Abayomi JC, Watkinson H, Boothby J, Topping J, Hackett AF Identification of ‘hot spots’ of obesity and being underweight in early pregnancy in Liverpool. J Hum Nutr Diet. 2009; 22:(3)246-54

Allgrove J, Mughal MZ Calcium deficiency rickets: extending the spectrum of ‘nutritional’ rickets. Arch Dis Child. 2014; 99:(9)794-5

Ashdown-Lambert JR A review of low birth weight: predictors, precursors and morbidity outcomes. J R Soc Promot Health. 2005; 125:(2)76-83

Bainbridge J The trouble with size 0…. British Journal of Midwifery. 2007; 15:(1)38-38

Barger MK Maternal nutrition and perinatal outcomes. J Midwifery Womens Health. 2010; 55:(6)502-11

Barker DJ, Gelow J, Thornburg K, Osmond C, Kajantie E, Eriksson JG The early origins of chronic heart failure: impaired placental growth and initiation of insulin resistance in childhood. Eur J Heart Fail. 2010; 12:(8)819-25

Bates B, Lennox A, Prentice A(eds). London: Public Health England; 2014

Bekker CL To supplement or not, that is the question… and then how much?. Professional Nursing Today. 2009; 13:(6)25-9

Bender DA The Vitamins. In: Gibney MJ, Vorster HH, Kok FJ (eds). Oxford: Blackwell Science; 2002

Bender DA, 3rd edn. New York: Oxford University Press; 2009

Berti C, Biesalski HK, Gärtner R Micronutrients in pregnancy: current knowledge and unresolved questions. Clin Nutr. 2011; 30:(6)689-701

Blumfield M, Hure A, MacDonald-Wicks L The association between the macronutrient content of maternal diet and the adequacy of micronutrients during pregnancy in the Women and Their Children's Health (WATCH) study. Nutrients. 2012; 4:(12)1958-76

Cnattingius S, Bergström R, Lipworth L, Kramer MS Prepregnancy weight and the risk of adverse pregnancy outcomes. N Engl J Med. 1998; 338:(3)147-52

London: The Stationery Office; 1991

Derbyshire E Nutrition in pregnant teenagers: how can nurses help. Br J Nurs. 2007; 16:(3)144-5

Devlieger R, Guelinckx I, Jans G, Voets W, Vanholsbeke C, Vansant G Micronutrient levels and supplement intake in pregnancy after bariatric surgery: a prospective cohort study. PLoS One. 2014; 9:(12)

Doak CM, Adair LS, Bentley M, Monteiro C, Popkin BM The dual burden household and the nutrition transition paradox. Int J Obes (Lond). 2005; 29:(1)129-36

Edwards JE Pregnancy after bariatric surgery. AWHONN Lifelines. 2005; 9:(5)388-93

Expert Group on Vitamins and Minerals. Safe upper levels for vitamins and minerals. 2003. (accessed 3 May 2016)

Fowles ER Comparing pregnant women's nutritional knowledge to their actual dietary intake. MCN Am J Matern Child Nurs. 2002; 27:(3)171-7

Fowles ER Comparing pregnant women's nutritional knowledge to their actual dietary intake. MCN Am J Matern Child Nurs. 2002; 27:(3)171-7

Gluckman PD, Cutfield W, Hofman P, Hanson MA The fetal, neonatal, and infant environments-the long-term consequences for disease risk. Early Hum Dev. 2005; 81:(1)51-9

Haider BA, Bhutta ZA Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2015; 11

Hallberg L Perspectives on nutritional iron deficiency. Annu Rev Nutr. 2001; 21:1-21

Han Z, Mulla S, Beyene J, Liao G, McDonald SD Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses. Int J Epidemiol. 2011; 40:(1)65-101

Harris AA, Barger MK Specialized care for women pregnant after bariatric surgery. J Midwifery Womens Health. 2010; 55:(6)529-39

Jackson AA, Robinson SM Dietary guidelines for pregnancy: a review of current evidence. Public Health Nutr. 2001; 4:(2B)625-30

Jeric M, Roje D, Medic N, Strinic T, Mestrovic Z, Vulic M Maternal pre-pregnancy underweight and fetal growth in relation to institute of medicine recommendations for gestational weight gain. Early Hum Dev. 2013; 89:(5)277-81

Jewell K, Avery A, Barber J, Simpson S The healthy eating and lifestyle in pregnancy (HELP) feasibility study. British Journal of Midwifery. 2014; 22:(10)727-36

