Multicomponent vitamin and mineral complexes as a basis for prevention of micronutrient deficiency at reproductive age

Shikh E.V., Makhova A.A.

I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russia
Micronutrient supplementation is a key factor for physiological pregnancy and directly correlates with positive maternal outcomes, has a direct impact on neonatal health and subsequent development. A relationship was found between the insufficient supply of mothers with nutrients and preeclampsia, fetal growth restriction, neural tube defects, skeletal deformities, and low birth weight. Multicomponent vitamin and mineral complexes intended to use in the pregravid period, during pregnancy, and lactation allow the entry of essential micronutrients, such as iron, folates and other B vitamins, iodine, zinc, and antioxidants, into the body at the physiological daily requirements. This review presents current evidence regarding the needs for macronutrients and micronutrients during pregnancy, the risks and consequences of their deficiency, and the impact of additional exogenous intake on pregnancy outcomes.

Keywords

micronutrients
vitamin and mineral complexes
pregnancy
pregnancy outcomes
newborns

References

  1. Rees W.D. Interactions between nutrients in the maternal diet and the implications for the long-term health of the offspring. Proc Nutr Soc. 2019 Feb; 78(1): 88–96. doi: 10.1017/S0029665118002537. Epub 2018 Oct 31.
  2. Ших Е.В., Махова А.А. Витаминно-минеральный комплекс при беременности. М.: ГЭОТАР-Медиа, 2016. 349 с. [Shikh Ye.V., Makhova A.A. Vitaminno-mineral'nyy kompleks pri beremennosti. M.: GEOTAR-Media, 2016. 349 p. (In Russian)]
  3. McKeating D.R., Fisher J.J., Perkins A.V. Elemental Metabolomics and Pregnancy Outcomes. Nutrients. 2019; 11(1): 73. doi:10.3390/nu11010073
  4. Darnton-Hill I., Mkparu U.C. Micronutrients in pregnancy in low- and middle-income countries. Nutrients. 2015; 7: 1744–68. doi: 10.3390/nu7031744.https://www.who.int/topics/pregnancy/ru/
  5. Moubarac J.C., Batal M., Louzada M.L., Martinez Steele E., Monteiro C.A. Consumption of ultra-processed foods predicts diet quality in Canada. Appetite. 2017; 108: 512–20. doi: 10.1016/j.appet.2016.11.006
  6. Кошелева Н.Г., Плужникова Т.А. Показания к применению препарата Витрум Пренатал Форте при плацентарной недостаточности и других осложнениях беременности. Гинекология. 2004; 6(1): 35–8. [Kosheleva N.G., Pluzhnikova T.A. Indications for use of the drug Vitrum Prenatal Forte with placental insufficiency and other pregnancy complications. Ginekologiya/Gynecology. 2004; 6(1): 35–8. (in Russian)].eLIBRARY ID: 21065298
  7. Прилепская В.Н., Кутуева Ф.Р., Кулешов В.М., Андреева М.Д., Ткаченко Л.В., Зайцева Т.Д., Погодина Т.А. Результаты Российской неинтервенционной (наблюдательной) программы по назначению витаминно-минерального комплекса для профилактики гиповитаминозов и дефицита минеральных веществ «ПРОГНОСТИК» у беременных женщин. Гинекология. 2016; 18(4): 5–11. [Prilepskaya V.N., Kutueva F.R., Kuleshov V.M., Andreeva M.D., Tkachenko L.V., Zaitseva T.D., Pogodina T.A. The results of the Russian non-interventional (observational) data monitoring program for the drug recommendation and prevention of hypovitaminosis and mineral deficiency “PROGNOSTIC” in pregnant women. Ginekologiya/Gynecology. 2016; 18(4): 5–11. (in Russian)]. eLIBRARY ID: 27719474
