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Two observational studies found that serum concentrations of chromium in pregnant women were not associated with glucose intolerance or gestational diabetes , , although serum chromium concentrations may not necessarily reflect tissue chromium concentrations. However, it is important to note that insulin therapy was still required to normalize the severely elevated blood glucose concentrations. Thus, more research, especially from randomized controlled trials , is needed to determine whether chromium supplementation has any utility in the treatment of gestational diabetes.

Adequate intake of this mineral is needed for maternal thyroid hormone production, and thyroid hormone is needed for myelination of the central nervous system and is thus essential for normal fetal brain development If iodine deficiency leads to inadequate production of thyroid hormone during pregnancy, irreversible brain damage in the fetus may occur Severe maternal iodine deficiency has also been associated with increased incidence of miscarriage, stillbirth, and birth defects One of the most devastating effects of severe maternal iodine deficiency is congenital hypothyroidism A severe form of congenital hypothyroidism may lead to a condition that is sometimes referred to as cretinism and result in irreversible mental retardation.

Cretinism occurs in two forms, neurologic and myxedematous, although there is considerable overlap between them. The neurologic form is characterized by mental and physical retardation and deafness; it results from maternal iodine deficiency that affects the fetus before its own thyroid is functional. The myxedematous or hypothyroid form is characterized by short stature and mental retardation Severe maternal iodine deficiency has also been linked to neurocognitive deficits in the offspring In severely iodine-deficient pregnant women, iodine supplementation effectively reduces rates of cretinism, and improves offspring cognitive function and survival reviewed in The timing of iodine supplementation appears to be important: supplementation should be initiated prior to conception and early in pregnancy before the 10 th week of gestation in order to see beneficial effects on offspring neurocognitive outcomes Even mild forms of maternal iodine deficiency may have adverse effects on cognitive development in the offspring , though this outcome is less well studied.

Randomized controlled trials conducted in moderately iodine deficient pregnant women demonstrate that iodine supplementation increases thyroid gland volume but has no effect on thyroid hormone concentrations compared to placebo reviewed in and The extent to which supplementation in moderately iodine deficient pregnant women affects neurocognitive outcomes in their offspring is currently under investigation Iodine deficiency is now accepted as the most common cause of preventable brain damage in the world Thus, adequate intake of the mineral throughout pregnancy is critical.

For more information on iodine and iodine deficiency disorders, see the article on Iodine. Many women have dietary iron intakes below current recommendations. Iron is needed for a number of biological functions see the article on Iron , but during pregnancy, the mineral is generally needed to support growth and development of the fetus and placenta and to meet the increased demand for red blood cells to transport oxygen. Intestinal absorption of dietary iron increases during the second and third trimesters to accommodate for expansion of red cell mass Despite maternal physiologic changes that enhance iron absorption, many women develop iron-deficiency or iron-deficiency anemia during pregnancy.

Anemias can be caused by deficiencies in other micronutrients, such as folate or vitamin B 12 , but iron deficiency is the primary cause of anemia during pregnancy 1. Two systematic reviews evaluated the effect of routine iron supplementation compared to placebo or no treatment on maternal and birth outcomes , Both reviews found that routine supplementation with iron improved maternal iron status and decreased the risk of iron deficiency and iron-deficiency anemia at term.

There is some indication that maternal iron supplementation could improve birth outcomes namely preterm birth and low birth weight in developing countries, but the evidence was deemed of low quality Iron status of the woman at the time of conception is important for a healthy pregnancy, to avoid postpartum anemia, and to provide the breast-feeding infant with sufficient iron stores until six months of age, when complementary feeding is recommended.

Absorption of nonheme iron, which is the form of iron found in supplements, is affected by a number of enhancers e.

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In general, iron supplements are better absorbed on an empty stomach. For more information about dietary and supplemental sources of iron, as well as the side effects and safety of iron, see the article on Iron. The mineral magnesium plays a number of important roles in the structure and the function of the human body see the article on Magnesium , and adequate intake of the mineral is needed for normal embryonic and fetal development. Good sources of magnesium include green leafy vegetables, whole grains , and nuts see the article on Magnesium.

