Gebelikte besin destekleri: güncel kanıtlar ışığında öneriler

Year 2025, Volume: 50 Issue: 1, 241 - 249, 31.03.2025

Selim Büyükkurt , İsmail Cüneyt Evrüke

https://doi.org/10.17826/cumj.1626746

Abstract

Gebelik sonuçlarını etkileyen pek çok neden arasında anne adayının beslenmesi önemli bir yer tutar. Beslenme bozukluğu bazen besin eksikliği ile kendini gösterirken, bazen de fazla beslenme olarak karşımıza çıkar. Bir diğer sorunsa beslenmeye destek olması umuduyla kullanılan besin dışı maddelerdir. Besin dışı maddelerin bir kısmı ilaç olarak üretilmiş ve ruhsatlanmışken, azımsanmayacak kadarı da gıda takviyesi olarak pazarlanmaktadır. Gıda takviyesi sıfatındaki ürünlerin içerikleri, hazırlanma yöntemleri de ilaçlardaki kadar sıkı denetim altında değildir. Hastalara bir ilaç ya da ürünü önerirken hedef, somut bir şekilde tanımlanmış yararı elde etmek olmalıdır. Sadece zararının olmayacağı, bu maddelerin içeriklerinin zaten vücutta doğal olarak bulunduğu düşüncesi yeterli değildir. Kullanılan maddenin olası yan etki, istenmeyen etki, ilaç etkileşimleri açısından yarar/zarar değerlendirmesi göz önüne alınmalıdır. Söz konusu grup gebeler olunca gebeliğin her haftasındaki fizyolojinin farklılıkları ile büyümekte olan fetusun ihtiyaçlarının değişiklik göstermesi ve dış etmenlere dayanaklılığının da değişiklik gösterdiği akılda tutulmalıdır. Yazımızda sıklıkla kullanılan, tavsiye edilen, reçete edilen, gebelik sonuçlarını olumlu etkilemesi beklenen ürünleri kanıta dayalı tıp açısından irdelemeye çalıştık. İncelememizin sonucunda rutin kullanımında yararı gösterilmiş ürünlerin sadece gebelik öncesi ve ilk üçayda folik asit ile tüm gebelik boyunca demir olduğunu gördük. Diğer ürünler için ise esas olarak besinler yoluyla elde edilmelerinin, tüm yaşam boyunca dengeli ve düzenli beslenmenin öneminin vurgulanmasının, eğitiminin verilmesinin geçerli yol olduğu sonucuna vardık.

Keywords

gebelik, beslenme, mineral, omega-3 yağ asidi, vitamin

Nutritional supplements in pregnancy: recommendations based on current evidence

Abstract

Among the many factors affecting the outcome of pregnancy, the nutrition of the expectant mother plays an important role. Malnutrition is sometimes manifested by nutrient deficiencies and sometimes by over-nutrition. Another problem is the use of non-nutrient products in the hope of supporting nutrition. While some of these non-nutrients are produced and licensed as medicines, a considerable number of them are marketed as food supplements. The ingredients and preparation methods of food supplements are not as strictly controlled as those of medicines. When recommending a drug or product to patients, the goal should be to achieve a concretely defined benefit. It is not enough to simply assume that there will be no harm and that the ingredients of these substances are already naturally present in the body. The benefit/harm assessment of the substance used in terms of possible side effects, undesirable effects and drug interactions should be taken into consideration. When the group in question is pregnant women, it should be kept in mind that the differences in physiology in each week of pregnancy and the needs of the growing fetus and its resistance to external factors also vary. In our article, we tried to examine the products that are frequently used, recommended, prescribed and expected to positively affect pregnancy outcomes in terms of evidence-based medicine. As a result of our review, we found that the only products that have been shown to be beneficial in routine use are folic acid before pregnancy and in the first trimester and iron throughout pregnancy. For the other products, we concluded that it is valid to provide education about the importance of balanced and regular nutrition throughout life. .

