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Zinc and pregnancy outcome

• Zinc – involved in 300 enzymes, nucleoprotein,

DNA and protein synthesis, cell division.
• Serum zinc levels in pregnant women
– Normal range -10 mol/l
– Fall (13)
– No change (6)
– Rise (one)
• Birth weight-
– Positive correlation in 4 studies
– Negative correlation in 1 study
– No correlation in 7 studies
Vitamin A
• Safe vitamin A dosage during pregnancy/Preentive-10000 IU daily or 25
000 IU weekly
• Indication for vitamin A supplementation :
– Vertical transmission of HIV (ongoing)
– Maternal anemia: posiitive interaction with iron in reducing anemia
– Infection
– Maternal mortality
• Vitamin A vs. Placebo RR 0.60 (0.37-0.97)
• Beta-carotene vs. Placebo RR 0.51 (0.30-0.86)
• Potential adverse effects of vitamin A and related substance :
– Total daily dose > 10.000 IU before 7th week of gestasional ssociated
wit birth defect: craniofacial, central nervous system, thymic cardiac
• Overall efectiveness and safety of vitamin A supplementation needs to be
Zinc and Pregnancy Outcome
• Intra-uterine growth retardation
– Positive correlation in 2 studies
– No correlation in 4 studies
• Pre-term babies
– Positive correlation in 2 studies
• Congenital abnormalities
– Positive correlation in 1 study
– Positive correlation only with extreme deficincy in 1 study
– No correlation in 2 studies
• Infection, atonic uterine bleeding, inefficient labour
– Positive correlation in 1 study
Cooper and pregnancy outcome
• Function – Cu-proenzymes, Cytochrome-c –
oxidase, angiogenesis, connective tissue
• Normal range varies – 110 to 210 micro gm/gl
– Peak value- 220-300 mcro gm/dl
– Pattern of rise- First/second trimester
– Postpartum levels- 2/4/8-12 weeks
• Rise in serum copper during pregnancy in all
• No correlation with abortion, weight, preterm
delivery or other advers pregnancy outcomes
• Invers relationship with bright weight
Maternal Malnutrition And Pregnancy
 Dietary restriction trials in pregnant women:-
-inconclusive result to demonstrate or exclude effect on
fetal growth or any significant effect on other outcomes
 Nutritional supplementation trials:-mixed result
-high protein:no evidence of benefit on fetal growth
-balanced protein and energy:minimal increase in average
birth weight (˜30g) and small decrease in incidence of
small for gestational age newborns
 Conclusion:-
-women manifesting nutritional deficits can benefit from a
balanced energy/protein supplementation
Maternal Malnutrition And Pregnancy
 Severe nutritional deprivation studies show:
-Periconception:decreased fertility, increased neural tube
-1st t trimester:increased stillbirths,preterm birth, early
newborn deaths.
-2 dan 3 trimester: low birth weight, small for gestational age,
preterm birth.
-Birth weight significantly influenced by starvation
-Perinatal mortality rate not affected.
-No increase in incidence of malformation.
-In healthy women, state of near starvation is needed to affect
pregnancy outcome.
Folid acid
 Strong evidence that folic acid prevents preconceptionally
recurrent and first occurent neural tube defect.
 Increasing evidence that folic acid reduces risk of some
other birth defects.
 Improves the hematologic indices in women receiving
routine iron and folic acid.
 USPHS/CDC recommends for US women
-400ug/day :all women in childbearing age
-1mg/day :pregnant women
-4mg/day :women with history of neural tube defect take
deliveries folix acid 1mounth prior to conception and
during first trimester
Micronutients and pregnancy outcome
Micronutrient deficiencies associated with adverse
pregnancy outcomes?.

Vitamin D : neonatal hypocalcaemia.

Vitamin K : haemorrahage.
Copper : anaemia, anencephaly, low birth weight.
Selenium : neural tube defect, dysfunction of brain,
and cardiovascular system, abortion.
Magnesium : increase blood coagulability,
toxaemia,pretrm birth.
Micronutients and pregnancy outcome
 Micronutrient deficiencies associated with adverse pregnancy

-Folid acid : neural tube defects.

-Iron : anaemia, haemorrhage
-Iodine : creatinism.
-Calcium : hypertension, pre-eclampsia.
-Zink : anaemia, neural tube defects, low birth
weight, anencephaly.
-Vitamin A : Vertical transmission of HIV, infant survival,
maternal anemia, infection, maternal mortality.