Preeclampsia is defined as the presence of elevated blood pressure and protein in the urine; severe swelling edema may also be present. Eclampsia occurs with the addition of seizures to these symptoms. A pooled analysis of randomized controlled trials concluded that oral magnesium supplementation during pregnancy has no significant effect on perinatal mortality, small-for-gestational age, or the risk of preeclampsia Intravenous administration of high-dose magnesium sulfate has been the treatment of choice for preventing eclamptic seizures that may occur in association with preeclampsia-eclampsia in late pregnancy or during labor Magnesium is believed to relieve cerebral blood vessel spasm and promote peripheral vasodilation , thereby increasing blood flow to the brain However, the results of maternal zinc supplementation trials in the US and developing countries have been mixed This analysis, however, did not find zinc supplementation to benefit other indicators of maternal or infant health.

Choline can be synthesized by the body in small amounts, but dietary intake is needed to maintain health Choline is essential for embryonic and fetal brain development, liver function, and placental function The choline metabolite betaine is a source of methyl CH 3 groups required for methylation reactions; DNA methylation that occurs during embryonic and fetal development modulates gene expression , cell differentiation , and the formation of organs A mother delivers large amounts of choline to the fetus across the placenta and to the infant via breast milk, placing an increased demand on maternal stores of choline during pregnancy and lactation The induction of de novo choline synthesis by the high levels of estrogen during pregnancy helps to meet this increased demand Additionally, pregnant women are encouraged to consume choline-rich foods, such as eggs, meat, and seafood for dietary sources, see the article on Choline.

Case-control studies have reported mixed results regarding the relationship between dietary choline intake or blood choline concentration and the risk of neural tube defects NTDs. One case-control study reported a lower risk of having an NTD-affected pregnancy in those with the highest intake of betaine and choline combined , while two other studies found no association between maternal choline intake and NTD risk , Similarly, one case-control study found low serum choline concentration was associated with a higher risk of NTDs , while another study found no such association Additionally, it is not known if supplementation with choline or betaine, like supplementation with folic acid see Folate above , will lower the incidence of NTDs.

More research is needed to determine whether choline is involved in the etiology of NTDs. Maternal intake of choline during pregnancy could possibly affect cognitive abilities of the offspring. Choline supplementation in pregnant rats, as well as rat pups during the first month of life, leads to improved performance in spatial memory tests months after choline supplementation has been discontinued A review by McCann et al.

It is not clear whether findings in rodent studies are applicable to humans. Finally, choline is important for homocysteine metabolism during pregnancy. Methyl groups derived from choline may be used to convert homocysteine to methionine. For more information on the importance of omega-3 fatty acids during these life stages, see two sections in the separate article on essential fatty acids: Visual and neurological development and Pregnancy and lactation.

Information about environmental contaminants in fish and supplements is included in the sections, Contaminants in fish and Contaminants in supplements. Breast-feeding confers health benefits to the child, as well as the mother Breast milk is the ideal source of nutrition for the infant and also contains a number of bioactive compounds important in immunity, such as antibodies , cytokines , antimicrobial agents, and oligosaccharides The American Academy of Pediatrics recommends exclusive breast-feeding for the first six months of infancy, followed by continued breast-feeding as complementary foods are introduced, with continuation of breast-feeding until 12 months postpartum or longer as mutually desired by the mother and child The World Health Organization recommends exclusive breast-feeding for the first six months of life and continued breast-feeding, with complementary feeding, up to two years or more postpartum There are, however, a few exceptions when breast-feeding is contraindicated, including those listed on the CDC website.

Likewise, the intake recommendations RDA or AI for most micronutrients , which are based on amounts secreted in breast milk, are higher for lactating women compared to pregnant women see Table 3. Breast milk is considered to be low in iron; however, the iron content of breast milk is not influenced by changes in maternal iron status, such as through maternal supplementation The RDA for folate is also lower during lactation compared with pregnancy. Dietary intake recommendations for calcium remain unchanged for lactating women compared to recommendations for nonlactating women, and calcium content in breast milk does not reflect maternal intake of the mineral.

