National Academies Press: OpenBook
« Previous: Assessing Weight Change
Suggested Citation:"Nutrient Supplementation." Institute of Medicine. 1992. Nutrition During Pregnancy and Lactation: An Implementation Guide. Washington, DC: The National Academies Press. doi: 10.17226/1984.
×

9
Nutrient Supplementation

Identifying Anemia

Blood Sampling

Blood is drawn for analysis of hemoglobin or hematocrit at the preconception/interconception and first prenatal visits. Venipuncture blood yields the most reproducible results and is recommended, in particular, for confirmatory and follow-up studies after anemia has been detected.

The use of skin puncture blood is acceptable but will result in more false-positive and false-negative values. Use of disposable, spring-loaded lancets is helpful. Make the process quick because a few minutes of anxiety results in a cold, sweaty hand and poor blood flow. To improve accuracy, discard the first drop of blood and do not squeeze the finger because this makes tissue fluids contaminate the blood.

Criteria for Anemia

Hemoglobin and hematocrit values are normally lower in pregnant than in nonpregnant women, and they reach the lowest values during the second trimester of pregnancy. Anemia should be defined using the appropriate cutoff values from Table 1 or 2 in Tab 1 (page 16), after adjusting the cutoff value for high altitude (see Table 3 on the next page), if applicable. The effects of altitude and smoking are additive.

Suggested Citation:"Nutrient Supplementation." Institute of Medicine. 1992. Nutrition During Pregnancy and Lactation: An Implementation Guide. Washington, DC: The National Academies Press. doi: 10.17226/1984.
×

TABLE 3. Adjustments for Altitudesa

 

Adjustment Value

 

Hemoglobin

Hematocrit

Altitude (feet)

(g/dl)

(%)

3,000-3,999

+0.2

+0.5

4,000-4,999

+0.3

+1.0

5,000-5,999

+0.5

+1.5

6,000-6,999

+0.7

+2.0

a From CDC.11 To avoid underdiagnosis of anemia at high altitude, add the appropriate value from this table to the cutoff value given in Table 1 or 2 in Tab 1, page 16.

Example: A woman living in Denver at an altitude of 5,280 ft and smoking 15 cigarettes per day would have a cutoff value for anemia of 11.8 g hemoglobin/dl during her first trimester:

11.3 + 0.5 for altitude.

If her hemoglobin were 11.5 g/dl at 11 weeks of gestation, she would be considered anemic.

Indications for Additional Testing

Serum Ferritin. Serum ferritin provides an estimate of iron reserves. Consider analysis of serum ferritin to confirm that an anemia is due to iron deficiency, especially if there has been inadequate or no hemoglobin or hematocrit response to iron supplementation.

Iron Supplements

Iron deficiency is the most common cause of anemia during pregnancy. To prevent iron deficiency anemia, routinely recommend iron supplementation at a low-dose, about 30 mg of elemental iron/day, for non-anemic pregnant women during the second and third

Suggested Citation:"Nutrient Supplementation." Institute of Medicine. 1992. Nutrition During Pregnancy and Lactation: An Implementation Guide. Washington, DC: The National Academies Press. doi: 10.17226/1984.
×

trimesters. Low-dose iron can be given alone or as part of a multivitamin/mineral supplement of appropriate composition for pregnancy Effective forms of iron include ferrous sulfate, ferrous fumarate, and ferrous gluconate. Liquid and chewable forms are available for women who have trouble swallowing tablets or capsules. These iron preparations may stain teeth, but the stain can be removed by brushing. Recommend taking the supplement at bedtime or between meals with water or juice, not with milk, tea, or coffee. (Fruit juice will not enhance the absorption of iron from supplements, but some women may be more likely to drink fruit juice if advised to do so with a supplement. On the other hand, it is important for a woman to know that water is fine if juice is not available.)

For anemic women, start a therapeutic dose of about 60 to 120 mg of elemental iron/day Give 60 mg/day as a single dose or 120 mg/day as two separate doses, between meals and/or at bedtime with water or juice. In addition, to ensure an adequate supply of zinc and copper, recommend a multivitamin/mineral supplement of appropriate composition for pregnancy (see “Suggested Content of Prenatal Vitamin/Mineral Supplements") to be taken with a meal. Side effects of nausea, "stomach" discomfort, constipation, or diarrhea may occur during the first few days. If they persist, try a slow-release iron preparation given with meals. Check the hemoglobin or hematocrit again after 1 month. If the anemia is not improved or resolved, consider other causes of anemia. If the anemia is resolved, lower the dose of iron to 30 mg/day For sample statements about iron supplements, see page 62.

