Estado de la nutrición de folato, vitamina B12 y hierro en adolescentes embarazadas

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Abstract

RESUMEN. El embarazo en la adolescencia conlleva a riesgos de tipo nutricional, ya que a la demanda de nutrientes para el crecimiento materno se suman a las necesidades del embarazo. Este estudio tuvo como propósito evaluar el estado de folato, vitamina B12 y de hierro en adolescentes embarazadas durante el primer trimestre del embarazo. Es una investigación transversal, descriptiva en 122 adolescentes embarazadas de Valencia, Estado Carabobo, 1997. Se determinaron los niveles de folato sérico, eritrocitario y de vitamina B12 sérica por radioensayo; ferritina sérica por enzimoinmunoanálisis; hemoglobina mediante método semi-automatizado. Se calculó promedios, desviación estándar y frecuencias. Para folato se encontró un 1,7% con balance negativo y 19,0% marginal, para folato eritrocitario un 5,8% de deficiencia y 1,7% marginal; vitamina B12 un 8,3% de deficiencia y 13,2% marginal, y un 19,0% de prevalencia de deficiencia de hierro. La prevalencia de anemia fue de 13,1%, siendo la deficiencia de hierro la principal causa. Existió una situación de riesgo nutricional respecto al hierro, a pesar de que su consumo excedió las recomendaciones, pero solo una pequeña proporción fue altamente biodisponible. Se concluye que la prevalencia de anemia fue inferior a la reportada en otros estudios. La prevalencia de deficiencia hierro fue superior a la de folato y vitamina B12. Las adolescentes embarazadas estudiadas se encontraron en riesgo biológico y nutricional para los nutrientes evaluados.

Translated abstract

SUMMARY. Folate, vitamin B12 and iron nutritional status in pregnant adolescents. Pregnancy in adolescence increases nutritional risk, due to higher demand of nutrients for maternal and fetal growth. This study was aimed to evaluate folate, vitamin B12 and iron status of pregnant adolescents at first trimester of pregnancy. A cross sectional, descriptive study was performed in 122 pregnant adolescents from Valencia, Carabobo state, 1997. Serum and erythrocyte folate and serum vitamin B12 was determined by radioassay; serum ferritin by enzimoimmunoassay; hemoglobin were performed by semi-automated method. Statistical analysis included standard deviation and frequencies. For serum folate 1.7% was found in negative balance and 19.0% at marginal status. For erythrocyte folate, 5.8% was deficient and 1.7% marginal. For serum vitamin B12, 8.3% was deficient and 13.2% marginal. Iron deficiency was found in 19.0% of the adolescents. Prevalence of anemia was of 13.1%, being iron deficiency the main cause. There was high nutritional risk regarding iron status, although iron intakes exceeded the recommendations, but only a small proportion was bioavailable. Prevalence of anemia was lower than reported by other studies and iron deficiency was higher than folic acid and vitamin B12 deficiences. Pregnant adolescents are at a high biological and nutritional risk.

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Iron requirements in pregnancy and strategies to meet them.

T BOTHWELL (2000)

Iron requirements are greater in pregnancy than in the nonpregnant state. Although iron requirements are reduced in the first trimester because of the absence of menstruation, they rise steadily thereafter; the total requirement of a 55-kg woman is approximately 1000 mg. Translated into daily needs, the requirement is approximately 0.8 mg Fe in the first trimester, between 4 and 5 mg in the second trimester, and >6 mg in the third trimester. Absorptive behavior changes accordingly: a reduction in iron absorption in the first trimester is followed by a progressive rise in absorption throughout the remainder of pregnancy. The amounts that can be absorbed from even an optimal diet, however, are less than the iron requirements in later pregnancy and a woman must enter pregnancy with iron stores of >/=300 mg if she is to meet her requirements fully. This is more than most women possess, especially in developing countries. Results of controlled studies indicate that the deficit can be met by supplementation, but inadequacies in health care delivery systems have limited the effectiveness of larger-scale interventions. Attempts to improve compliance include the use of a supplement of ferrous sulfate in a hydrocolloid matrix (gastric delivery system, or GDS) and the use of intermittent supplementation. Another approach is intermittent, preventive supplementation aimed at improving the iron status of all women of childbearing age. Like all supplementation strategies, however, this approach has the drawback of depending on delivery systems and good compliance. On a long-term basis, iron fortification offers the most cost-effective option for the future.

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Anemia vs iron deficiency: increased risk of preterm delivery in a prospective study.

T Scholl, M L Hediger, R L Fischer … (1992)

Using criteria from the Centers for Disease Control, anemia and iron-deficiency anemia (anemia with serum ferritin concentrations less than 12 micrograms/L) were assessed in greater than 800 inner-city gravidas at entry to prenatal care. Iron-deficiency anemia was associated with significantly lower energy and iron intakes early in pregnancy and a lower mean corpuscular volume. The odds of low birth weight were tripled and of preterm delivery more than doubled with iron deficiency, but were not increased with anemia from other causes. When vaginal bleeding at or before entry to care accompanied anemia, the odds of a preterm delivery were increased fivefold for iron-deficiency anemia and doubled for other anemias. Inadequate pregnancy weight gain was more prevalent among those with iron-deficiency anemia and in those with anemias of other etiologies. The prevalence of iron-deficiency anemia (3.5%), however, was lower than anticipated for an inner-city, minority population in whom most anemias had been attributed clinically to iron deficiency.