Journal Reading

Influence of Mineral and Vitamin

Supplements on Pregnancy Outcome
*Hovdenak a, Kjell Haram
Supervisor :
DR. dr. Donel S, Sp.OG (K)
Agung Pamungkas, S.Ked
Indah Prasetya Putri, S.Ked
Ismail, S.Ked
Novy Nasnalanda, S.Ked
Nuraini Indallah, S.Ked
Rahmatul Khairiyah, S.Ked

CLINICAL CLERKSHIP IN OBSTETRIC AND GYNECOLOGY DEPARTMENT

FACULTY OF MEDICINE RIAU UNIVERSITY
ARIFIN ACHMAD PEKANBARU GENERAL HOSPITAL
PEKANBARU 2013
 1. Introduction
Vitamin
&
Mineral
Energy and
Nutrition

Pre-eclamsia/eclamsia

Fetal’s Growth
Mother’s Health

Aim: Foccus to problem because vitamin and mineral

deficiency to pregnant woman and learn about
indication from this nutrition supplements
 2. Methods
• Use observation study, randomised
controlled trials,meta analyses and review
• Search literature in PubMed and Cochrane
Database with link keyword “mineral” or
“Vitamin” related to be “pregnancy” and
“Supplementation”
Multiple
Minerals Vitamins Micronutrients
MINERALS
 Minerals
• Iron (Fe)
• Calcium (Ca)
• Magnesium (Mg)
• Zinc
• Selenium (Se)
 Iron (Fe)
• Haemoglobin synthesis and several organ functions
• It may lead to anaemia, intrauterine growth retardation
(IUGR) and neonates small for gestational age (SGA).
• Fe deficiency induces maternal and fetal stress
• A controlled study : 513 low income pregnant women, 48%
of whom had low ferritin and haemoglobin, showed a
significantly higher mean birth weight,a significantly
improved birth weight in the supplemented group
 Calcium (Ca)
• Mediating muscle function, blood vessel
dynamics, nerve impulse transmission,
secretion of hormones, blood coagulation,
cell membrane functions, and skeletal
development.
• Pregnant woman need increase demand of
calcium occurs
• Deficiency is rare in pregnancy, but is
associated with pre-eclampsia, and may
induce IUGR
 Magnesium (Mg)
• A widespread enzyme cofactor and activator
• Gestational Mg deficiency may interfere
with fetal growth and development until
hematological to teratogenic damage
 Zinc
• Essential for embryogenesis and important for
normal fetal growth and growth during
childhood and adolescence
• 1965 => 580 pregnant woman => Birth Weight
• 17 reviews=> no evidence for beneficial effect
 Selenium (Se)
• An antioxidant supporting humoral and cell
mediated immunity
• Low Se status is associated with recurrent
abortions, pre-eclampsia and IUGR
 Vitamins
-An average 20–30% of pregnant women suffer from a
vitamin deficiency
-A high percent of vitamin A, B6, niacin, thiamin and B12
hypovitaminemia was noted during all pregnancy
trimester
 Vitamins
• Vitamin A; for gene regulation, cell differentiation,
proliferation and growth. recommended upper limit for
retinol supplements is 5000 IU/day
• Vitamin B complex: B1 (thiamine), B6 (pyridoxine) and
Folate
– Vitamin B1; especially in the developing brain
– Vitamin B6; metabolism in development of the central
nervous system.
• Folate; the synthesis of DNA,RNA and certain amino acids
25% pregnant woman in India being folate deficient.
Deficient => Congenital Malformation
Supplemental dose of 400 mg/day of folate is recommended
 Vitamins
• Vitamin B12; for eritropoesis
• Vitamins C and E; have to antioxidant activity to prevent
pre-eclamsia
• Vitamin D; Calcium homeostatis, associated with poor fetal
and infant skeletal growth and tooth mineralisation
 Multiple Micronutrients (MMN)
• Causes as insufficient availability of adequate food quality,
cultural differences, seasonal variations, poverty, and
infections in the population
• MMN can be implemented in a large-scale programme and
should be well suited for developing countries
• In addition, improvements in ante-natal health services
and securing of adequate food supplies must have priority.
 Discussion
• For many decades vitamin supplements have
been regarded as solely health-promoting
• Deficiencies= significant morbidity
• In determining the consequences on pregnancy
and fetal growth.
• Normal mineral and vitamin metabolism is
important for successful pregnancies
• Micronutritients of particular importance for
prevention of adverse pregnancy outcomes are
folic acid, Zn, and Fe
 Conclusion
• Substitution therapy and supplementation maybe
beneficial during pregnancy, but specific
deficiencies should be sought
• Folat supplement before pregnancy or first
trimester of pregnancy
• Fe supplement
• Vegetarian Dietary => increase risk of deficiencies
Vitamin B12
• Vitamin D may be beneficial against development
of preeclampsia.
THANK YOU