Micronutrient deficiency in women living in industrialized countries during the reproductive years: Is there a basis for supplementation with multiple micronutrients?

Schaefer, Ella

doi:10.4172/2161-0509.1000199

Cited by 12Nutrition and Health StudiesPublic Health and NutritionFolate and B Vitamins Research

Micronutrient deficiency in women living in industrialized countries during the reproductive years: Is there a basis for supplementation with multiple micronutrients?

Schaefer, Ella·2016·Journal of Nutritional Disorders & Therapy

DOI 10.4172/2161-0509.1000199

Open this paper in CoChat — free account

Abstract

Maternal diet is widely recognized to be one of the major environmental factors influencing the development of the embryo and fetus. It is important that women of childbearing age maintain good nutrition throughout their reproductive years, including before conception, as there is a strong relationship between fertility and a successful pregnancy, and a sufficient intake of micronutrients. Yet even in ‘high-income’, industrialized countries, where dietary resources are more readily available, micronutrient levels in such women may be inadequate. This review looked at the micronutrient status of women of childbearing age in industrialized countries, as well as those who were pregnant, to determine whether there are any gaps in micronutrient levels. A second objective was to assess whether the evidence indicates a role for multiple micronutrients other than folate and iron during these periods. Results indicated that although some women might have a sufficient intake of micronutrients (although not necessarily all of them), there are those who have lower than the currently-recommended daily intake of micronutrients, particularly folate, vitamin B12, vitamin D, calcium, iodine, iron and selenium. The evidence suggests that multiple micronutrient supplementation during the periconceptional period (i.e. before conception until the end of the first trimester) and throughout pregnancy could help to address inadequate dietary intake of micronutrients, improve maternal status prior to and during pregnancy, and thereby help to minimize reproductive risks.

Integrity signals

Registry

Crossref · 10.4172/2161-0509.1000199

Cites

72 of 72 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Even in industrialized nations, social, economic, educational, ethnic and cultural backgrounds influence diet and may adversely affect an individual's micronutrient status.
“Even in industrialized nations, where it may be presumed that healthy, nutritious food is easier to obtain, social, economic, educational, ethnic and cultural backgrounds influence the diet and may adversely affect an individual’s micronutrient status [8].”
From Immune function and micronutrient requirements change over the life course (2018) · cites this paper as [8]

Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline
Holick, M. F., Binkley, N., Bischoff-Ferrari, H. A., Gordon, C. M., Hanley, D. A., Heaney, R. P., Murad, M. H., & Weaver, C. M. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-0385 · Cited by 10,556 · cited 1× · see citing works
“There is a need for future studies to thoroughly investigate any potential adverse effects, but in the meantime the data is insufficient to impact on the proven benefits of folate supplementation [72,95-98].”
Background
Dietary factors influencing zinc absorption.
Lönnerdal, B. (2000) · Journal of NutriLife · doi:10.1093/jn/130.5.1378s · Cited by 1,003 · cited 1× · see citing works
“Micronutrient/food interactions Certain foods or micronutrients can inhibit the absorption of other micronutrients; for example, zinc absorption is inhibited by phytate (in staple foods such as cereals, corn and rice), while increasing amounts of zinc in a meal can itself decrease the absorption of zinc [92]”
Background
Present knowledge in nutrition
Brown, M. L. (1990) · JAMA · doi:10.1001/jama.1954.03690350086043 · Cited by 777 · see citing works
Folate Levels and Neural Tube Defects
Daly, L. (1995) · JAMA · doi:10.1001/jama.1995.03530210052030 · Cited by 760 · cited 2× · see citing works
“The study aimed to ascertain at what point red blood cell (RBC) folate levels considered preventive of NTD (906 nmol/l [14]) could be reached.”
Background
Unintended pregnancy: worldwide levels, trends, and outcomes.
Singh, S., Sedgh, G., & Hussain, R. (2010) · Studies in Family Planning · doi:10.1111/j.1728-4465.2010.00250.x · Cited by 731 · cited 1× · see citing works
“In addition, not all pregnancies are planned; it has been estimated that up to 41% of pregnancies worldwide are unintended [5].”
Background
Effect of Women's Nutrition before and during Early Pregnancy on Maternal and Infant Outcomes: A Systematic Review
Ramakrishnan, U., Grant, F. K. E., Goldenberg, T., Zongrone, A. A., & Martorell, R. (2012) · Paediatric and Perinatal Epidemiology · doi:10.1111/j.1365-3016.2012.01281.x · Cited by 581 · cited 10× · see citing works
“This is particularly true in women of childbearing age, as there is always the potential of becoming pregnant - and normal development of the embryo and fetus depends on the availability and supply of nutrients from the mother, and thus on her nutritional state [1-4].”
BackgroundInfluential
Periconceptional Maternal Folic Acid Use of 400 µg per Day Is Related to Increased Methylation of the IGF2 Gene in the Very Young Child
Steegers‐Theunissen, R. P. M., Obermann-Borst, S. A., Kremer, D., Lindemans, J. W., Siebel, C., Steegers, E. A. P., Slagboom, P. E., & Heijmans, B. T. (2009) · PLoS ONE · doi:10.1371/journal.pone.0007845 · Cited by 456 · cited 2× · see citing works
“The situation was similar in pregnant women, where insufficient intakes ranged from 21% to 97% of the recommended amount [7,40-78].”
Background
Micronutrient Deficiency Conditions: Global Health Issues
Tulchinsky, T. (2010) · Public health reviews · doi:10.1007/bf03391600 · Cited by 371 · cited 1× · see citing works
“In general, micronutrient status and deficiency have been assessed in pregnant women from developed countries [25].”
Background
Effect of increasing dietary folate on red-cell folate: implications for prevention of neural tube defects.
Cuskelly, G., McNulty, H., & Scott, J. (1996) · The Lancet · doi:10.1016/s0140-6736(96)91205-2 · Cited by 338 · cited 1× · see citing works
“When folate levels are inadequate, the risk of NTD increases [14,15].”
Background
Role of micronutrients in the periconceptional period
Cetin, I., Berti, C., & Calabrese, S. (2009) · Human Reproduction Update · doi:10.1093/humupd/dmp025 · Cited by 320 · cited 10× · see citing works
“the period before conception until the end of the first trimester) may support normal fertility, conception, placentation and embryogenesis and ultimately lead to better pregnancy outcomes [2].”
BackgroundInfluential
Center for Food Safety and Applied Nutrition
(2009) · Nutrition Reviews · doi:10.1111/j.1753-4887.1997.tb05493.x · Cited by 290 · see citing works
Preconception care: nutritional risks and interventions
Dean, S. V., Lassi, Z. S., Imam, A. M., & Bhutta, Z. A. (2014) · Reproductive Health · doi:10.1186/1742-4755-11-s3-s3 · Cited by 279 · cited 2× · see citing works
“The situation was similar in pregnant women, where insufficient intakes ranged from 21% to 97% of the recommended amount [7,40-78].”
Background
WITHDRAWN: Periconceptional supplementation with folate and/or multivitamins for preventing neural tube defects.
Lumley, J., Watson, L., Watson, M., et al. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001056.pub2 · Cited by 275 · cited 1×
“The protective effect of folate during the first 28 days of pregnancy is a familiar and accepted concept, and supplementation is proven to significantly reduce the risk of congenital anomalies such as NTD [11-13].”
Background
A systematic review and meta-analysis of micronutrient intakes during pregnancy in developed countries