  8. De-Regil L.M., Peña-Rosas J.P., Fernández-Gaxiola A.C., Rayco-Solon P. Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database Syst Rev. 2015; 12: CD007950. doi: 10.1002/14651858
  9. de Benoist B. Conclusions of a WHO technical consultation on folate and vitamin B12 deficiencies. Food Nutr. Bull. 2008; 29: S238–S244. doi: 10.1177/15648265080292S129
  10. Cordero A.M., Crider K.S., Rogers L.M., Cannon M.J., Berry R.J. Optimal Serum and Red Blood Cell Folate Concentrations in Women of Reproductive Age for Prevention of Neural Tube Defects: World Health Organization. MMWR Morb Mortal Wkly Rep. 2015; 64(15): 421–3. PMCID: PMC5779552
  11. van Uitert E.M., Steegers-Theunissen R.P. Influence of maternal folate status on human fetal growth parameters. Mol Nutr Food Res. 2013; 57: 582–95.http://dx.doi.org/10.1002/mnfr.201200084
  12. Kim J., Lei Y., Guo J., et al. Formate rescues neural tube defects caused by mutations in Slc25a32. Proc Natl Acad Sci U S A. 2018; 115(18): 4690–5.doi: 10.1073/pnas.1800138115
  13. Berry R.J., Li Z., Erickson J.D., Li S., Moore C.A., Wang H., Mulinare J., Zhao P., Wong L.Y., Gindler J., et al. Prevention of neural-tube defects with folic acid in china. China-u.S. Collaborative project for neural tube defect prevention. N. Engl. J. Med. 1999; 341: 1485–90. doi: 10.1056/NEJM199911113412001
  14. Institute of Medicine, Board on Global Health, Committee on Improving Birth Outcomes. Reducing Birth Defects: Meeting the Challenge in the Developing World. National Academies Press (US); 2003. 270 p.ISBN 9780309086080
  15. Rees W.D. Manipulating the sulfur amino acid content of the early diet and its implications for long-term health. Proc Nutr Soc. 2002; 61: 71–7. doi: 10.1079/pns2001137
  16. Gregory J.F., DeRatt B.N., Rios-Avila L., et al. Vitamin B6 nutritional status and cellular availability of pyridoxal 5′-phosphate govern the function of the transsulfuration pathway’s canonical reactions and hydrogen sulfide production via side reactions. Biochimie. 2016; 126: 21–6. doi: 10.1016/j.biochi.2015.12.020
  17. Tsang B.L., Devine O.J., Cordero A.M., et al. Assessing the association between the methylenetetrahydrofolatereductase (MTHFR) 677C>T polymorphism and blood folate concentrations: a systematic review and meta‐analysis of trials and observational studies. Am J Clin Nutr. 2015; 101: 1286–94. doi: 10.1016/j.metabol.2014.10.001
  18. Hiraoka M., Kagawa Y. Genetic polymorphisms and folate status. Congenital Anomalies. 2017; 57: 142–9. doi: 10.1111/cga.12232
  19. Ang C.D., Alviar M.J.M., Dans A.L., Bautista-Velez G.G.P., Villaruz-Sulit M.V.C., Tan J.J., Co H.U., Bautista M.R.M., Roxas A.A. Vitamin B for treating peripheral neuropathy. Cochrane Database Syst Rev. 2008; (3): CD004573. doi: 10.1002/14651858
  20. Williamson C.S. Nutrition in pregnancy. Nutr. Bull. 2006; 31: 28–59. doi: 10.1111/j.1467-3010.2006.00541.x
  21. Sukumar N., Rafnsson S.B., Kandala N.-B., Bhopal R., Yajnik C.S., Saravanan P. Prevalence of vitamin B-12 insufficiency during pregnancy and its effect on offspring birth weight: A systematic review and meta-analysis. Am. J. Clin. Nutr. 2016; 103: 1232–51. doi: 10.3945/ajcn.115.123083.
