Optimising nutrition and micronutrient status during the perinatal period can have a significant impact on the health of the pregnant woman and her child. GPs are well placed to guide women on their nutritional needs during pregnancy and advise on any additional supplementation on an individual basis, in line with national evidence-based guidelines.
- Pregnant women often rely on their general practitioner for information regarding nutrition during pregnancy.
- Women should be encouraged to eat a healthy, varied diet during pregnancy to ensure nutrient requirements are met, and counselling should be provided regarding appropriate supplement use.
- Dietary patterns consistent with the Australian Dietary Guidelines will allow most women to meet micronutrient requirements in pregnancy. However, routine supplementation with folic acid and iodine is recommended.
- Supplementation with other micronutrients may be advised on an individual basis following assessment of nutritional status.
Women’s nutrition in the preconception period and throughout pregnancy is crucial to ensuring optimal outcomes for both the mother and child. Requirements for many vitamins and minerals, referred to collectively as micronutrients, increase during pregnancy to support the growth and development of the fetus. Inadequate stores or intake of micronutrients during this critical period, may have adverse effects on both the mother and the baby.1 It is therefore important that pregnant women make some dietary changes to ensure they meet their increased micronutrient needs. This article discusses common nutrient deficiencies that may occur in pregnancy and summarises the evidence base for supplementation for women during pregnancy.
Pregnancy requires additional nutrient and caloric intake, although the recommended increase in calories is relatively small.2,3 Pregnant women can largely meet their nutritional needs by following government-endorsed dietary guidelines, such as the Australian Dietary Guidelines, and by adding extra daily serves of some core food groups, listed in Table 1.2 By adding extra serves of grains and cereals, dairy and other protein-rich foods such legumes, eggs, nuts, fish, seafood and unprocessed meats, it is possible to meet the extra need for important micronutrients such as iron, zinc, iodine, folate and omega-3 fatty acids. However, some water-soluble micronutrients such as folate can be leeched or destroyed during the cooking process, which adds to the difficulty of meeting the increased requirements for some nutrients. Although micronutrient supplementation is often used as a preventative health measure in pregnancy, only some supplements are beneficial and routine supplementation of all women is only recommended for specific micronutrients including folic acid and iodine.3 Supplementation with other nutrients such as omega-3 long-chain polyunsaturated fatty acids (LCPUFAs), vitamin D or iron may be advised based on depleted nutrient status of the women. Women should be advised that, in the absence of an identified deficiency, taking high-dose supplements of vitamin A, C or E is of little or no benefit in pregnancy and may cause harm (Table 2).3
Many pregnant women rely on their GP for information regarding nutrition, emphasising the importance of evidence-based advice as an essential component of antenatal care.4 Antenatal visits should include questions about the woman's current eating patterns and an assessment of known risk factors for micronutrient deficiencies, including ethnicity (which has been linked to vitamin D levels) and diet (e.g. vegan or vegetarian diets).5,6 Advice regarding supplementation with micronutrients should be tailored to the individual woman with consideration of the availability and affordability of foods appropriate to the woman’s cultural practices and preferences, and the need for and affordability of supplements.