Shri Swami Samarth Institute of Pharmacy Malwadi Bota.
Micronutrients, vitamins and minerals accessible from the diet, are essential for biologic activity. Micronutrient status varies widely throughout pregnancy and across populations. Women in low-income countries often enter pregnancy malnourished, and the demands of gestation can exacerbate micronutrient deficiencies with health consequences for the foetus. Pregnancy may be a dynamic state that needs accrued nutrient intakes so as to support the growing foetus, placenta and maternal tissues, and therefore a triple-crown physiological condition outcome. Maternal nutrient deficiencies during pregnancy are commonly associated with health complications. Women of reproductive age in low- to middle-income countries frequently experience multiple micronutrient deficiencies, which are intensified during pregnancy due to increased nutritional requirements. This can have negative consequences for both the mother and the developing fetus. These observations highlight the importance of considering the context of the population in assessing health needs and addressing significant knowledge gaps. The use of multiple micronutrient supplements has been shown to lower the risk of low birth weight, being small for gestational age, and stillbirth in undernourished populations, underscoring the need for micronutrient interventions alongside antenatal care.
Pregnancy is a dynamic process characterized by significant changes in maternal physiology and anatomy to support the development of the fetus and placenta. Adjustments in nutrient metabolism are crucial not only for the growth of the fetus but also for the mother's health. Pregnant women must maintain sufficient levels of essential vitamins and minerals, collectively known as micronutrients. These nutrients are required in small amounts and play vital roles in nearly all metabolic processes, including cell signaling, movement, growth, differentiation, and programmed cell death. These essential biological functions during early development are critical for the proper growth and maturation of the fetus, ultimately leading to the birth of a healthy newborn. Pe Most vitamins and trace minerals are referred to as micronutrients. Some essential nutrients, such as calcium, magnesium is considered ‘macro’ minerals because they are required in greater than trace quantities and will not be discussed in this Review; nor will semi-essential or conditionally required nutrients. Micronutrients receiving most attention in pregnancy, and commonly provided as supplements, include vitamins A, D, E, folate, B12, B6, and C, iron, zinc. Although other B-complex vitamins are included in dietary supplements. Deficiencies in bound micronutrients, either through reduced dietary intake or impaired enteric absorption or excretion, will have direct consequences on maternity. Pregnancy complications, together with pre-eclampsia, physiological condition high blood pressure, intrauterine growth restriction and preterm birth, have an effect on one in 5 first pregnancies and predict womb-to-tomb morbidity and mortality for each mother and the child. The reason behind several of those complications is totally unknown. nutrients are r Essential vitamins and minerals are crucial dietary components needed in small amounts for a wide range of metabolic processes, such as cell signaling, movement, growth, differentiation, and programmed cell death, all of which play a vital role in maintaining tissue growth, function, and balance. Proper nutrition is essential for fetal development, contributing to the healthy maturation of the newborn. These nutrients are integral at every stage of maternal, placental, and fetal interactions, supporting a successful gestation. Most of these vitamins and trace minerals are categorized as "micronutrients." Complications during pregnancy can arise, including conditions like preeclampsia, which is characterized by high blood pressure.
Aim:
Relatively few studies have investigated characteristics associated with multivitamins in pregnant women. We examined multivitamin use among pregnant and non-pregnant women of child bearing age, which is relation to socio-economic factors, health status and health behaviours. Multiple-micronutrient deficiencies often coexist among women of reproductive age in low- to middle-income countries. They are exacerbated in pregnancy due to the increased demands, leading to potentially adverse effects on the mother and developing foetus. Though supplementation with MMNs has been recommended earlier because of the evidence of impact on pregnancy outcomes, a consensus is yet to be reached regarding the replacement of iron and folic acid supplementation with MMNs. Since the last update of this Cochrane review, evidence from a few large trials has recently been made available, the inclusion of which is critical to inform.
Objective:
1. To evaluate the benefits of oral multiple-micronutrient supplementation during pregnancy on maternal, foetal and infant health outcomes.
2. To characterize the multivitamins.
3. To study the various characteristics.
4. To formulate and evaluate Ice-cream containing multivitamins.
5. To characterize the prepared ice-cream physicochemical parameters.
6. To perform evaluation on result
Concentration Of Drugs During
Pregnancy :
1. Cynacobalamin
2. Iron
3. Folate Vitamin B9
4. Zinc
5. Iodine
1.Cynacobalamin:
The causes of preterm birth are multifaceted, and there are limited interventions currently available to prevent it. Among the essential nutrients, Vitamin B12 plays a crucial metabolic role, particularly in relation to folate and homocysteine metabolism, and is exclusively found in animal-derived foods. This vitamin is vital for DNA synthesis and methylation, as well as for cellular energy production. There is a growing hypothesis that Vitamin B12 may have significant effects on placentation and fetal development, particularly because Vitamin B12 deficiency can be prevalent in certain pregnant populations, affecting more than three-quarters of individuals in some cases.
