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TECNOCIENCIA CHIHUAHUA, Vol. XVIII (3): e1584 (septiembre-diciembre, 2024)

Literature review paper

Teenage Pregnancy and Micronutrient Deficiency: A

Critical Review

Embarazo adolescente y deficiencia de micronutrientes: Una revisión

crítica

*Correspondencia: Correo electrónico: sunday_nupo@uadec.edu.mx (Aldair Olguin-Romero)

DOI:

Recibido: 22 de julio de 2024; Aceptado: 12 de noviembre de 2024

Publicado por la Universidad Autónoma de Chihuahua, a través de la Dirección de Investigación y Posgrado.

Editor de Sección: Dr. Julián Esparza-Romero

Abstract

Adolescence is a critical stage where growth is at its peak and when a pregnancy occurs in this

period, it represents a greater nutritional risk for both the mother and the growing fetus. Young

pregnant adolescents are more likely to give birth to babies with certain congenital anomalies, lower

birth weight, and higher chances of infant mortality. Insufficient micronutrients in maternal

nutrition during pregnancy can increase the risk of birth defects in newborns. This can be attributed

to the fact that the developing fetus depends on the mother's nutrition for its proper growth,

metabolic processes, and proper development. Malnutrition during pregnancy can lead to a variety

of birth defects, including neural tube closure defects, cleft lip and palate, congenital heart defects,

and increased fetal mortality. Iron deficiency early in pregnancy in the first and second trimesters

could lead to premature birth or decreased birth weight and negatively impact the health of

newborns. Most spontaneous abortions observed in adolescents during the first trimester could be

attributed to nutritional deficiency of the mothers prior to conception. Few of the miscarriages

observed in adolescents during the first trimester could be attributed to the nutritional deficiency of

the mothers prior to conception.

Keywords: anaemia, teenagers, pregnancy, micronutrients.

Sunday Sedodo Nupo1*, Viridiana Martínez-De la Fuente2, Gabriela Ortiz-Cruz1, José Lauro

Cortés-Hernández2

1 Universidad Autónoma de Coahuila, Centro de Investigación en Genética y Genómica (CIGEN), Calzada

Francisco I. Madero 1291, Zona Centro, Segundo piso, HUS, 25000 Saltillo, Coah.

2 Hospital Universitario de Saltillo “Dr. Gonzalo Valdés Valdés” (HUS). Calzada Francisco I. Madero 1291,

Zona Centro, 25000 Saltillo, Coah.

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TECNOCIENCIA CHIHUAHUA, Vol. XVIII (3): e1584 (septiembre-diciembre, 2024)

Resumen

La adolescencia, etapa crítica donde el crecimiento está en su punto máximo y cuando un embarazo

ocurre en este período, representa un mayor riesgo nutricional tanto para la madre como para el feto

en crecimiento. Las jóvenes adolescentes embarazadas tienen una mayor tendencia de dar a luz a

bebés con ciertas anomalías congénitas, menor peso al nacer y mayores posibilidades de mortalidad

infantil. La insuficiencia de micronutrientes en la nutrición materna durante la gestación puede

aumentar el riesgo de defectos congénitos en los recién nacidos. Esto se puede atribuir a que el feto

en desarrollo depende de la nutrición de la madre para su adecuado crecimiento, procesos

metabólicos y adecuado desarrollo. La desnutrición durante el embarazo puede provocar una

variedad de anomalías congénitas, como defectos de cierre del tubo neural, labio y paladar hendido,

defectos cardíacos congénitos y mayor mortalidad fetal. La deficiencia de hierro al inicio del

embarazo en el primer y segundo trimestre podría provocar un parto prematuro o una disminución

del peso al nacer y un impacto negativo en la salud de los recién nacidos. Pocos de los abortos

espontáneos observados en adolescentes durante el primer trimestre podrían atribuirse a la

deficiencia nutricional de las madres antes de la concepción.

Palabras clave: anemia, adolescentes, embarazo, micronutrientes.

1. Introduction

Malnutrition refers to an imbalance in nutrition within the human body, either in excess or

deficit. This term is most associated with the latter form of malnutrition in the context of low and

middle-income countries (LMICs) [Yimer and Wolde, 2022]. The high prevalence and serious

implications of malnutrition including micronutrient deficiencies make the nutrition of teenage girls

and young women in LMICs particularly crucial (Keats et al., 2022). Malnutrition can manifest in

different ways resulting in infections, noncommunicable diseases, disability, or death. It becomes a

significant issue when observed in adolescents, who have specific nutritional requirements for their

bodies, especially during pregnancy. Micronutrient deficiencies affect two billion people living in

(LMICs). Micronutrient deficits deteriorate during pregnancy and have long-term effects on both the

mother and the fetus. Women who receive micronutrient supplements throughout pregnancy and

breastfeeding may be able to lessen these effects (Shinde et al., 2022).

