Current status of micronutrient supplementation in pregnancy

Well-balanced and adequate maternal nutrition prior conception and during pregnancy affects the course and outcome of pregnancy, and enables achievement of a: 1) healthy pregnancy, 2) uncomplicated delivery of a full-term and well-developed baby, 3) lower risk of maternal postpartum complications, and 4) sufficient source for lactation. Adequate maternal nutrition also improves future maternal health in general and reproductive health in particular. As it is now widely recognized that the risk of various chronic diseases in adulthood might have their origins in intrauterine life, the new goal of the contemporary approach in pregnancy nutrition is to establish the nutritional foundations for a healthy adults during intrauterine life. Pregnancy represents a special maternal demand for high-quality nutrients, as it is regarded as a metabolic stress that is increasing according to the course of the gestation. Although it is not completely clear how nutritional status of the mother influences her own health as well as fetal growth/development, nutrition imbalance could be harmful to the pregnant woman, influencing both the outcome of pregnancy and the composition of breast milk. In well-nourished women these increased needs are best met by biological and metabolic adaptation to pregnancy. Increasing demands should be achieved by appropriate dietary intake, which contains all nutrition requirements. In cases of imbalanced dietary intake, preexisting deficiencies of micronutrients, previous adverse pregnancy outcomes, and in all cases of high-risk pregnancies micronutrient supplementation is especially important. However, until now there is insufficient evidence to define whether there is a need for routine antepartum supplementation or should nutritional intervention be restrained to deficient populations and high-risk pregnancies. As the data on the effectiveness of supplementation in preventing or treating pregnancy-related disorders and perinatal complications are contradictory, future well designed randomized control trials would try to solve this dilemma. Micronutrient supplementation supporters have a standpoint that the potential benefits of routine supplementation overweigh any potential adverse reaction that can be attributed. In the other hand, the daily requirements are easily met in all individuals having a balanced diet. Although deficiency states are rare, several pharmaceutical companies produce over-the-counter vitamin - plus-mineral nutritional supplements, despite the lack of clear evidence to support their supplemental consumption. Currently, micronutrient supplementation should be chosen on an individual basis. In the near future, the goal would be to estimate micronutrient status prior to conception or in the early pregnancy, in order to define patients who must receive appropriate micronutrient supplementation.