Adequate calcium is maintained in breast milk because of maternal physiological changes that involve transient bone resorption ; increased maternal intake of calcium through diet and supplementation does not prevent maternal bone demineralization, and studies have shown that maternal bone mineral content is restored upon weaning Thus, meeting daily intake recommendations for these micronutrients is important for the health of the child. Maternal vitamin deficiencies can negatively affect infant growth and development; for instance, vitamin B 12 deficiency during infancy can impair brain development and cause neurological problems Vitamin B 12 deficiency has been documented in nursing infants of mothers who have untreated pernicious anemia and also in women who are strict vegetarians vegans Vitamin B 12 is found only in foods of animal origin and fortified foods, and lactating women who follow vegetarian diets should take supplemental vitamin B Vitamin B 12 deficiency that results from pernicious anemia can easily be corrected with high-dose daily supplementation or with monthly intramuscular injections of the vitamin see the article on Vitamin B However, there has been relatively little research on the effect of oral vitamin B 12 supplementation in lactating women, and it has been suggested that supplementation during lactation may be too late to restore adequate milk concentrations and infant status Supplementation during pregnancy may more effectively improve infant vitamin B 12 status.

The concentrations of other water-soluble vitamins in breast milk, including thiamin , riboflavin , and vitamin B 6 , are also strongly dependent on maternal intake of these vitamins 59 , Likewise, vitamin C concentration in human milk varies with the vitamin C status of the mother. Compared to water-soluble vitamins, the concentrations of fat-soluble vitamins vitamins A, D, E, and K in breast milk are less correlated with maternal dietary intake.

At such levels of maternal intake, breast milk is a good source of vitamin A and provides the infant with a sufficient amount of the vitamin In contrast, breast milk is considered to be low in vitamins D and K. Vitamin D concentrations are low in breast milk, presumably because many women have insufficient vitamin D status. Vitamin D supplementation during lactation has been shown to improve vitamin D status in the woman and the infant Liquid vitamin D supplements are commercially available for infant supplementation. Human milk is also relatively low in vitamin K.

Thus, exclusively breast-fed newborns are at increased risk for vitamin K deficiency. In general, newborns have low vitamin K status for the following reasons: 1 vitamin K is not easily transported across the placental barrier; 2 the newborn's intestines are not yet colonized with bacteria that synthesize vitamin K; and 3 the vitamin K cycle may not be fully functional in newborns, especially premature infants Because VKDB is life-threatening and easily prevented, the American Academy of Pediatrics and a number of similar international organizations recommend that an injection of phylloquinone vitamin K 1 be administered to all newborns shortly after birth , , Additionally, the vitamin E content in breast milk varies with maternal diet and vitamin E supplement use , Maternal dietary intake recommendations for the 14 essential minerals during lactation are shown in Table 3.

The content of minerals in breast milk does not correlate well with maternal intake or status, except for iodine and selenium 1 , Iodine-deficient women who are breast-feeding may not be able to provide sufficient iodine to their infants who are particularly vulnerable to the effects of iodine deficiency see the article on Iodine.

The tolerable upper intake level UL for each micronutrient is shown in the Table 4. The UL, established by the Food and Nutrition Board of the Institute of Medicine, is the highest level of daily intake that is likely to pose no risk of adverse health effects in almost all individuals. Originally written in July by: Victoria J. Drake, Ph. Updated in March by: Giana Angelo, Ph. Reviewed in August by: Berthold V.


Koletzko, M. Katz DL. Diet, pregnancy, and lactation. Nutrition in Clinical Practice. Kramer MS. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ. The epidemiology of adverse pregnancy outcomes: an overview. J Nutr. Kanaka-Gantenbein C. Fetal origins of adult diabetes. Ann N Y Acad Sci. Barker DJP. Mothers, Babies and Health in Later Life.

Edinburgh: Churchill Livingstone; Christian P. Micronutrients, birth weight, and survival. Annu Rev Nutr. Food and Nutrition Board, Institute of Medicine. Washington, D. National Academy Press. Comparison of national policies on periconceptional use of folic acid to prevent spina bifida and anencephaly SBA. Ann Intern Med. The National Academies Press. Molecular biology of biotin attachment to proteins. Watanabe T.