Supplementing with micronutrients during pregnancy is essential for promoting good growth and

development and guarding against preterm birth and low birth weight (Bekele et al., 2024). Depletion

may result from the fetus' rapid growth and development throughout pregnancy as well as its

enlarged vascular volume (Georgieff et al., 2020). Research has indicated that inadequate intake of

certain micronutrients during pregnancy can heighten the likelihood of low birth weight and

premature deliveries (Georgieff et al., 2020). The World Health Organization (WHO) advises all

pregnant women to take a daily supplement of iron throughout their pregnancy to lessen these

effects (WHO, 2016). The deficits of certain micronutrients such as iodine, selenium, iron, zinc,

calcium, magnesium, and folate that are germane in the proper fetus formation in pregnancy and

their effects on adolescent pregnancies are the main topics of this narrative review.

Firstly, the development of the cranium is one of the most intricate processes in the human body

(Babai and Irving, 2023). Birth deformities that affect the mouth and face include cleft lip and palate.

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When the tissues that make up the lip and palate don't fuse correctly during development, these

abnormalities happen. Although the exact cause of cleft lip and palate is unknown, inadequate

nutrition for expectant mothers has been associated with an increased incidence of the condition.

Another birth issue that may be connected to inadequate nourishment for the mother is heart defect.

The structure and function of the heart may be impacted by several disorders, which can range in

severity. According to research, women who consumed more folic acid both before and throughout

their first pregnancy were less likely to give birth to a baby who had a congenital heart abnormality.

Pregnant women have long utilized folic acid (FA), a synthetic version of folate, as a dietary

supplement. It has been established that supplementing with FA can prevent fetal neural tube

abnormalities (NTDs) from occurring and from recurring. On the other hand, congenital heart

disease (CHD) incidence has been rising globally in tandem (Cheng et al., 2022).

Furthermore, micronutrient deficiencies during pregnancy can have long-term effects on the

developing fetus. A prolonged period of severe nutrient shortage can result in several crises,

including weakened immune function, redox signaling, wounds scarring, and the expression of

genes that regulate the development of diseases (Zemrani and Bines, 2020). Moreover, iodine and

iron deficits have been linked to harm to the fetus' neurodevelopment (Zemrani and Bines, 2020).

The fetus has a store of nutrients during the second and third trimesters of adolescent pregnancy

that can be used after birth; as a result, children's growth during the first two years of life defined as

the child's first 1000 days is accelerated in comparison to children without adequate store of nutrients

(Beluska, 2019). This time frame is necessary for growth and development and is remarkably the

result of the dietary standards provided; if these standards are not met, the baby may experience

deficiencies in development, including brain function (Beluska, 2019). Most reviews on pregnancy

that were done on adults concentrated on vitamin D and folate (Wilson et al., 2018; Palacios et al.,

2019; Rajwar et al., 2020).

Pregnant teens should be provided with a choice of nutrient-dense foods that will support their

growth and their increased requirement for many nutrients should be highlighted. The months of

pregnancy are crucial because during this time, the mother's and the fetus' growth and development

depend more on several nutrients. The body requires the greatest amount of micronutrients at this

time to support several functions, such as bone formation and metabolic functions. Women who start

menstruating have considerably higher iron needs, and these needs only grow when they get

pregnant. Also, their need for magnesium, vitamin A, and folate rises and resembles those of adults.

Deficiencies of iron, iodine, and zinc are often neglected despite their major role in the health of

pregnant adolescents. Thus, this review focuses on the effects of selected micronutrients that are vital

to teenage pregnancy

2. Methods

This is a narrative review of studies published prior to August 2024 using "Pregnancy and

Micronutrient Deficiency / Adolescent Pregnancy and Micronutrient Deficiency” in biomedical

databases. The main inclusion criterion was that articles needed to have systematic reviews and meta-

analyses of the micronutrient status of pregnant women, teenage pregnancy, and micronutrient

deficiency. The following search strategy was applied: articles were extracted from PubMed, google

scholar, web of Science, and grey literature using the terms “Pregnancy”, “Adolescent pregnancy”,

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“micronutrients”, “micronutrients deficiency”, and in combination with ‘’Teenage pregnancy

micronutrients efficiency”. The most relevant and essential literature in the field was identified using

expert knowledge on nutrition and incorporated into the article. These articles' titles and abstracts

were screened to determine if they fulfilled the eligibility criteria. The articles included had to be

related to pregnancy, teenage pregnancy, micronutrients, importance and deficiencies of

micronutrients. Studies were excluded if: 1) subjects did not have micronutrients deficient status

reported; 2) micronutrients status was not reported quantitatively using primary micronutrient

markers; 3) the micronutrients status was not reported in association with

prenatal/maternal/intrauterine; 4) full - length text was not available; 7) specific study types,

including, dissertations, animal studies, correspondences, editorials, conference proceedings, and

health letters.

