Evidence based fact sheet (FOLATE)

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IUGR%or%intrauterine% growth%retardation%is% designated%when%the%birth% weight%is%>%two%standard% deviations%below%median% weight%for%gestational%age% (5).% ! IUGR!is!associated!with:!

• Neonatal!death! • Poor!cognitive!development!

• Neurological!impairment!in! adulthood!

• Learning!disabilities!

• Childhood!psychiatric!disorder! • Hypertension!

• Cardiovascular!disease! • Pulmonary!disease!

• Renal!disease!(2,6)!

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1.!AbuHSaad!K,!Fraser!D.!Maternal!nutrition!and!birth!outcomes.!

Epidemiologic+reviews.!2010;32(1):5–25.!! !

2.!AbuHSaad!K,!Shahar!DR,!Fraser!D,!Vardi!H,!Friger!M,!Bolotin!A,!

Freedman!LS.!Adequacy!of!usual!dietary!intake!and!nutritional!

status!among!pregnant!women!in!the!context!of!nutrition!

transition:!the!DEPOSIT!Study.!The+British+journal+of+nutrition.! 2012:1–10.!!

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3.!Bhasin!KKS,!Nas!AV,!Martin!LJ,!Davis!RC,!Devaskar!SU.!Maternal!

LowHProtein!Diet!or!Hypercholesterolemia!Reduces!Circulating!

Essential!Amino!Acids!and!Leads!to!Intrauterine!Growth!

Restriction.!2009;58(March):559–566.!

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4.!Brown!J.!Nutrition+Through+the+Life+Cycle.!4th!ed.!Belmont,!CA:! Wadsworth;!2011:!224.!

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5.!Gropper!SS,!Smith!JL,!Groff!JL.!Advanced+Nutrition+and+Human+ Metabolism.!5th!ed.!Belmont,!CA:!Wadsworth;!2009:!189.! !

5.!Imdad!A,!Bhutta!Z!a.!Effect!of!balanced!protein!energy!

supplementation!during!pregnancy!on!birth!outcomes.!BMC+public+ health.!2011;11!Suppl!3(Suppl!3):S17.!! !

6.!Muthayya!S,!Kurpad!a!V,!Duggan!CP,!Bosch!RJ,!Dwarkanath!P,!

Mhaskar!a,!Mhaskar!R,!Thomas!a,!Vaz!M,!Bhat!S,!Fawzi!WW.!Low!

maternal!vitamin!B12!status!is!associated!with!intrauterine!growth!

retardation!in!urban!South!Indians.!European+journal+of+clinical+ nutrition.!2006;60(6):791–801.!! !

7.!Stephens!BE,!Walden!RV,!Gargus!R!a,!Tucker!R,!McKinley!L,!

Mance!M,!Nye!J,!Vohr!BR.!FirstHweek!protein!and!energy!intakes!

are!associated!with!18Hmonth!developmental!outcomes!in!

extremely!low!birth!weight!infants.!Pediatrics.!2009;123(5):1337–43.!! !

School!of!Nutrition!and!Health!Promotion!!

Phoenix,!Arizona!85004!

[email protected]!

Farryl%Bertmann,%MA,%MS%

References!

IUGR!

Protein!and!

IUGR!

Consuming!adequate!protein!

during!pregnancy!can!protect!

against!intrauterine!growth!

retardation!

!

!

!

!It!has!been!found!that!in!nutritional!interventions!

conducted!in!developing!countries,!the!most!promising!

interventions!in!preventing!adverse!pregnancy!

outcomes!is!protein!supplementation!(3,5).!!In!a!review!

of!literature,!there!is!a!significant!reduction!of!

intrauterine!growth!retardation!(restriction)!(IUGR)!and!

small!for!gestational!age!(SGA)!with!a!pooled!relative!

risk!(RR)!of!0.69!when!protein!was!supplemented!(5).!

These!interventions!have!a!more!pronounced!impact!of!

malnourished!mothers!(5).!The!IUGR!designation!is!used!

for!both!the!pathological!inhibition!of!fetal!growth!and!

lack!of!full!fetal!growth!attainment!(3,5).!!IUGR!however!

does!not!have!an!agreed!upon!definition;!definitions!

include!birth!weight!less!than!2!standard!deviations!

below!the!median!weight!for!gestational!age,!3 rd !or!5

th !

percentile!weight!for!age,!and!a!birth!weight!of!less!than!

the!10 th !percentile!(5).!The!majority!of!low!birth!weight!

(LBW)!infants!in!the!developing!world!are!a!result!of!

IUGR!(1,6).!!Complications!such!as!IUGR!and!LBW!

account!for!40%H80%!of!neonatal!death!(2).!In!addition!

to!protein!deficiency,!factors!such!as!low!socioHeconomic!

status!(SES)!and!maternal!illiteracy!are!associated!with!

IUGR!(6).!In!the!developing!world,!many!expecting!

mothers!have!a!diet!based!primarily!on!cereal.!Cereal!is!

an!incomplete!source!of!protein!and!is!limited!in!the!

essential!amino!acid!lysine!(2).!!Lysine!plays!a!key!role!in!

protein!synthesis!making!it!a!critical!amino!acid!during!

gestation!(1,2).!!In!animal!studies,!lysine!restricted!diets!

have!been!directly!associated!with!LBW!(2).!In!lysineH

deficient!human!populations!there!has!been!an!increase!

in!infant!birth!weight!in!mothers!who!either!receive!

protein!supplements!or!have!consistent!access!to!dairy!

during!pregnancy!(2).!!These!improvements!have!been!

found!to!positively!affect!the!child’s!growth!and!mental!

capacities!in!follow!up!studies!at!age!3!(2,7).!It!is!critical!

that!the!expecting!mother!consumes!adequate!animal!

and!soyHbased!protein!during!gestation!or!incorporates!a!

wide!variety!of!plantHbased!protein!to!meet!adequate!

percentages!and!quantities!of!all!the!essential!amino!

acids.!

1.1+gram+/+kg+body+weight+is+the+recommended+protein+ intake+for+expecting+mothers+(4)+

Inexpensive!

Sources!of!Protein!

Protein!is!an!important!component!

of!a!healthy,!wellHbalanced!diet.!!

Protein!can!be!found!in!animal!and!

plantHbased!sources,!but!fruits!and!

oils!contain!little!to!no!protein!(5).!!

Animal!sources!of!protein!such!as!

chicken,!fish,!pork!and!beef!as!well!

as!soybean!products!such!as!tofu!

contain!the!same!essential!amino!

acid!percentages!that!are!needed!

by!the!human!body.!PlantHbased!

protein!is!limited!in!one!or!more!

essential!amino!acids.!By!eating!a!

variety!of!plantHbased!protein!

sources;!expecting!mothers!can!

overcome!limited!essential!amino!

acids!associated!with!plantHbased!

proteins.!For!example,!an!

inexpensive!source!of!protein,!

which!contains!all!of!the!essential!

amino!acids,!is!a!meal!of!rice!and!

beans.!!