Erfahrungsheilkunde 2018; 67(06): 358-365
DOI: 10.1055/a-0759-8302
Praxis
© MVS Medizinverlage Stuttgart GmbH & Co. KG Stuttgart · New York

Schwangerschaft und funktionelle Ernährungsmedizin

Udo Böhm
Further Information

Publication History

Publication Date:
02 January 2019 (online)

Zusammenfassung

Eine optimale Versorgung mit Mikronährstoffen ist für einen normalen Schwangerschaftsverlauf unverzichtbar, da Unterversorgungen den Schwangerschaftsverlauf und die Entwicklung des Fötus ernsthaft beeinträchtigen können. Die Basisbetreuung Schwangerer muss deshalb Lebensstilfaktoren und vollwertige Ernährung beinhalten. Nährstoffdefizite bzw. ein Mehrbedarf müssen diagnostiziert und ausgeglichen werden.

Der Artikel gibt einen Überblick über die wichtigsten Mikronährstoffe sowie deren optimalen Status während der Schwangerschaft.

Abstract

An optimal supply of micronutrients is indispensable for a normal course of pregnancy, because an undersupply can seriously impair the course of pregnancy and the development of the fetus. The basic care for pregnant women must therefore include lifestyle factors and a wholesome nutrition. Nutrient deficits or an additional need must be diagnosed and balanced.

The article provides an overview of the most important micronutrients and their optimal status during pregnancy.

 
  • Literatur

  • 1 Böhm U, Epple-Waigel I. Vegetarisch oder Vegan – aber richtig. Hilden: Becker Joest Volk Verlag; 2017
  • 2 Böhm U, Reuss F. Zellschutz – Entgiftung – Prävention. Die gesundheitliche Bedeutung von Glutathion.
  • 3 Resveratrol in der funktionellen Ernährungsmedizin. Bremen: Unimed; 2013
  • 4 Böhm U. Alpha-Liponsäure. Freising: SUM Verlag; 2014
  • 5 Böhm U. Die Bedeutung von Vitamin K in der funktionellen Ernährungsmedizin. Freising: SUM Verlag; 2016
  • 6 Burger K. Ernährung in der Schwangerschaft. Vorsicht Vitamine! SZ 10.10.2017. Im Internet: https://www.sueddeutsche.de/gesundheit/ernaehrung-in-der-schwangerschaft-vorsicht-vitamine-1.3697569
  • 7 Bolz M. et al. Begleiterkrankungen in der Schwangerschaft. Dtsch Ärzteblatt Int 2017; 114: 616-626
    • Sonstige Quellen