Jones RL, Cederberg HM, Wheeler SJ Relationship between maternal growth, infant birthweight and nutrient partitioning in teenage pregnancies. BJOG. 2010; 117:(2)200-11

Judd J Rickets in the 21st century: A review of the consequences of low vitamin D and its management. Int J Orthop Trauma Nurs. 2013; 17:(4)199-208

Keen CL, Clegg MS, Hanna LA The plausibility of micronutrient deficiencies being a significant contributing factor to the occurrence of pregnancy complications. J Nutr. 2003; 133:(5 Suppl 2)1597S-1605S

Lassi ZS, Salam RA, Haider BA, Bhutta ZA Folic acid supplementation during pregnancy for maternal health and pregnancy outcomes. Cochrane Database Syst Rev. 2013; 3

Liu RH Dietary bioactive compounds and their health implications. J Food Sci. 2013; 78:A18-25

McMahon DM, Liu J, Zhang H, Torres ME, Best RG Maternal obesity, folate intake, and neural tube defects in offspring. Birth Defects Res A Clin Mol Teratol. 2013; 97:(2)115-22

Montgomery KS Improving nutrition in pregnant adolescents: recommendations for clinical practitioners. J Perinat Educ. 2003; 12:(2)22-30

Moran LJ, Sui Z, Cramp CS, Dodd JM A decrease in diet quality occurs during pregnancy in overweight and obese women which is maintained post-partum. Int J Obes (Lond). 2013; 37:(5)704-11

National Institute for Health and Care Excellence. Maternal and child nutrition. 2008. (accessed 16 May 2016)

National Institute for Health and Care Excellence. Weight management before, during and after pregnancy. 2010. (accessed 29 April 2016)

National Institute for Health and Care Excellence. Maternal and child nutrition. 2014. (accessed 29 April 2016)

Nyaradi A, Li J, Hickling S, Foster J, Oddy WH The role of nutrition in children's neurocognitive development, from pregnancy through childhood. Front Hum Neurosci. 2013; 7

Osmond C, Barker DJ Fetal, infant, and childhood growth are predictors of coronary heart disease, diabetes, and hypertension in adult men and women. Environ Health Perspect. 2000; 108:545-53

Pelizzo G, Calcaterra V, Fusillo M Malnutrition in pregnancy following bariatric surgery: three clinical cases of fetal neural defects. Nutr J. 2014; 13

Picciano MF Pregnancy and lactation: physiological adjustments, nutritional requirements and the role of dietary supplements. J Nutr. 2003; 133:(6)1997S-2002S

Polańska K, Muszyński P, Sobala W, Dziewirska E, Merecz-Kot D, Hanke W Maternal lifestyle during pregnancy and child psychomotor development – Polish Mother and Child Cohort study. Early Hum Dev. 2015; 91:(5)317-25

Poston L Influence of maternal nutritional status on vascular function in the offspring. Microcirculation. 2011; 18:(4)256-62

Poston L, Briley AL, Barr S Developing a complex intervention for diet and activity behaviour change in obese pregnant women (the UPBEAT trial); assessment of behavioural change and process evaluation in a pilot randomised controlled trial. BMC Pregnancy Childbirth. 2013; 13

Public Health England, Department of Health, Royal College of Midwives. 2015. (accessed 29 April 2016)

Rao KR, Padmavathi IJ, Raghunath M Maternal micronutrient restriction programs the body adiposity, adipocyte function and lipid metabolism in offspring: a review. Rev Endocr Metab Disord. 2012; 13:(2)103-8

Reza López SA, Poon AN, Szeto IM, Ma DW, Anderson GH High multivitamin intakes during pregnancy and postweaning obesogenic diets interact to affect the relationship between expression of PPAR genes and glucose regulation in the offspring. J Nutr Biochem. 2013; 24:(5)877-81

Royal College of Obstetricians and Gynaecologists. Healthy eating and vitamin supplements in pregnancy. 2014. (accessed 29 April 2016)

Salihu HM, Lynch O, Alio AP, Mbah AK, Kornosky JL, Marty PJ Extreme maternal underweight and feto-infant morbidity outcomes: a population-based study. J Matern Fetal Neonatal Med. 2009; 22:(5)428-34