Keywords

pregnancy, nutrition, mineral, omega-3 fatty acid, vitamin

References

• World Bank. Fertility Rate, Total (Births Per Woman). https://data.worldbank.org/indicator/SP.DYN.TFRT.IN. 2022. (Accessed: 08.01.2025).
• Bearak JM, Popinchalk A, Beavin C, Ganatra B, Moller AB, Tunçalp Ö et al. Country-specific estimates of unintended pregnancy and abortion incidence: a global comparative analysis of levels in 2015–2019. BMJ Glob Health. 2022;7:e007151.
• Hanson MA, Bardsley A, De-Regil LM, Moore SE, Oken E, Poston L, et al. The international federation of gynecology and obstetrics (FIGO) recommendations on adolescent, preconception, and maternal nutrition: “think nutrition first”. Int J Gynecol Obstet. 2015;131:213–53.
• Middleton P, Gomersall JC, Gould JF, Shepherd E, Olsen SF, Makrides M. Omega-3 fatty acid addition during pregnancy. Cochrane Database of Syst Rev. 2018;11:CD003402.
• Cetin I, Carlson SE, Burden C, da Fonseca EB, di Renzo GC, Hadjipanayis A et al. Omega-3 fatty acid supply in pregnancy for risk reduction of preterm and early preterm birth. Am J Obstet Gynecol MFM. 2024;6:101251.
• Christifano DN, Crawford SA, Lee G, Brown AR, Camargo JT, Kerling EH et al. Docosahexaenoic acid (dha) intake estimated from a 7-question survey identifies pregnancies most likely to benefit from high-dose DHA supplementation. Clin Nutr ESPEN. 2023;53:93–9.
• Jiang Y, Chen Y, Wei L, Zhang H, Zhang J, Zhou X et al. DHA supplementation and pregnancy complications. J Transl Med. 2023;21:394.
• WHO. WHO Antenatal Care Recommendations for a Positive Pregnancy Experience. Nutritional Interventions Update: Multiple Micronutrient Supplements during Pregnancy. Geneva, World Health Organization. 2020.
• American College of Obstetricians and Gynecologists. Committee opinion no 495. Vitamin d: screening and supplementation during pregnancy. Obstet Gynecol. 2011;118:197-8.
• WHO antenatal care recommendations for a positive pregnancy experience. nutritional interventions update: vitamin d supplements during pregnancy. Geneva: World Health Organization. 2020. (accessed: 08 January 2025).
• Bastos Maia S, Rolland Souza AS, Costa Caminha MF, Lins da Silva S, Callou Cruz RSBL, Carvalho Dos Santos C et al. Vitamin a and pregnancy: a narrative review. Nutrients. 2019;11:681.
• Rajwar E, Parsekar SS, Venkatesh BT, Sharma Z. Effect of vitamin a, calcium and vitamin d fortification and supplementation on nutritional status of women: an overview of systematic reviews. Syst Rev. 2020;9:248.
• Nucera B, Brigo F, Trinka E, Kalss G. Treatment and care of women with epilepsy before, during, and after pregnancy: a practical guide. Ther Adv Neurol Disord. 2022;15:1–31.
• Rumbold A, Ota E, Hori H, Miyazaki C, Crowther CA. Vitamin e supplementation in pregnancy. Cochrane Database Syst Rev. 2015;9:CD004069.
• Rumbold A, Ota E, Nagata C, Shahrook S, Crowther CA. Vitamin c supplementation in pregnancy. Cochrane Database Syst Rev. 2015;9:CD004072.
• Fejzo MS, Trovik J, Grooten IJ, Sridharan K, Roseboom TJ, Vikanes Å et al. Nausea and vomiting of pregnancy and hyperemesis gravidarum. Nat Rev Dis Primers. 2019;12;5:62.
• Palawaththa S, Islam RM, Illic D, Rabel K, Lee M, Romero L et al. Effect of maternal dietary niacin intake on congenital anomalies: a systematic review and meta-analysis. Eur J Nutr. 2022;61:1133-42.
• Jayawardena R, Majeed S, Sooriyaarachchi P, Abeywarne U, Ranaweera P. The effects of pyridoxine (vitamin b6) supplementation in nausea and vomiting during pregnancy: a systematic review and meta-analysis. Arch Gynecol Obstet. 2023;308:1075-84.
• Salam RA, Zuberi NF, Bhutta ZA. Pyridoxine (vitamin b6) supplementation during pregnancy or labour for maternal and neonatal outcomes. Cochrane Database Syst Rev. 2015;6:CD000179.
• de Andrade Silva Cavalcanti R, Diniz ADS, de Arruda IKG. Concentrations of intra-erythrocyte folate, serum vitamin b12, and hemoglobin in women of childbearing age and associated factors. J Am Coll Nutr. 2019;38:739-45.
• Wilson RD, Audibert F, Brock JA, Carroll J, Cartier L, Gagnon A et al. Pre-conception folic acid and multivitamin supplementation for the primary and secondary prevention of neural tube defects and other folic acid-sensitive congenital anomalies. J Obstet Gynaecol Can. 2015;37:534–49.
• Wojtowicz A, Babczyk D, Galas A, Skalska-Swistek M, Gorecka M, Witkowski R et al. Evaluation of the prevalence of folic acid supplementation before conception and through the first 12 weeks of pregnancy in polish women at high risk of fetal anomalies. Ginekol Pol. 2022;93:489-95.
• Sinkey RG, Ogunsile FJ, Kanter J, Bean C, Greenberg M. Society for maternal-fetal medicine consult series #68: sickle cell disease in pregnancy. Am J Obstet Gynecol. 2024;230:B17-40.
• Moussa HN, Hosseini Nasab S, Haidar ZA, Blackwell SC, Sibai BM. Folic acid supplementation: what is new? fetal, obstetric, long-term benefits and risks. Future Sci OA. 2016;21:FSO116.
• Rashid S, Meier V, Patrick H. Review of vitamin b12 deficiency in pregnancy: a diagnosis not to miss as veganism and vegetarianism become more prevalent. Eur J Haematol. 2021;106:450-5.
• WHO. WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience. Geneva, World Health Organization. 2016.
• Hofmeyr GJ, Lawrie TA, Atallah ÁN, Torloni MR. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev. 2018;10:CD001059.
• WHO. WHO Antenatal Care Recommendations for a Positive Pregnancy Experience. Nutritional Interventions Update: Zinc Supplements during Pregnancy. Geneva, World Health Organization, 2021.
• Luo L, Zhou K, Zhang J, Xu L, Yin W. Interventions for leg cramps in pregnancy. Cochrane Database Syst Rev 2020;12:CD010655