孕期补充钙、铁、锌对孕妇健康的影响

目的 研究孕中期单纯补纯的同时补铁、补锌对孕妇健康的影响,探讨妊娠期间改善钙、铁、锌营养状态的途径和方法。方法 选择初产健康孕妇313名,按孕妇入院体检顺序循环分为5个试验组。试验组给予强化饼干至分娩时止,饼干中分别强化维生素D（VD）,钙、锌、铁和维生素C。对照组系在前5组均收集到1个样品时,在医院随机选择1例临产非试验对象。结果 孕妇膳食钙、锌、铁的摄入量平均仅达到每日膳食中营养素供给量的47.7%、54.7%和86.7%。孕中期孕妇贫血患病率高达35.2%,补铁能有效地改善营养性贫血,试验前钙 铁 锌 VD组和钙 铁 VD组的贫血率分别为35.3%和40.7%,试验后则降低到0.0%和4.0%,而没有补铁组试验后贫血率角较高。钙补充组,血浆钙均值都有所上升,以钙 VD组最为明显,就补钙而言,单纯补钙组效果优于其他组。血浆锌水平随孕期进展而下降,补锌对血浆锌有一定的改善作用,而血清碱性磷酸酶活性随孕期进展而上升。分娩2个月后各试验组和对照组母亲的桡骨和尺骨骨密度差异无显性。单纯补钙组母体桡骨和尺骨骨密度与钙摄入量有显相关性。结论 联合补充钙、铁、锌,使其达到或接近目前的每日膳食中营养素供给量,是改善孕妇营养状况的最佳方式。

Effects of supplementing of calcium, iron and zinc on women's health during pregnancy

OBJECTIVES: To determine the effects of supplementing biscuits fortified with calcium (Ca) and vitamin D (VD), iron (Fe), vitamin C (VC) and zinc (Zn) to pregnant women from the 5th month of gestation until delivery on their health, and to explore a way to improve their Ca, Fe and Zn nutritional status during pregnancy. METHODS: A total of 313 healthy and primary pregnant women were enrolled and divided into five study groups based on their order visiting the hospitals for prenatal care. Each woman of the study groups was given three pieces of biscuit fortified with VD, Ca and VD, Ca, Zn and VD (Ca + Zn + VD), Ca, Fe, VC and VD (Ca + Fe + VD), Ca, Fe, VC, Zn and VD (Ca + Fe + Zn + VD), respectively, from the 15th month of gestation until delivery (24 weeks in total) daily. The fortified levels were 10 micrograms VD, 400 mg Ca from carbonate calcium, 10 mg Zn from lactate zinc, 10 mg Fe from ferrous lactate, and 50 mg VC, respectively. A parturient women was selected from the same hospital as control after one trial subject for each study groups selected. RESULTS: The daily dietary intakes of Ca, Zn and Fe in pregnant women were only 47.7%, 54.7% and 86.7% of the Recommended Dietary Allowances for Chinese. Incidence of anemia for mid-term pregnant women was 35.2%, and Fe-supplementation could significantly improved their hemoglobin level (P < 0.05). Prevalence of anemia in the groups of Ca + Fe + Zn + VD and Ca + Fe + VD was 35.3% and 40.7%, respectively, before Fe supplementation and reduced to zero and 4.0%, respectively, after Fe supplementation. Whereas, prevalence of anemia in the other groups without Fe supplementation still kept in a relatively high level. In the groups supplemented with Ca, their plasma Ca level increased, especially with the best results in Ca + VD group. Plasma level of Zn declined with length of gestation, which could be improved by Zn supplementation. Serum level of alkaline phosphatase activity increased a little bit with length of gestation. There was no significant difference in radial and ulnar bone mineral density (BMD) between trial groups and controls two months after delivery. Maternal radial and ulnar BMD correlated significantly with their dietary Ca intakes in Ca + VD group. CONCLUSION: The best way to improve maternal nutritional status is supplementation of Ca + Fe + Zn + VitD, based on the Recommended Dietary Allowances for Chinese.