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Is It Necessary Folic Acid, Vitamin B12, Vitamin D and Iodine Supplementation in Pregnancy?: Posssible Risks

Yıl 2021, Cilt: 16 Sayı: 3, 439 - 447, 01.11.2021
https://doi.org/10.17517/ksutfd.832401

Öz

Due to the increasing nutritional requirements in the pregnancy, taking certain micronutrients as dietary supplements and thus minimizing the risks associated with deficiency is of great importance in the protection of maternal and fetal health. In pregnancy, dietary supplements are vital in severe or moderate deficiency of nutrients, also bring various risks in conditions of mild deficiency or adequate maternal nutrient storage. The effect of folic acid supplementation on prevent congenital anomalies, has been proven. In maternal period, excessive intake of folic acid may cause carcinogenicity, negatively affect the absorption of zinc, lead to delays in the diagnosis and treatment of vitamin B12 deficiency, and may be associated with the risk of childhood asthma and allergy. Vitamin B12 is another vitamin whose deficiency is associated with fetal anomalies. Although the toxic effect of vitamin B12 is not reported, a case report showing allergic reactions was found in the literature review in case of excessive intake. Vitamin D, which is beneficial in the prevention of neonatal hypocalcemia and rickets, excessive intake of the supplement may be a teratogenic effect. Iodine supplement is effective in preventing diseases such as cretinism associated with iodine insufficiency. However, it has been stated that excessive intake of iodine supplement may lead to an increase in the prevalence of thyroid dysfunction of the pregnant woman, subclinical and overt hypothyroidism during pregnancy and negatively affect the psychomotor development of the baby. The use of nutritional supplements at the recommended doses during pregnancy is appropriate, but attention should also be paid to excessive intake as well as prevention of insufficiency. In this review, the risks of excessive intake of folic acid, vitamin B12, vitamin D, and iodine supplements used in pregnancy are discussed

Kaynakça

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Gebelikte Folik Asit, B12 Vitamini, D Vitamini ve İyot Destekleri Kullanmak Gerekli Midir? Olası Riskler

Yıl 2021, Cilt: 16 Sayı: 3, 439 - 447, 01.11.2021
https://doi.org/10.17517/ksutfd.832401

Öz

Gebelik sürecinde artan gereksinimler dolayısıyla; özellikle bazı mikro besin ögelerinin besin desteği olarak alınması ve böylece yetersizlik ile ilişkili risklerinin en aza indirilmesi, maternal ve fetal sağlığın korunmasında büyük öneme sahiptir. Gebelikte, besin ögelerinin ciddi veya orta düzeyde yetersizliğinde, hayat kurtarıcı nitelikte olan destekler; hafif yetersizlik veya maternal depoların yeterli olduğu koşullarda, çeşitli riskleri de beraberinde getirmektedir. Doğumsal anomalilerin önlenmesinde etkisi kanıtlanmış olan folik asitin maternal dönemde fazla alımı durumunda kanserojeniteyi tetikleyebileceği, çinko emilimini olumsuz etkileyebileceği, B12 vitamini eksikliğinin tanısında ve tedavisinde gecikmelere yol açabileceği, çocukluk çağı astım, alerji riski ile ilişkili olabileceği görülmüştür. Eksikliği fetal anomaliler ile ilişkilendirilen bir diğer vitamin olan B12’nin toksik etkisi bildirilmemekle birlikte literatür taramasında fazla alımı durumunda alerjik reaksiyonlar gösteren bir vaka raporuna rastlanmıştır. Yenidoğan hipokalsemisi ve raşitizmin önlenmesinde etkili D vitamini desteğinin fazla alımı teratojen etki gösterebilir. İyot yetersizliği ile ilişkili kretenizm gibi hastalıkların önlenmesinde etkili olan iyot desteğinin fazla alımının gebenin tiroid disfonksiyonuna, gebelikteki subklinik ve aşikâr hipotiroidizm prevalansında artışa yol açabileceği ve bebeğin psikomotor gelişimini olumsuz etkileyebileceği belirtilmiştir. Gebelikte önerilen dozlarda besin desteklerinin kullanımı uygundur ancak yetersizliğin önlenmesi kadar fazla alım konusunda da dikkatli olunmalıdır. Bu derlemede; gebelikte yaygın olarak kullanılan folik asit, B12 vitamini, D vitamini ve iyot besin desteklerinin fazla alımına ilişkin riskler tartışılmıştır.