Blumfield, M., Hure, A. J., MacDonald‐Wicks, L. K., Smith, R., & Collins, C. E. (2013) · Nutrition Reviews · doi:10.1111/nure.12003 · Cited by 264 · cited 2× · see citing works
“Yet many women are at risk of insufficient micronutrient intake, and not just in developing countries [6,7].”
Background
How to use the world's scarce selenium resources efficiently to increase the selenium concentration in food
Haug, A., Graham, R. D., Christophersen, O. A., & Lyons, G. H. (2007) · Microbial Ecology in Health and Disease · doi:10.1080/08910600701698986 · Cited by 261 · cited 2× · see citing works
“selenium in China, [93] iodine deficiency in mountainous or flood-risk regions [94])”
Background
Assessment of iron status in US pregnant women from the National Health and Nutrition Examination Survey (NHANES), 1999–2006
Mei, Z., Cogswell, M. E., Looker, A. C., Pfeiffer, C. M., Cusick, S. E., Lacher, D. A., & Grummer‐Strawn, L. M. (2011) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.110.007195 · Cited by 247 · see citing works
Intrauterine Growth Restriction: Implications for Placental Metabolism and Transport. A Review
Cetin, I., & Alvino, G. (2009) · Placenta · doi:10.1016/j.placenta.2008.12.006 · Cited by 246 · see citing works
Influence of mineral and vitamin supplements on pregnancy outcome
Hovdenak, N., & Haram, K. (2012) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2012.06.020 · Cited by 221 · cited 3× · see citing works
“Vitamin B12 Neural tube defects [3] Teratogenicity [3] Reduced fetal growth [75] Neurological abnormalities (cognitive disturbances, dementia, paresthesias, ataxia) [3,75] Fetal demyelination [3] Myelopathy Anemia Megaloblastic anemia [75]”
Background
A prospective study of micronutrient status in adolescent pregnancy
Baker, P. N., Wheeler, S. J., Sanders, T. A. B., Thomas, J. E., Hutchinson, C., Clarke, K., Berry, J., Jones, R. L., Seed, P. T., & Poston, L. (2009) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.2008.27097 · Cited by 184 · cited 7× · see citing works
“In pregnant women, iron intake was slightly higher but was still insufficient in many cases [7,29,50,51].”
BackgroundInfluential
Preconception care policy, guidelines, recommendations and services across six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom
Shawe, J., Delbaere, I., Ekstrand, M., Hegaard, H. K., Larsson, M., Mastroiacovo, P., Stern, J., Steegers, E. A. P., Stephenson, J., & Tydén, T. (2014) · The European Journal of Contraception & Reproductive Health Care · doi:10.3109/13625187.2014.990088 · Cited by 141 · see citing works
Folic acid supplementation in pregnancy and implications in health and disease
Barua, S., Kuizon, S., & Junaid, M. A. (2014) · Journal of Biomedical Science · doi:10.1186/s12929-014-0077-z · Cited by 136 · cited 3× · see citing works
“The situation was similar in pregnant women, where insufficient intakes ranged from 21% to 97% of the recommended amount [7,40-78].”
Background
Public nutrition in complex emergencies
Young, H., Borrel, A., Holland, D., & Salama, P. (2004) · The Lancet · doi:10.1016/s0140-6736(04)17447-3 · Cited by 131 · cited 1× · see citing works
“In addition, it should be noted that deficiencies in vitamins and minerals can occur in both undernutrition and overnutrition [9].”
Background
Micronutrients and women of reproductive potential: required dietary intake and consequences of dietary deficiency or excess. Part I – Folate, Vitamin B12, Vitamin B6
Simpson, J. L., Bailey, L. B., Pietrzik, K. F., Shane, B., & Holzgreve, W. (2010) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.3109/14767051003678234 · Cited by 126 · cited 4× · see citing works
“This is particularly true in women of childbearing age, as there is always the potential of becoming pregnant - and normal development of the embryo and fetus depends on the availability and supply of nutrients from the mother, and thus on her nutritional state [1-4].”
BackgroundInfluential
How Personal Factors, Including Culture And Ethnicity, Affect The Choices And Selection Of Food We Make
Dindyal, S., & Dindyal, S. (2003) · doi:10.5580/2231 · Cited by 122 · cited 5×
“Home-grown or farmed produce [90] Food choice is season dependent, which can limit choice [90] In some regions, the soil may lack certain micronutrients (e.”
BackgroundInfluential
Effect of Multiple Micronutrient Supplementation on Pregnancy and Infant Outcomes: A Systematic Review
Ramakrishnan, U., Grant, F. K., Goldenberg, T., Bui, V., Imdad, A., & Bhutta, Z. A. (2012) · Paediatric and Perinatal Epidemiology · doi:10.1111/j.1365-3016.2012.01276.x · Cited by 116 · cited 2× · see citing works
“The situation was similar in pregnant women, where insufficient intakes ranged from 21% to 97% of the recommended amount [7,40-78].”
BackgroundMethod
Homocysteine and neural tube defects.
Mills, J. L., Scott, J., Kirke, P. N., et al. (1996) · Journal of NutriLife · doi:10.1093/jn/126.suppl_3.756s · Cited by 105 · cited 2× · see citing works