3. Effects of minerals on teenage pregnancy and fetal development

3.1. Iodine (I)

This is a crucial part of the thyroid hormones thyroxine (T4) and triiodide-thyronine (T3),

which regulate the thyroid gland and the immune system in several biological processes (Shahid et

al., 2024). Iodine deficiency exists throughout all life cycle but is more severe in pregnant teenagers,

lack of iodine leads to hypothyroidism and other disorders, classified as iodine deficiency disorders

(IDDs) [Zhou et al., 2019]. Iodine supplementation can be recommended to fulfill individual needs,

especially for juvenile expectant mothers, to prevent the potential impacts that its deficiency can

have on the neural development of the fetus (Zhou et al., 2019).

Teenagers who are pregnant need more nutrients during their pregnancy to meet the needs of both

the mother and the developing fetus. In addition to giving the fetus iodine, the mother's thyroid

hormones must be maintained at normal levels, especially during the first trimester. Furthermore,

especially in the first trimester of pregnancy, this increase is necessary to supply iodine clearance by

the kidneys (Zimmermann, 2016). Likewise, iodine deficiency can manifest in other forms such as

oxidative stress, causing disturbances in trophoblastic cell function and the placental vascular net,

and weakened redox balance since it can compete with free radicals or induce the action of enzymes

with antioxidant activity (Olivo-Vidal et al.,2016).

Due to its irreversible effects, iodine deficiency is particularly risky for teenage pregnancies,

reproductive-age women, and women who are pregnant or nursing. This mineral increases the risk

of irreparable damage because it is essential for neuron migration and myelination in the brain and

causes hypothyroxinemia when levels are low (Olivo-Vidal et al.,2016). The primary cause of the

unavoidable mental delay during the embryonic phase is iodine deficiency, which can cause an IQ

(Intelligence Quotient) decline of up to 20 points (Olivo-Vidal et al.,2016).

3.2. Selenium (Se)

A mineral with antioxidant properties is selenium. It is an integral component of the

antioxidant enzyme GSH-Px, which balances free radicals and prevents the body from producing

more of them. It also maintains the body's natural defenses, controls growth and development,

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activates the immune system, and guards against cancer and heart disease (Hofstee et al., 2020).

Foods high in selenium include cereals, vegetables, meat, and oilseeds such as nuts, but the amount

of selenium in the diet varies depending on the climate. Selenium is easily absorbed from diets

because of its high bioavailability (Olivo-Vidal et al., 2016). For people aged 19 to 50, the

recommended daily consumption quantities are 45 to 50 µg, 60 µg for women, and 70 µg for adults

and for men and nursing moms, it is 75 µg (Stoffaneller and Morse, 2015). Selenium levels below 0.9

µmol/L have been associated with reduced thyroid hormone balance; this effect is more pronounced

in older persons over 65 and youngsters. Significant amounts of selenium have been found in the

thyroid gland, indicating that the mineral is necessary for regular biological activity.

More specifically, there has been a stronger correlation shown between decreased innate and

adaptive immune system activity and the activity of selenium-containing proteins in the oxidative

system, which eliminates free oxygen radicals produced during the synthesis of thyroid hormones.

Selenium insufficiency is also associated with the development of cretinism because of its direct

linkage with iodine during the body's conversion of hormones (Stoffaneller and Morse, 2015; Mao et

al., 2016; Nogales et al.,2017).

A shortage in selenium during pregnancy can impact the T cells, leading to an increase in oxidant

substance production and other issues that impact both the mother and the developing fetus. Pre-

eclampsia, glucose intolerance, changes in the lipid profile, mental and psychomotor delay, and

other diseases are some of the associated issues (Mao et al., 2016; Amorós et al., 2018; Jiang et al.,

2019).

3.3. Iron (Fe)

Iron is a necessary mineral for several biological processes, such as the production of

erythrocytes and the transport of oxygen. It also co-occurs in the transport of enzymes, primarily

those involved in the metabolism of lipids, and is vital for the immune system's upkeep (WHO, 2017;

Rees et al., 2019). When a pregnant teenager's iron requirements are out of balance and insufficient

to maintain homeostasis, iron deficiency results (Georgieff, 2020). This is a global public health issue

that mostly affects women of reproductive age, nursing mothers, and infants (Harvey and Boksa

2014; Saydam et al., 2017; WHO, 2017).