Kaynakça

  • 1. Richard K, Holland O, Landers K, Vanderlelie JJ, Hofstee P, Cuffe JS, et al. Effects of maternal micronutrient supplementation on placental function. Placenta. 2017;54:38-44.
  • 2. Gernand AD, Schulze KJ, Stewart CP, West Jr KP, Christian P. Micronutrient deficiencies in pregnancy worldwide: health effects and prevention. Nature Reviews Endocrinology. 2016;12(5):274.
  • 3. Berti C, Biesalski H, Gärtner R, Lapillonne A, Pietrzik K, Poston L, et al. Micronutrients in pregnancy: current knowledge and unresolved questions. Clinical nutrition. 2011;30(6):689-701.
  • 4. Christian P, Stewart CP. Maternal micronutrient deficiency, fetal development, and the risk of chronic disease. The Journal of nutrition. 2010;140(3):437-445.
  • 5. Ho A, Flynn AC, Pasupathy D. Nutrition in pregnancy. Obstetrics, Gynaecology & Reproductive Medicine. 2016;26(9):259-264.
  • 6. Procter SB, Campbell CG. Position of the Academy of Nutrition and Dietetics: nutrition and lifestyle for a healthy pregnancy outcome. Journal of the Academy of Nutrition and Dietetics. 2014;114(7):1099-1103.
  • 7. Plećaš D, Plešinac S, Kontić-Vučinić O. Nutrition in pregnancy: basic principles and recommendations. Srpski arhiv za celokupno lekarstvo. 2014;142(1-2):125-130.
  • 8. T.C. Sağlık Bakanlığı. Türkiye Beslenme Rehberi (TÜBER): T.C. Sağlık Bakanlığı, Türkiye Halk Sağlığı Kurumu, 2015. Erişim Adresi: https://dosyasb.saglik.gov.tr/Eklenti/10915,tuber-turkiye-beslenme-rehberipdf.pdf.
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  • 11. Antony AC. In utero physiology: role of folic acid in nutrient delivery and fetal development. The American journal of clinical nutrition. 2007;85(2):598-603.
  • 12. Khan KM, Jialal I. Folic acid (folate) deficiency. StatPearls [Internet]: StatPearls Publishing; 2019.
  • 13. Jing Y, Zheng YZ, Cao LJ, Liu YY, Wen L, Huang GW. Periconceptional folic acid supplementation in Chinese women: a cross-sectional study. Biomedical and Environmental Sciences. 2017;30(10):737-748.
  • 14. Obeid R, Murphy M, Solé-Navais P, Yajnik C. Cobalamin status from pregnancy to early childhood: lessons from global experience. Advances in Nutrition. 2017;8(6):971-979.
  • 15. Aksu H, Sevil Ü, Yurtsev E, Güvendiren G. Nöral tüp defektleri ve folik asit. Maltepe Üniversitesi Hemşirelik Bilim ve Sanat Dergisi. 2010;2:1992.
  • 16. Li K, Wahlqvist ML, Li D. Nutrition, one-carbon metabolism and neural tube defects: a review. Nutrients. 2016;8(11):741.
  • 17. Gaskins AJ, Rich-Edwards JW, Hauser R, Williams PL, Gillman MW, Ginsburg ES, et al. Maternal prepregnancy folate intake and risk of spontaneous abortion and stillbirth. Obstetrics and gynecology. 2014;124(1):23.
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  • 48. Acılmıs YG, Dikensoy E, Kutlar AI, Balat O, Cebesoy FB, Ozturk E, et al. Homocysteine, folic acid and vitamin B12 levels in maternal and umbilical cord plasma and homocysteine levels in placenta in pregnant women with pre‐eclampsia. Journal of Obstetrics and Gynaecology Research. 2011;37(1):45-50.
  • 49. Muthayya S, Dwarkanath P, Mhaskar M, Mhaskar R, Thomas A, Duggan C, et al. The relationship of neonatal serum vitamin B 12 status with birth weight. Asia Pacific journal of clinical nutrition. 2006;15(4).
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  • 52. Puri M, Kaur L, Walia GK, Mukhopadhhyay R, Sachdeva MP, Trivedi SS, et al. MTHFR C677T polymorphism, folate, vitamin B12 and homocysteine in recurrent pregnancy losses: a case control study among North Indian women. Journal of perinatal medicine. 2013;41(5):549-554.