    • 8 Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev 2017; 4: CD004905
    • 9 Louis GM. et al. Lifestyle and pregnancy loss in a contemporary cohort of women recruited before conception: The LIFE Study. Fertil Steril 2016; 106 (01) 180-188
    • 10 Vitamin supplementation in pregnancy. Drug Ther Bull 2016; 54 (07) 81-84
    • 11 Romieu I. et al. Maternal fish intake during pregnancy and atopy and asthma in infancy. Clin Exp Allergy 2007; 37 (04) 518-525
    • 12 Klemens CM. et al. The effect of perinatal omega-3 fatty acid supplementation on inflammatory markers and allergic diseases: a systematic review. BJOG 2011; 118 (08) 916-925
    • 13 Furuhjelm C. et al. Fish oil supplementation in pregnancy and lactation may decrease the risk of infant allergy. Acta Paediatr 2009; 98 (09) 1461-1467
    • 14 Furuhjelm C. et al. Allergic disease in infants up to 2 years of age in relation to plasma omega-3 fatty acids and maternal fish oil supplementation in pregnancy and lactation. Pediatr Allergy Immunol 2011; 22 (05) 505-514
    • 15 Maslova E. et al. Fish intake during pregnancy and the risk of child asthma and allergic rhinitis – longitudinal evidence from the Danish National Birth Cohort. Br J Nutr 2013; 110 (07) 1313-1325
    • 16 Koletzko B. et al. The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations. J Perinat Med 2008; 36 (01) 5-14
    • 17 Koletzko B. et al. Current information and Asian perspectives on long-chain polyunsaturated fatty acids in pregnancy, lactation, and infancy: systematic review and practice recommendations from an Early Nutrition Academy Workshop. Ann Nutr Metab 2014; 65: 49-80
    • 18 Grootendorst-van Mi NH. et al. Maternal plasma n-3 and n-6 polyunsaturated fatty acids during pregnancy and features of fetal health: Fetal growth velocity, birth weight and duration of pregnancy. Clin Nutr 2017; pii: S0261–5614(17)30221–2
    • 19 Bisgaard H. et al. Fishoil derived fatty acids in pregnancy and wheeze and asthma in offspring. N Engl J Med 2016; 375: 2530-2539
    • 20 Larque E. et al. Omega 3 fatty acids, gestation and pregnancy outcomes. Br J Nutr 2012; 107 (Suppl. 02) S77-84
    • 21 Middleton P. et al. Omega-3 supplementation during pregnancy: an updated Cochrane review. First published: 20 April 2017 Full publication history; DOI: 10.1111/jpc.13494_201 View/save citation
    • 22 Gunaratne AW. et al. Fish oil (n-3 or omega-3) for pregnant mothers or breastfeeding mothers to prevent allergies in their young children. Cochrane Database of Systematic Reviews 2015; 7: CD010085 DOI: 10.1002/14651858.CD010085.pub2
    • 23 Coletta JM. et al. Omega-3 fatty acids and pregnancy. Rev Obstet Gynecol 2010; 3 (04) 163-171
    • 24 Ramakrishnan U. et al. Prenatal supplementation with DHA improves attention at 5 y of age: a randomized controlled trial. Am J Clin Nutr. 2016 doi.3945/ajcn.114.101071
    • 25 Rogers LK. et al. DHA supplementation: current implications in pregnancy and childhood. Pharmacol Res 2013; 70 (01) 13-19
    • 26 Carlson SE. et al. DHA supplementation and pregnancy outcomes. Am J Clin Nutr 2013; 97 (04) 808-815
    • 27 Olsen SF. et al. Randomised clinical trials of fish oil supplementation in high risk pregnancies. Br J Obstet Gynaecol 2000; 107: 382-395
    • 28 Olsen SF. et al. Low consumption of seafood in early pregnancy as a risk factor of preterm delivery: prospective cohort study. BMJ 2002; 324 (7335) 447
    • 29 Smuts CM. et al. A randomized trial of docosahexaenoic acid supplementation during the third trimester of pregnancy. Obstet Gynecol 2003; 101 (03) 469
    • 30 Dunstan JA. Fish oil supplementation in pregnancy modifies neonatal allergen-specific immune responses and clinical outcomes in infants at high risk of atopy: a randomized, controlled trial. J Allergy Clin Immunol 2003; 112: 1178-1184
    • 31 Helland IB. et al. Maternal supplementation with very-long-chain n-3 fatty acids during pregnancy and lacatation augments children’s IQ at 4 years of age. Pediatrics 2003; 111: e39-e44
    • 32 Cheruku SR. et al. Higher maternal plasma docosahexaenoic acid during pregnancy is associated with more mature neonatal sleep-state patterning. Am J Clin Nutr 2002; 76: 608-613
    • 33 Willers SM. et al. Maternal food consumption during pregnancy and asthma, respiratory and atopic syndroms in 5-year-old children. Thorax 2007; 62: 773-779
    • 34 Balogun OO. et al. Vitamin supplementation for preventing miscarriage. Cochrane Database of Systematic Reviews. 2016 Issue 5. Art. No.: CD004073
    • 35 McCauley ME. et al. Vitamin A supplementation during pregnancy for maternal and newborn health outcomes. Cochrane Database Syst Rev 2015; CD008666
    • 36 De-Regil LM. et al. Vitamin D supplementation for women during pregnancy. Cochrane Database of Systematic Reviews. 2016 Issue 1. Art. No.: CD008873
