The Effects of Malnutrion on Fetal Development During ...
The Effects of Malnutrion on Fetal Development During Pregnancy
Introduction
The importance of proper nutrition at all stages of life cannot be understated. Even still, one of the most critical points for proper nutrition is during pregnancy, for this affects both the mother and her unborn child. In order to understand the importance of proper nutrition during pregnancy, the effects of malnutrition on fetal development must be examined. This paper will make an effort to discuss the effects of malnutrition on fetal development during pregnancy. Maternal malnutrition can contribute to poor health of the fetus, low birth-weight, and short-term and long-term infant morbidity and mortality¹. Nutrients that are especially important during pregnancy include folate, vitamin B12, iron, vitamin D, essential fatty acids, and protein². While these and minerals are very important to a developing fetus, there are other dietary factors that are of utmost importance. In order for the nutritional needs of both the fetus and the mother to be met, the required calorie intake of the mother needs to see a quantitative increase. Insufficient amounts of the nutrients previously mentioned could cause poor health in the unborn child. While some studies have shown that a fetus can sometimes adjust to altered nutrient environments while in utero, other studies have demonstrated that consequences of these adaptations may reveal themselves later in life as susceptibilities to diet-related diseases³.
Folate and Folic Acid
As demonstrated in the opening, there are many important factors that must be considered in a pregnant woman’s diet. However, one of the most important nutrients in her diet is folate or folic acid. Folate aids in the process of producing and maintaining new cells, which makes it especially significant during times of rapid growth and cell division, the exact environment that occurs during pregnancy. Folate has been shown to help prevent neural tube defects in developing fetuses. Folate is especially important during the first 17 to 30 days of the gestation period. This time period is a critical period for neural tube defects. This is the critical time when the neural tube is just beginning to develop, making it especially susceptible to nutrient deficiencies or excesses. Adequate folate supplies can help protect against neural tube defects, which can result in malformations of the spine, skull, and brain. The risk of these defects is reduced significantly when supplemental folate is used. Types of neural tube defects include anencephaly, encephaloceles, hydranencephaly, iniencephaly, schizencephaly, and spina bifida. Two of the most common types of neural tube defects are anencephaly and spina bifida. Anencephaly, which means without brain, occurs when the head end of the neural tube fails to close around the 23rd and 26th days of pregnancy. This results in a major portion of the brain and skull being absent. Infants with this condition are born without the main part of the forebrain, which is the largest part of the cerebrum. Infants born in this condition are usually blind, deaf, and unconscious. The lack of a functioning cerebrum will ensure that the infant will never gain consciousness. Infants are either stillborn or usually die shortly after birth. Spina bifida is another neural tube defect that can occur. This is a developmental congenital disorder caused by incomplete closing of the embryonic neural tube. Some vertebrae overlying the spinal cord are not fully formed and remain unfused and open. If the opening is large enough, this allows a portion of the spinal cord to protrude through the opening in the bones. There may or may not be a fluid-filled sac surrounding the spinal cord. Spina bifida can be surgically closed after birth, however, this does not restore normal function to the affects part of the spinal cord. Physical signs of spina bifida can include leg weakness and paralysis, orthopedic abnormalities, bladder and bowel control problems, including urinary tract infections and poor renal failure, pressure sores and skin irritations, and abnormal eye movement2.
Folate also has influence on the birth weight of the child. Studies have shown that folate supplementation results in a considerable increase in birth weight. A low birth weight is associated with a myriad of health problems for infants. These problems include low oxygen levels at birth, inability to maintain body temperature, difficulty feeding and gaining weight, infection and sudden infant death syndrome. There may also be breathing problems that occur, such as respiratory distress syndrome, which is a respiratory disease of prematurity caused by immature lungs. Gastrointestinal problems such as necrotizing enterocolitis, which is a serious disease of the intestines, may occur. The risk of long term complications and disability increase for babies with very low birth weight. Generally, the lower the birth weight of the child, the greater the chances are for he or she to developing intellectual and neurological problems. These problems include cerebral palsy, blindness, deafness, and mental retardation Problems of low birth weight increase the lower the weight of the baby. The survival of low-birth weight babies is directly related to their weight at birth4.
