Maternal ve fetal sağlık üzerinde B12, folik asit, A, D, E ve C vitaminlerinin etkileri

Gebelik döneminde yeterli dengeli beslenme ve uygun ağırlık kazanımı gebeliğe bağlı kısa ve uzun süreli komplikasyonlardan korunmak açısından önemlidir. Gebelik süresince enerji ve besin ögesi ihtiyacı artmaktadır. Gebelik süresince besin ögelerinin yeterli alımı hem annenin hem de gelişmekte olan fetüsün sağlığı üzerinde önemli etkilere sahiptir. Gebelik döneminde vitamin eksiklikleri veya aşırı alımları maternal ve fetal sağlık sorunları riskinin artmasına neden olabilmektedir. Maternal dönemde folik asit, vitamin B12, A vitamini, D vitamini veya antioksidan vitaminlerin (E ve C vitamini) eksiklikleri fetal büyüme ve gelişme sorunlarına ayrıca preeklampsi veya gestasyonel diyabet gibi gebelik komplikasyonlarının ortaya çıkmasına neden olabilmektedir. Bunlara ek olarak maternal dönemde bu vitaminlerin yetersiz alımı bebeğin sağlığında da kalıcı sorunların oluşum riskini arttırmaktadır. Maternal dönem vitamin yetersizliklerinin çocuklarda bilişsel gelişimi de olumsuz etkileyebileceği belirtilmektedir. Günümüzde gebelik döneminde nöral tüp defekti riskini engelleyen folik asit dışındaki vitaminlerin genel bir besin desteği yapılmamakla birlikte, son yıllarda gebelik dönemi vitamin desteği ile ilgili çalışmalar yürütülmektedir. Folik asidin B12 vitamini ile birlikte homosistein düzeylerinin azaltılması yönündeki etkilerinin fetal büyüme yetersizliği ve düşük doğum ağırlığı riskinden koruyucu olabileceği de belirtilmektedir. Ayrıca D vitamininin kemik gelişim sorunları, diyabet, preeklampsi, inflamasyon ve enfeksiyon riskinden koruyabileceği bildirilmektedir. E ve C vitaminleri (antioksidan vitaminler) ile yürütülen çalışmalar ise preeklampsi riskinin engellenmesi üzerindeki etkilerine dayanmaktadır. Tüm etkileri göz önünde bulundurulduğunda bu vitaminlerin maternal dönemdeki kesin etkilerinin ve mekanizmalarının belirlenebilmesi için daha fazla çalışmaya ihtiyaç duyulmaktadır. Böylece gebeliğin ilerleyen dönemlerinde vitaminlerin besin desteği olarak verilmesi yönünde farklı uygulamalar yapılabilecektir. Günümüzde gebelik öncesi dönemden itibaren yeterli ve dengeli beslenmenin izlenmesi vitamin yetersizliklerinin erken dönemde belirlenmesini sağlayarak gebelik süresince ortaya çıkabilecek sorunların riskini azaltabilir. Bu derlemede vitamin B12, folik asit, A, D, E ve C’nin anne ve fetüsün sağlığı üzerindeki fizyolojik görevleri ve beslenme ile alım düzeylerine bağlı olarak anne ve bebek sağlığı üzerindeki etkilerinin değerlendirilmesi amaçlanmıştır.