Anemia is highly prevalent in several continents such as Africa, Asia, South America, and even

Eastern Europe, especially in women of reproductive age (WHO, 2017, Saydam et al., 2017).

Anemia has been associated with inadequate ingestion of iron, deficiency of folate and vitamin B12,

problems of low absorption, inefficient iron transport, parasite infections, and diseases, such as HIV,

for example. The condition is characterized by a low level of hemoglobin in the blood, which

interferes with the body's ability to transport oxygen (WHO, 2017). Anemia can be thought of as the

last stage of iron deficiency (Georgieff, 2020). It is possible to notice symptoms like exhaustion and

trouble completing everyday tasks. Measurements of serum ferritin and/or transferrin receptor

levels, as well as hemoglobin concentration, are advised for diagnosis. Moreover, types of anemia:

normocytic, macrocytic, and microcytic, each of which has a different etiology (WHO, 2017). When

a teenager needs iron for proper development and growth is pregnant, one of the observed problems

is the reduced activity of the immune system, especially a significant reduction in the number of T

cells produced and available for use.

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Thus, both innate and adaptative immune systems are weakened, exposing the mother and the fetus-

to bacteria, viruses, and other pathogens attacks. The immune system whose foremost function is to

protect the mother and fetus from infections caused by several sorts of pathogens becomes weakened

and compromised. Iron deprivation at the beginning of pregnancy can lead to premature birth or

low birth weight and threaten the health of the newborn (Harvey and Boksa, 2014; WHO, 2017).

Gestational anemia is related to a higher maternal mortality rate as well as interferes with the weight

and health of the neonatal (Chikakuda et al., 2018). It also can lead to miscarriage during the first

trimester (Guo et al., 2019).

3.4. Zinc (Zn)

One of the several metallic ions that are frequently present in the human brain is zinc. In the

body, this mineral is essential. Approximately 90 % of this oligo element is found in the bones and

skeleton muscles. It is absorbed in the small intestine through a mechanism mediated by

transporters. Studies have indicated that different population groups absorb it at different rates

depending on the type of diet and the molar proportion of phytate. The concentration of zinc in the

gastrointestinal tract is the only factor that determines its absorption; it has been shown that people

who consume high levels of zinc in their diet also tend to absorb zinc less readily (Galetti et al., 2016).

Teenagers who are pregnant may lose zinc through their gastrointestinal tract, urine, or skin, hair,

or perspiration. Hexa and pentaphosphate of inositol should not be consumed simultaneously with

phytic acid for optimal absorption. Phytic acid is the main dietary component that is known to

impede zinc binding to transporter cells.

More than 50 % of preterm and severely premature neonates have cerebral white matter damage

(WMI), the main component of the premature brain, which can be brought on by a zinc shortage

(Volpe, 2019). Since the pre-oligodendrocyte (pre-OL), the progenitor of OLs that create mature

myelin, is the target in the cellular core area of WML, its morphologic effects are subjacent to most

documented future neurological impairments. Hypomyelination results from the preterm brain's

pre-OL failing due to lesions (Volpe, 2019).

3.5. Calcium (Ca)

The mineral calcium (Ca), which depends on a number of genetic and environmental factors,

is responsible for the development and upkeep of bone tissue. One of the most important indicators

of bone health, bone mineral density (BMD), has a phenotypic manifestation that is known to be

influenced by genetics to a degree of 60 % to 70 %. Furthermore, between 30 % and 40 % of BMD is

influenced by environmental variables, including nutrition and lifestyle. The likelihood of changing

these environmental elements and, therefore, improving bone tissue becomes crucial when

describing their impact on the skeleton. Of these, the dietetic Ca content is the most pertinent to bone

health (Bromage et al., 2016).

The mother's and the fetus's bone health are greatly impacted by calcium deficiency. Severe Ca

deficiency during adolescent pregnancy can be fatal to the mother, raising the possibility of pre-

eclampsia, and detrimental to the fetus by increasing the likelihood of spontaneous preterm. Pre-

eclampsia raises the risk of infant mortality by causing miscarriage or drug-induced preterm birth

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(Weaver et al., 2014). When it comes to preterm delivery, a shortage in calcium can limit intrauterine

growth, cause low birth weight, and eventually have several physical and cognitive effects, such as

greater atrophy. Pre-natal Ca ingestion can reduce the risk of premature birth and can be associated

with its function in supporting fetal growth and maturity (Mosha et al., 2017).