Despite its importance, there have been relatively few studies exploring the impact of Vitamin B12 supplementation during pregnancy on outcomes such as birth weight and gestational length. Given that the requirements for cobalamin increase during pregnancy and lactation to support the nutritional demands of both the mother and the developing fetus, further research into this nutrient’s role in preventing preterm birth is warranted. Overall, understanding the complex etiology of preterm birth and the potential contributions of micronutrients like Vitamin B12 is essential for developing effective interventions and improving maternal and fetal health outcomes.
Women of childbearing age from low-income settings and those with low intake of animal products are at risk of cobalamin deficiency. Low cobalamin intake and status during pregnancy or lactation have been linked to adverse maternal and perinatal health outcomes, whereas low cobalamin status during early childhood is associated with impaired development in children. Women who begin pregnancy with depleted stores (low or very low plasma cobalamin) will give birth to depleted infants who are likely to develop deficiency symptoms during the first few weeks or months postpartum. Newly ingested cobalamin during pregnancy and lactation (from diet or supplements) is transferred to the child and is not likely to correct cobalamin status in depleted women.
02. Folate Vitamin B9 :
Folate is naturally present in a wide variety of foods, including vegetables (especially dark green leafy vegetables), fruits and fruit juices, nuts, beans, peas, seafood, eggs, dairy products, meat, poultry, and grains. Spinach, liver, asparagus, and brussels sprouts are among the foods with the highest folate levels. Birth defects represent a significant challenge to public health, with estimates from the Centers for Disease Control and Prevention indicating that approximately one in every 33 newborns in the U.S. is affected, leading to over 20% of all pediatric fatalities. Among these, exodermal defects are particularly prevalent and are complex disorders linked to the neurulation processes of the brain and spinal cord, which occur during a critical window of 21 to 28 days post-conception. The prevalence of these defects varies globally, influenced by ethnic and geographic factors, with reported rates ranging from 1 to 10 per 1,000 births or established pregnancies. While our understanding of the underlying causes is evolving, current evidence suggests that both genetic and environmental factors, such as maternal nutritional status and obesity, play a role in the development of these conditions. Folic acid is available in multivitamins and prenatal vitamins, supplements containing other Bcomplex vitamins, and supplements containing only folic acid. Common doses range from 680 to 1,360 mcg Dietary Folate Equivalent (400 to 800 microgram folic acid) in supplements for adults and 340 to 680 microgram Dietary Folate Equivalent (200 to 400 microgram folic acid) in children’s multivitamins. Folic acid has long been provided as a supplement in combination with iron during pregnancy, largely on the basis of haematological benefits, although deficiency has also been associated with pregnancy complications and congenital malformations.
03. Zinc:
Zinc plays a crucial role in supporting a healthy immune system, promoting normal growth, aiding in DNA metabolism, and facilitating quick wound healing. A lack of zinc has been linked to various complications during pregnancy and childbirth, including preeclampsia, premature rupture of membranes, and preterm deliveries. It can also contribute to fetal growth retardation and congenital abnormalities. This essential mineral offers significant health benefits for both pregnant women and their developing babies. Zinc can be obtained naturally from certain foods or added to the diet through supplements.
Zinc advantages for Pregnant ladies:
1. Helps balance the hormones.
2. Aids within the production of the placenta
3. Atomic number 30 advantages for Developing Baby.
4. Boosts cell growth.
5. Averts intrauterine infection. and functioning
6. Provides structural support to the proteins that compose the cells.
7. Recommended Daily Intake of atomic number 30 in gestation.
8. The daily intake of atomic number 30 for a pregnant lady depends on the age issue, greatly.
04 . Iodine:
Iodine plays a crucial role in thyroid function during pregnancy, as a deficiency can lead to serious consequences such as cretinism, fetal wastage, or preterm delivery. Addressing this widespread issue in developing countries has involved strategies such as administering iodized oil before or during pregnancy and ensuring the availability of iodized salt in areas where iodine deficiency is prevalent. Iodine is a vital component of thyroid hormones, which regulate numerous enzymes and metabolic activities. The Estimated Average Requirement for iodine has been established based on the accumulation and turnover of iodine in the thyroid gland. For adult men and women, the Recommended Dietary Allowance is set at 150 micrograms per day. In the United States, median iodine intake from food ranges from approximately 240 to 300 micrograms per day for men and 190 to 210 micrograms per day for women. The Tolerable Upper Intake Level for adults is 1,100 micrograms per day, determined by the serum concentration of thyrotropin in response to varying levels of dietary iodine.
05.Iron:
Iron functions as a component of a number of proteins, including enzymes and haemoglobin, the latter being important for the transport of oxygen to tissues throughout the body for metabolism. Factorial modelling was used to determine the Estimated Average Requirement for iron.