    • 37 Holmes VA. et al. Vitamin D deficiency and insufficiency in pregnant woman: a longitudinal study. Br J Nutr 2009; 102: 876-881
    • 38 Litonjua AA. et al. Is vitamin D deficiency to blame for the asthma epidemic?. J Allergy Clin Immunol 2007; 120: 1031-1035
    • 39 Camargo CA. et al. Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age. Am J Clin Nutr 2007; 85: 788-795
    • 40 Goncalves DR. et al. Recurrent pregnancy loss and vitamin D: A review of the literature. Am J Reprod Immunol 2018; e13022
    • 41 Mansura JL. Vitamin D in pediatrics, pregnancy and lactation. Arch Argent Pediatr 2018; 116 (04) 286-290
    • 42 Javaid MK. et al. Maternal vitamin D status during pregnancy and childhood bonemass at age 9 years: a longitudinal study. Lancet 2006; 367: 36-43
    • 43 Mannion CA. et al. Association of low intake of milk and vitamin D during pregnancy with decreased birth weight. CMAJ. 2006 doi:10.1503/cmaj.1041388
    • 44 De-Regil L. et al. Folic acid supplements before conception and in early pregnancy (up to 12 weeks) for the prevention of birth defects. 14–12–2015 https://www.cochrane.org/CD007950/PREG_folic-acid-supplements-conception-and-early-pregnancy-12-weeks-prevention-birth-defects
    • 45 Relton CL. et al. The influence of erythrocyte folate and serum vitamin B12 status on birth weight. Br J Nutr 2005; 93: 593-599
    • 46 Moore LL. et al. Folate intake and the risk of neural tube defects. an estimation of dose-response. Epidemiology 2003; 14 (02) 200-205
    • 47 Tolarova M, Harris J. Reduced recurrence of orofacial clefts after periconceptional supplementation with high dose folic acid and multivitamins. Eur J Clin Invest 1995; 29: 1003-1009
    • 48 Barkal G. et al. Frequency of Down’s syndrome and neural-tube defects in the same family. Lancet 2003; 361: 1331-1335
    • 49 Groenen PMW. et al. Marginal maternal vitamin B12 status increases the risk of offspring with spina bifida. Am J Obstet Gynecol 2004; 191: 11-17
    • 50 Krapels IPC. et al. Maternal dietary B vitamin intake, other than folate, and the association with orofacial cleft in the offspring. Eur J Nutr 2004; 43: 7-14
    • 51 Vollset ST. et al. Plasma total homocysteine, pregnancy complicaitons, and adverse pregnancy outcomes: the Hordaland Homocysteine Study. Am J Clin Nutr 2000; 71: 962-968
    • 52 Lopez-Quesada E. et al. Plasma total homocysteine in uncomplicated pregnancy and in preeclampsia. Eur J Obstet Gynecol Reprod Biol 2003; 108: 45-49
    • 53 Chappell LC. et al. Effects of antioxidants on the occurence of pre-eclampsia in women at increased risk: a randomised trial. The Lancet 1999; 354: 810
    • 54 Zhang C. et al. Vitamin C and the risk of preeclampsia: results from dietary questionnaire and plasma assay. Epidemiology 2002; 13: 409-416
    • 55 Zhang C. et al. Maternal plasma ascorbic acid (Vitamin C) and risk of gestational diabetes mellitus. Epidemiology 2004; 15: 597-604
    • 56 Lee BE. Influence of maternal serum levels of vitamins C and E during the second trimester on birth weight and length. Eur J Clin Nutr 2004; 58: 1365-1371
    • 57 Serdar Z. et al. Lipid and protein oxidation and antioxidant function in women with mild and severe preeclampsia. Arch Gynecol Obstet 2003; 268: 19-25
    • 58 Rumbold AR. et al. Dietary intake of vitamin C and vitamin E and the development of hypertensive disorders of pregnancy. Eur J Obstet Gynecol Reprod Biol 2005; 119: 67-71
    • 59 Devereux G. et al. Low maternal vitamin E intake during pregnancy is associated with asthma in 5-year-old children. Am J Respir Crit Care Med 2006; 174 (05) 499-507
    • 60 Hininger I. et al. Effects of a combined micronutrient supplementation on maternal biological status and newborn anthropometrics measurements: a randomize d double-blind, placebo-controlled trial in apparently healthy pregnant women. Eur J Clin Nutr 2004; 58: 52-59
    • 61 Botto LD. et al. Occurrence of congenital heart defects in relation to maternal multivitamin use. Am J Epidemiol 2000; 15: 878-848
    • 62 Bodnar LM. et al. Periconceptional multivitamin use reduces the risk of preeclampsia. Am J Epidemiol 2006; 164 (05) 470-477
    • 63 Correa A. et al. Do multivitamin supplements attenuate the risk for diabetes-associatied birth defects?. Pediatrics 2003; 111: 1146-1151
    • 64 Baker H. et al. Vitamin profile of 563 gravides during trimesters of pregnancy. J Am Coll Nutr 2002; 21: 33-37
    • 65 Kirschner W. et al. Eisenmangel in der Schwangerschaft. Der Gynäkologe 2011; 9: 759-765
    • 66 Pena-Rosas J. et al. Effects and safety of preventive oral iron or iron + folic acid supplementation for women during pregnancy. Cochrane. 2015 https://www.cochrane.org/CD004736/PREG_effects-and-safety-preventive-oral-iron-or-iron-folic-acid-supplementation-women-during-pregnancy