London: SACN; 2006

London: The Stationery Office; 2007

London: The Stationery Office; 2010

Scholl TO Maternal iron status: relation to fetal growth, length of gestation, and iron endowment of the neonate. Nutr Rev. 2011; 69:S23-9

Sebire NJ, Jolly M, Harris JP Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord. 2001; 25:(8)1175-82

Shah PS, Ohlsson A Effects of prenatal multimicronutrient supplementation on pregnancy outcomes: a meta-analysis. CMAJ. 2009; 180:(12)E99-108

Smith DM, Whitworth M, Sibley C The design of a community lifestyle programme to improve the physical and psychological well-being of pregnant women with a BMI of 30 kg/m2or more. BMC Public Health. 2010; 10

Stanner MS Too much of a good thing?. Nutr Bull. 2000; 25:(3)193-5

Strain JJ, Cashman KD Minerals and Trace Elements. In: Gibney MJ, Vorster HH, Kok FJ Oxford: Blackwell Science; 2002

Treffers PE, Olukoya AA, Ferguson BJ, Liljestrand J Care for adolescent pregnancy and childbirth. Int J Gynaecol Obstet. 2001; 75:(2)111-21

Tyree S, Baker BR, Weatherspoon D On veganism and pregnancy. Int J Childbirth Educ. 2012; 27:(3)43-9

Verkaik-Kloosterman J, McCann MT, Hoekstra J, Verhagen H Vitamins and minerals: issues associated with too low and too high population intakes. Food Nutr Res. 2012; 56

Williams DJ, Edwards D, Hamernig I Vegetables containing phytochemicals with potential anti-obesity properties: A review. Food Research International. 2013; 52:(1)323-33

Williamson CS Nutrition in pregnancy. Nutr Bull. 2006; 31:(1)28-59

Williamson C, Wyness L Nutritional requirements in pregnancy and use of dietary supplements. Community Pract. 2013; 86:(8)44-7

Wood-Bradley RJ, Henry SL, Vrselja A, Newman V, Armitage JA Maternal dietary intake during pregnancy has longstanding consequences for the health of her offspring. Can J Physiol Pharmacol. 2013; 91:(6)412-20

Yang Z, Huffman SL Review of fortified food and beverage products for pregnant and lactating women and their impact on nutritional status. Matern Child Nutr. 2011; 7:19-43

Yetley EA Multivitamin and multimineral dietary supplements: definitions, characterization, bioavailability, and drug interactions. Am J Clin Nutr. 2007; 85:(1)269S-276S

Zerfu TA, Ayele HT Micronutrients and pregnancy; effect of supplementation on pregnancy and pregnancy outcomes: a systematic review. Nutr J. 2013; 12

Micronutrients and the use of vitamin and mineral supplements during pregnancy and lactation

02 June 2016
Volume 24 · Issue 6


A pregnant woman's dietary intake can have a profound effect on the outcomes of pregnancy, and may lead to a risk of disease in the child's later life. This is particularly the case for some vulnerable groups of pregnant women including adolescents, vegetarians and vegans, underweight women, obese women, and women who have undergone bariatric surgery. These groups present nutritional challenges and may require additional supervision during pregnancy. This paper discusses the effects of dietary supplements in relation to the specific needs of the aforementioned groups in comparison to the needs of the general pregnant population.

Optimal birth weight is often seen as the primary indicator of a positive pregnancy outcome, while a low birth weight or a baby born small for gestational age (SGA) is indicative of impaired fetal development (Gluckman et al, 2005). However, cardiovascular disease (CVD), obesity, type 2 diabetes mellitus (T2DM) and depression associated with birth weights within the ‘normal’ range have also been observed (Jackson and Robinson, 2001). This suggests that nutritional factors play an important role in fetal development and pregnancy outcomes. Pregnancy is a time when the maternal diet is essential, not only for the health and wellbeing of the woman herself but also for the healthy development of the growing fetus. There has been more focus on maternal diet in recent years, highlighting the consequences of suboptimal nutrition in terms of pregnancy outcomes and long-term risks to offspring. There is a growing body of evidence linking maternal diet with an increased risk for adult-onset metabolic diseases such as T2DM, CVD and some cancers (Poston, 2011; Blumfield et al, 2012; Rao et al, 2012; Wood-Bradley et al, 2013). Research by Nyaradi et al (2013) has highlighted that micronutrients such as vitamin B12, folate, zinc and iodine play a role in the neurocognitive development of babies and children.

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month