  22. Dias F.M., Silva D.M., Doyle F.C., Ribeiro A.M. The connection between maternal thiamine shortcoming and offspring cognitive damage and poverty perpetuation in underprivileged communities across the world. Med. Hypotheses. 2013; 80: 13–6. doi: 10.1016/j.mehy.2012.09.01
  23. Shaw G.M., Carmichael S.L., Yang W., Lammer E.J. Periconceptional nutrient intakes and risks of conotruncal heart defects. Birth Defects Res. Part A Clin. Mol. Teratol. 2010; 88: 144–51. doi: 10.1002/bdra.20648
  24. Gernand A.D., Schulze K.J., Stewart C.P., West K.P., Jr., Christian P. Micronutrient deficiencies in pregnancy worldwide: Health effects and prevention. Nat. Rev. Endocrinol. 2016; 12: 274–89. doi: 10.1038/nrendo.2016.37
  25. Rogne T., Tielemans M.J., Chong M.F.-F., Yajnik C.S., Krishnaveni G.V., Poston L., Jaddoe V.W.V., Steegers E.A.P., Joshi S., Chong Y.-S., et al. Maternal vitamin B12 in pregnancy and risk of preterm birth and low birth weight: A systematic review and individual participant data meta-analysis. Am. J. Epidemiol. 2017; 185: 212–23. doi: 10.1093/aje/kww212
  26. Rumbold A., Ota E., Hori H., Miyazaki C., Crowther C.A. Vitamin E supplementation in pregnancy. Cochrane Database Syst. Rev. 2015; (9): CD004069. doi: 10.1002/14651858.
  27. Rumbold A., Ota E., Nagata C., Shahrook S., Crowther C.A. Vitamin C supplementation in pregnancy. Cochrane Database Syst. Rev. 2015; (9): CD004072. doi: 10.1002/14651858
  28. McCauley M.E., van den Broek N., Dou L., Othman M. Vitamin A supplementation during pregnancy for maternal and newborn outcomes. Cochrane Database Syst. Rev. 2015; (11): CD008666. doi: 10.1002/14651858
  29. Stipanuk M.H., Caudill M.A. Biochemical, Physiological and Molecular Aspects of Human Nutrition. Saunders, 2013. 968 p.
  30. Black R.E., Victora C.G., Walker S.P., Bhutta Z.A., Christian P., de Onis M., Ezzati M., Grantham-McGregor S., Katz J., Martorell R., et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013; 382: 427–51. doi: 10.1016/S0140-6736(13)60937-X.
  31. Mousa A., Naqash A., Lim S. Macronutrient and Micronutrient Intake during Pregnancy: An Overview of Recent Evidence. Nutrients. 2019; 11(2): 443. doi:10.3390/nu11020443
  32. DeLuca H.F. Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr. 2004; 80(6 Suppl): 1689S-96S. doi: 10.1093/ajcn/80.6.1689S
  33. De-Regil L.M., Palacios C., Ansary A., Kulier R., Peña-Rosas J.P. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev. 2012; 2(2): CD008873. doi:10.1002/14651858
  34. McCullough M. Vitamin D deficiency in pregnancy: bringing the issues to light. Journal of Nutrition. 2007; 137(2): 305–6. https://academic.oup.com/jn/article/137/2/305/4664522
  35. Ших Е.В., Махова А.А. Эндемичность территории по дефициту микронутриентов как критерий формирования состава базового витаминно-минерального комплекса для периконцепционального периода. Акушерство и гинекология. 2018; 10: 25–32. [Shikh E.V., Makhova A.A. The endemicity of an area in terms of micronutrient deficiencies as a criterion for compounding a basic vitamin-mineral complex for the periconceptional period. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2018; 10: 25–32. (in Russian)]. https://dx.doi.org/10.18565/aig.2018.10.25-32
  36. Dutra L.V., Affonso-Kaufman F.A., Cafeo F.R. et al. Association between vitamin D plasma concentrations and VDR gene variants and the risk of premature birth. BMC Pregnancy Childbirth. 2020; 20(1): 3. doi:10.1186/s12884-019-2671-2
