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Applied Nursing Research 35 (2017) 1317

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The dietary composition of women who delivered preterm and

full-term infants
Wioletta Waksmaska a,, Rafa Bobiski a, Izabela Ulman-Wodarz a, Anna Pielesz b, Monika Mikulska a
Faculty of Health Sciences, Department of Nursing and Emergency Medicine, University of Bielsko-Biala, ul. Willowa 2, 43-309 Bielsko-Biala, Poland
Faculty of Materials, Civil and Environmental, Engineering, University of Bielsko-Biala, ul. Willowa 2, 43-309 Bielsko-Biala, Poland

a r t i c l e i n f o a b s t r a c t

Article history: Objectives: Literature data show that excess and primary deciency in particular nutrients, vitamins and minerals
Received 20 November 2016 may lead to pre-eclampsia, gestational diabetes, hypertension and neural tube defects in the foetus. The aim of
Accepted 1 February 2017 the study was to determine differences in average daily consumption of selected nutrients during pregnancy
Available online xxxx in women who did not supplement their diet and to evaluate the inuence of dietary habits on the occurrence
of pre-term delivery and hypertension in pregnant women.
Sample group and methods: Information on the course of pregnancy and the newborn's health status at birth was
Caesarean section
derived from the Charter of Pregnancy and documents recorded by the hospital. Women's eating habits and di-
Hypertension etary composition were analyzed on the basis of a dietary questionnaire. The sample group was divided into four
Minerals groups: women who delivered neonates appropriate for gestational age (AGA), women with gestosis who deliv-
Premature delivery ered AGA neonates by means of caesarean sections, women who delivered pre-term neonates (PTB) and women
with gestosis who delivered PTB by means of caesarean sections.
Results: In the case of women with vaginal delivery at term the average intake of iodine was always higher than in
other groups. Analysis of average daily intake of folates revealed a higher intake in the group of women who gave
birth to full-term neonates with proper neonatal weight in comparison with the groups of women with pre-term
delivery. P 0.05.
Conclusions: Statistically signicant differences in average daily intake of folates, iodine, retinol, magnesium and
iron were observed between the group of women with vaginal delivery at term and the groups of women with
diagnosed hypertension who delivered preterm. Correlation was demonstrated between average daily intake of
iodine and vitamin D and the occurrence of arterial hypertension. Supplementation of the diet of women in the
preconception and prenatal period with minerals and vitamins should be considered.
2017 Elsevier Inc. All rights reserved.

1. Introduction WHO, 2010). The remaining energy demand, i.e. 4560%, should be pro-
vided by carbohydrates (Jarosz, 2012; WHO, 2007b).
The diet of a pregnant woman, which conditions proper development Studies have shown that supplying an insufcient amount of protein
of the foetus, should be the source of wholesome protein, fats and to the body during pregnancy has an adverse effect on foetal develop-
carbohydrates and take into account recommendations on the right pro- ment and birth body weight of neonates, and low birth weight is associ-
portions and caloric value which vary depending on the trimester of preg- ated with the risk of hypertension, diabetes, obesity or hyperlipidemia
nancy. According to recommendations of the Food and Nutrition Board, at a later age (Jarosz, 2012; Akbari, Mansourian, & Kelishadi, 2015;
daily intake of protein for pregnant women is about 1 g per kilogram of Ostachowska-Gsior, 2008). An excessive intake of carbohydrates dur-
body weight, which constitutes 1015% of daily energy demand (WHO, ing pregnancy is associated with the risk of hyperglycemia for the moth-
2007a) Consumption of fats should be an average of 2530% of daily en- er and leads to hyperglycemia and hyperinsulinemia in the foetus,
ergy demand. During pregnancy, depending on the trimester, fat content leading to increased protein synthesis in the foetus and deposition of
in the diet should be increased by 1115 g daily on average, an adequate fat and glycogen in tissues, which result in macrosomia and the occur-
content of fatty acids should also be taken into account (Jarosz, 2012; rence of polyhydramnios (Wang, Jiang, Yang, & Zhang, 2015).
An important element of proper nutrition of pregnant women is the
supply of adequate amounts of vitamins and minerals, especially those
Corresponding author at: Faculty of Health Sciences, Department of Nursing and
Emergency Medicine, University of Bielsko-Biala, ul. Willowa 2, 43-300 Bielsko-Biala,
scarcely present in food products.
Poland. In accordance with recommendations concerning deciency of vita-
E-mail address: (W. Waksmaska). min D - daily intake of the vitamin for pregnant women is 2025 g.
0897-1897/ 2017 Elsevier Inc. All rights reserved.
14 W. Waksmaska et al. / Applied Nursing Research 35 (2017) 1317