Folate is one of the B vitamins and is found naturally in food. Folic acid is a synthetic form of folate that is found in supplements; it is also added to foods. Folate is found in leafy green vegetables, such as spinach, and is also found in fruits, such as citrus fruits and fruit juices, and in dried beans and peas. The FDA passed regulations in 1996 requiring the addition of folic acid to breads, cereals, pastas, rice and other grain products. This was done due to the large number of unplanned pregnancies each year and the vital role that folate plays early in the stages of development. It is recommended that women who are pregnant receive 600 μ of folate per day4.
Vitamin B12
Vitamin B12 aids in the activation of folate, making it a necessary vitamin during pregnancy. Lack of vitamin B12 during pregnancy may also lead to problems such as failure to thrive, movement disorders, developmental delays, and megaloblastic anemia. It is recommended that someone who is pregnant consume 2.6 μ of vitamin B12 in order to prevent a deficiency. Large amounts of folate may mask the effects of a deficiency of vitamin B12 by correcting the megaloblastic anemia; however, this does not correct the neurological damage that occurs along with it. Because of this, folic acid from fortified foods and supplements should not exceed 1,000 μ per day. A slight vitamin B12 deficiency may not negatively affect the risk of birth defects or other problems; however, a severe deficiency can have severe consequences. A deficiency of vitamin B12 may cause neural tube defects, similar to a lack of folic acid. There is also some evidence suggesting it may increase the risk of infertility, recurrent spontaneous abortions, and preterm birth. If a severe vitamin B12 deficiency is present, much more vitamin B12 may be required than is found in a typical prenatal vitamin. Vitamin B is found in foods that come from animals, such as fish and shellfish, meats, liver, poultry, eggs, milk, and milk products. Vegans may also have trouble obtaining all of the vitamin B12 that they need and should therefore consume a B12 containing supplement5.
Iron
Iron is essential for the manufacture of red blood cells that carry oxygen around the blood. A supplemental iron supply is also needed during pregnancy. This additional iron is needed in order to ensure that there is enough iron to support an enlarged blood volume and to meet the needs of the placenta and fetus. Iron is especially important in the last half of pregnancy. Deficiency in a mother’s iron intake early in pregnancy may have a profound and long-lasting effect on the brain development of the child. Infants with iron deficiencies develop more slowly and display brain abnormalities such as slow language learning and behavioral problems. An iron deficiency may also cause anemia, which is a condition in which the body doesn’t have enough healthy red blood cells. This is problematic because red blood cells are responsible for carrying oxygen to the body’s tissues. There are signs that a woman may exhibit if she is iron deficient. This may include excessive tiredness, lethargy, lack of motivation, and feeling irritable and weaker than normal. More symptoms include headaches, poor resistance to minor illnesses, looking pale, and getting cold easily6. Foods that are sources of iron include red meat, chicken, clams, dry peas and lentils, berries, broccoli and enriched rice and pasta. When eating plant based sources of iron, such as legumes, nuts, and leafy green vegetables, it is important that vitamin C is eaten at the same meal. This is important because iron from these foods is not absorbed as easily by the body as it is from animal foods. Consuming vitamin C aids the body in absorption of this type of iron. Caffeine may inhibit the absorption of iron. For this reason, it is best to consume foods with iron or iron supplements one to three hours before or after drinking or eating foods that contain caffeine.
Vitamin D
Vitamin D is another vitamin that is important during pregnancy, as it is important for calcium absorption and utilization. A deficiency in vitamin D in children may cause rickets during infancy. With rickets, bone formation and development are severely altered. If the mother has a vitamin D deficiency, there is a mirrored vitamin D deficiency in the fetus. There are severe consequences of vitamin D deficiency during pregnancy. It plays a role in fetal skeletal development, tooth enamel formation, and the overall feral growth and development. Studies have been conducted that show a relationship between the amount of milk and vitamin D consumed by the mother and the birth weight of the child. It was reported that for every additional 40 IU of maternal vitamin D intake, there was an increase of 11g in birth weight. Recent reports of newborns monitored for acute viral infections and bronchiolitis from respiratory syncytial virus sustain the premise that deficiencies do impact the health of young infants and suggest that there is a greater role for vitamin D outside bone health. Studies are underway that are examining the role of vitamin D deficiency and its influence on later adult diseases including schizophrenia, multiple sclerosis, certain cancers, cardiovascular disease, and certain autoimmune diseases such as diabetes and lupus. In the U.S., it is found that women with darker skin pigmentation have a higher rate of vitamin D deficiency. However, there are also deficiencies that exist in Hispanic and Caucasian women that are exposed to limited sunlight. Obesity is a risk factor for vitamin B deficiency, as the adipose tissue serves as a repository for vitamin D that does not get into the circulation. This problem may be combined with limited sunlight and calorie rich but nutrient-poor diets, leading to numerous nutrient deficiencies that may affect both mother and fetus7.