  37. Imdad A., Jabeen A., Bhutta Z.A. Role of calcium supplementation during pregnancy in reducing risk of developing gestational hypertensive disorders: a meta-analysis of studies from developing countries. BMC Public Health. 2011; 11 Suppl 3: S18. doi: 10.1186/1471-2458-11-S3-S18
  38. Hovdenak N., Haram K. Influence of mineral and vitamin supplements on pregnancy outcome. Eur J Obstet Gynecol Reprod Biol. 2012; 164(2): 127–32. doi: 10.1016/j.ejogrb.2012.06.020.
  39. WHO. Guideline: Calcium supplementation in pregnant women. Geneva, World Health Organization, 2013.
  40. Buppasiri P., Lumbiganon P., Thinkhamrop J., Ngamjarus C., Laopaiboon M., Medley N. Calcium supplementation (other than for preventing or treating hypertension) for improving pregnancy and infant outcomes. Cochrane Database Syst Rev. 2015; (2): CD007079. doi:10.1002/14651858.CD007079.pub3
  41. Hofmeyr G.J., Lawrie T.A., Atallah Á.N., Duley L., Torloni M.R. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst. Rev. 2014; (6): CD001059.doi: 10.1002/14651858
  42. Платонова Н.М. Йододефицитные заболевания (профилактика, диагностика, лечение и мониторинг): дис. ... д-ра мед. наук ГУ «Эндокринологический научный центр РАМН». М., 2010. [Platonova N.M. Iodine deficiency diseases (prevention, diagnosis, treatment and monitoring): dis. of DM. M.: State Institution “Endocrinological Research Center of the Russian Academy of Medical Sciences”, 2010.(in Russian.)].
  43. Harding K.B., Peña-Rosas J.P., Webster A.C., Yap C.M.Y., Payne B.A., Ota E., De-Regil L.M. Iodine supplementation for women during the preconception, pregnancy and postpartum period. Cochrane Database Syst. Rev. 2017; 3: CD011761. doi: 10.1002/14651858
  44. Prado E.L., Dewey K.G. Nutrition and brain development in early life. Nutr. Rev. 2014; 72: 267–84. doi: 10.1111/nure.12102.
  45. Skeaff S.A. Iodine Deficiency in Pregnancy: The Effect on Neurodevelopment in the Child. Nutrients. 2011; 3(2): 265–73. doi: 10.3390/nu3020265
  46. Henderson B., Kühn L. Interaction between iron-regulatory proteins and their RNA target sequences, iron-responsive elements. Prog. Mol. Subcell. Biol. 1997; 18: 17–139.
  47. Milman N. Iron and pregnancy – A delicate balance. Ann. Hematol. 2006; 85: 559. doi: 10.1007/s00277-006-0108-2.
  48. Beard J.L. Effectiveness and strategies of iron supplementation during pregnancy. Am. J. Clin. Nutr. 2000; 71: 1288S–1294S. doi: 10.1093/ajcn/71.5.1288s
  49. WHO. Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. Department of Nutrition for Health and Development (NHD), World Health Organization; Geneva,Switzerland: 2011.
  50. Peña-Rosas J.P., De-Regil L.M., Garcia-Casal M.N., Dowswell T. Daily oral iron supplementation during pregnancy. Cochrane Database Syst. Rev. 2015; (7): CD004736. doi: 10.1002/14651858
  51. WHO. WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience. World Health Organisation; Geneva, Switzerland? 2016. available at: www.who.int/reproductivehealth/publications/maternal_perinatal_health/anc-positive-pregnancy-experience/en/
  52. Mei Z., Cogswell M.E., Looker A.C., et al. Assessment of iron status in US pregnant women from the National Health and Nutrition Examination Survey (NHANES), 1999–2006. Am J Clin Nutr. 2011; 93(6): 1312–20. doi: 10.3945/ajcn.110.007195