“The situation was similar in pregnant women, where insufficient intakes ranged from 21% to 97% of the recommended amount [7,40-78].”
Background
Advisory Committee on Immunization Practices Recommended Immunization Schedules for Persons Aged 0 Through 18 Years—United States, 2014
Akinsanya-Beysolow, I. (2014) · American Journal of Transplantation · doi:10.1111/ajt.12730 · Cited by 103 · see citing works
Effects of vitamin A deficiency during pregnancy on maternal and child health
Radhika, M., Bhaskaram, P., Balakrishna, N., et al. (2002) · BJOG: an International Journal of Obstetrics and Gynaecology · doi:10.1111/j.1471-0528.2002.01010.x · Cited by 103 · cited 2×
“Vitamin A Premature birth [74] Malformed offspring [2] Vitamin A-deficiency anemia [2,74] Xerophthalmia [2] Night blindness [2]”
Background
Selenium status in UK pregnant women and its relationship with hypertensive conditions of pregnancy
Rayman, M. P., Bath, S. C., Westaway, J. A. F., Williams, P., Mao, J., Vanderlelie, J. J., Perkins, A. V., & Redman, C. W. G. (2015) · British Journal Of Nutrition · doi:10.1017/s000711451400364x · Cited by 100 · see citing works
Low‐income mothers, nutrition and health: a systematic review of qualitative evidence
Attree, P. (2005) · Maternal and Child Nutrition · doi:10.1111/j.1740-8709.2005.00022.x · Cited by 99 · cited 1× · see citing works
“Social and economic Poverty/low income [87-89] May limit access to nutritious foods [90], little dietary diversity [89] May have poor knowledge of nutrition [89] Associated with most of the major risk factors for adverse pregnancy outcomes [87]”
Background
Vitamin D status in Chinese pregnant women and their newborns in Beijing and their relationships to birth size
Song, S.-J., Si, S.-Y., Liu, J.-L., et al. (2012) · Public Health Nutrition · doi:10.1017/s1368980012003084 · Cited by 95 · cited 3× · see citing works
“The greatest insufficiency was observed in China [44-46], Japan [47] and the USA [38,48], but was less apparent in Denmark [40], Sweden [39], New Zealand [42] and Australia [43].”
Background
Micronutrients and women of reproductive potential: required dietary intake and consequences of dietary deficienty or excess. Part II - Vitamin D, Vitamin A, Iron, Zinc, Iodine, Essential Fatty Acids
Simpson, J. L., Bailey, L. B., Pietrzik, K. F., Shane, B., & Holzgreve, W. (2010) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.3109/14767051003678226 · Cited by 90 · cited 5× · see citing works
“This is particularly true in women of childbearing age, as there is always the potential of becoming pregnant - and normal development of the embryo and fetus depends on the availability and supply of nutrients from the mother, and thus on her nutritional state [1-4].”
BackgroundInfluential
Content
Elmadfa, I., Meyer, A. L., & Nowak, V. (2009) · Annals of Nutrition and Metabolism · doi:10.1159/000242478 · Cited by 87 · cited 7× · see citing works
“*Values provided as listed in Elmadfa 2009, for non-pregnant women [7]; † depending on age; ‡ menstruating women.”
BackgroundInfluential
Relationship between dietary folate intakes, maternal plasma total homocysteine and B-vitamins during pregnancy and fetal growth in Japan
Takimoto, H., Mito, N., Umegaki, K., Ishiwaki, A., Kusama, K., Abe, S., Yamawaki, M., Fukuoka, H., Ohta, C., & Yoshiike, N. (2007) · European Journal of Nutrition · doi:10.1007/s00394-007-0667-6 · Cited by 86 · cited 9× · see citing works
“The exception was in nonpregnant women in Japan [34], whose folate levels were apparently sufficient (Table 2); however, the recommended level of folate for such women in Japan is lower than for other countries, apart from the UK (Table 2).”
BackgroundInfluential
Effect of maternal and postweaning folic acid supplementation on global and gene‐specific DNA methylation in the liver of the rat offspring
Sie, K. K. Y., Li, J. S. Y., Ly, A., Sohn, K., Croxford, R., & Kim, Y. (2013) · Molecular Nutrition & Food Research · doi:10.1002/mnfr.201200186 · Cited by 78 · cited 2× · see citing works
“The situation was similar in pregnant women, where insufficient intakes ranged from 21% to 97% of the recommended amount [7,40-78].”
Background
Poor knowledge and practices related to iodine nutrition during pregnancy and lactation in australian women: Pre- and post-iodine fortification
Charlton, K., Yeatman, H., Lucas, C., Axford, S., Gemming, L., Houweling, F., Goodfellow, A., & Ma, G. (2012) · Nutrients · doi:10.3390/nu4091317 · Cited by 67 · cited 2× · see citing works
“The situation was similar in pregnant women, where insufficient intakes ranged from 21% to 97% of the recommended amount [7,40-78].”
Background
Vitamin D status and its predictive factors in pregnancy in 2 Australian populations
Perampalam, S., Ganda, K., Chow, K.-A., et al. (2011) · Australian and New Zealand journal of obstetrics and gynaecology · doi:10.1111/j.1479-828x.2011.01313.x · Cited by 67 · cited 5× · see citing works
“The situation was similar in pregnant women, where insufficient intakes ranged from 21% to 97% of the recommended amount [7,40-78].”
BackgroundInfluential