3.6. Magnesium (Mg)

This is the fourth cation present in the human body universally and it is the second most

commonly found cation inside human cells. About 53 % of it is found in bones, approximately 27 %

in muscles, 19 % present in soft tissues that are not muscles, and only 1 % in the extracellular liquid;

the majority of it is bonded to different chelators in the intracellular space, including ATP, adenosine

diphosphate, protein, RNA, DNA, and citrate (Altura et al., 2016).

The parathyroid hormone (PTH) and vitamin D both affect its absorption. When calcitriol was given

to uremic patients, the amount of magnesium absorbed through the jejunum returned to normal; in

patients who were also malpositioned and had insufficient vitamin D, this absorption decreased

(Conlon and Bird, 2015). This nutrient is widely available in all food sources; deficiencies in it are

uncommon under normal circumstances and are typically associated with the presence of a

concomitant illness (Altura et al., 2016).

Magnesium deficiency manifests with diverse symptoms such as severe reduction in cognitive

capacity, processing, and in particular decreased attention span, increased aggression, weariness,

and lack of focus and concentration (Elbaz et al., 2017). Other prevalent symptoms may include

frequent irritation, anxiety, and fluctuating humor (Viktorinova et al., 2016). Magnesium deficiency

has been adversely implicated in maternal and perinatal settings, as it has been associated with risks,

such as hypertensive pregnancy syndrome, leg cramps, and premature birth. Mg deficiency has also

been associated with the highest Apgar scores among newborns and reduced occurrence of hypoxic-

ischemic encephalopathy; however, as only 2 of the 10 randomized clinical trials were considered of

the highest quality, the authors concluded that there was insufficient evidence to support oral Mg

supplementation during pregnancy as beneficial for the mother and/or the fetus (Farias et al., 2020).

Magnesium aids in the production of ATP and energy, the removal of ammonia from the brain

associated with inattention, and the conversion of important fatty acids into DHA (docosahexaenoic

acid), which is necessary for the healthy construction and operation of brain cells. It can help lessen

oxidative stress associated with the physiopathology of attention deficit hyperactivity disorder

(ADHD) due to its antioxidant properties. Magnesium can also help with sleep disturbances

associated with ADHD, which can negatively impact attention (de Araújo et al.,2020).

3.7. Folate

Folate (vitamin B9) is one of the thirteen essential vitamins, present in food items, but folic

acid is a synthetic supplement that is added to food for fortification. Metabolically inert, vitamin B9

(natural dietary folate) is sometimes referred to as folic acid which is the synthetic form (Jouanne et

al., 2021). Folic acid has a higher bioavailability and is chemically more stable than folate. Although

there are differences in data on the bioavailability of food folate, food is thought to comprise 50 % of

total bioavailable folic acid. Considering this variation in bioavailability, the notion of dietary folate

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equivalents (DFEs) is employed: 0.6 μg of folic acid in fortified foods, 0.5 μg in supplements, or 1 μg

of dietary folate are all comparable to 1 μg of DFE (Argyridis, 2019; Jouanne et al., 2021). Folate

deficiency is frequently caused by pregnancy, particularly in cases of multiple pregnancies or

complex pregnancies with vomiting. Certain pregnancy issues, such as congenital heart disease,

preeclampsia, intrauterine growth restriction, and neural tube abnormalities (NTD), such as spina

bifida and anencephaly, can be caused by a folate shortage (Argyridis, 2019). It is also critical to

stress that women with pregestational diabetes should take 5 mg of the medication daily (Jouanne

et al., 2021).

4. Conclusion

The effects of the micronutrients on teenage pregnancy are so crucial to the extent that if

deficiency occurs in the juveniles, it causes congenital abnormalities, affects the mother’s health, and

the unborn babies and may eventually lead to maternal mortality and deaths of the fetus. If the babies

survive the gestational period, the baby may develop diverse metabolic syndromes. Policymakers,

physicians, nutritionists, and other health workers should focus more attention on the micronutrient

status of adolescents. Therefore, it becomes paramount that proper education should be given to

pregnant teenagers and more research should be focused on nutritional intervention for these

vulnerable groups.

Acknowledgments

Special thanks to the management and staff of Universidad Autonoma de Coahuila Hospital, Mexico

for their support and help.

Conflict of interest

There is no conflict of interest in the publication of these research notes.