Teratogenic effects of biotin deficiency in mice. Watanabe T, Endo A. Species and strain differences in teratogenic effects of biotin deficiency in rodents. Indicators of marginal biotin deficiency and repletion in humans: validation of 3-hydroxyisovaleric acid excretion and a leucine challenge. Am J Clin Nutr. Increased urinary excretion of 3-hydroxyisovaleric acid and decreased urinary excretion of biotin are sensitive early indicators of decreased biotin status in experimental biotin deficiency.

C: National Academy Press; Conflicting indicators of biotin status from a cross-sectional study of normal pregnancy. J Am Coll Nutr. Biotin status assessed longitudinally in pregnant women. Pregnancy and lactation alter biomarkers of biotin metabolism in women consuming a controlled diet. Marginal biotin deficiency during normal pregnancy. Mock DM. Marginal biotin deficiency is common in normal human pregnancy and is highly teratogenic in mice.

Zempleni J, Mock DM. Marginal biotin deficiency is teratogenic. Proc Soc Exp Biol Med. J Am Diet Assoc. Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database Syst Rev. Folate deficiency and folic acid supplementation: the prevention of neural-tube defects and congenital heart defects. Eskes TK. Open or closed?

Nutrient Regulation during Pregnancy, Lactation, and Infant Growth

A world of difference: a history of homocysteine research. Nutr Rev. Effects and safety of periconceptional folate supplementation for preventing birth defects. Accelerated folate breakdown in pregnancy. US Food and Drug Administration. Food standards: amendments of standards of identity for enriched grain products to require addition of folic acid. Fed Regist ;— Updated estimates of neural tube defects prevented by mandatory folic Acid fortification - United States, Czeizel AE.

Periconceptional folic acid and multivitamin supplementation for the prevention of neural tube defects and other congenital abnormalities. Is 5-methyltetrahydrofolate an alternative to folic acid for the prevention of neural tube defects? J Perinat Med. A randomized, placebo-controlled trial in women of childbearing age to assess the effect of folic acid and methyl-tetrahydrofolate on erythrocyte folate levels.

Vitam Miner. Supplementation with [6S]methyltetrahydrofolate or folic acid equally reduces plasma total homocysteine concentrations in healthy women. Comparison of the effect of low-dose supplementation with Lmethyltetrahydrofolate or folic acid on plasma homocysteine: a randomized placebo-controlled study.

Increases in blood folate indices are similar in women of childbearing age supplemented with [6S]methyltetrahydrofolate and folic acid. Protective effect of periconceptional folic acid supplements on the risk of congenital heart defects: a registry-based case-control study in the northern Netherlands. Eur Heart J. Maternal periconceptional use of multivitamins and reduced risk for conotruncal heart defects and limb deficiencies among offspring. Am J Med Genet. Occurrence of congenital heart defects in relation to maternal mulitivitamin use.

Am J Epidemiol. Periconceptional multivitamin use and the occurrence of conotruncal heart defects: results from a population-based, case-control study. Do multivitamin supplements attenuate the risk for diabetes-associated birth defects? Reduction of urinary tract and cardiovascular defects by periconceptional multivitamin supplementation. Hungarian cohort-controlled trial of periconceptional multivitamin supplementation shows a reduction in certain congenital abnormalities. Prenatal multivitamin supplementation and rates of congenital anomalies: a meta-analysis.

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J Obstet Gynaecol Can. Homocysteine and folate concentrations in early pregnancy and the risk of adverse pregnancy outcomes: the Generation R Study. Maternal homocysteine and small-for-gestational-age offspring: systematic review and meta-analysis. Plasma total homocysteine, pregnancy complications, and adverse pregnancy outcomes: the Hordaland Homocysteine study.

Duley L. The concentration of some vitamins in breast milk depends on their levels in the mother, and deficiencies in the mother can lead to deficiencies in the infant. This is particularly relevant for thiamine B 1 , riboflavin B 2 , and vitamins B 6 , B 12 , E and A, and consequently an increase in their intake is recommended during lactation. It is involved in the photochemical reactions of the retina, it is an antioxidant, and has antimicrobial properties. The vitamin A content in milk decreases as lactation progresses.