Folic acid supplementation in pregnancy: are there devils in the detail?
Burdge, G. C., & Lillycrop, K. A. (2012) · British Journal Of Nutrition · doi:10.1017/s0007114512003765 · Cited by 66 · cited 4× · see citing works
“There is a need for future studies to thoroughly investigate any potential adverse effects, but in the meantime the data is insufficient to impact on the proven benefits of folate supplementation [72,95-98].”
BackgroundInfluential
Effects of once-a-week or daily folic acid supplementation on red blood cell folate concentrations in women
Norsworthy, B., Skeaff, C., Adank, C., et al. (2004) · European Journal of Clinical Nutrition · doi:10.1038/sj.ejcn.1601843 · Cited by 64 · cited 1×
“The situation was similar in pregnant women, where insufficient intakes ranged from 21% to 97% of the recommended amount [7,40-78].”
Background
Maternal vitamin D status and infant anthropometry in a US multi-centre cohort study
Eckhardt, C., Gernand, A., Roth, D., et al. (2014) · Annals of Human Biology · doi:10.3109/03014460.2014.954616 · Cited by 60 · cited 3× · see citing works
“The greatest insufficiency was observed in China [44-46], Japan [47] and the USA [38,48], but was less apparent in Denmark [40], Sweden [39], New Zealand [42] and Australia [43].”
Background
Revised D-A-CH intake recommendations for folate: how much is needed?
Krawinkel, M. B., Strohm, D., Weißenborn, A., Watzl, B., Eichholzer, M., Bärlocher, K., Elmadfa, I., Leschik‐Bonnet, E., & Heseker, H. (2014) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2014.45 · Cited by 54 · cited 1× · see citing works
“Folate, μg/d 14-50 y: 400 Pregnancy: 600 14-50 y: 400 Pregnancy: 600 15-19 y: 300 [83] 20+ y: 400 Pregnancy: 550 [7] 14-50 y: 400 Pregnancy: 600 15-50 y: 200 Pregnancy: 300 400 Pregnancy (2nd half): 600 14-50 y: 400 Pregnancy: 600 15-17 y: 250 18-49 y: 240 Pregnancy: 480490†”
Low Maternal Vitamin D Status during the Second Trimester of Pregnancy: A Cross-Sectional Study in Wuxi, China
Xiao, J.-P., Zang, J., Pei, J.-J., Xu, F., Zhu, Y., & Liao, X.-P. (2015) · PLOS ONE · doi:10.1371/journal.pone.0117748 · Cited by 53 · see citing works
Micronutrient Status in Female University Students: Iron, Zinc, Copper, Selenium, Vitamin B12 and Folate
Fayet‐Moore, F., Petocz, P., & Samman, S. (2014) · Nutrients · doi:10.3390/nu6115103 · Cited by 53 · cited 11× · see citing works
“Non-pregnant younger girls appeared to be at greatest risk of inadequate intake in Europe [7].”
BackgroundInfluential
Supplementation with a multivitamin containing 800 microg of folic acid shortens the time to reach the preventive red blood cell folate concentration in healthy women.
Brämswig, S., Prinz‐Langenohl, R., Lamers, Y., et al. (2009) · International journal for vitamin and nutrition research. Internationale Zeitschrift fur Vitamin- und Ernahrungsforschung. Journal international de vitaminologie et de nutrition · doi:10.1024/0300-9831.79.2.61 · Cited by 53 · cited 2×
“around 500-600 nmol/l, whereas that thought to be protective of NTD is 906 nmol/l) [21-23].”
Background
Vitamin D status during normal pregnancy and postpartum. A longitudinal study in 141 Danish women
Milman, N., Hvas, A.-M., & Bergholt, T. (2012) · Journal of Perinatal Medicine · doi:10.1515/jpm.2011.120 · Cited by 51 · cited 3× · see citing works
“The greatest insufficiency was observed in China [44-46], Japan [47] and the USA [38,48], but was less apparent in Denmark [40], Sweden [39], New Zealand [42] and Australia [43].”
Background
Physiologic changes in homocysteine metabolism in pregnancy: A longitudinal study in Spain
Úbeda, N., Reyes, L., González-Medina, A., Alonso-Aperte, E., & Varela‐Moreiras, G. (2011) · Nutrition · doi:10.1016/j.nut.2010.10.017 · Cited by 47 · cited 5× · see citing works
“In both Spain [31] and Australia [33], intake decreased over the course of the pregnancy, while in Australia the intake increased again after giving birth [33].”
BackgroundInfluential
Vitamin D status of pregnant women in Shanghai, China
Tao, M., Shao, H., Gu, J., & Zhen, Z. (2011) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.3109/14767058.2011.569613 · Cited by 45 · cited 3× · see citing works
“The greatest insufficiency was observed in China [44-46], Japan [47] and the USA [38,48], but was less apparent in Denmark [40], Sweden [39], New Zealand [42] and Australia [43].”
Background
Tracking of 25-hydroxyvitamin D status during pregnancy: the importance of vitamin D supplementation
Moon, R. J., Crozier, S., Dennison, E. M., Davies, J. H., Robinson, S. M., Inskip, H. M., Godfrey, K. M., Cooper, C. C., & Harvey, N. C. (2015) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.115.115295 · Cited by 43 · cited 2× · see citing works
“The situation was similar in pregnant women, where insufficient intakes ranged from 21% to 97% of the recommended amount [7,40-78].”
Background
Folate, vitamin B12 and homocysteine status in an Italian blood donor population
Zappacosta, B., Persichilli, S., Iacoviello, L., Castelnuovo, A. F. D., Graziano, M., Gervasoni, J., Leoncini, E., Cimino, G. G., & Mastroiacovo, P. (2011) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2011.10.001 · Cited by 39 · cited 3× · see citing works