Protein
During pregnancy, the protein needs of a mother increase by an additional 25g per day2. It is important that there is a balanced protein-energy supplementation during pregnancy in order for the developing fetus to be healthy. The mother’s protein-energy malnutrition (PEM) has numerous negative effects on the fetus. PEM may cause stunting, wasting, and low birth-weight. Stunting implies long-term malnutrition and poor health, while wasting implies recent malnutrition. Malnutrition increases the effects of diseases on child mortality. If an infant is malnourished from birth, the risk of the infant acquiring a disease increases. This can happen in cases of severe malnutrition, in addition to mild to moderate malnutrition. PEM may also impair cognitive and behavioral development1.
During World War II, several studies were conducted in the Netherlands, Leningrad, and Germany. From these studies came most of the knowledge of the relationship between birth outcomes and malnutrition. A common aspect of the studies was that there was a shortage of food due to the war. In the winter of 1944-45, the Dutch famine lasted about six months. Official rations fell to as low as 590 calories a day. This resulted in maternal weight loss of as much as 2.5 kg from pre-famine levels. This also affected the birth weight of the infant and the mean birth weight fell by about 300 g when the famine was at its height. The infants conceived before the famine but born during the famine were the ones affected greatest by the shortage of food. Women who were in their third trimester were affected the most, while women who experienced the famine during the 2nd and 3rd trimesters were affected the same. This shows that the famine had the most affect on the 3rd trimester. Infants that were conceived during the famine and throughout the 2nd trimester, but were given adequate nutrition in the 3rd experienced no adverse affects due to the famine. Infants exposed to intrauterine famine may be predisposed to the development of hypertension, obesity and diabetes mellitus later in life1.
In the research paper Maternal Nutrition and Birth Outcomes: Effect of Balanced Protein Energy Supplementation, data from 16 studies is discussed. Balanced protein-energy supplementation, and proper protein-energy balance has a positive impact on the birth weight of an infant. Balanced protein-energy supplementation is also shown to reduce the prevalence of low birth weight by 32%. Also, the prevalence of small for gestational age was reduced by 44%1.
In a study performed in Iran, it was found that balanced protein-energy supplementation was more effective in malnourished women than in women who were adequately nourished. It can then be inferred that a food supplement with balanced protein-energy content seems to be the most appropriate intervention for women who are experiencing malnutrition in order to increase the birth weight of the infant1.
Malnutrition
Malnutrition may have many different causes. A mother may have food available, but the food may not be nutritionally adequate. This is a major problem in developing countries, where the main food staples may consist mostly of carbohydrates and little protein. Malnutrition may also stem from lack of education. A mother may not know what she needs to eat in order to give her developing fetus the correct nutrients required. Cultural beliefs may also play a role as to why a mother and fetus or infant are malnourished8. For instance, the sub-Saharan African region of the world has the highest maternal, infant, and under five mortality rates and PEM; some research suggests that this is caused by cultural food habits and infant feeding practices. From a cultural point of view, a healthy child is viewed as a ‘fat baby’. Because of this belief, foods that are perceived to increase the size and weight of the baby are considered good. The foods that are thought to do this include cassava, maize, and yam flour. These commonly consumes foods contain little protein. Even in countries that have a high prevalence of PEM and a poor economy, such as the ones found in the sub-Sahara African region, there are always legumes and oil seeds and fruits that are able to supply many of the much needed nutrients in vulnerable groups. However, because of cultural practices concerning food, legumes and oils seeds, such as beans and groundnuts, are rarely eaten. Because of the prevalence of legumes and oil seeds found in the sub-Sahara African region, it can be inferred that women have not made better use of local food sources not because of poverty, but because of traditional beliefs and cultural food practices8. In some cultures, it is normal for the head of the family to receive the largest portion of protein at meals, leaving the children to have the smallest. There are also some cultures that believe that giving children eggs or meat will cause the child to start stealing9.
