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  • Print publication year: 2012
  • Online publication date: August 2012

16 - Intervention strategies to improve outcome in obese pregnancies: micronutrients and dietary supplements

from Section 4 - Interventions


This chapter reviews data highlighting the vulnerability of obese women to multiple micronutrient deficiencies. It summarizes the evidence supporting the effectiveness of nutrition interventions at preventing key birth outcomes among obese pregnant women. Increased body mass index (BMI) in non-pregnant women is associated with decreased serum folate, ascorbic acid, vitamin E, total carotenoids, and selenium in a variety of populations. With the poor micronutrient status of obese women of childbearing age, and potentially the same relationship in obese pregnant women, it is critical to understand whether micronutrient interventions could positively impact birth outcomes in obese pregnancy. Several high-quality observational studies of birth defects, pre-eclampsia may provide additional insight into whether micronutrient supplementation may reduce the likelihood of poor outcomes among obese pregnant women. Future rigorous observational studies exploring a wide range of micronutrients and risk of poor outcomes of women with high pre-pregnancy BMIs will add to the evidence base.

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Bodnar, L M Baker, P Balen, A H Poston, L Sattars, N Obesity and Reproductive Health London RCOG Press 2007 145
Garcia, O P Long, K Z Rosado, J L Impact of micronutrient deficiencies on obesity Nutr Rev 2009 67 559
Mojtabai, R. Body mass index and serum folate in childbearing age women Eur J Epidemiol 2004 19 1029
Kimmons, J E Blanck, H M Tohill, B C Zhang, J Khan, L K Associations between body mass index and the prevalence of low micronutrient levels among us adults Med Gen Med 2006 8 59
Ortega, R M Lopez-Sobaler, A M Andres, P Folate status in young overweight and obese women: changes associated with weight reduction and increased folate intake J Nutr Sci Vitaminol (Tokyo) 2009 55 149
Han, Y S Ha, E H Park, H S Kim, Y J Lee, S S Relationships between pregnancy outcomes, biochemical markers and pre-pregnancy body mass index Int J Obes (Lond) 2010 35 570
Poston, L Briley, A L Seed, P T Kelly, F J Shennan, A H Vitamin C and vitamin E in pregnant women at risk for pre-eclampsia (VIP trial): randomised placebo-controlled trial Lancet 2006 367 1145
Rajasingam, D Seed, P T Briley, A L Shennan, A H Poston, L. A prospective study of pregnancy outcome and biomarkers of oxidative stress in nulliparous obese women Am J Obstet Gynecol 2009 200 395e1
Bates, C J Mishra, G D Prentice, A. Gamma-tocopherol as a possible marker for nutrition-related risk: results from four national diet and nutrition surveys in Britain Br J Nutr 2004 92 137
Hahn, S Haselhorst, U Tan, S Low serum 25-hydroxyvitamin d concentrations are associated with insulin resistance and obesity in women with polycystic ovary syndrome Exp Clin Endocrinol Diabetes 2006 114 577
Bodnar, L M Catov, J M Roberts, J M Simhan, H N Prepregnancy obesity predicts poor vitamin D status in mothers and their neonates J Nutr 2007 137 2437
Chambers, E C Heshka, S Gallagher, D Serum iron and body fat distribution in a multiethnic cohort of adults living in New York City J Am Diet Assoc 2006 106 680
Zimmermann, M B Zeder, C Muthayya, S Adiposity in women and children from transition countries predicts decreased iron absorption, iron deficiency and a reduced response to iron fortification Int J Obes (Lond) 2008 32 1098
Bodnar, L M Siega-Riz, A M Arab, L Chantala, K McDonald, T. Predictors of pregnancy and postpartum iron status in low-income women Public Health Nutr 2004 7 701
Garn, S M Petzold, A S Fatness and hematological levels during pregnancy Am J Clin Nutr 1982 36 729
Bodnar, L M Siega-Riz, A M Cogswell, M E High prepregnancy BMI increases the risk of postpartum anemia Obes Res 2004 12 941
Tamura, T Goldenberg, R L Johnston, K E Chapman, V R Relationship between pre-pregnancy bmi and plasma zinc concentrations in early pregnancy Br J Nutr 2004 91 773
Major, G C Chaput, J P Ledoux, M Recent developments in calcium-related obesity research Obes Rev 2008 9 428
Zemel, M B Shi, H Greer, B Dirienzo, D Zemel, P C Regulation of adiposity by dietary calcium FASEB J 2000 14 1132