Effects of vitamins B12, folic asid, A, D, E and C on maternal and fetal health

Adequate and balanced nutrition together with appropriate weight gain during pregnancy is important for being protected from short and long term complications. During pregnancy energy and nutrition requirements increase. Sufficient intake of nutrients has important effects on both the mother’s and the developing fetus’s health. Deficient or excessive intakes of important vitamins can increase the risk of maternal and fetal health problems. Folic acid, vitamin B12, vitamin A, vitamin D, or antioxidant vitamins (vitamin E and C) deficiencies can cause fetal growth and developmental disorders in addition to pregnancy complications such as preeclampsia and gestational diabetes. Moreover, insufficient intake of these vitamins during maternal period increases the risk of permanent health problems for the baby. Additionally, it is stated that vitamin deficiencies during the maternal period can have negative effects even on cognitional development of the children. Nowadays, only folic acid supplementation is applied to prevent the risk of neural tube defect, and recently studies are being conducted on vitamin supplementations in the maternal stage. It is stated that the effects of folic acid together with vitamin B12 on lowering the homocysteine levels can protect against the risks of insufficient fetal growth and low birth weight. Additionally, it is reported that vitamin D can be protective against bone development problems, diabetes, preeclampsia, inflammation, and infection. Studies carried on vitamins E and C (antioxidant vitamins) were focused on their effects on preventing the risk of preeclampsia. Therefore, further studies are needed to determine the exact effects and mechanisms of vitamins during the maternal period. Future research in this area may lead to successful vitamin supplementation practices during pregnancies in the future. Nowadays, following a sufficient and balance diet starting at pre-gestational period leads to early determination of vitamin deficiencies and can decrease the risk of problems that may arise during pregnancy. This review was aimed to evaluate the physiological functions and effects of vitamins B12, folic acid, A, D, E, and C on the mother’s and the fetus’s health.

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1. McArdle HJ, Ashworth CJ. Micronutrients in fetal growth and development. Br Med Bull, 1999; 55: 499-510.
2. Kabaran S, Samur G. Maternal Obezite ve Gebelik. Beslenme ve Diyet Dergisi, 2010; 38 (1-2): 45-52.
3. Roberfroid D, Huybregts L, Lanou H, Habicht JP, Henry MC, Meda N, et al. Prenatal Micronutrient Supplements Cumulatively Increase Fetal Growth. J Nutr, 2012; 142: 548-54.
4. Zempleni J, Rucker RB, McCormick DB, Suttie JW. Handbook of vitamins. 4th ed. New York: CRC Press, Taylor and Francis Group, 2007, 2-403
5. Greene ND, Stanier P, Copp AJ. Genetics of human neural tube defects. Hum Mol Genet, 2009; 18: 113-29.
6. El-Khairy L, Vollset SE, Refsum H, Ueland PM. Plasma total cysteine, pregnancy complications, and adverse pregnancy outcomes: the Hordaland homocysteine study. Am J Clin Nutr, 2003; 77: 467-72.
8. Gadhok AK, Sinha M, Khunteta R, Vardey SK, Upadhyaya C, Sharma TK, Jha M. Serum homocysteine level and its association with folic acid and vitamin B12 in the third trimester of pregnancies complicated with intrauterine growth restriction. Clin Lab, 2011; 57 (11-12): 933-8.
9. Yajnik CS, Deshmukh US. Fetal programming: Maternal nutrition and role of one-carbon metabolism. Rev Endocr Metab Disord, 2012; 13(2): 1-7.
10. Bergen NE, Jaddoe VWV, Timmermans S, Hofman A, Lindemans J, Russcher H, et al. Homocysteine and folate concentrations in early pregnancy and the risk of adverse pregnancy outcomes: The generation R study. BJOG, 2012; 119 (6): 739-51.
11. Dorum BA, Şilfeler İ, Dorum S, Şilfeler DB, Canbak Y, Kurnaz H. Anne vitamin B12 ve folat düzeylerinin bebek doğum ağırlığı üzerine etkisi. J Kartal TR, 2009; 20 (3): 121-9.
12. Shaw GM, Carmichael SL, Nelson V, Selvin S, Schaffer DM. Occurrence of low birthweight and preterm delivery among California infants before and after compulsory food fortification with folic acid. Public Health Rep, 2004; 119: 170-3.
13. Dülger H, Reşber H, Şekeroğlu MR, Yılmaz C, Özcan S. Prematür bebeklerin annelerinde homosistein düzeylerinin araştırılması. Tıp Araştırmaları Dergisi, 2008; 6 (1): 7-12.