The intake obtained with a balanced diet is adequate and supplementation is not necessary. However, in developing countries it is recommended that all mothers take a single supplementary dose of , IU of vitamin A as soon as possible after delivery.. Vitamin D deficiency is fairly frequent in pregnant and lactating women.

Mothers that have restricted diets, such as strict vegetarians, and those with limited exposure to UV radiation mothers with limited exposure to sunlight, with dark skin, or that wear a veil may have very low plasma levels. Supplementation will continue until the child starts consuming one litre of vitamin D-enriched formula a day.

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The concentration of vitamin E in breast milk is sensitive to maternal intake, so the maternal diet must be assessed and supplemented if intake is inadequate. Vitamin K is also synthesised by bacteria lining the gastrointestinal tract. If the diet is adequate, the lactating mother does not require vitamin K supplementation.

Newborns usually have low levels of vitamin K, as this vitamin is not easily mobilised through the placenta and the bacterial flora of the newborn is inadequate for its synthesis in the first days of life. Following birth, intramuscular administration of 1 mg of vitamin K is recommended for the prevention of haemorrhagic disease of the newborn. Parents that refuse intramuscular administration of vitamin K are offered the oral route as an alternative 2 mg of oral vitamin K at birth, followed by 1 mg weekly until week 12 in infants that are partially or exclusively breastfed..

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The concentration of water-soluble vitamins in milk depends to a great extent on maternal levels, so that deficiencies in the mother can lead to deficiencies in the infant. In the early weeks of life, the vitamin B 6 stores accumulated during pregnancy are crucial in maintaining adequate levels in breastfed children. The manifestations of vitamin B 6 deficiency in infants also depend on its severity, although in general it presents with neurologic symptoms and different forms of dermatitis.

Vitamin B 12 concentrations in the milk of well-nourished mothers are adequate. However, its levels are low in mothers that are strictly vegetarian vegan , are malnourished or have pernicious anaemia, even if they do not show signs of deficiency. In these cases, it is important that mothers receive a vitamin B 12 supplement the entire time they are breastfeeding, as vitamin B 12 deficiency in the infant can have short- and long-term neurological effects. The plasma and tissue concentrations of vitamin C in smokers are lower than in nonsmokers, so an increase in vitamin C intake is recommended in mothers that smoke..

The recommended concentration of folic acid in breast milk can be easily achieved through dietary intake or supplementation, if needed. Compared to vitamins, the concentrations of minerals do not seem to be correlated to maternal intake, except for iron and iodine. Iodine, iron, copper, magnesium and zinc have a high bioavailability in breast milk. The selenium content is strongly influenced by the mother's diet..

Iron supplementation is usually recommended to make up for losses sustained during childbirth, although it must be noted that women that practise exclusive breastfeeding usually experience amenorrhoea for a minimum of six months and thus do not lose iron through menstruation during that time. Therefore, it could be said that breastfeeding exerts a protective effect against maternal iron deficiency. Calcium is essential during lactation, during which it is subject to special regulatory mechanisms that lead to increased absorption, decreased renal excretion and greater mobilisation of bone calcium.

To meet maternal calcium requirements, the American Academy of Paediatrics recommends lactating mothers to consume five servings a day of calcium-rich foods of any kind, such as low-fat yoghourt or cheese, and other nondairy foods that contain calcium, such as fish consumed with its bones for example, canned sardines , salmon, broccoli, sesame seeds or cabbages, which may provide the — mg daily recommended allowance for lactating women. Zinc is essential to growth, cell immunity and enzyme synthesis. While zinc concentrations in human milk are not high, they suffice to satisfy the needs of the child due to its high bioavailability.

Selenium is a mineral involved in the immune system, cholesterol metabolism and thyroid function. The concentration of selenium in breast milk is three times that in artificial formulae.. The iodine requirements of lactating women nearly double those of healthy adult women, as in addition to meeting maternal requirements, iodine levels must guarantee that the baby receives sufficient iodine from the milk to synthesise thyroid hormones.

