Current issues and perspectives in prenatal nutrition

The typical American diet, characterized by energy-dense foods rich in starches, sugars, and saturated fats, and low in fruits and vegetables, is relatively unhealthy and is associ- ated with nutritional deficiencies. Suboptimal diets for pregnant women have been associated with serious maternal medical complications (eg, iron deficiency anemia, high blood pressure, gestational diabetes, and morning sickness), as well as an increased risk of intrauterine growth restriction, birth defects, developmental delays after birth, and future chronic health problems, (eg, heart disease, type 2 diabetes, high blood pressure, and high cholesterol) during childhood, as well as later in life. Folic acid deficiency is one of the most common problems among pregnant women, and supplementation with folic acid during pregnancy has been reported to decrease the occurrence and recurrence of fetal neural tube defects. Folate supplementation beginning preconception, along with a multivitamin, at least 12 weeks prior to conception is recommended to achieve maximal risk reduction. The reported benefits of supplementing docosahexaenoic acid, an unsaturated omega-3 essential fatty acid, during pregnancy include promoting proper neurodevelopment in fetuses and infants that extends into childhood. Pregnancy is also associ- ated with an increased susceptibility to oxidative stress, resulting from the imbalance between oxygen free radicals and the essential antioxidants that maintain homeostasis. Associated complications include preeclampsia, preterm labor, and intrauterine growth restriction. There is not enough evidence to support routine use of antioxidants, such as vitamins C and E during pregnancy, but coenzyme Q10 and lycopene are additional antioxidants under study and are yielding promising results by decreasing the occurrence of maternal complications.