“Vitamin B12 (cobalamin): There was some deficiency in cobalamin intake in non-pregnant women (42% [7] and 55% [28] of the recommended intake in Europe), as well as in some pregnant women in Belgium [30], Spain [31] and Australia [33].”
Background
Folate, vitamin B12, and vitamin B6status of a group of high socioeconomic status women in the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort
Fayyaz, F., Wang, F., Jacobs, R. L., O’Connor, D. L., Bell, R. C., Field, C. J., & the APrON Study Team (2014) · Applied Physiology, Nutrition, and Metabolism · doi:10.1139/apnm-2014-0181 · Cited by 39 · cited 5× · see citing works
“Where folate was insufficient, intakes ranged from 23% to 98% of the recommended nutrient intake in non-pregnant women [7,26-28] (depending on the reference value used), and between 30% and 95% in pregnant women [7,29-37].”
BackgroundInfluential
Advisory Committee on Immunization Practices Recommended Immunization Schedules for Persons Aged 0 Through 18 Years—United States, 2015
Strikas, R. A. (2015) · American Journal of Transplantation · doi:10.1111/ajt.13293 · Cited by 37 · see citing works
Weekly High-Dose Folic Acid Supplementation Is Effective in Lowering Serum Homocysteine Concentrations in Women
Adank, C., Green, T. J., Skeaff, C., et al. (2003) · Annals of Nutrition and Metabolism · doi:10.1159/000069278 · Cited by 36 · cited 1×
“The situation was similar in pregnant women, where insufficient intakes ranged from 21% to 97% of the recommended amount [7,40-78].”
Background
Determinants of Vitamin D Status in Fair-Skinned Women of Childbearing Age at Northern Latitudes
Hedlund, L., Brembeck, P., & Olausson, H. (2013) · PLoS ONE · doi:10.1371/journal.pone.0060864 · Cited by 35 · cited 2× · see citing works
“The greatest insufficiency was observed in China [44-46], Japan [47] and the USA [38,48], but was less apparent in Denmark [40], Sweden [39], New Zealand [42] and Australia [43].”
Background
A Longitudinal Study of Maternal Folate and Vitamin B12 Status in Pregnancy and Postpartum, with the Same Infant Markers at 6 Months of Age
Hure, A. J., Collins, C., & Smith, R. G. (2012) · Maternal and Child Health Journal · doi:10.1007/s10995-011-0782-0 · Cited by 35 · cited 7×
“In both Spain [31] and Australia [33], intake decreased over the course of the pregnancy, while in Australia the intake increased again after giving birth [33].”
BackgroundInfluential
Vitamin D: increasing supplement use among at-risk groups (NICE guideline PH56)
Wood, C., & Cheetham, T. (2015) · Archives of Disease in Childhood - Education and Practice · doi:10.1136/archdischild-2015-308299 · Cited by 31 · cited 1×
“Vitamin D, μg/d 14-50 y: 5 Pregnancy: 5 14-50 y: 15 Pregnancy: 15 5 14-50 y: 5 Pregnancy: 5 Pregnancy: 10[84] 10 Pregnancy (2nd half): 12.”
Folic Acid Supplementation during Pregnancy Induces Sex-Specific Changes in Methylation and Expression of Placental 11β-Hydroxysteroid Dehydrogenase 2 in Rats
Peñailillo, R. S., Guajardo, A., Llanos, M. N., Hirsch, S., & Ronco, A. M. (2015) · PLoS ONE · doi:10.1371/journal.pone.0121098 · Cited by 30 · cited 2× · see citing works
“The situation was similar in pregnant women, where insufficient intakes ranged from 21% to 97% of the recommended amount [7,40-78].”
Background
Dietary folate intake, use of folate supplements, lifestyle factors, and serum folate levels among pregnant women in Tokyo, Japan
Matsuzaki, M., Haruna, M., Ota, E., et al. (2008) · The journal of obstetrics and gynaecology research · doi:10.1111/j.1447-0756.2008.00821.x · Cited by 30
Demographic and lifestyle factors associated with vitamin D status in pregnant Japanese women.
Shiraishi, M., Haruna, M., Matsuzaki, M., et al. (2014) · Journal of Nutritional Science and Vitaminology · doi:10.3177/jnsv.60.420 · Cited by 29 · cited 7×
“The situation was similar in pregnant women, where insufficient intakes ranged from 21% to 97% of the recommended amount [7,40-78].”
BackgroundInfluential
Bone Density in Axial and Appendicular Skeleton in Patients with Lactose Intolerance: Influence of Calcium Intake and Vitamin D Status
Segal, E., Dvorkin, L., Lavy, A., Rozen, G. S., Yaniv, I., Raz, B., Tamir, A., & Ish‐Shalom, S. (2003) · Journal of the American College of Nutrition · doi:10.1080/07315724.2003.10719294 · Cited by 27 · cited 2× · see citing works
“lactose intolerance reduces tolerance of dairy products, leading to low calcium intake and impaired vitamin D status [20]”
Background
Determinants of folate status in pregnant women: results from a national cross-sectional survey in Belgium
Vandevijvere, S., Amsalkhir, S., Oyen, H. J. V., & Moreno‐Reyes, R. (2012) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2012.111 · Cited by 26 · cited 3× · see citing works
“Iron: Suboptimal levels of iron were evident in both non-pregnant [7,26,38] and pregnant women [7,29,50,51], according to the varied recommendations set by each country or region.”