Suggested Citation:"Nutrient Supplementation." Institute of Medicine. 1992. Nutrition During Pregnancy and Lactation: An Implementation Guide. Washington, DC: The National Academies Press. doi: 10.17226/1984.
×

Suggested Content of Prenatal Vitamin/Mineral Supplements

The following is the suggested approximate composition of prenatal multivitamin/mineral supplements for use by women identified to be at high nutritional risk. (See the chart "Indications for Nutrient Supplementation" in Tab 1 for further information.)

Iron

30-60 mg

Zinc

15 mg

Copper

2 mg

Calcium

250 mg

Vitamin D

10 µg (400 IU)

Vitamin C

50 mg

Vitamin B6

2 mg

Folate

300 µg

Vitamin B12

2 µg

If vitamin A is included, beta-carotene is preferred over retinol to reduce the risk of toxicity or other adverse reactions. Since calcium and magnesium may interfere with iron absorption, upper limits of 250 and 25 mg/dose, respectively, are recommended as a part of vitamin/ mineral supplements.

Some calcium supplements provide less than the recommended 600 mg of elemental calcium per tablet. It is advisable to take calcium supplements (e.g., calcium carbonate) with meals to promote absorption of the calcium.

Suggested Citation:"Nutrient Supplementation." Institute of Medicine. 1992. Nutrition During Pregnancy and Lactation: An Implementation Guide. Washington, DC: The National Academies Press. doi: 10.17226/1984.
×
Page 109
Suggested Citation:"Nutrient Supplementation." Institute of Medicine. 1992. Nutrition During Pregnancy and Lactation: An Implementation Guide. Washington, DC: The National Academies Press. doi: 10.17226/1984.
×
Page 110
Suggested Citation:"Nutrient Supplementation." Institute of Medicine. 1992. Nutrition During Pregnancy and Lactation: An Implementation Guide. Washington, DC: The National Academies Press. doi: 10.17226/1984.
×
Page 111
Suggested Citation:"Nutrient Supplementation." Institute of Medicine. 1992. Nutrition During Pregnancy and Lactation: An Implementation Guide. Washington, DC: The National Academies Press. doi: 10.17226/1984.
×
Page 112
Next: Nutrition Referrals and Resources »
Nutrition During Pregnancy and Lactation: An Implementation Guide Get This Book
×
Buy Paperback | $39.95
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

Authorities agree that nutritional care for pregnant, about-to-be pregnant, and nursing women can prevent health problems that are costly in terms of both dollars and quality of life. Yet many women still receive little guidance regarding maternal nutrition.

Now, health care professionals can turn to a handy, practical guide for help in smoothly integrating maternal nutritional care into their practices. Nutrition During Pregnancy and Lactation provides physicians, nurses, primary care providers, and midwives with a ready-made, step-by-step program for helping new mothers.

The guide—based on the two most authoritative volumes available on the topic, both from the Institute of Medicine—Nutrition During Pregnancy (1990) and Nutrition During Lactation (1991)—makes the findings and recommendations detailed in these books readily accessible for daily use. In keeping with recommendations by the U.S. Surgeon General, the guide promotes breastfeeding and includes practical information for mothers on how to breastfeed.

Providing background details, resource lists, and a "toolbox" of materials, this implementation guide makes nutritional care simple and straightforward.

Part I walks the health care professional through the process of providing nutritional advice for new mothers—from the pre-pregnancy questionnaire to the final postpartum visit. It includes helpful tools such as weight charts and checklists to follow during each patient visit. It also offers suggestions on encouraging nutritional eating habits and helping patients with problems such as nausea and nursing twins.

Part II offers a wide range of practical information and guidelines on important topics, such as serving culturally diverse populations, making dietary assessments throughout pregnancy and lactation, and providing dietary advice in understandable, day-to-day terms. The guide explains how to determine if patients need vitamin-mineral supplements and what regimens to recommend. And, it includes information on referring patients to federal food and nutrition programs.

The guide is tabbed for quick reference and each page is designed for the reader to find information easily.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!