 and it is reasonable to expect that a large number of women are also iron-deficient. Low-income, less than 12 years of education and increased parity are all associated with a greater risk of iron deficiency and iron-deficiency anemia. 42,108 The global prevalence of iron-deficiency anemia is estimated to be 47.4% in pregnant women. 18 The recommended iron intakes established by the IOM increase from 18 mg/day to 27 mg/day during pregnancy for women ages 19 to 50 years 20 while the WHO has established different recommended intakes based on the bioavailability of dietary iron consumed. In developing countries, it is reasonable to use iron bioavailability levels of 5% and 10% translating into recommended nutrient intakes for lactating women of 30 and 15 mg/day respectively. In developed countries consuming a more Western diet, it is more appropriate to use bioavailability levels of 12% and 15%, translating into recommended nutrient intakes for lactating women of 12.5 and 10 mg/day of iron, respectively. The WHO establishes no recommended nutrient intakes for iron in pregnant women because the iron balance in the diet depends on amounts of stored iron in addition to the bioavailability of dietary iron. 21 Iron stores at the time of conception are a strong indicator of risk for iron-deficiency anemia later in pregnancy. 42 Serum ferritin levels are a measure of stored iron in the body and can be used with a hematocrit to confirm irondeficiency anemia when there is no evidence of inflammation 108 before and during pregnancy. Iron-deficiency anemia during pregnancy has been associated with an increased risk for preterm birth, low birth weight, and perinatal mortality. 109-111 However, results of recent studies on the effects of maternal iron status and supplementation during pregnancy on fetal growth have been inconsistent. In a recent review on iron supplementation and pregnancy outcome, studies starting supplementation in mid- or late pregnancy found an increase in maternal iron markers, but no effect on fetal growth with the exception of one study where high-dose supplementation showed a positive association with birth length (not with birth weight) in a low-income setting. However, in studies starting supplementation in early pregnancy, maternal iron status did not improve, but there was a beneficial effect on fetal growth. 112 Iron absorption during pregnancy is determined by several factors including the amount and bioavailability of dietary iron as well as the changes in iron absorption that occur during pregnancy. Although there is an increase in iron absorption, it is difficult for the mother to consume enough dietary iron to meet her iron requirements during pregnancy. 21 The typical American diet provides inadequate iron to meet the recommendations for the pregnancy state. 113 In addition, the endogenous iron stores of women may be insufficient to provide for the increased iron demands of pregnancy. 65 In the US, the CDC recommends that all pregnant women take 30 mg of supplemental elemental iron every day to prevent anemia 2 and 60 to 120 mg of elemental iron daily to treat anemia once it is diagnosed. 2,113 In the UK, prophylactic iron supplementation is not recommended for pregnant women. However, pregnant women are monitored throughout pregnancy for iron-deficiency anemia and recommendations for supplementation based on iron status tests are established. 107 There is some concern that such prophylactic iron supplementation in women without anemia or iron-deficiency anemia may increase the risk of pregnancy complications. 42 However, iron supplementation during pregnancy has merit, as a large proportion of women have difficulty maintaining iron stores during pregnancy and are at risk for anemia. 113 The WHO recommends that pregnant women be supplemented with 60 mg iron in conjunction with 400 µg of folic acid daily. 18 19
Page 1 and 2: MATERNAL NUTRITION bY Elizabeth M.
Page 3 and 4: TAbLE OF CONTENTS EXECUTIVE SUMMARY
Page 5 and 6: EXECUTIVE SUMMARY A mother’s nutr
Page 7 and 8: INTRODUCTION A mother’s nutrition
Page 9 and 10: Preconception Care In 2005, the WHO
Page 11 and 12: Nutrient Needs during Pregnancy and
Page 13 and 14: During lactation, the U.S. Dietary
Page 15 and 16: The United States has not establish
Page 17 and 18: Folate and Folic Acid Folate is a g
Page 19: Vitamin D Vitamin D’s principal r
Page 23 and 24: Table 10. WHO Recommended Nutrient
Page 25 and 26: Guidelines for Physical Activity du
Page 27 and 28: FOOD SAFETY ISSUES Fish and Seafood
Page 29 and 30: the recommendations, summarized bel
Page 31 and 32: Women are encouraged to enter pregn
Page 33 and 34: 53. Viswanathan M, Siega-Riz AM, Mo
Page 36: XXXXXX NEW 12/12 ©2012 Mead Johnso

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