Major, G C Alarie, F P Dore, J Tremblay, A Calcium plus vitamin d supplementation and fat mass loss in female very low-calcium consumers: potential link with a calcium-specific appetite control Br J Nutr 2009 101 659
Rifas-Shiman, S L Rich-Edwards, J W Kleinman, K P Oken, E Gillman, M W Dietary quality during pregnancy varies by maternal characteristics in Project Viva: a US cohort J Am Diet Assoc 2009 109 1004
Laraia, B A Bodnar, L M Siega-Riz, A M Pregravid body mass index is negatively associated with diet quality during pregnancy Public Health Nutr 2007 10 920
Pearson, T C Guthrie, D L Simpson, J Interpretation of measured red cell mass and plasma volume in adults: Expert Panel on Radionuclides of the International Council for Standardization in Haematology Br J Haematol 1995 89 748
Andersen, L F Jacobs, D R Gross, M D Longitudinal associations between body mass index and serum carotenoids: the Cardia study Br J Nutr 2006 95 358
Wortsman, J Matsuoka, L Y Chen, T C Lu, Z Holick, M F Decreased bioavailability of vitamin D in obesity Am J Clin Nutr 2000 72 690
McClung, J P Karl, J P Iron deficiency and obesity: the contribution of inflammation and diminished iron absorption Nutr Rev 2009 67 100
Vincent, H K Innes, K E Vincent, K R Oxidative stress and potential interventions to reduce oxidative stress in overweight and obesity Diabetes Obes Metab 2007 9 813
Al-Saleh, E Nandakumaran, M Al-Harmi, J Sadan, T Al-Enezi, H. Maternal–fetal status of copper, iron, molybdenum, selenium, and zinc in obese pregnant women in late gestation Biol Trace Elem Res 2006 113 113
Lee, D H Steffen, L M Jacobs, D R Association between serum gamma-glutamyltransferase and dietary factors: the coronary artery risk development in young adults (CARDIA) study Am J Clin Nutr 2004 79 600
Lee, D H Gross, M D Jacobs, D R Association of serum carotenoids and tocopherols with gamma-glutamyltransferase: the cardiovascular risk development in young adults (CARDIA) study Clin Chem 2004 50 582
Henson, M C Castracane, V D Leptin in pregnancy Biol Reprod 2000 63 1219
Shankar, P Boylan, M Sriram, K. Micronutrient deficiencies after bariatric surgery Nutrition 2010 26 1031
Block, G Mangels, A R Patterson, B H Body weight and prior depletion affect plasma ascorbate levels attained on identical vitamin c intake: a controlled-diet study J Am Coll Nutr 1999 18 628
Modder, J Fitzsimons, K J 2010
American College of Obstetricians and Gynecologists ACOG Committee Opinion number 315, September 2005. Obesity in pregnancy Obstet Gynecol 2005 106 671
Fall, C H Fisher, D J Osmond, C Margetts, B M Multiple micronutrient supplementation during pregnancy in low-income countries: a meta-analysis of effects on birth size and length of gestation Food Nutr Bull 2009 30 S533
Villar, J Purwar, M Merialdi, M World Health Organisation multicentre randomised trial of supplementation with vitamins C and E among pregnant women at high risk for pre-eclampsia in populations of low nutritional status from developing countries BJOG 2009 116 780
Goldenberg, R L Tamura, T Neggers, Y The effect of zinc supplementation on pregnancy outcome. [see comment] JAMA 1995 274 463
Werler, M M Louik, C Shapiro, S Mitchell, A A Prepregnant weight in relation to risk of neural tube defects JAMA 1996 275 1089
Ray, J G Wyatt, P R Vermeulen, M J Meier, C Cole, D E Greater maternal weight and the ongoing risk of neural tube defects after folic acid flour fortification Obstet Gynecol 2005 105 261
Watkins, M L Botto, L D Maternal prepregnancy weight and congenital heart defects in offspring Epidemiology 2001 12 439
Velie, E M Block, G Shaw, G M Maternal supplemental and dietary zinc intake and the occurrence of neural tube defects in California Am J Epidemiol 1999 150 605
Carmichael, S L Shaw, G M Selvin, S Schaffer, D M Diet quality and risk of neural tube defects Med Hypotheses 2003 60 351
Bodnar, L M Tang, G Ness, R B Harger, G Roberts, J M Periconceptional multivitamin use reduces the risk of preeclampsia Am J Epidemiol 2006 164 470
Catov, J M Nohr, E A Bodnar, L M Association of periconceptional multivitamin use with reduced risk of preeclampsia among normal-weight women in the Danish national birth cohort Am J Epidemiol 2009 169 1304
Catov, J M Bodnar, L M Ness, R B Markovic, N Roberts, J M Association of periconceptional multivitamin use and risk of preterm or small-for-gestational-age births Am J Epidemiol 2007 166 296