Background
Iodine Status from Childhood to Adulthood in Females Living in North-East Italy: Iodine Deficiency Is Still an Issue
Watutantrige Fernando, S., Cavedon, E., Nacamulli, D., Pozza, D., Ermolao, A., Zaccaria, M., Girelli, M. E., Bertazza, L., Barollo, S., & Mian, C. (2016) · European Journal of Nutrition · doi:10.1007/s00394-015-0853-x · Cited by 25 · cited 2× · see citing works
“The situation was similar in pregnant women, where insufficient intakes ranged from 21% to 97% of the recommended amount [7,40-78].”
Background
First-trimester serum folate levels and subsequent risk of abortion and preterm birth among Japanese women with singleton pregnancies
Yamada, T., Morikawa, M., Yamada, T., Kishi, R., Sengoku, K., Endo, T., Saito, T., Cho, K., & Minakami, H. (2012) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-012-2501-5 · Cited by 24 · cited 2× · see citing works
“Intake was regularly less than half of the daily amount required [7,27,28,31,33,36,37].”
Background
Nutritional status as assessed by nutrient intakes and biomarkers among women of childbearing age – is the burden of nutrient inadequacies growing in America?
Rai, D., Bird, J. K., McBurney, M. I., & Chapman‐Novakofski, K. (2014) · Public Health Nutrition · doi:10.1017/s1368980014002067 · Cited by 22 · cited 9× · see citing works
“Calcium: Calcium intakes were insufficient in many cases, ranging from 50% to 82% of recommended levels in non-pregnant women [7,38] and 61% to 92% in pregnant women [7,29,49].”
BackgroundInfluential
Vitamin B12 and folic acid status of term pregnant women and newborns in the Antwerp region, Belgium.
Jacquemyn, Y., Ajaji, M., Karepouan, N., et al. (2014) · Clinical and experimental obstetrics & gynecology · doi:10.12891/ceog16802014 · Cited by 21 · cited 2×
“Vitamin B12 (cobalamin): There was some deficiency in cobalamin intake in non-pregnant women (42% [7] and 55% [28] of the recommended intake in Europe), as well as in some pregnant women in Belgium [30], Spain [31] and Australia [33].”
Background
Survey of iodine nutritional status in 2011, Zhejiang, China.
Mao, G.-M., Ding, G., Lou, X., et al. (2015) · Asia Pacific Journal of Clinical Nutrition · doi:10.6133/apjcn.2015.24.2.08 · Cited by 17
Urinary Excretion Levels of Water-Soluble Vitamins in Pregnant and Lactating Women in Japan
Shibata, K., Fukuwatari, T., Sasaki, S., Sano, M., SUZUKI, K., Hiratsuka, C., Aoki, A., & Nagai, C. (2013) · Journal of Nutritional Science and Vitaminology · doi:10.3177/jnsv.59.178 · Cited by 16 · cited 7× · see citing works
“The exception was in nonpregnant women in Japan [34], whose folate levels were apparently sufficient (Table 2); however, the recommended level of folate for such women in Japan is lower than for other countries, apart from the UK (Table 2).”
BackgroundInfluential
Lifestyle and Environmental Factors That Can Adversely Affect Maternal Nutritional Status and Pregnancy Outcomes
Bendich, A. (1993) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.1993.tb26127.x · Cited by 12 · cited 4×
“The need to work [87] Inadequate time for shopping and food preparation [87] Work-related travel alters eating habits (e.”
BackgroundInfluential
Folate status and socio‐demographic predictors of folate status, among a national cohort of women aged 26–36 in Australia, 2004–2006
Gall, S., Seal, J. A., Taylor, R. E., Dwyer, T., & Venn, A. (2012) · Australian and New Zealand Journal of Public Health · doi:10.1111/j.1753-6405.2012.00910.x · Cited by 11 · cited 2× · see citing works
“Intake was regularly less than half of the daily amount required [7,27,28,31,33,36,37].”
Background
Iodine Nutrition During Pregnancy in Toronto, Canada
Katz, P. M., Leung, A. M., Braverman, L. E., Pearce, E. N., TOMLINSON, G. A., He, X., Vertes, J., Okun, N. B., Walfish, P. G., & Feig, D. S. (2012) · Endocrine Practice · doi:10.4158/ep12193.or · Cited by 10 · see citing works
Impact of periconceptional multi-micronutrient supplementation on gestation: a population-based study.
Wang, Y.-F., Pei, L., Song, X., et al. (2013) · Biomedical and environmental sciences : BES · doi:10.3967/0895-3988.2013.01.003 · Cited by 9
Calcium and magnesium status is not impaired in pregnant women.
Rocha, V. S., Lavanda, I., Nakano, E., et al. (2012) · Nutrition Research · doi:10.1016/j.nutres.2012.05.010 · Cited by 6 · cited 2×
“Calcium: Calcium intakes were insufficient in many cases, ranging from 50% to 82% of recommended levels in non-pregnant women [7,38] and 61% to 92% in pregnant women [7,29,49].”
Background
A Randomized, Placebo-Controlled Trial in Women of ChildbearingAge to Assess the Effect of Folic Acid and Methyl-Tetrahydrofolate onErythrocyte Folate Levels
Schaefer, E., Bieri, G., Sancak, O., et al. (2016) · doi:10.4172/2376-1318.1000134 · Cited by 4 · cited 2×
“These results were confirmed in a later study using an MMN supplement containing 400 μg folic acid plus 451 μg L-5-methyl-tetrahydrofolate (MTHF), which also determined its efficacy in achieving NTD-protective RBC folate levels [23].”
BackgroundResultSelf-citation