References

Altura B.M., Li W., Zhang A., Zheng T., Shah N.C., Shah G.J., & Altura B.T. (2016). Sudden Cardiac

Death in Infants, Children and Young Adults: Possible Roles of Dietary Magnesium Intake

and Generation of PlateletActivating Factor in Coronary Arteries. J. Heart Health 2:(2).

http://dx.doi.org/10.16966/2379-769X.121

Amorós R., Murcia M., Ballester F., Broberg K., Iñiguez C., Rebagliato M., Skröder H., González L.,

Lopez-Espinosa M.-J., & Llop S. (2018). Selenium status during pregnancy: Influential factors

and effects on neuropsychological development among Spanish infants. Sci. Total

Environ. 610:741–749. https://doi.org/10.1016/j.scitotenv.2017.08.042

Argyridis, S. (2019). Folic acid in pregnancy. Obstet. Gynaecol. Reprod. Med. 29(4): 118–120.

https://doi.org/10.1016/j.ogrm.2019.01.008

Nupo et.al

TECNOCIENCIA CHIHUAHUA, Vol. XVIII (3): e1584 (septiembre-diciembre, 2024)

Babai, A., & Irving, M. (2023). Orofacial Clefts: Genetics of Cleft Lip and Palate. Genes (Basel)

14(8):1603. https://doi.org/10.3390/genes14081603

Bekele, Y., Gallagher, C., Batra, M., Vicendese, D., Buultjens, & M., Erbas, B. (2024). Is Oral Iron and

Folate Supplementation during Pregnancy Protective against Low Birth Weight and Preterm

Birth in Africa? A Systematic Review and Meta-Analysis. Nutrients 16(16): 2801.

https://doi.org/10.3390/nu16162801

Beluska-Turkan, K., Korczak, R., Hartell, B., Moskal, K., Maukonen, J., Alexander, D.E., Salem, N.,

Harkness, L., Ayad, W., Szaro, J., Zhang, K., & Siriwardhana, N. (2019). Nutritional Gaps and

Supplementation in the First 1000 Days. Nutrients 11(12): 2891.

https://doi.org/10.3390/nu11122891

Bromage S., Ahmed T., & Fawzi W.W. (2016). Calcium Deficiency in Bangladesh: Burden and

Proposed Solutions for the First 1000 Days. Food Nutr. Bull 37(4): 475–493.

https://doi.org/10.1177/0379572116652748

Conlon, M.A., & Bird, A.R. (2014). The impact of diet andlifestyle on gut microbiota and human

health. Nutrients 7(1):17–44. https://doi.org/10.3390/nu7010017

Cheng, Z., Gu, R., Lian, Z., Gu, H.F. (2022). Evaluation of the association between maternal folic acid

supplementation and the risk of congenital heart disease: a systematic review and meta-

analysis. Nutr J. Mar 21(1):20. https://doi.org/10.1186/s12937-022-00772-2

Chikakuda, A.T., Shin, D., Comstock, S.S., Song, S., & Song, W.O. (2018). Compliance to prenatal iron

and folic acid supplement use in relation to low birth weight in Lilongwe, Malawi. Nutrients

10(9): 1275. https://doi.org/10.3390/nu10091275

de Araújo, C.A.L., Ray, J.G., Figueiroa, J.N., & Alves, J.G. (2020). BRAzil magnesium (BRAMAG)

trial: A double- masked randomized clinical trial of oral magnesium supplementation in

pregnancy. BMC Pregnancy Childbirth.20:234. https://doi.org/10.1186/s12884-020-02935-7

Elbaz, F., Zahra, S., & Hanafy, H. (2017). Magnesium, zinc and copper estimation in children with

attention deficit hyperactivity disorder (ADHD) Egypt J. Med. Hum. Gen. 18(2):153–163.

https://doi.org/10.1016/j.ejmhg.2016.04.009

Farías, P.M., Marcelino, G., Santana, L.F., de Almeida, E.B., Guimarães, R.C.A., Pott, A., Hiane, P.A.,

& Freitas, K.C. (2020). Minerals in Pregnancy and Their Impact on Child Growth and

Development. Molecules 25(23): 5630. https://doi.org/10.3390/molecules25235630

Galetti, V., Mitchikpè, C.E.S., Kujinga, P., Tossou, F., Hounhouigan, D.J., Zimmermann, M.B., &

Moretti, D. (2016). Rural Beninese children are at risk of zinc deficiency according to stunting

prevalence and plasma zinc concentration but not dietary zinc intakes. J. Nutr. 146(1): 114–

123. https://doi.org/10.3945/jn.115.216606

Georgieff, M.K. (2020). Iron deficiency in pregnancy. Am. J. Obstet. Gynecol. 223(4): 516-524.