Literature data show that vitamin D affects expression of genes regulat- To obtain a homogeneous group of women, the following inclusion
ing angiogenesis. During pregnancy vitamin D is essential to maintain criteria were applied:
the foetus. Vitamin D deciency may lead to the occurrence of pre-
1. Polish nationality (excluding naturalized Polish citizens); single
eclampsia, gestational diabetes, and in the foetus - to the development
pregnancy; pregnancy IIII (consider parity);
of rickets (Gruber, 2015; Misiorowska & Misiorowski, 2014; Robinson,
2. Stable socioeconomic status. Socioeconomic status was determined
Wagner, Hollis, Baatz, & Johnson, 2011; Sadin, Pourghassem Gargari,
based on factors such as income, marital status, education, place of
Fard, & Tabrizi, 2015).
residence. Women eligible for the study were married, had good
Calcitriol - an active form of vitamin D, affects calcium-phosphate
housing conditions, had secondary or higher education level; lived
metabolism of the organism and inhibits secretion of parathormone
in a highly industrialized urban region, both the women and their
(Misiorowska & Misiorowski, 2014).
husbands had a steady job;
Another important vitamin in the diet of pregnant women is vitamin
3. Following a typical diet for the Polish population. The diet of the
B9, also called folic acid. The consumption norm concerning folates dur-
women was determined on the basis of Album of Photographs of
ing pregnancy is 600 g.
Food products and Dishes (Szponar, Wolnicka, & Rychlik, 2010)
Folates participate in the synthesis of red cells and joining of alkyl
(the women accepted into the study were neither vegetarians nor
groups to nucleobases. They are also a cofactor of metabolic changes
followed any other special diets). Their diet was not modied in
of homocysteine (Kapka-Skrzypczak, Niedwiecka, Skrzypczak, &
any way;
Wojtya, 2012).
4. Granting consent to participate in the study.
Deciency of folates leads to an increase in homocysteine concentra-
The following exclusion criteria were applied:
tion, which is a risk factor of development of thrombotic disorders. Dur-
ing the preconception period and early pregnancy, deciency of folates 1. Chronic diseases occurring in the women before pregnancy, such as
may lead to neural tube defects in the foetus, and later in pregnancy, it chronic hypertension, pre-gestational diabetes; infections during
may increase the risk for premature birth, the occurrence of pre- pregnancy (any kind of infection in the perinatal period, such as
eclampsia and hypertension (Kapka-Skrzypczak et al., 2012; Cielik & fever, respiratory infections, urinary infections, etc.); miscarriages
Kociej, 2012; Seremak-Mrozikiewicz, 2013). and/or premature birth resulting in the death of the child or develop-
Another important element of the diet during pregnancy is iodine. mental anomalies in the foetus;
Daily intake of iodine recommended by WHO is 250 g (Hubalewska- 2. AIDS and sexually transmitted diseases;
Dydejczyk, Lewiski, Milewicz, et al., 2011). Iodine is essential for the 3. Adherence to a vegetarian diet, Mediterranean diet, or any other spe-
production of the thyroid hormone - thyroxine, which participates in, cial diet;
among others, proliferation of neural cells of the developing foetus 4. Lack of the mother's consent to take part in the research program or
(Zygmunt & Lewinski, 2015). withdrawal of consent during the study.
Severe iodine deciency during pregnancy may lead to an increased Women who participated in the research program were classied
risk of miscarriage, preterm delivery, impaired foetal lung development, into four groups according to the following criteria:
deafness, damage to the central nervous system and even to irreversible -Group A - Group of women who delivered neonates appropriate for
brain underdevelopment in the foetus (Zygmunt & Lewinski, 2015). gestational age. (AGA), healthy mothers, routine, uneventful pregnancy
The risk of hypertension in pregnant women is increased in the case (neonatal weight 10th90th percentile) (n = 11),
of magnesium deciency. Magnesium is a cofactor of carbohydrate, fat -Group B - Group of women who delivered neonates appropriate for
and protein metabolism. Magnesium takes part in glycolysis, calcium gestational age by means of caesarean sections due to gestational high
homeostasis, vitamin D hydroxylation and synthesis of high-energy blood-pressure (neonatal weight 10th90th percentile) (n = 10),
bonds (ATP, GTP). By creating complex formations with phospholipids, -Group C - Group of women who delivered preterm neonates (PTB),
magnesium is also part of the structure of cell membranes (Iskra, healthy mothers, routine, uneventful pregnancy (n = 7),
Krasiska, & Tykarski, 2013). -Group D - Group of women who delivered preterm neonates (PTB),
Pregnancy complications concerning both the mother and foetus af- by mean of caesarean sections due to gestational high blood-pressure
fect the increase of perinatal mortality, which constitutes an important (n = 8) (Table 1).
public health issue. Women eligible for the study underwent three ultrasound examina-
To date, research has proved that women's awareness of balanced tions (between the 12th and 14th weeks of gestation, between the 20th
nutrition during pregnancy and the inuence of nutrition on the health and 22nd weeks and between the 32nd and 33rd week). All the foetuses
of the mother and her future child is insufcient, both in terms of choice had normal karyotypes and no malformation at birth.
of nutritional ingredients and dietary supplements (Akbari et al., 2015; The mothers did not receive any dietary supplementation during
Kapka-Skrzypczak et al., 2012; Seremak-Mrozikiewicz, 2013; Zygmunt pregnancy. The mothers in PTB did not receive corticosteroids. Those
& Lewinski, 2015; Hamuka, Wawrzyniak, & Pawowska, 2010; Suliga, children whose weight exceeded the 90th percentile (Large for gesta-
2013; Waszkowiak, Szymandera-Buszka, & Szewczyk, 2010). tional age - LGA) were not included in the study.
The information on the course of pregnancy of the women came
from the Charter of Pregnancy, i.e. the document recorded by the gyne-
2. Aim of the study
cologist who took care of the pregnant woman. All the information
The aim of the study was to determine differences in average daily
consumption of selected nutrients during pregnancy in women who
did not supplement their diet, and to evaluate the inuence of dietary Table 1
habits on the occurrence of preterm delivery and hypertension in preg- Analysis of the studied groups, g - gram.
nant women. Studied Size of Mean age of Birth order Average birth
group group participants dened in % weight (g)

