expert opinion

Vitamins for the first 1000 days: Preparing for Life

February 15, 2013

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Ibrahim Elmadfa, PhD, President of the International Union of Nutritional Science, University of Vienna, Austria

“Vitamins are essential nutrients for many bodily functions and are particularly impor-tant during growth. An adequate supply of vitamins to the child during pregnancy and in early infancy is therefore crucial. While all vitamins are necessary, some are more critical than others. A well-known example linked to pregnancy is folic acid, which plays an important role in the development of the brain and nervous system and the prevention of fetal neural tube defects (NTD). To prevent problems further down the line, this has prompted many countries, high and low-income alike, to mandatorily fortify flour and certain other grain products with folic acid. Surveys showing a reduc-tion in incidences of NTD have attested to the success of this measure. However, other deficiencies or a suboptimal status of B vitamins, particularly B6 and B12, have been repeatedly reported in pregnant women, even in high-income countries.

Vitamin A deficiency is one of three micronutrient disorders of public health concern globally, with pregnant women and young children, particularly those living in Africa or South Asia, most at risk. Around 19 million pregnant women and 190 million children are affected worldwide. Night blindness, anemia and immunode-ficiency are major consequences of an inadequate supply of vitamin A in these populations. Much attention has also been recently accorded to vitamin D, again crucially important to pregnant women and young child-ren due to its role in bone mineralization. It was also recently discovered to have an immune-modulating function, which is believed to prevent the development of autoimmune diseases such as Type 1 diabetes.

An adequate supply of vitamins during pregnancy and lactation is not only necessary for the optimal development of the child, but also prevents the mother’s body stores from becoming exhausted. Indeed, consecutive pregnancies further deplete vitamin stores in the body due to malnutrition, with detrimental consequences for the mother and fetus. The mother’s micronutrient status determines that of the infant,
as it allows for the build-up of the child’s stores during the first four to six months of life. After this time, complementary feeding becomes necessary in order to cover the child’s growing vitamin requirements, particularly of vitamins A and D.

It must be taken into consideration that there is still a lack of knowledge concerning vitamin intake recom-mendations for pregnant women and children older than six months. Recommendations for intake levels have generally been obtained by extrapolation from data for infants, based in turn on the contents in breast milk and those for adults. A healthy, balanced diet provides the best basis for optimal pregnancy outcome, lactation performance and complementary feeding. However, supplements or fortified foods may be needed to cover the high requirements especially of essential vitamins such as vitamin D and folic acid, and to cor-rect unfavorable dietary patterns in women or to adapt foods to the needs of young children.”

Based on: Elmadfa I. and Meyer A. L. Vitamins for the first 1000 days: Preparing for Life. Symposium
‘100 years of vitamins – Past, present, future: Micronutrients – Macro impact’. November 2012. Basel, Switzerland.