E. IRON Iron is an essential component of numerous

proteins and enzymes in the human body. Iron is stored in the form of ferritin,

primarily in the liver but also in bone marrow and the spleen.

With the exception of pregnancy and menstruation, the iron content

of the body is highly conserved. The

secretion of iron into breast milk is low, with the average milk iron being in the order of 0.35 mg/l.

Maternal dietary intake has little effect on milk iron levels.

Iron requirements during lactation (9 mg/day) are lower than those for nonpregnant, nonlactating (18 mg/day) assuming that exclusively breastfeeding women will not resume menses for a period of 6 months postpartum. If the mother is adolescent; iron is10 mg/day.

The UL for all breastfeeding women is 45 mg of iron per day.

Iron-deficiency anemia during pregnancy, particularly in the third trimester, is common, and also maternal iron deficiency early postpartum, despite women meeting dietary recommendations for lactation.

Maternal iron status is related to fatigue, depression,

decreased work capacity, and decreased ability of the mother to care for her newborn infant

Median iron intake of nonpregnant nonlactating women is ~12 mg/day, and that of pregnant women is 15 mg/day.

Sources of iron; heme and nonheme iron. Heme iron is obtained from animal sources such as meat, chicken, and fish, and is about 20–30% absorbed. Non-heme iron, present in plant foods, iron fortificants, and iron supplements, is less bioavailable with absorption of 5–10% s. Dietary factors such as vitamin C and the presence of meat, fish or poultry can enhance the absorption of non-heme iron, while

phytates found in legumes, grains and rice, polyphenols (in tea, coffee, and red wine) and vegetable proteins, such as those in soybeans, can inhibit non-heme iron absorption.

The requirement for iron is 1.8 times greater for vegetarians.

F. Long-Chain Polyunsaturated Fatty LC-PUFAs are fatty acids with a backbone of greater than 20

carbons, and are of either of the omega-3 or omega-6 series; humans are able to synthesis these LC-PUFAs from

fatty acid precursors via a series of elongation and desaturation steps at all stages of the life cycle.

LC-PUCFAs are essential for the development and maturation of

the fetal and neonatal brain, fluidity in membranes, and gene expression.

Infants fed formulas without DHA and ARA, have lower levels of DHA and ARA in their blood compared with either breastfed infants or infants fed formulas supplemented with these fatty acids.

The US Institute of Medicine assumes that the fatty acid composition of breast milk meets the requirements of most infants.

New evidence does suggest that supplementation of women prenatally with DHA may affect maturation of the visual system of infants and their ability to problem solving.

There is some evidence to suggest a potential for omega-3 fatty acids in the prevention of depression during the postpartum period,

Currently, there are no specific recommendations for DHA, EPA, or ARA intake; 12 g/day may be enough

Sources of LC-PUFAs; meat and eggs are rich sources of ARA, while EPA and DHA are derived mainly from fatty fish such as mackerel, salmon, herring, trout, and sardines. Several foods are available that have added omega-3 fats including eggs, milk, yogurt, cheese, pasta, and bread.

Iron Requirements and Adverse Outcomes

Iron deficiency continues to be one of the most prevalent nutritional deficiency diseases in the world and has a particularly high prevalence in pregnancy (around 60% in developing countries)

The assessment of iron in pregnancy can be challenging due to the rapid expansion of the maternal blood volume and then rapid fetal and placental growth.

Iron deficiency in pregnancy has several negative effects including maternal and infant mortality in severe cases, but also shortened gestation, prematurity, and poorer infant development in less severe cases.

Poor iron, even in the first trimester, is associated with IUG restriction, and development and persistent consequences for infant neurodevelopment and functioning.

Iron Balance In Pregnancy

Iron Needs for Mother and Fetus Iron requirements increase quite dramatically

during pregnancy. Iron requirements increased from <1 mg Fe/day

to 4.6 mg Fe/day, 6.75 mg Fe/day by the 3rd trimester.

The reasons for increased iron requirements is associated with expansion of the red cell mass (450 mg), needs for fetal and placental iron (370 mg), and postpartum blood losses during and (150–250 mg). Thus, the total estimated additional needs are between 1,040 and 1,240 mg of iron.

The iron requirements in the 1st trimester for the fetus (25 mg) and the umbilicus and placenta (5 mg) total 30 mg of iron.

2nd trimester, this increases dramatically to 75 mg for fetal growth and 25 mg for the placenta.

The 3rd trimester, there is another large increase in requirements to 145 mg Fe for the fetus and >45 mg for the umbilicus and placenta for a total requirement of >220 mg.

Iron for the Maternal Red Cell Mass and Anemia

RBCs mass in pregnancy is not a static number and can be affected by the amount of iron supplementation that has occurred during the pregnancy

Table 16.1 Estimated Median Iron

Requirements (mg) During Pregnancy

Total3rd trimester2nd trimester 1st trimester245 mg145 mg 75 mg 25mgFetu75 mg45 mg 25 mg 5 mg Placenta &umbilicus 450 mg225 mg 225 mg 5–10 mg RBC mass 415 mg325 mg 35–40 mg Total

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