Malnutrition has many consequences for both the mother and infant. If the mother is malnourished, the infant will most likely have a low birth weight and have a high risk of prenatal mortality and morbidity. The child also has a high chance of a lower immunity than would be expected from an infant with a higher birth weight. The mother may experience tiredness with dizziness if she in malnourished. It may be difficult to perform daily activities, such as cooking or walking long distances. The mother may also experience weight loss, anorexia, anemia, reduced immunity, and mental and physical weakness. Malnutrition also effects brain development of the fetus. In order for adequate fetal growth and development to occur, it is imperative that there is consistent nutrition from the mother. Nutrient availability to the fetus depends on the concentration of nutrients in maternal blood, the rate at which maternal blood passes through the placenta, and the rate that nutrients move across the placenta to the fetal circulation. Once the infant is born, breast milk will not be as plentiful if the mother is malnourished. Abortion and premature delivery may also be a result of malnutrition9. In order for the pregnancy to be successful and for the mother and infant to be healthy, proper nutrition is vital.
Conclusion
Nutrition is of obvious important in the everyday lives of people. The importance of nutrition is even more evident in the life of a woman who is pregnant. This paper specifically discussed the consequences of malnutrition on fetal development during pregnancy. Maternal malnutrion puts the developing fetus at risk for poor health, low birth-weight, and short-term and long-term infant morbidity and mortality. There are specific nutrients that are especially important during pregnancy in order to achieve optimal health for the fetus. These nutrients include folate, vitamin B12, iron, vitamin D, essential fatty acids, and protein. In addition to these important vitamins and minerals, the mother carrying the fetus also needs to increase the amount of calories she consumes in a day. This is so that the nutritional needs of both her and the fetus are developed during pregnancy. If there is a deficient amount of these nutrients consumed, the consequences could include poor health in the unborn child. While it has been observed that a fetus can sometimes adjust to altered nutrient environments while in utero, some studies suggest that the consequences of these adaptations may show up later in life in ways such as susceptibilities to diet-related diseases. Women who are pregnant should be encouraged to eat a nutritionally sound diet, for both the unborn child’s health, as well as the woman’s health.
References
1. Imdad A, Bhutta ZA. Maternal Nutrition and Birth Outcomes: Effect of Balanced Protein Energy Supplementation. Paediatric and Perinatal Epidemiology. 2012. 26(s1): 178-190. DOI: 10.1111/j.1365-3016.2012.01308.x
2. Rolfes SR, Pinna K, Whitney E. Understanding Normal and Clinical Nutrition. Belmont, CA: Yoland Cossie; 2009
3. Krol E, Kreipcio Z, Chmurzynska A. Folic acid and protein content in maternal diet and postnatal high-fat feeding affect the tissue levels of iron, zinc, and copper in the rat. Biological Trace Element Research. 2011; 144(1-3): 885-893.
4. Fekete K, Berti C, Trovato M, Lohner S, Dullemeijer C, Souverein OW, Cetin I, Decsi T. Effects of folate intake on health outcomes in pregnancy: a systematic review and mate-analysis on birth weight, placental weight and length of gestation. Nutrition Journal. 2012. 11(75) doi: 10.1186/1475-2891-11-75.
5. National Institutes of Health: Office of Dietary Supplements. Dietary Supplement Fact Sheet: Vitamin B12. National Institutes of Health. . Published June 24, 2001. Accessed October 14, 2012.
6. HL Huffman, Schofield D. Consequenes of malnutrition in early life and strategies to improve maternal and child diets through targeted fortified products. Maternal & Child Nutrition. 2011; 7(s3): 1-4. doi: 10.1111/j.1740-8709.2011.00348.x
7. Wagner CL, Taylor SN, Dawodu A, Johnson DD, Hollis BW. Vitamin D and its role during pregnancy in attaining optimal health of mother and fetus. Nutrients. 2012; 4(3): 208-230. doi: 10.3390/nu4030208.
8. Ogunjuyigbe, Peter O., Ebenezer O. Ojofetimi. Culture and Feeding Practices: Major Underlying Causes of Childhood Malnutrition in Developing Countries.
9. Opara JA, Adebola HE, Oguzor NS, Abere SA. Malnutrition During Pregnancy among Child Bearing Mothers in Mbaitolu of South-Eastern Nigeria. Advances in Biological Research. 2011. 5(2): 111-115. (2)/8.pdf.
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