Nutrition and nutritional supplements for pregnant and lactating women - the power of prevention

Pregnancy and childbirth are miraculous processes of physical and emotional union of mother and child. Planning a pregnancy represents a change in the entire lifestyle, but also in the style of eating, guided by the instincts of what is best for your child.

Pregnancy, that is, another state, is described as something new and different with a positive sign. Accordingly, both the woman and the future child change, going through a period of growth and maturation that enables it to adapt to the outside world. Numerous studies have made it possible to understand the dynamic processes that take place during pregnancy, but also immediately after childbirth in a woman's body. Pregnancy represents an extremely anabolic/catabolic state accompanied by numerous physiological changes in the woman's metabolism and body with the aim of maintaining the pregnancy and giving birth to a healthy child. There is an increase in blood volume, but also an increase in heart rate and an increase in stroke volume with a relative thickening of the heart muscle. Rapid breathing and shortness of breath of the pregnant woman are more present due to a decrease in the total lung capacity of the pregnant woman during the second and third trimester. Precisely because of the intense anabolic-catabolic process, with the aim of building a new being and changing the basal metabolism, the need for nutrients increases during pregnancy. The energy requirement does not change significantly; only 10% (or 230-350 kcal) more is needed to prevent the mother's energy deficit. Carbohydrates - simple (glucose) or complex (cereals, lentils, beans, potatoes) form the basis of the energy source. The energy requirement of a pregnant woman increases to 2400 kcal/day. Proteins form the basis of the construction of the placenta, amniotic fluid, child and mother's blood, so it is considered that the minimum daily intake is 60 grams (1 cup of milk or 50 g of meat) is sufficient for building needs. Precisely the correct intake of macronutrients (carbohydrates, fats and proteins) ensure adequate energy needs as well as essential nutrients necessary for the growth and maintenance of the basic functions of the mother and fetus.

Energy adjustments are accompanied by changes in hormone levels that have numerous effects with the aim of maintaining pregnancy. An increase in circulating progesterone leads to the relaxation of smooth muscle (myometrium - uterine muscle) in order to maintain pregnancy, but as an unwanted effect of smooth muscle relaxation, a certain number of pregnant women have a decrease in intestinal peristalsis and/or gastric reflux. An increase in the production of relaxin enables the ligamentous system to stretch, but it is also the cause of pain in the area of ​​the pubic bone, pelvis and spine. Joint swelling occurs due to fluid retention. Due to the increased need for calcium, there is an increase in the volume of the parathyroid glands and, at the same time, an increase in the volume of the pituitary gland, in the last trimester, due to the increased secretion of oxytocin and prolactin.The principle of proper nutrition during pregnancy is based on the correct intake of nutrients: carbohydrates, fats and proteins in the correct proportions, along with adequate water intake. During pregnancy, there is an increase in the level of triglycerides, fatty acids, and lipids in the blood, which leads to the accumulation of 3.5 kilograms of fat in the pregnant woman (30,000 kcal), i.e. 0.5 kg in the fetus, which is necessary for the energetic adaptation of the child to the outside world and the mother to feed her child. During pregnancy and breastfeeding, the need for a large number of micronutrients increases due to the building and feeding of a new being, but also due to the metabolic process of decomposition in the mother's organism. Therefore, the daily intake of 1,200 mg of calcium, 400 μg of folic acid, 15-30 mg of iron, 10 mcg of vitamin D, 350-600 mg of magnesium, 11-15 mg of zinc, and 220 mcg of iodine is noted.The most important nutrients are folic acid, vitamin B12, calcium, magnesium, iron, iodine, omega-3 fatty acids and probiotics.

Numerous studies on the positive effects of supplementation over the past two decades, and since its active introduction in 1997, show its positive effect during pregnancy in the prevention of numerous structural abnormalities (neural tube defect with consequent neurological outbursts) which can result in numerous health problems and conditions during pregnancy (growth arrest, hypertension).

Folic acid forms the basis for the development of the fetal cell and its division, and forms the basis of the construction of not only the fetus, but also the uterus, placenta, erythrocytes, epithelial tissue and bone matrix. Folic acid deficiency is noted in pregnant women with a monotonous and inadequate diet, in malnourished women or extremely obese women, and in women who have a reduced ability to store folate in the liver or a reduced ability to absorb it from the intestines. Additional supplementation is extremely important in pregnant women with anemia, hemoglobinopathies and thalassemia, and in pregnant women under anticonvulsant therapy, and especially in pregnant women who had a child with a neural tube defect (spina bifida) and in areas where higher incidence of neural tube defects (Wales, Southeast Asia). Adequate daily supplementation with folic acid is 400-800 μg and should be started before pregnancy is planned (6-8 weeks) in the form of nutritional supplements and food intake rich in folic acid.Its exceptional role is in the prevention of 50-75% of neural tube defects, cleft lip, gingiva, palate, megaloblastic anemia in mothers and newborns, or fetal growth retardation. Adequate iodine intake is extremely important for proper fetal development (iodized salt and seafood) as prevention of goiter, hypothyroidism and metal retardation of the fetus, recommended daily doses are 100-150 μg the day immediately before pregnancy, 220-250 μg during pregnancy and 250-290 μg during breastfeeding. Numerous recent studies confirm the importance of omega-3 fatty acid intake (200 mg DHA) due to, not only an important factor in the stabilization of phospholipid membranes, but also due to the positive effect on the neurological development of the child (dysgraphia, dyslexia, AD/HD). Vitamin D is a necessary factor in the mobilization of calcium and its incorporation within the bone matrix.Its deficiency is characterized by metabolic diseases: osteomalacia, rickets, along with numerous biochemical changes. Insufficient sun exposure, absorption disorder (obesity, intestinal resection), metabolism disorder (liver, kidneys, fat malabsorption), inadequate diet (lactose intolerance, vegans), lead to hypovitaminosis with all its health consequences. Iron intake is an important factor, especially in the second and third trimester. It is extremely important as an oxygen carrier, and its deficiency results in maternal anemia, reduced blood supply to the placenta with consequent smaller fetal growth, reduced blood supply to fetal tissue and possible hypoxia of the fetal brain and neurological developmental consequences.

Supplementation, especially with vitamin D, iodine, folic acid, is extremely important for the growth and development of the newborn.