    • 67 Hofmeyr GJ. et al. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane. 24–06-2014
    • 68 Hofmeyr GJ. et al. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev. (3) 2006
    • 69 Ota E. et al. Zinc supplementation for improving pregnancy and infant outcome. Cochrane. 2015 https://www.cochrane.org/CD000230/PREG_zinc-supplementation-improving-pregnancy-and-infant-outcome
    • 70 Scholl TO. et al. Low zinc intake during pregnancy: Its Association with Preterm and Very Preterm Delivery. Am J Epidemiol 1993; 137: 1115-1124
    • 71 Wang H. et al. Maternal serum zinc concentration during pregnancy is inversely associated with risk of preterm birth in a Chinese population. J Nutr 2016; 146: 509-515
    • 72 Harding KB. et al. Iodine supplementation for women during the preconception, pregnancy and postpartum period. Cochrane Database of Systematic Reviews 2017; 3: CD011761 DOI: 10.1002/14651858.CD011761.pub2
    • 73 Zimmermann M. et al. Iodine supplementation of pregnant women in Europe: a review and recommendations. Eur J Clin Nutr 2004; 58: 979-984
    • 74 The Magpie Trial Collaborative Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet 2002; 359: 1877-1890
    • 75 Manta-Vogli PD. et al. The significant role of amino acids during pregnancy: nutritional support. J Matern Fetal Neonatal Med. 2018 doi: 10.1080/14767058.2018.1489795
    • 76 Gomez Arango LF. et al. Probiotics and pregnancy. Curr Diab Rep 2015; 15 (01) 567
    • 77 Isolauri E. et al. Role of probiotics in reducing the risk of gestational diabetes. Diabetes Obes Metab 2015; 17 (08) 713-719
    • 78 Barrett HL. et al. Probiotics: a potential role in the prevention of gestational diabetes?. Acta Diabetol 2012; 49 (Suppl. 01) S1-13
    • 79 Barrett HL. et al. Probiotics to prevent gestational diabetes mellitus. Cochrane. 2014 https://www.cochrane.org/CD009951/PREG_probiotics-to-prevent-gestational-diabetes-mellitus
    • 80 Rautava S. et al. Probiotics during pregnancy and breast-feeding might confer immunomodulatory protectioon against atopic disease in the infant. J Allergy Immunol 2002; 109: 119-121
    • 81 Kallimäki M. et al. Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial. Lancet 2003; 361: 1869-1871
    • 82 Shalev E. Ingestion of probiotics: optional treatment of bacterial vaginosis in pregnancy. Isr Med Assoc J 2002; 4: 357-360
    • 83 Vinutha B. et al. Vitamin a status of pregnant women and effect of post partum vitamin a supplementation. Indian Pediatr 2000; 37 (011) 1188-1193
    • 84 Meram I. et al. Vitamin A and beta-carotene levels during pregnancy in Gaziantep, Turkey. Acta Medica (Hradec Kralove) 2004; 47 (03) 189-193
    • 85 Strobel M. et al. The importance of beta-carotene as a source of vitamin A with special regard to pregnant and breastfeeding women. Eur J Nutr 2007; 46 01. I1-20
    • 86 Wuertz C. et al. Cross-sectional study of factors that influence the 25-hydroxyvitamin D status in pregnant women and in cord blood in Germany. BJON 2013; 110: 1895-1902
    • 87 Zhang Z. et al. Dietary intakes of EPA and DHA omega-3 fatty acids among US childbearing-age and pregnant women: an analysis of NHANES 2001–2014. Nutrients. 2018 doi: 10.3390/nu10040416
    • 88 Mistry HD, Williams PJ. The importance of antioxidant micronutrients in pregnancy. Oxid Med Cell Longev 2011; 2011: 841749
    • 89 Cohen JM. et al. Maternal antioxidant levels in pregnancy and risk of preeclampsia and small for gestational age birth: a systematic review and meta-analysis. PLoS One 2015; 10 (08) e0135192
    • 90 Jenkins C. et al. Antioxidants: their role in pregnancy and miscarriage. Antioxid Redox Signal 2000; 2 (03) 623-628
    • 91 www.dge.de/ernaehrungspraxis/bevoelkerungsgruppen/schwangere-stillende/handlungsempfehlungen-zur-ernaehrung-in-der-schwangerschaft
    • 92 www.dge.de/wissenschaft/referenzwerte/energie/
    • 93 Hilbig A. Ernährung in Schwangerschaft und Stillzeit. Ernährungs-Umschau 2013; 8: M 466
    • 94 www.dge.de/fileadmin/public/doc/ws/ll-fett/v2/02-Fettzufuhr-in-Deutschland-DGE-Leitlinie-Fett-2015.pdf
    • 95 Koletzko B. et al. Ernährung in der Schwangerschaft – Handlungsempfehlungen des Netzwerks „Gesund ins Leben – Netzwerk Junge Familie“. http://shop.aid.de/_assets/downloads_free/3589_empfehlungen_ernaehrung_schwangerschaft_x000.pdf (abgerufen 17.12.2014)
    • 96 Leitzmann C, Keller M. Vegetarische Ernährung. 3. Aufl.. Ulmer: 2013
    • 97 Shahrook S. et al. Vitamin K supplementation during pregnancy for improving outcomes. Cochrane Database of Systematic Reviews. 2014 doi: 10.1002/14651858.CD010920
    • 98 Cornelissen M. et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Am J Obstet Gynecol 1993; 168 (3 Pt 1) 884-888