Optimizing Pregnancy Outcomes With Micronutrients
A woman’s nutritional status prior to conception can have serious implications on her health and birth outcomes.
Each month, The Clinical Advisor makes one new clinical feature available ahead of print. Don't forget to take the poll. The results will be published in the next month's issue.
Micronutrients are an often-overlooked consideration in primary care. Family practitioners caring for women of childbearing age must consider the effects of these essential nutrients on health and pregnancy outcomes. Healthy levels of folic acid, iodine, magnesium, vitamin D, and iron all demonstrate improved outcomes in pregnancy.1 This article reviews the function of each of these micronutrients and their ensuing implications on pregnancy outcomes.
Case 1: A healthy 25-year old woman (gravida 0, para 0) presents to the office to undergo laboratory testing required for her employers “Healthy Employee” insurance discount. She is newly married and usually uses condoms for birth control. She states that she is hoping to become pregnant in the next year and asks if there is anything she can do now to help her have a healthy pregnancy.
Case 2: A woman (gravida 1, para 1) presents for annual gynecologic care and reports that she takes “no daily medications.” Her provider asks if she plans to have more children, and the patient reports she is not sure when the timing will be right. Her provider then asks the patient about her nutritional status and if she takes any supplements on a regular basis. The patient responds, “I just need to start taking folic acid if I want to get pregnant, right?”
Case 3: A woman (gravida 0, para 0) presents to her gynecologist for annual care. She reports taking daily supplementation of magnesium, iron, and folic acid. “My friend told me I need to take these. I assume since they are available without a prescription they can't do any harm.”
All of these case examples demonstrate scenarios in which a provider must understand micronutrients and how they can affect a patient's current health. For women of childbearing age, these implications extend to potential future pregnancies. More than half of all pregnancies are unintended; therefore, communication regarding diet and lifestyle should be directed to all women who are capable of becoming pregnant.2
Primary care providers are often the last to know about their patients' plans for pregnancy. However, a woman's nutritional status prior to conception can have serious implications on her health and birth outcomes. A focused history with direct questions about pregnancy intentions at every encounter with all women of childbearing age can help practitioners provide optimal preconception care. This care often begins with valuable guidance on smoking, alcohol consumption, vaccinations, and disease management.3 Importantly, it should also include a review of micronutrients — including folic acid, iodine, magnesium, vitamin D, and iron — which can have significant effects on pregnancy outcomes. A summary of recommendations for each of these micronutrients is provided in the accompanying Table.