The components of iron requirement used as factors in the modelling include basal iron losses, menstrual losses, foetal requirements in pregnancy, increased requirement during growth for the expansion of blood volume, and/or increased tissue and storage iron
Intake Of Iron
Food Sources
The iron content of vegetables, fruits, breads, and pasta varies from 0.1 to 1.4 microgram/serving. Because most grain products are fortified with iron, approximately one-half of ingested iron comes from bread and other grain products such as cereals and breakfast bars.
Some fortified cereals contain as much as 24 mg of iron per 1-cup serving.
Heme iron represents only 7 to 10 percent of dietary iron of girls and women and only 8 to 12 percent of dietary iron for boys and men. Human milk provides approximately 0.27 microgram/day.
Selection Of Drugs And Other Excipients :
Ingredients:
1.Iron
2.Follic Acid
3.Vitamins
4.Iodine
5.Other Nutrients
Other Excipients:
1.Flavouring Agent
2.Stabilizer
3.Emulsifier
4.Colouring Agent
5.Sweetning Agent
Evaluation And Test Parameter:
1.Stability test
2.PH
3.Acidity (%)
4.Weight variation
5.Moisture (%)
6.Hardness test
Delivery System:
1. Tablets
2. Capsules
3. Softgels
4. Powders
5. Liquid suspensions
6. Emulsions
7. Gummies
8. Chewable
Types Of Formulations:
1.Prenatal vitamins and minerals
2. Maternal nutrition supplements (e.g., omega-3, probiotics)
3. Infant formula with added nutrients (e.g., Docosahexanoic acid, choline)
4. Functional foods (e.g., nutrition bars, fortified beverages)
5. Nutraceuticals (e.g., prenatal multivitamins, fertility supplements
Clinical Applications:
1. Guidance on prenatal care for healthcare professionals.
2. Customized nutritional advice for expectant mothers.
3. Creation of specialized nutritional supplements.
4. Better management strategies for gestational diabetes, hypertension, and preeclampsia.
5. Enhanced monitoring of fetal growth and development.
Contraindications:
Nutrient-Specific Contraindications:
1. High levels of vitamin A (over 5,000 International Units per day) may pose teratogenic risks.
2. Excess iron supplementation (exceeding 60 micrograms per day) can lead to gastrointestinal issues.
3. High caffeine consumption (more than 200 micrograms per day) increases the risk of miscarriage and potential growth restrictions.
4. Excessive intake of folic acid (beyond 1,000 micrograms per day) may interact with other medications.
Food-Specific Contraindications:
1. Consuming raw or undercooked meats, poultry, seafood, or eggs can increase the risk of foodborne illnesses.
2. Unpasteurized dairy products and juices may pose a risk for listeriosis and other infections.
3. High-mercury fish (such as shark, swordfish, and king mackerel) can present neurodevelopmental hazards.
RESULTS:
Micronutrient sufficiency at conception and throughout pregnancy is crucial for various pregnancy outcomes. Ensuring adequate levels of essential micronutrients, such as folic acid and possibly zinc, prior to conception is essential for preventing birth defects. However, implementing effective interventions requires targeting all women of reproductive age, particularly those at higher risk of conception. For certain outcomes, interventions initiated after pregnancy is confirmed can still yield positive effects. A common strategy for enhancing micronutrient levels during pregnancy includes supplementation with essential nutrients like iron and folic acid. Nonetheless, this approach faces challenges, such as limited availability of supplements, insufficient training for healthcare providers, and low adherence to supplementation regimens, which can result in less than optimal impacts on anemia management. To address these issues, efforts could pivot towards incorporating nutritional interventions within maternal health and prenatal care programs, especially in low- and middle-income countries. Research indicates that pregnant women who receive appropriate supplementation are less likely to have low birthweight infants or those who are small for their gestational age. Conversely, excessive maternal nutrition can lead to macrosomia, characterized by increased body fat and a heightened risk of obesity in childhood.
CONCLUSION:
Micronutrient and nutrient supplementation is a crucial intervention for improving the nutrition, health, and well-being of mothers and children, particularly in low- and middle-income countries (LMICs). This approach should be prioritized during pregnancy, regardless of the mother's pre-existing nutritional status. This review suggests that multiple micronutrient (MMN) supplementation should be considered the preferred option for standard prenatal care instead of iron and folic acid (IFA) alone, especially regarding outcomes such as stillbirths, small for gestational age (SGA) infants, and low birth weight. Additionally, single nutrient supplementation has shown benefits for specific outcomes; for instance, calcium (Ca) may reduce the risk of preeclampsia and eclampsia, while vitamin A can improve maternal serum or plasma vitamin A levels. However, there are fewer studies on lipid-based nutrient supplement (LNS) compared to MMN, indicating a need for further research to better understand the differences and effectiveness of these supplementation types..
REFERENCES
Shruti Yede*, Akshada Suryawanshi, A Novel Approach to Maternal Nutrition, Int. J. of Pharm. Sci., 2025, Vol 3, Issue 1, 1404-1410. https://doi.org/10.5281/zenodo.14679551
10.5281/zenodo.14679551