3. Research and method I II III

Group A 11 32 9% 91% 3470.45

In accordance with Polish perinatology protocols, mothers and chil- Group B 10 31 60% 40% 3433
dren were admitted onto the Maternity Ward in Hospital in Tychy in III Group C 7 32 43% 57% 2137.14
Group D 8 27 100% 2052
2016, for 3 days after the delivery.
W. Waksmaska et al. / Applied Nursing Research 35 (2017) 1317 15

concerning the birth and postpartum period, the newborn's health sta- 5. Statistics
tus at birth and the results of their physical examination was taken from
the documents recorded by the hospital. The Kruskal-Wallis ANOVA test was used to determine differences in
The study was approved by the Bioethics Review Board of Bielsko- food intake by the three groups. The Kruskal-Wallis nonparametric
Biala (No: 2016/02/11/4) which is in accordance with the Declaration analysis of variance was used due to high absolute values of the skew-
of Helsinki. ness and kurtosis of a large number of the variables. A detailed post
hoc analysis was also conducted.
4. Procedures The statistical signicance was determined at P b 0.05.
Gestational age was calculated according to the Naegele's rule. The
The women's eating habits and dietary composition were ana- mean age of subjects ranged between 27 and 32 years. In the group of
lyzed based on a monthly dietary questionnaire designed by the women who delivered at term it was second pregnancy for them in
National Food and Nutrition Institute in Warsaw, Poland. The 91%. For women who gave birth before the due date it was the rst preg-
women specied their diet during the last month of their pregnancy. nancy in 43%, and in 57% - the third pregnancy. Women diagnosed with
Portion sizes were veried using The Album of Photographs of Food hypertension who at the same time had a caesarean section performed
Products and Dishes (Szponar et al., 2010). Before the research before the due date it was their rst pregnancy in 100% (Table 1).
began every participant was clearly instructed and offered training
on how to ll in the questionnaire as well as how to record the vol- 6. Results
ume or the mass of foods using standard household measures such
as a spoonful, a glass, etc. The mothers were not given any hints or The highest average daily intake of fatty acids has been recorded in
tips on how to diet. Based on the album, the women lled in the the group of women with full-term delivery by means of caesarean sec-
questionnaire specifying the quantity and quality of the food con- tion (group B). Rather considerable differences concerning average
sumed. The questionnaire allowed the researchers to determine the daily intake of calcium, magnesium, iron and vitamin D have been re-
daily consumption of each particular dietary component (proteins, corded between women who delivered vaginally at term (group A)
carbohydrates, fats, fatty acids, vitamins) as well as the mother's and other studied groups. In the case of women with vaginal delivery
calorie consumption over a one-month period. at term (group A) the average intake of iodine was always higher (and
The questionnaire included a list of products grouped according to statistically signicant) than in other groups. Analysis of average daily
the following 22 food groups: milk and dairy products, eggs, meat, sau- intake of folates revealed a higher intake in the group of women who
sages, offal, sh, seafood, animal and vegetable fats, vegetables, fruit and gave birth to full-term neonates with proper neonatal weight (group
fruit-products, potatoes and potato-based products, seeds, legumes, ce- A) in comparison with the groups of women with preterm delivery
reals and cereal-products, pre-cooked ready meals, salty snacks, nuts (groups C and D). Lower than recommended norms of folates and iodine
and grains, sugar and sweets, soft drinks, alcohol, soup concentrates, consumption were reported in all analyzed groups (Table 2).
sauces and spices. The study participants had to record how frequently The highest average daily cholesterol consumption was reported in
they consumed each product, with the options being: daily, several the group of women with preterm vaginal delivery (group C). When
times a week, once a week, 23 times a month or never. The question- compared to women diagnosed with hypertension and who gave
naire was lled in by each mother in the hospital, three days after child- birth to pre-term neonates by means of caesarean section (group D),
birth. The DIETA FAO program, which includes data on 1067 typical women who gave birth to full-term neonates (group A) consumed
Polish dishes or food products, was used to estimate the quantity of daily more retinol, folates, iodine, magnesium and iron on average.
the aforementioned components. Dietary consumption was validated The differences were statistically signicant. No statistically signicant
via the Food Intake Frequency Questionnaire, a 7-day nutritional sur- differences concerning average daily consumption of nutrients were re-
vey. The method employed was to write down all the products and corded in the group of women who gave full-term birth by caesarean
dishes that were consumed each day, for a period of 7 days. Food por- section due to arterial hypertension (group B) when compared to
tion sizes were given in household measures, and in the case of some women with preterm vaginal delivery (group C).
products, where possible, also in grams. The sizes of portions and food No statistically signicant differences between average values of
products quantities were veried via direct consultation with each daily intake of proteins, fats, carbohydrates and mineral substances
member of the study, using the Album of Photographs of Food Products were found in groups of women who gave preterm birth regardless of
and Dishes (Szponar et al., 2010). the type of delivery (Table 2).