14. Berti C, Biesalski HK, Gärtner R, Lapillonne A, Pietrzik K, Poston L, et al. Micronutrients in pregnancy: Current knowledge and unresolved questions. Clin Nutr, 2011; 30: 689-701.
15. Scholl TO, Johnson WG. Folic acid: influence on the outcome of pregnancy. Am J Clin Nutr, 2000; 71: 1295–300.
16. Czeizel AE, Dobó M, Vargha P. Hungarian cohort- controlled trial of periconceptional multivitamin supplementation shows a reduction in certain congenital abnormalities. Birth Def Res (Part A), 2004; 70: 853-61.
17. Hacettepe Üniversitesi Beslenme ve Diyetetik Bölümü. Türkiye’ye özgü beslenme rehberi. T.C. Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü Beslenme ve Fiziksel Aktiviteler Daire Başkanlığı, 2004: 57-60.
18. McNulty H, Scott JM. Intake and status of folate and related B-vitamins: considerations and challenges in achieving optimal status. Br J Nutr, 2008; 99: 48-54.
19. Daly LE, Kirke PN, Molloy A, Weir DG, Scott JM. Folate levels and neural tube defects. Implication for prevention. JAMA, 1995; 274: 1698-702.
20. Lamers Y, Prinz-Langenohl R, Brämswig S, Pietrzik K. Red blood cell folate concentrations increase more after supplementation with [6S]- 5-methyltetrahydrofolate than with folic acid in women of childbearing age. Am J Clin Nutr, 2006; 84: 156-61.
21. Çakmak P, Minareci Y, Yuvanç O, Var T, Güngör T, Mollamahmutoğlu L. Gebelik öncesi dönem ve gebelikte folik asit kullanımı. J Turk Soc Obstet Gynecol, 2006; 3 (3): 157-61.
22. Institute of Medicine. Panel on Folate, Other B Vitamins, and Choline. Dietary Reference Intake; Thiamine, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington: National Academy Press, 1998.
23. Suarez L, Hendricks K, Felkner M, Gunter E. Maternal serum B12 levels and risk for neural tube defect in a Texas-Mexico Border Population. Ann Epidemiol, 2003; 13: 81–8.
24. Wang ZP, Shang XX, Zhao ZT. Low maternal vitamin B12 is a risk factor for neural tube defects: a meta- analysis. J Matern Fetal Neonatal Med, 2012; 25 (4): 389–94.
25. Molloy AM, Kirke PN, Troendle JF, Burke H, Sutton M, Brody LC, et al. Maternal vitamin B12 status and risk of neural tube defects in a population with high neural tube defect prevalence and no folic acid fortification. Pediatrics, 2009; 123 (3): 917-23.
26. Karaca NE, Karaca E, Onay H, Gunduz C, Egemen A, Ozkinay F. Nöral tüp defektlerinde annelerde MTHFR gen polimorfizmleri ve diğer risk faktörlerinin değerlendirilmesi. Ege Tıp Dergisi, 2012; 51 (1): 37-42.
27. Hollingsworth JW, Maruoka S, Boon K, Garantziotis S, Li Z, Tomfohr J, et al. In utero supplementation with methyl donors enhances allergic airway disease in mice. J Clin Invest, 2008; 118 (10): 3462–69.
28. Waterland RA, Michels KB. Epigenetic epidemiology of the developmental origins hypothesis. Annu Rev Nutr, 2007; 27: 363–88.
29. Haberg SE, London SJ, Stigum H, Nafstad P, Nystad W. Folic acid supplements in pregnancy and early childhood respiratory health. Arch Dis Child, 2009; 94: 180-4.
30. Whitrow MJ, Moore VM, Rumbold AR, Davies MJ. Effect of supplemental folic acid in pregnancy on childhood asthma: a prospective birth cohort study. Am J Epidemiol, 2009; 170: 1486-93.