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  • 57. Karras SN, Wagner CL, Castracane VD. Understanding vitamin D metabolism in pregnancy: from physiology to pathophysiology and clinical outcomes. Metabolism. 2018;86:112-23.
  • 58. Amegah AK, Klevor MK, Wagner CL. Maternal vitamin D insufficiency and risk of adverse pregnancy and birth outcomes: a systematic review and meta-analysis of longitudinal studies. PLoS One. 2017;12(3).
  • 59. Arnold DL, Enquobahrie DA, Qiu C, Huang J, Grote N, VanderStoep A, et al. Early pregnancy maternal vitamin D concentrations and risk of gestational diabetes mellitus. Paediatric and perinatal epidemiology. 2015;29(3):200-210.
  • 60. Wang H, Xiao Y, Zhang L, Gao Q. Maternal early pregnancy vitamin D status in relation to low birth weight and small-for-gestational-age offspring. The Journal of steroid biochemistry and molecular biology. 2018;175:146-150.
  • 61. Sørensen IM, Joner G, Jenum PA, Eskild A, Brunborg C, Torjesen PA, et al. Vitamin D‐binding protein and 25‐hydroxyvitamin D during pregnancy in mothers whose children later developed type 1 diabetes. Diabetes/metabolism research and reviews. 2016;32(8):883-890.
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  • 64. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism. 2011;96(7):1911-1930.
  • 65. Pludowski P, Holick MF, Grant WB, Konstantynowicz J, Mascarenhas MR, Haq A, et al. Vitamin D supplementation guidelines. The Journal of steroid biochemistry and molecular biology. 2018;175:125-35.
  • 66. T.C. Sağlık Bakanlığı. Gebelere D Vitamini Destek Programı 2011. Erişim Adresi: https://www.saglik.gov.tr/TR,11158/gebelere-d-vitamini-destek-programi.html.
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  • 87. Velasco I, Carreira M, Santiago P, Muela JA, García-Fuentes E, Sanchez-Munoz B, et al. Effect of iodine prophylaxis during pregnancy on neurocognitive development of children during the first two years of life. The Journal of Clinical Endocrinology & Metabolism. 2009;94(9):3234-3241.
  • 88. Amiri P, Hamzavi Zarghani N, Nazeri P, Ghofranipour F, Karimi M, Amouzegar A, et al. Can an educational intervention improve iodine nutrition status in pregnant women? A randomized controlled trial. Thyroid. 2017;27(3):418-425.
  • 89. Çan G, Ökten A, Green J. The role of local mass media in promoting the consumption of iodized table salt. Health Education Research. 2001;16(5):603-607.
  • 90. Russell R, Beard JL, Cousins RJ, Dunn JT, Ferland G, Hambidge K, et al. Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. A Report of the Panel on Micronutrients, Subcommittees on Upper Reference Levels of Nutrients and of Interpretation and Uses of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes Food and Nutrition Board Institute of Medicine. 2001.
Toplam 90 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Derlemeler
Yazarlar

Hilal Şimşek 0000-0002-2744-1610

Yasemin Karaağaç 0000-0002-2757-2485

Esra Tunçer 0000-0001-7151-842X

Hülya Yardımcı 0000-0002-2664-4176

Yayımlanma Tarihi 1 Kasım 2021
Gönderilme Tarihi 28 Kasım 2020
Kabul Tarihi 30 Ocak 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 16 Sayı: 3

Kaynak Göster

AMA Şimşek H, Karaağaç Y, Tunçer E, Yardımcı H. Gebelikte Folik Asit, B12 Vitamini, D Vitamini ve İyot Destekleri Kullanmak Gerekli Midir? Olası Riskler. KSÜ Tıp Fak Der. Kasım 2021;16(3):439-447. doi:10.17517/ksutfd.832401