Table 2
Presentation of average daily intake of selected nutrients in analyzed groups.

Studied variable and unit Group A Group B Group C Group D Statistical signicance Daily norm of average consumption for pregnant woman

Average caloric value of daily calorie intake 2262 2320 2150 2005 No 25003000 kcal
Protein (g) 101.8 98.41 93.09 87.36 No 0.98 g/kg of bodyweight
Fats (g) 88.49 99.66 85.55 76.18 No 70115 g
Carbohydrates (g) 286.28 277.46 271.69 260.23 No 175 g
Saturated fatty acids (g) 38.07 40.09 34.45 29.98 No Lowest possible
Monounsaturated fatty acids (g) 33.49 38.55 31.59 29.89 No Not determined
Polyunsaturated fatty acids (g) 10.31 13.96 12.72 10.46 No Not determined
Calcium (mg) 903.02 783.50 793.31 738.54 No 8001100 mg
Vitamin D (g) 5.13 3.46 4.17 2.95 No 2025 g
Folates (g) 317.15 261.02 236.67 219.53 Yes: A and C; A and D 600 g
Iodine g 221.79 128.06 152.27 111.65 Yes: A and B; A and C; 250 g
A and D
Retinol (g) 431.87 474.36 433.09 264.59 Yes: A and D; B and D 530 g
Magnesium (mg) 373.73 327.19 332.95 300.26 Yes: A and D 300335 mg
Iron (mg) 13.03 12.97 12.22 10.41 Yes: A and D 23 mg
Cholesterol (mg) 424.73 480.60 488.44 244.44 Yes: B and D Not determined
16 W. Waksmaska et al. / Applied Nursing Research 35 (2017) 1317