31. Martinussen MP, Risnes KR, Jacobsen GW, Bracken MB. Folic acid supplementation in early pregnancy and asthma in children aged 6 years. Am J Obstet Gynecol, 2012; 206: 1-7.
32. Redman CW, Sacks GP, Sargent IL. Preeclampsia: an excessive maternal inflammatory response to pregnancy. Am J Obstet Gynecol, 1999; 180: 499-506.
33. Raijmakers MT, Dechend R, Poston L. Oxidative stress and pre-eclampsia; rationale for antioxidant clinical trials. Hypertension, 2004; 44: 374-80.
34. Perkins AV. Endogenous anti-oxidants in pregnancy and preeclampsia. Aust New Zealand J Obstetr Gynaecol, 2006; 46: 77-83.
35. Chappell LC, Seed PT, Briley AL, Kelly FJ, Lee R, Hunt BJ, et al. Effect of antioxidants on the occurrence of pre-eclampsia in women at increased risk: a randomised trial. Lancet, 1999; 354: 810-6.
36. Poston L, Briley AL, Seed PT, Kelly FJ, Shennan AH; Vitamins in Preeclampsia (VIP) Trial Consortium. Vitamin C and vitamin E in pregnant women at risk for pre-eclampsia (VIP trial): randomised placebo-controlled trial. Lancet, 2006; 367: 1145-54.
37. Roberts JM, Myatt L, Spong CY, Thom EA, Hauth JC, Leveno KJ, et al. Vitamins C and E to prevent complications of pregnancy-associated hypertension. N Engl J Med, 2010; 362: 1282-91.
38. Villar J, Purwar M, Merialdi M, Zavaleta N, Thi Nhu Ngoc N, Anthony J, et al. World Health Organisation multicentre randomised trial of supplementation with vitamins C and E among pregnant women at high risk for pre-eclampsia in populations of low nutritional status from developing countries. BJOG, 2009; 116 (6): 780-8.
39. Özçelik B, Başbuğ M, Sarıkaya M, Serin İS, Tayyar M, Kendirci M. Low dose vitamin E supplementation is not effective in the prevention of preeclampsia in low risk women according to historical risk factors. Gynecol Obstet Reprod Med, 2004; 10: 167-71.
40. Conde-Agudelo A, Romero R, Kusanovic JP, Hassan SS. Supplementation with vitamins C and E during pregnancy for the prevention of preeclampsia and other adverse maternal and perinatal outcomes: a systematic review and metaanalysis. Am J Obstet Gynecol, 2011; 204(6): 503. e1-12.
41. Afzhal-Ahmed I, Mann CE, Shennan AH, Poston L, Naftalin RJ. Pre-eclampsia inactivates glucose-6- phopshate dehydrogenase and impairs the redox status of erythrocytes and fetal endothelial cells. Free Radic Biol Med, 2007; 42: 1781-90.
42. Strobel M, Tinz J, Biesalski HK. The importance of beta-carotene as a source of vitamin A with special regard to pregnant and breastfeeding women. Eur J Nutr, 2007; 46: 1-20.
43. Duerbeck NB, Dowling DD. Vitamin A: Too Much of a Good Thing? Obstet Gynecol Surv, 2012; 67: 122-8.
44. Urrutia RP, Thorp JM. Vitamin D in pregnancy: current concepts. Curr Opin Obstet Gynecol, 2012; 24: 57–64.
45. Kurtoğlu S, Korkmaz L, Memur Ş. D vitamininin intrauterin etkileri. Turkiye Klinikleri J Pediatr Sci, 2012; 8(2): 18-23.
46. Lapillonne A. Vitamin D deficiency during pregnancy may impair maternal and fetal outcomes. Med Hypotheses, 2010; 74: 71-5.