Iodised table salt the source of iodine recommended for all individuals only contributes half of the required intake during lactation, while salt consumption may decrease during this period. When the iodisation of the water supply becomes nationwide and has been established for at least two years, and once its consumption has become widespread in the population, iodine supplementation will no longer be necessary in pregnant and lactating women.. The unique biological benefits of human milk justify the promotion of breastfeeding as the ideal method for feeding infants. Increased intake of certain nutrients or the use of certain supplements in lactating women is recommended to satisfy the demands of milk production and to protect the infant from nutrient deficiencies 38,39 Table Dietary and lifestyle recommendations for breastfeeding women..

The authors have no conflicts of interest to declare. We thank all the paediatricians that have been members of the Committee on Breastfeeding since its constitution.. An Pediatr Barc. ISSN: Previous article Next article. Issue 6. Pages The importance of maternal nutrition during breastfeeding: Do breastfeeding mothers need nutritional supplements?.

Download PDF. Susana Ares Segura a ,. Corresponding author. This item has received. Article information. Table 1.

Table 2. Show more Show less. Lactation raises nutrient needs, mainly because of the loss of nutrients, first through colostrum and then through breastmilk. The nutrients present in this milk come from the diet of the mother or from her nutrient reserves. Mothers should not receive less than calories per day. Los nutrientes presentes en la leche proceden de la dieta de la madre o de sus reservas de nutrientes. Palabras clave:.

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Introduction Breast milk must guarantee the adequate nutrition of the infant as a continuation of intrauterine nutrition, and both the mother's nutritional status as well as her diet may influence breast milk composition, and therefore nutrient intake in the infant. Unless they are extremely malnourished, all mothers can produce milk in appropriate amounts and of appropriate quality. Minimum nutrient requirements for healthy women as well as pregnant and lactating women. ND, not determined due to a lack of studies in these population subsets; RDA, recommended dietary allowance.

The intake must come from food sources to avoid potential overdoses. Dietary and lifestyle recommendations for breastfeeding women. We thank all the paediatricians that have been members of the Committee on Breastfeeding since its constitution. Appendix A. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids.

The National Academy Press, ,. Barness, P. Dallman, H. Anderson, P. Collipp, B. Nichols Jr. Walker, et al. Pediatrics, 68 , pp. Multiple micronutrients in pregnancy and lactation: an overview. Am J Clin Nutr, 81 , pp. Maternal micronutrient malnutrition: effects on breast milk and infant nutrition, and priorities for intervention.

SCN News, , pp. Hall, N. Lowe, N. Crossland, C. Berti, I.

  1. Introduction.
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  4. Cetin, M. Hermoso, et al. Nutritional requirements during lactation. Matern Child Nutr, 6 , pp. Temas de la OMS. Chapman, L. Impact of maternal nutritional status on human milk quality and infant outcomes: an update on key nutrients. Adv Nutr, 3 , pp. Valentine, C. Nutritional management of the breastfeeding dyad. Pediatr Clin North Am, 60 , pp. Impact of breastfeeding on maternal nutritional status. Adv Exp Med Biol, , pp.

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    An implementation guide. National Academy Press, ,. Michaelsen, P. Larsen, B. Thomsen, G. The Copenhagen Cohort Study on Infant Nutrition and Growth: breast-milk intake, human milk macronutrient content, and influencing factors. Am J Clin Nutr, 59 , pp. Iron deficiency and iron deficiency anemia are prevalent among pregnant women. The extent to which iron deficiency affects maternal and neonatal health is uncertain.

    Existing data suggest that maternal iron deficiency anemia may be associated with adverse outcomes, including preterm delivery and higher maternal mortality. Further research is needed on the maternal and neonatal benefits of iron supplementation during pregnancy. Volume 55 , Issue 4. The full text of this article hosted at iucr. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account.

    If the address matches an existing account you will receive an email with instructions to retrieve your username. Nutrition Reviews Volume 55, Issue 4. Lindsay H. Allen Ph.