7. Discussion The risk of hypertension is also increased in the event of deciency of

magnesium which takes part in the regulation of cell membranes func-
Provision of medical services for women during the preconception tioning. Magnesium deciency causes an increase of calcium ions inux
and prenatal period should include health education on proper nutri- to vascular myocytes leading to disorders of membrane potential repo-
tion. Knowledge about the inuence of poor nutrition on the occurrence larization (Kopaski & Maslyak, 2014). The authors' own research
of diseases has signicantly increased (Suliga, 2015). Proper nutrition of showed a statistically signicant difference in daily magnesium intake
the future mother is an essential factor in infant mortality reduction between women with vaginal delivery at term and women with diag-
(Akbari et al., 2015). A properly balanced diet provides the body with nosed hypertension who gave preterm birth by caesarean section.
all essential nutrients adjusted to the physiological status of the organ- The research proved that the risk of pre-eclampsia, hypertension
ism and, at the same time, reduces the risk of disease complications at a or preterm birth increases also in the case of folates deciency
later age. Deciency of protein, the basic component of every human (Kapka-Skrzypczak et al., 2012; Cielik & Kociej, 2012;
cell, may lead to immunity impairment, muscle atrophy and protein-en- Seremak-Mrozikiewicz, 2013; Laskowska-Klita, Chechowska,
ergy malnutrition. Deciency of protein, calcium and vitamin D in the Ambroszkiewicz, & Gajewska, 2012). Folates inuence proper func-
future mother's diet results in the reduction of foetal bone mass and in- tioning of cells, and thus the proper development and functioning of
creases the frequency of bone fractures during childhood (Mitchell, the whole organism, particularly the hematopoietic and nervous systems
Cooper, Dawson-Hughes, Gordon, & Rizzoli, 2015). The study conducted (Laskowska-Klita et al., 2012). At the same time, proper use of folates in
by Ostachowska-Gsior revealed that an average consumption of pro- the organism depends on the consumption of other nutrients such as vi-
tein per day by pregnant women amounted to 7486 g, depending on tamin C, iron and zinc (Kapka-Skrzypczak et al., 2012; Cielik & Kociej,
the pregnancy trimester (Ostachowska-Gsior, 2008). The analysis of 2012). Folates intake was identied as lower than the recommended
the author's material pointed to a higher average daily protein intake. values in each tested group, even with regard to the recommended
The highest daily intake of protein - 101.8 g (and, at the same time, of dose of 400 g for an adult. In two groups of women who gave preterm
calcium and vitamin D) was observed among women who delivered birth, regardless of the type of delivery, the values were the lowest and
vaginally at term, whereas the lowest daily intake of protein - 87.6 g amounted to 219.53 and 236.67 g respectively. A statistically signicant
was noted among women with diagnosed hypertension who gave pre- difference was demonstrated in daily folates intake between the above
term birth by caesarean section. Longer duration of pregnancy in the mentioned groups and women who gave vaginal birth to healthy
case of women with full-term delivery is more benecial for foetus in children at term, which conrms the inuence of folates deciency on
terms of protein intake. The authors' research results did not reveal preterm birth (Cielik & Kociej, 2012; Seremak-Mrozikiewicz, 2013;
any statistically signicant differences in daily consumption of proteins, Laskowska-Klita et al., 2012).
carbohydrates and fats. An important element of pregnant woman's diet The increased incidence of premature births is also noted in the case
are polyunsaturated fatty acids which guarantee proper development of of iodine deciency (Kapka-Skrzypczak et al., 2012; Cielik & Kociej,
the foetal nervous system. Polyunsaturated fatty acid deciency may 2012; Seremak-Mrozikiewicz, 2013). It is conrmed by the authors'
lead to stunted growth of the foetus and smaller head circumference own research which showed statistically signicant differences in