47. Zhang C, Qiu C, Hu FB, David RM, van Dam RM, Bralley A, et al. Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus. PLoS ONE, 2008; 3 (11): e3753 1-6.
48. Poel YHM, Hummel P, Lips P, Stam F, van der Ploeg T, Simsek S. Vitamin D and gestational diabetes: A systematic review and meta-analysis. Eur J Intern Med, 2012; 23 (5): 465-9.
49. Sørensen IM, Joner G, Jenum PA, Eskild A, Torjesen PA, Stene LC. Maternal serum levels of 25-hydroxy vitamin D during pregnancy and risk of type 1 diabetes in the offspring. Diabetes, 2012; 61 (1): 175-8.
50. Peechakara SV, Pittas AG. Vitamin D as a potential modifier of diabetes risk. Nat Clin Pract Endocrinol Metab, 2008; 4: 182-3.
51. Teegarden D, Donkin SS. Vitamin D: emerging new roles in insulin sensitivity. Nutr Res Rev, 2009; 22: 82-92.
52. Chiu KC, Chu A, Go VL, Saad MF. Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am J Clin Nutr, 2004; 79: 820-5.
53. Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab, 2007; 92: 3517-22.
54. Wei S, Audibert F, Hidiroglou N, Sarafin K, Julien P, Wu Y, et al. Longitudinal vitamin D status in pregnancy and the risk of pre-eclampsia BJOG, 2012; 119 (7): 832-9.
55. Evans KN, Nguyen L, Chan J, Innes BA. Effects of 25-Hydroxyvitamin D3 and 1,25-dihydroxyvitamin D3 on cytokine production by human decidual cells. Biol Reprod, 2006; 75: 816-22.
56. Saffery R, Ellis J, Morley R. A convergent model for placental dysfunction encompassing combined sub-optimal one-carbon donor and vitamin D bioavailability. Med Hypotheses, 2009; 73: 1023-8.
57. Perçin Z, Kurtoğlu E. The association of maternal serum calcium and 25-hydroxyvitamin D concentration in each trimester of pregnancy with preeclampsia. J Exp Clin Med, 2011; 28: 145-9.
58. Brannon PM. Symposium 3: Vitamin D and immune function: from pregnancy to adolescence: Vitamin D and adverse pregnancy outcomes: Beyond bone health and growth. Proc Nutr Soc, 2012; 71 (2): 205-12.
59. Hewison M. Vitamin D and innate immunity. Curr Opin Investig Drugs, 2008; 9: 485-90.
60. Litonjua AA. Vitamin D deficiency as a risk factor for childhood allergic disease and asthma. Curr Opin Allergy Clin Immunol, 2012; 12: 179-85.
61. Camargo Jr CA, Rifas-Shiman SL, Litonjua AA, Rich- Edwards JW, Weiss ST, Gold DR, 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: 788-95.
62. Yeşiltepe-Mutlu G, Hatun Ş. Perinatal D vitamini yetersizliği. Çocuk Sağlığı ve Hastalıkları Dergisi, 2011; 54: 87-98.
63. Orbak Z, Hatun Ş, Özkan B, Döneray H, Çizmecioğlu F, Toprak D. Erken bebeklik döneminde D vitamini yetersizliğinin özellikleri. Çocuk Sağlığı ve Hastalıkları Dergisi, 2005; 48: 8-13.
64. Hollis BW. Circulating 25-hydroxyvitamin D levels indicative of vitamin D sufficiency: implications for establishing a new effective dietary intake recommendation for vitamin D. J Nutr, 2005; 135: 317-22.
65. Bodnar LM, Simhan HN, Powers RW, Frank MP, Cooperstein E, Roberts JM. High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates. J Nutr, 2007; 137: 447-52.
66. Pehlivan İ, Hatun Ş, Aydoğan M, Babaoğlu K, Türker G, Gökalp AS. Maternal serum vitamin D levels in the third trimester of pregnancy. Turk J Med Sci, 2002; 32: 237-241.