Flagged first, then by citations

24 of the 96 references couldn’t be matched to a known paper.

Sorted by citations

Immune function and micronutrient requirements change over the life course
Maggini, S., Pierre, A., & Calder, P. C. (2018) · Nutrients · doi:10.3390/nu10101531 · Cited by 710 · see citing works
Female Fertility and the Nutritional Approach: The Most Essential Aspects
Skoracka, K., Ratajczak, A. E., Rychter, A. M., Dobrowolska, A., & Krela‐Kaźmierczak, I. (2021) · Advances in Nutrition · doi:10.1093/advances/nmab068 · Cited by 151 · see citing works
“One study showed that many women fail to meet nutrient needs—particularly in terms of folic acid, calcium, iodine, iron, selenium, vitamin D, and vitamin B-12—and thus have lower blood concentrations (116).”
Background
Increased Micronutrient Requirements during Physiologically Demanding Situations: Review of the Current Evidence
Wishart, K. (2017) · Vitamins & Minerals · doi:10.4172/2376-1318.1000166 · Cited by 51 · see citing works
“A higher intake of both calcium [143-145] and vitamin D (which is necessary for calcium absorption, and which is often deficient in many women) [146,147] has been associated with a lower risk of PMS symptoms.”
Background
The Impact of Preconceptional Multiple-Micronutrient Supplementation on Female Fertility
Schaefer, E., & Nock, D. (2019) · Clinical Medicine Insights: Women's Health · doi:10.1177/1179562x19843868 · Cited by 32 · see citing works
Self-citation
Multiple Micronutrients and Docosahexaenoic Acid Supplementation during Pregnancy: A Randomized Controlled Study
Massari, M., Novielli, C., Mandò, C., Francesco, S. D., Porta, M. G. D., Cazzola, R., Panteghini, M., Savasi, V. M., Maggini, S., Schaefer, E., et al. (2020) · Nutrients · doi:10.3390/nu12082432 · Cited by 41 · see citing works
“Therefore, micronutrient supplementation is frequently recommended during pregnancy to help improve pregnancy outcomes in the mother and child [11,12].”
BackgroundResultSelf-citation
Multiple Micronutrients, Lutein, and Docosahexaenoic Acid Supplementation during Lactation: A Randomized Controlled Trial
Schaefer, E., Demmelmair, H., Horak, J., Holdt, L. M., Grote, V., Maar, K., Neuhofer, C., Teupser, D., Thiel, N., Göckeler-Leopold, E., et al. (2020) · Nutrients · doi:10.3390/nu12123849 · Cited by 26 · see citing works
“It is common for women of child-bearing age to have insufficient levels of vitamin D [48].”
BackgroundSelf-citation
A landscape of micronutrient status in women through the reproductive years: Insights from seven regions in Asia
Chong, M. F., Bui, C. T., Jaisamrarn, U., Pacquing-Songco, D. F., Shaw, S. W., Tam, C. T., & Bardosono, S. (2020) · Women s Health · doi:10.1177/1745506520973110 · Cited by 21 · see citing works
Vital role for primary healthcare providers: urgent need to educate the community about daily nutritional self-care to support immune function and maintain health
Calder, P. C., Bach-Faig, A., Bevacqua, T., López, C. G. C., Chen, Z., Connolly, D., Koay, W. L., Meydani, S. N., Pinar, A.-S., Filho, D. R., et al. (2023) · BMJ Nutrition Prevention & Health · doi:10.1136/bmjnph-2023-000755 · Cited by 7 · see citing works
Clinical Benefits and Safety of Multiple Micronutrient Supplementation During Preconception, Pregnancy, and Lactation: A Review
Liu, J., Mantantzis, K., Kaufmann, L., Goenaga, Z. C., Громова, О. А., Kuroda, K., Qi, H., Картлосовна, Т. Н., & Renzo, G. C. D. (2025) · Nutrition Reviews · doi:10.1093/nutrit/nuaf079 · Cited by 7 · see citing works
Sanitation and Multiple Micronutrient Supplementation in Pregnancy Outcomes: Literature Review
Miranti, M., Arsin, A. A., Amiruddin, R., et al. (2022) · Open Access Macedonian Journal of Medical Sciences · doi:10.3889/oamjms.2022.9052 · Cited by 1 · see citing works
“This infection can cause disability, abortion, and intrauterine fetal death [16].”
Background
Impact of nutrients on infertility to menopause and vaginal infections
Sawant, N. D., Ahire, R., Desai, N., Pingale, P. L., & Dua, K. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-34003-1.00008-0

Dietary intake and micronutrient deficiency in children with cancer
Morrell, M. B. G., Baker, R. A., Johnson, A., Santizo, R. O., Liu, D., & Moody, K. M. (2019) · Pediatric Blood & Cancer · doi:10.1002/pbc.27895 · Cited by 27 · see citing works
Phytosiderophore release in relation to multiple micronutrient metal deficiency in wheat
Khobra, R., & Singh, B. (2017) · Journal of Plant Nutrition · doi:10.1080/01904167.2017.1404610 · Cited by 24 · see citing works
Comment on: Micronutrient status in morbidly obese females prior to bariartic surgery
Furtado, M. M. (2011) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2011.10.010
Anaemia and micronutrient deficiencies
van den Broek, N. R. (2003) · British Medical Bulletin · doi:10.1093/bmb/ldg004 · Cited by 110 · see citing works
Efficacy of different schemes of supplementation with micronutrient powder for the control of anemia and micronutrient deficiency in children
Zavaleta, N. (2013) · doi:10.1186/isrctn47136464

Authors: Schaefer, E.
Corresponding author: Schaefer, Ella
ORCID: Schaefer, Ella
Venue: Journal of Nutritional Disorders & Therapy
Publisher: OMICS Publishing Group
Published: 2016
Volume: 06
Issue: 04
ISSN: 2161-0509 (ISSN-L)
DOI: 10.4172/2161-0509.1000199
OpenAlex: W2564687176
Cited by: 12
References: 96
Citations by year: 2026: 1 · 2025: 2 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 3 · 2019: 1 · 2018: 1 · 2017: 1
FWCI: 0.99
Type: journal article
Language: en
Open access: closed
Locations: Journal of Nutritional Disorders & Therapy (publishedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutrition and Health Studies
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Public Health and Nutrition
Health Sciences › Medicine › Rheumatology › Folate and B Vitamins Research
Keywords: micronutrient deficiency, women of reproductive age, pregnancy, multiple micronutrient supplementation, periconceptional period, folic acid, vitamin B12, vitamin D, calcium, iodine, iron, selenium, maternal nutrition, developed countries

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

Micronutrient deficiency in women living in industrialized countries during the reproductive years: Is there a basis for supplementation with multiple micronutrients?

Abstract

Integrity signals

Claims the paper makes

Claims other papers make about this one

Cites

Cited by

Related

Record

About these checks