(WHO, 2010; Bobiski & Mikulska, 2012). The authors' own research daily iodine intake between women who delivered healthy children at
showed that the highest daily intake of polyunsaturated fatty acids term vaginally and the other tested groups, including the groups of
was noted among women with diagnosed hypertension who gave women who delivered preterm.
birth by caesarean section (13.96 g), whereas the lowest intake of poly- The most recent WHO recommendations referring to the reduction
unsaturated fatty acids was observed among women with vaginal deliv- of salt consumption resulted in the necessity to increase iodine concen-
ery at term (10.31 g). Differences in daily intake of polyunsaturated tration in milk which is, as a food product, an important element of
fatty acids in the analyzed groups were not statistically signicant. pregnant women's diet (Waszkowiak et al., 2010). However, achieving
Another important element of pregnant woman's diet is vitamin D an adequate level of iodine through diet does not seem possible. Despite
which takes part in the process of bone mineralization. Analysis of the supplementation recommendations, only 35% of women supplement its
studied material revealed that women who delivered vaginally at deciency (Gietka-Czernel, Dbska, Kretowicz, et al., 2010). In the ana-
term consumed the largest amount of vitamin D - the average daily lyzed material none of the women applied dietary supplements, neither
intake being 5.13 g, which constituted 1/41/5 of the recommended vitamins nor minerals. Suliga's study demonstrated that 3145.8% of
dose. Studies conducted in Canada, aiming at determining vitamin women (depending on their education) did not take vitamin supple-
intake before pregnancy in two groups of women - pregnant and non- ments during pregnancy (Suliga, 2013), whereas Hamuka and the co-
pregnant, showed that pregnant women consumed more vitamin D authors showed that N98% of questioned women took vitamins and
(5.8 g) in the preconception period compared to non-pregnant minerals (Hamuka et al., 2010). However, the researchers did not
women (5.2 g). These values were nonetheless considerably lower analyze the inuence of mineral and vitamin supplements on the total
than the recommended values. Research on calcium intake brought content of nutrients in diet. They did not analyze the effects of the sup-
similar results. Pregnant women declared their calcium intake during plements on the occurrence of such complications as hypertension or
the preconception period to be 1146 mg and non-pregnant women - preterm birth either.
988 mg. However, the authors of the study point to the fact that Preterm birth, which results in giving birth to a premature infant, in-
pregnant women had to reconstruct their diet from 8 to 9 months creases the risk of serious health consequences for the child and, at the
back which fact could have affected the accuracy of the data (Ramage same time, for public health. Previous studies testify to the lack of
et al., 2015). knowledge on rational nutrition. Education should be particularly relat-
The authors' own research did not concentrate on the consumption ed to supplementation of pregnant women's diet, bearing in mind that
of nutrients in the preconception period, however, vitamin D intake both deciency and excess of vitamins and minerals have a negative ef-
during pregnancy was lower compared to the Canadian study and, at fect on health (Kapka-Skrzypczak et al., 2012; Hamuka et al., 2010;
the same time, lower than the recommended values. The lowest values Suliga, 2013).
of vitamin D intake (3.46 and 2.95 g) were reported in two groups of
women with diagnosed hypertension. It is common knowledge that hy-
8. Conclusions
pertension is one of the symptoms of pre-eclampsia, the risk of which
increases in the case of vitamin D deciency. Thus, the results of the au-
thors' own research conrm the inuence of vitamin D deciency on the 1. Statistically signicant differences in average daily intake of folates,
occurrence of pre-eclampsia. iodine, retinol, magnesium and iron were observed between the
W. Waksmaska et al. / Applied Nursing Research 35 (2017) 1317 17

