MICROgenics Pregnancy & Breastfeeding Multivitamin

Fertility

Fertility issues in women are becoming more common, believed to be largely because of the older age of would-be first-time mothers. In Australia, the age at which women have their first child is rising, averaging 30 years in 2003, with twelve per cent of first births in women over 35 years.¹ IVF treatment is becoming more of a necessity and one in four women on IVF are 40 years of age or older.²

Nutrition and female fertility

As part of the US Nurses' Health Study II, 17,544 women with no history of infertility were followed for eight years and the dietary intakes of those who became pregnant were assessed.³ A 'fertility diet' was established, that was found to reduce the risk of infertility by 66%. The 'fertility diet' included more monounsaturated fats, low glycaemic index carbohydrates, and high-fat dairy products, fewer trans fats, more vegetable protein than animal protein, higher iron intake, and the use of multivitamin supplements. Other important factors associated with fertility were a lower body mass index and regular vigorous physical activity for 30 minutes a day.

Nutritional support for pregnancy and breastfeeding

During pregnancy, extra amounts of omega-3 fats, folic acid, iodine, iron, B vitamins, protein, vitamin C, zinc, magnesium, selenium, and chromium are needed.⁴ Important micronutrients for breastfeeding women are thiamin, riboflavin, vitamins B6 and B12, vitamin A, and iodine.⁵

• Fish oil
  Fish oil is a good source of the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Omega-3 fats have a beneficial effect on pregnancy progression. They can reduce the incidence of premature births, possibly by mediating production of prostaglandins that control the birth process. Women who deliver prematurely have increased omega-6 and decreased omega-3 fatty acids in the body and supplementation with EPA and DHA can prolong the duration of gestation.⁶ Pregnant women who develop pre-eclampsia have low levels of omega-3 fatty acids and a 15% increase in the omega-3:omega-6 ratio was found to cut the risk by nearly half.⁷ DHA supports the development of the baby's brain, nervous system and eyesight. Children of mothers having a DHA-rich diet in pregnancy have enhanced stereoscopic vision at age 3.5 years, irrespective of the child's postnatal diet.⁸ Supplementation with EPA and DHA during pregnancy and lactation has been found to enhance children's IQ at four years of age.⁹ Fish oil may be preferable to fatty fish for pregnant women because it is tested for mercury, pesticides, herbicides and other contaminants, unlike fatty fish that contain variable levels of contaminants.
• Folic acid
  

  Folic acid is a single carbon donor essential for DNA synthesis and the remethylation of homocysteine to form methionine. Conversion of dietary folate or folic acid to its active form requires vitamin B2, B3, B6 and zinc, and vitamin B12 is required to reactivate folic acid when it becomes inactive during metabolism. Folic acid supplementation is regarded as essential in pregnancy and should be used with nutrients that support folic acid metabolism.

  
  

  Folic acid is essential for normal cell division and is particularly important before and during conception and throughout pregnancy to support the growth and development of the baby and for growth of the mother's placenta, circulation, uterine tissues, and breasts. It has a major role in the development of the baby's spinal cord, brain, and central nervous system that begins in the third week of pregnancy. A lack of folic acid before conception and in the first weeks of pregnancy can cause neural tube defects such as spina bifida, in which there is incomplete closure of the spinal column causing herniation or exposure of the spinal cord and/or meninges. Spina bifida can cause walking difficulties (in severe cases, paraplegia) and bowel, bladder and brain malfunctions. It is estimated that up to 70% of spina bifida cases can be prevented by maternal periconceptional folic acid supplementation.¹⁰ A population study found that a folate-rich diet with folic acid supplements and multivitamins during early pregnancy reduced the risk of cleft lip by about a third.¹¹ Use of folic acid supplements for three months before pregnancy may also decrease the baby's risk of talipes equinovarus (clubfoot) but more research is needed to confirm this.¹²

  
  

  Folic acid is a water-soluble vitamin with limited storage in the body so a regular daily intake is needed. Food content may be depleted by food processing, heating, exposure to light, and room temperature storage. Key factors that may impair folate metabolism include alcohol consumption, smoking, and specific drugs.¹³

  
  

  Folate is the polyglutamate form of folic acid found in foods and is poorly absorbed, whereas folic acid is a simpler monoglutamate form that is more easily absorbed and more stable and is the form used in fortified foods and supplements. Food folate has about 50% absorption but folic acid supplements can have 100% absorption if taken on an empty stomach.¹⁴ Synthetic folic acid from supplements or fortified foods has been found to increase folate levels in the blood more effectively than folate-containing foods and an intake of synthetic folic acid may be the best and fastest way for all women to increase their blood levels and enable delivery to the developing embryo. ¹⁵