https://doi.org/10.1016/j.ajog.2020.03.006

Guo, Y., Zhang, N., Zhang, D., Ren, Q., Ganz, T., Liu, S., & Nemeth, E. (2019). Iron homeostasis in

pregnancy and spontaneous abortion. Am. J. Hematol. 94(2): 184–188.

https://doi.org/10.1002/ajh.25341

Nupo et.al

TECNOCIENCIA CHIHUAHUA, Vol. XVIII (3): e1584 (septiembre-diciembre, 2024)

Harvey, L., & Boksa, P. (2014). Additive effects of maternal iron deficiency and prenatal immune

activation on adult behaviors in rat offspring. Brain, Behavior, and Immunity 40: 27–37.

https://doi.org/10.1016/j.bbi.2014.06.005

Hofstee, P., McKeating, D.R., Bartho, L.A., Anderson, S.T., Perkins, A.V., & Cuffe, J.S. (2020). Maternal

selenium deficiency in mice alters offspring glucose metabolism and thyroid status in a

sexually dimorphic manner. Nutrients 12(1): 267. https://doi.org/10.3390/nu12010267

Jiang, S., Yang, B., Xu, J., Liu, Z., Yan, C., Zhang, J., Li, S., & Shen, X. (2019) Associations of Internal-

Migration Status with Maternal Exposure to Stress, Lead, and Selenium Deficiency Among

Pregnant Women in Shanghai, China. Biol. Trace Elem. Res. 190(2): 309–317.

https://doi.org/10.1007/s12011-018-1570-0

Jouanne, M., Oddoux, S., Noël, A., & Voisin-Chiret, A.S. (2021). Nutrient Requirements during

Pregnancy and Lactation. Nutrients 13 (2): 692. https://doi.org/10.3390/nu13020692

Keats, E.C., Akseer, N., Thurairajah, P., Cousens, S., Bhutta, Z.A., & Global Young Women’s Nutrition

Investigators’ Group. (2022). Multiple-micronutrient supplementation in pregnant

adolescents in low- and middle-income countries: a systematic review and a meta-analysis

of individual participant data. Nutr Rev. 80(2): 141-156.

https://doi.org/10.1093/nutrit/nuab004

Mao, J., Vanderlelie, J.J., Perkins, A.V., Redman, C.W., Ahmadi, K.R., & Rayman, M.P. (2016). Genetic

polymorphisms that affect selenium status and response to selenium supplementation in

United Kingdom pregnant women. Am. J. Clin. Nutr. 103(1): 100–106.

https://doi.org/10.3945/ajcn.115.114231

Mosha, D., Liu, E., Hertzmark, E., Chan, G., Sudfeld, C., Masanja, H., & Fawzi, W. (2017). Dietary

iron and calcium intakes during pregnancy are associated with lower risk of prematurity,

stillbirth and neonatal mortality among women in Tanzania. Public Health Nutr. 20(4): 678–

686. https://doi.org/10.1017/s1368980016002809

Nogales, F., Ojeda, M.L., Del Valle, P.M., Serrano, A., Murillo, M.L., & Carreras-Sánchez, O. (2017).

Metabolic syndrome and selenium during gestation and lactation. Eur. J. Nutr. 56(2): 819–

830. https://doi.org/10.1007/s00394-015-1129-1

Olivo-Vidal, Z.E., Rodríguez, R.C., & Arroyo-Helguera, O. (2016) Iodine affects differentiation and

migration process in trophoblastic cells. Biol. Trace Elem. Res. 169(2): 180–188.

https://doi.org/10.1007/s12011-015-0433-1

Palacios, C., Kostiuk, L.K., & Peña‐Rosas, J.P. (2019). Vitamin D supplementation for women during

pregnancy. Cochrane Database of Systematic Reviews 7(7): CD008873.

https://doi.org/10.1002/14651858.cd008873.pub4

Rajwar, E., Parsekar, S.S., & Venkatesh, B.T (2020). Effect of vitamin A, calcium and vitamin D

fortification and supplementation on nutritional status of women: an overview of systematic

reviews. Syst. Rev. 9: 248. https://doi.org/10.1186/s13643-020-01501-8

Rees, W.D., Hay, S.M., Hayes, H.E., Stevens, V.J., Gambling, L., & McArdle, H.J (2020). Iron deficiency

during pregnancy and lactation modifies the fatty acid composition of the brain of neonatal

rats. J. Dev. Origins Health Dis. 11(3): 264–272. https://doi.org/10.1017/s2040174419000552

Nupo et.al

TECNOCIENCIA CHIHUAHUA, Vol. XVIII (3): e1584 (septiembre-diciembre, 2024)

Saydam, B.K., Genc, R.E., Sarac, F., & Turfan, E.C. (2017). Prevalence of anemia and related factors

among women in Turkey. Pak. J. Med. Sci. 33(2): 433-438.

https://doi.org/10.12669/pjms.332.11771

Shinde, S., Wang, D., Yussuf, M.H., Mwanyika-Sando, M., Aboud, S., & Fawzi, W.W. (2022).