  53. Aschner M., Dorman D.C. Manganese: pharmacokinetics and molecular mechanisms of brain uptake. Toxicol Rev. 2006; 25(3): 147–54. doi: 10.2165/00139709-200625030-00002
  54. Keen C.L., Zidenberg-Cherr S. Manganese. In: Ziegler E.E., Filer L.J., eds. Present Knowledge in Nutrition. Washington D.C.: ILSI Press; 1996:334–43.
  55. Henn B.C., Bellinger D.C., Hopkins M.R., Coull B.A., Ettinger A.S., Jim R., Hatley E., Christiani D.C., Wright R.O. Maternal and cord blood manganese concentrations and early childhood neurodevelopment among residents near a mining-impacted superfund site. Environ. Health Perspect. 2017; 125(6): 067020. doi: 10.1289/EHP92
  56. Методические рекомендации «Нормы физиологических потребностей в энергии и пищевых веществах для различных групп населения Российской Федерации», МР 2.3.1.2432-08. [Metodicheskiye rekomendatsii «Normy fiziologicheskikh potrebnostey v energii i pishchevykh veshchestvakh dlya razlichnykh grupp naseleniya Rossiyskoy Federatsii», MR 2.3.1.2432-08. (in Russian)].
  57. Peña M.M., Lee J., Thiele D.J. A delicate balance: Homeostatic control of copper uptake and distribution. J. Nutr. 1999; 129: 1251–60.doi: 10.1093/jn/129.7.1251
  58. Ших Е.В., Махова А.А. Витамины в клинической практике. М.: Практическая медицина, 2014. 368 c. [Shikh E.V., Makhova A.A. Vitamins in clinical practice. M.: Practical medicine, 2014. 368 p. (in Russian)]
  59. Ota E., Mori R., Middleton P., Tobe-Gai R., Mahomed K., Miyazaki C., Bhutta Z.A. Zinc supplementation for improving pregnancy and infant outcome. Cochrane Database Syst. Rev. 2015; (2): CD000230. doi: 10.1002/14651858
  60. Chaffee B.W., King J.C. Effect of zinc supplementation on pregnancy and infant outcomes: A systematic review. Paediatr. Perinat. Epidemiol. 2012; 26(Suppl.1): 118–37. doi: 10.1111/j.1365-3016.2012.01289.x
  61. Foster M., Herulah U.N., Prasad A., Petocz P., Samman S. Zinc status of vegetarians during pregnancy: A systematic review of observational studies and meta-analysis of zinc intake. Nutrients. 2015; 7: 4512–25. doi: 10.3390/nu7064512
  62. Spencer B., Vanderlelie J., Perkins A. Essentiality of trace element micronutrition in human pregnancy: A systematic review. J. Pregnancy Child Health. 2015; 2: 2. doi: 10.4172/2376-127X.1000157

Received 25.11.2019

Accepted 29.11.2019

About the Authors

Evgenia V. Shikh, MD, professor, head Department of Clinical Pharmacology and Propaedeutics of Internal Diseases FGAOU VO First MGMU im. I. M. Sechenov
of the Ministry of Health of Russia (Sechenov University). Tel .: +7 (495)609-19-91. E-mail: chih@mail.ru; https://orcid.org/0000-0001-6589-7654.
Address: 119991, Russia, Moscow, ul. Trubetskaya, d. 8, p. 2.
Anna A. Makhova, MD, associate professor of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases FSAEI HE First MGMU named after I.M.Sechenova of the Ministry of Health of Russia (Sechenov University). Phone: +7(495) 609-19-91. Email: annabramova@gmail.com; https://orcid.org/0000-0001-9817-9886
Address: 119991, Russia, Moscow, ul. Trubetskaya, d. 8, p. 2.

For citation: Shikh E.V., Makhova A.A. Multicomponent vitamin and mineral complexes as a basis for prevention of micronutrient deficiency at reproductive age.
Akusherstvo i Ginekologiya/ Obstetrics and gynecology. 2020; 1: 54-62. (In Russian).
https://dx.doi.org/10.18565/aig.2020.1.54-62

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