Darnton-Hill Ian, Mkparu Uzonna C
The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, NSW 2006, Australia.
The Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA 021111, USA.
Nutrients. 2015 Mar 10;7(3):1744-68. doi: 10.3390/nu7031744.
Pregnancy is one of the more important periods in life when increased micronutrients, and macronutrients are most needed by the body; both for the health and well-being of the mother and for the growing foetus and newborn child. This brief review aims to identify the micronutrients (vitamins and minerals) likely to be deficient in women of reproductive age in Low- and Middle-Income Countries (LMIC), especially during pregnancy, and the impact of such deficiencies. A global prevalence of some two billion people at risk of micronutrient deficiencies, and multiple micronutrient deficiencies of many pregnant women in LMIC underline the urgency to establishing the optimal recommendations, including for delivery. It has long been recognized that adequate iron is important for best reproductive outcomes, including gestational cognitive development. Similarly, iodine and calcium have been recognized for their roles in development of the foetus/neonate. Less clear effects of deficiencies of zinc, copper, magnesium and selenium have been reported. Folate sufficiency periconceptionally is recognized both by the practice of providing folic acid in antenatal iron/folic acid supplementation and by increasing numbers of countries fortifying flours with folic acid. Other vitamins likely to be important include vitamins B12, D and A with the water-soluble vitamins generally less likely to be a problem. Epigenetic influences and the likely influence of micronutrient deficiencies on foetal origins of adult chronic diseases are currently being clarified. Micronutrients may have other more subtle, unrecognized effects. The necessity for improved diets and health and sanitation are consistently recommended, although these are not always available to many of the world's pregnant women. Consequently, supplementation programmes, fortification of staples and condiments, and nutrition and health support need to be scaled-up, supported by social and cultural measures. Because of the life-long influences on reproductive outcomes, including inter-generational ones, both clinical and public health measures need to ensure adequate micronutrient intakes during pregnancy, but also during adolescence, the first few years of life, and during lactation. Many antenatal programmes are not currently achieving this. We aim to address the need for micronutrients during pregnancy, the importance of micronutrient deficiencies during gestation and before, and propose the scaling-up of clinical and public health approaches that achieve healthier pregnancies and improved pregnancy outcomes.
孕期是生命中较为重要的时期之一，此时身体对微量营养素和常量营养素的需求增加，这对母亲的健康和幸福以及成长中的胎儿和新生儿都至关重要。本简要综述旨在确定低收入和中等收入国家（LMIC）育龄妇女，尤其是孕期可能缺乏的微量营养素（维生素和矿物质），以及此类缺乏的影响。全球约有20亿人面临微量营养素缺乏风险，且LMIC许多孕妇存在多种微量营养素缺乏，这凸显了确定最佳建议（包括分娩建议）的紧迫性。长期以来人们认识到，充足的铁对实现最佳生殖结局（包括孕期认知发育）很重要。同样，碘和钙在胎儿/新生儿发育中的作用也已得到认可。关于锌、铜、镁和硒缺乏的影响报道较少。围孕期叶酸充足既体现在产前补充铁/叶酸制剂中添加叶酸的做法上，也体现在越来越多的国家对面粉进行叶酸强化上。其他可能重要的维生素包括维生素B12、D和A，而水溶性维生素一般不太可能成为问题。目前正在阐明表观遗传影响以及微量营养素缺乏对成人慢性病胎儿起源的可能影响。微量营养素可能还有其他更细微、未被认识到的影响。尽管世界上许多孕妇往往无法获得，但改善饮食、健康和卫生条件的必要性一直得到推荐。因此，需要扩大补充剂计划、主食和调味品强化以及营养和健康支持，并辅以社会和文化措施。由于对生殖结局（包括代际生殖结局）有终身影响，临床和公共卫生措施既要确保孕期摄入充足的微量营养素，也要确保青春期、生命最初几年以及哺乳期摄入充足的微量营养素。目前许多产前计划并未做到这一点。我们旨在满足孕期对微量营养素的需求，强调孕期及孕前微量营养素缺乏问题的重要性，并提议扩大临床和公共卫生措施，以实现更健康的妊娠和改善妊娠结局。
