Nutrition in pregnancy: mineral and vitamin supplements

Pregnancy is associated with physiologic changes that result in increased p lasma volume and red blood cells and decreased concentrations of circulatin g nutrient-binding proteins and micronutrients. In many developing countrie s, these physiologic changes can be aggravated by undernutrition, leading t o micronutrient deficiency states, such as anemia, that can have disastrous consequences for both mothers and newborn infants. Multiple micronutrients are often taken by pregnant women in developed countries, but their benefi ts are limited, except for prophylactic folic acid taken during the pericon ceptional period. Women in developing countries may benefit from multiple-m icronutrient prophylaxis in pregnancy, but the underlying basis and rationa le for changing from supplementation with iron and folate to supplementatio n with multiple micronutrients has not been debated in the context of exist ing program objectives. There is an urgent need for this discussion so that both program effectiveness and program efficacy can be improved.