group of women with vaginal delivery at term and the groups of Kopaski, Z., & Maslyak, Z. (2014). Magnesium in human physiology and pathology.
JPHNMR, 1, 46.
women with diagnosed hypertension who delivered preterm. Laskowska-Klita, T., Chechowska, M., Ambroszkiewicz, J., & Gajewska, J. (2012). Folic acid
2. Correlation was demonstrated between average daily intake of io- Its role in the cellular metabolism. Bromat Chem Toksykol, 2, 144151.
dine and vitamin D and the occurrence of arterial hypertension. Misiorowska, J., & Misiorowski, W. (2014). The role of vitamin D in pregnancy. Post Nauk
Med, 12, 865871.
3. The content of iodine and folates in the diet of women with preterm Mitchell, P. J., Cooper, C., Dawson-Hughes, B., Gordon, C. M., & Rizzoli, R. (2015). Life-
delivery was statistically lower compared to women who gave full- course approach to nutrition. Osteoporosis International, 26, 27232742.
term birth. Ostachowska-Gsior, A. (2008). Protein intake in diet of pregnant women with correct
and incorrect pre-pregnancy nutritional status versus the newborns' body mass.
4. Supplementation of the diet of women in the preconception and pre-
Problem Hig Epidemiology, 89(4), 537542.
natal period with minerals and vitamins should be considered. Ramage, S. M., McCargar, L. J., Berglund, C., Harber, V., Bell, R. C., & the APrON Study Team
(2015). Assessment of pre-pregnancy dietary intake with a food frequency question-
naire in Alberta women. Nutrients, 7(8), 61556166.
Robinson, C. J., Wagner, C. L., Hollis, B. W., Baatz, J. E., & Johnson, D. D. (2011). Maternal
vitamin D and fetal growth in early-onset severe preeclampsia. American Journal of
Our grateful thanks to the women who participated in the survey. Obstetrics and Gynecology, 204(6), 14 (556e).
Sadin, B., Pourghassem Gargari, B., Fard, P., & Tabrizi, F. (2015). Vitamin D status in pre-
eclamptic and non-preeclamptic pregnant women: A case-control study in the
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