• Iron
  Iron transports oxygen in red blood cells and extra iron is needed to support increased red blood cell production in the pregnant woman and in the baby's developing circulation. Vegetarians may need up to 80% more iron to compensate for poorer absorption.4 It can be difficult to obtain the extra iron required in pregnancy solely from food and supplements are often needed. Lower-dose organic iron supplements are usually better tolerated than high-dose inorganic iron supplements that can cause bowel irritation, constipation, and black faeces.
• Iodine
  Iodine is incorporated into thyroid hormones that regulate every aspect of the baby's normal growth and development during pregnancy and breastfeeding. Iodine deficiency is becoming more common in Australia. A study of pregnant women in NSW, Victoria and Tasmania found that half were iodine deficient.¹⁶ Iodine deficiency can lead to low blood levels of thyroid hormones and goitre formation. Severe iodine deficiency during pregnancy can cause mental and physical retardation (cretinism) in the baby and a milder deficiency can reduce the baby's IQ and cause oedema, prolonged jaundice, feeding problems, sluggishness, excessive sleepiness and poor muscle tone.
• Zinc
  Zinc helps regulate growth and development, immune response, nerve function and reproduction. Zinc supplementation in pregnancy has been shown to improve neonatal immune status and infant morbidity from infectious diseases and it may have a role in preventing congenital malformations such as cleft lip or palate.¹⁷
• B vitamins
  B vitamins play important roles in protein, carbohydrate and fat metabolism, cell replication, nerve function, and immune responses. Requirements for most B vitamins increase in pregnancy. Vitamin B6, B12 and folic acid play an essential role in the methylation cycle required for cell replication. Inadequate vitamin B12 causes folic acid to become inactive in the body and low B12 levels have been linked to increased risk of spina bifida.¹⁸ Vitamin B6 can help relieve nausea in pregnancy¹⁹.
• Vitamin D
  Vitamin D helps maintain normal blood levels of calcium by increasing calcium uptake from food, reducing urinary losses and mobilising it from bones. Vitamin D is important for the baby's growth, nervous system development, lung maturation and immune function. Vitamin D deficiency in infancy and childhood can result in rickets, in which inadequate calcium impairs bone formation and leads to deformities of the skeleton. An Australian case is reported of maternal vitamin D deficiency causing low calcium levels that resulted in neonatal convulsions.²⁰
• Other supporting nutrients
  Vitamin C, betacarotene and selenium are potent antioxidants that scavenge damaging free radicals and have a general protective effect on body tissues in pregnancy. Although calcium is important for bone growth, the recommended daily intake does not increase in pregnancy as absorption increases markedly. Magnesium is important for bone, nerve and muscle function and works with vitamin B6 in many enzyme systems. Manganese and silica assist connective tissue formation and chromium helps regulate blood glucose.

References

1. Laws PJ, Sullivan EA. Australia's mothers and babies 2003. Sydney: Australian Institute of Health and Welfare National Perinatal Statistics Unit, 2005. (AIHW Cat. No. PER 29; Perinatal Statististics Series No. 16.)
2. Waters A-M, Dean JH, Sullivan EA. Assisted reproduction technology in Australia and New Zealand 2003. Sydney: Australian Institute of Health and Welfare National Perinatal Statistics Unit, 2006. (AIHW Cat. No. PER 31; Assisted Reproduction Series No. 9.)
3. Chavarro JE, et al. Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstet Gynecol. 2007 Nov;110(5):1050-8.
4. Australian Government, Department of Health and Ageing & National Health and Medical Research Council, New Zealand Government, Ministry of Health. Nutrient Reference Values for Australia and New Zealand. Commonwealth of Australia, 2006.
5. Allen LH. Multiple micronutrients in pregnancy and lactation: an overview. Am J Clin Nutr. 2005 May;81(5):1206S-1212S.
6. Olsen SF, et al. Randomized controlled trial of effect of fish-oil supplementation on pregnancy duration. Lancet 1992 339:1003–1007.
7. Williams MA, et al. Omega-3 fatty acids in maternal erythrocytes and risk of preeclampsia. Epidemiology. 1995 6:232–237.
8. Williams C, et al; Avon Longitudinal Study of Pregnancy and Childhood Study Team. Stereoacuity at age 3.5 y in children born full-term is associated with prenatal and postnatal dietary factors: a report from a population-based cohort study. Am J Clin Nutr. 2001 Feb;73(2):316-22.
9. Helland IB, et al. Maternal supplementation with very-long-chain n-3 fatty acids during pregnancy and lactation augments children's IQ at 4 years of age. Pediatrics. 2003 Jan;111(1):e39-44.
10. Mitchell LE, et al. Spina bifida. Lancet. 2004 Nov 20-26;364(9448):1885-95.
11. Wilcox AJ, et al. Folic acid supplements and risk of facial clefts: national population based case-control study. BMJ. 2007 Mar 3;334(7591):464.
12. Cardy AH, et al. Pedigree analysis and epidemiological features of idiopathic congenital talipes equinovarus in the United Kingdom: a case-control study. BMC Musculoskelet Disord. 2007 Jul 5;8:62.
13. Bailey LB. Folate status assessment. J Nutr. 1990 Nov;120 Suppl 11:1508-11.
14. Institute of Medicine, Food and Nutrition Board, National Academy of Sciences (IOM/NAS). Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press, 1998.
15. Neuhouser ML, et al. Absorption of dietary and supplemental folate in women with prior pregnancies with neural tube defects and controls. Am Coll Nutr. 1998 Dec;17(6):625-30.
16. Li M, et al. Re-emergence of iodine deficiency in Australia. Asia Pac J Clin Nutr. 2001 10(3):200-3.
17. Shah D, Sachdev HP. Zinc deficiency in pregnancy and fetal outcome. Nutr Rev. 2006 Jan;64(1):15-30.
18. Groenen PM, et al. Marginal maternal vitamin B12 status increases the risk of offspring with spina bifida. Am J Obstet Gynecol. 2004 Jul;191(1):11-7.
19. Vutyavanich T, Wongtra-ngan S, Ruangsri R. Pyridoxine for nausea and vomiting of pregnancy: a randomized, double-blind, placebo-controlled trial. Am J Obstet Gynecol. 1995 Sep;173(3 Pt 1):881-4.
20. Camadoo L, Tibbott R, Isaza F. Maternal vitamin D deficiency associated with neonatal hypocalcaemic convulsions. Nutr J. 2007 Sep 19;6:23.