Micronutrient Supplementation for Pregnant and Lactating Women to Improve Maternal

and Infant Nutritional Status in Low-and Middle-Income Countries: Protocol for a

Systematic Review and Meta-analysis. JMIR Res Protoc. 11(8): e40134.

https://doi.org/10.2196/40134

Shahid, M.A., Ashraf, M.A., & Sharma, S. (2024). Physiology, Thyroid Hormone. In: StatPearls

[Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

https://www.ncbi.nlm.nih.gov/books/NBK500006/

Stoffaneller, R., & Morse, N.L. (2015). A review of dietary selenium intake and selenium status in

Europe and the Middle East. Nutrients. 7(3): 1494–1537. https://doi.org/10.3390/nu7031494

Viktorinova, A., Ursinyova, M., Trebaticka, J., Uhnakova, I., Durackova, Z., & Masanova, V. (2016).

Changed plasma levels of zinc and copper to zinc ratio and their possible associations with

parent-and teacher-rated symptoms in children with attention-deficit hyperactivity disorder.

Biol. Trace Elem. Res. 169(1): 1–7. https://doi.org/10.1007/s12011-015-0395-3

Volpe, J.J. (2019). Iron and zinc: Nutrients with potential for neurorestoration in premature infants

with cerebral white matter injury. J. Neonatal. Perinatal. Med. 12(4): 365–368.

https://doi.org/10.3233/npm-190369

Weaver, C.M., & Heaney, R.P. (2014). Calcium. In: Ross, A.C., Caballero, B., Cousins, R.J., Tucker,

K.L., & Ziegler, T.R., editors. Modern Nutrition in Health Disease. 11th ed. Lippincott

Williams & Wilkins; Baltimore, MD, USA: 2014. pp. 133–149.

WHO (2016) Recommendations on Antenatal Care for a Positive Pregnancy Experience; World

Health Organization: Geneva, Switzerland, 2016.

https://iris.who.int/bitstream/handle/10665/259947/WHO-RHR-18.02-eng.pdf

WHO (2017). Nutritional Anaemias: Tools for Effective Prevention and Control. World Health

Organization; Geneva, Switzerland

https://apps.who.int/iris/bitstream/handle/10665/259425/9789241513067-eng.pdf

WHO (2018). Weekly Iron and Folic Acid Supplementation as an Anaemia-Prevention Strategy in

Women and Adolescent Girls: Lessons Learnt from Implementation of Programmes Among

Non-Pregnant Women of Reproductive Age. World Health Organization; Geneva,

Switzerland. https://apps.who.int/iris/bitstream/handle/10665/274581/WHO-NMH-NHD-

18.8-eng.pdf

Wilson, R.L., Bianco-Miotto, T., Leemaqz, S.Y., Grzeskowiak, L.E., Dekker, G.A., & Roberts, C.T.

(2018). Early pregnancy maternal trace mineral status and the association with adverse

pregnancy outcome in a cohort of Australian women. J. Trace Elem. Med. Biol. 46: 103–109.

https://doi.org/10.1016/j.jtemb.2017.11.016

Yimer, B., & Wolde, A. (2022). Prevalence and predictors of malnutrition during adolescent

pregnancy in southern Ethiopia: a community-based study. BMC Pregnancy Childbirth 22(1):

130. https://doi.org/10.1186/s12884-022-04460-1

Nupo et.al

TECNOCIENCIA CHIHUAHUA, Vol. XVIII (3): e1584 (septiembre-diciembre, 2024)

Zimmermann, M.B. (2016). The Importance of Adequate Iodine during Pregnancy and Infancy. World

Rev. Nutr. Diet. 115:118–124. https://doi.org/10.1159/000442078

Zemrani, B., & Bines, J.E. (2020). Recent insights into trace element deficiencies: Causes, recognition

and correction. Curr. Opin. Gastroenterol 36(2): 110–117.

https://doi.org/10.1097/mog.0000000000000612

Zhou, S.J., Condo, D., Ryan, P., Skeaff, S.A., Howell, S., Anderson, P.J., McPhee, A.J., & Makrides, M.

(2019). Association between maternal iodine intake in pregnancy and childhood

neurodevelopment at age 18 months. Am. J. Epidemiol. 188(2): 332–338.

https://doi.org/10.1093/aje/kwy225

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