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Supplement: Nutrition as a Preventive Strategy against Adverse Pregnancy Outcomes

Iron and Oxidative Stress in Pregnancy ^{1 ,2}

Esther Casanueva^* and Fernando E. Viteri^,**,3

^* Instituto Nacional de Perinatología, Mexico, DF, Mexico, Department of Nutritional Sciences and Toxicology, University of California, Berkeley and ^** Children's Hospital Oakland Research Institute, Oakland (CHORI), CA 94720

³ To whom correspondence should be addressed. E-mail: viteri{at}nature.berkeley.edu.

Pregnancy, mostly because of the mitochondria-rich placenta, is a condition that favors oxidative stress. Transitional metals, especially iron, which is particularly abundant in the placenta, are important in the production of free radicals. Protective mechanisms against free radical generation and damage increase throughout pregnancy and protect the fetus, which, however, is subjected to a degree of oxidative stress. Oxidative stress peaks by the second trimester of pregnancy, ending what appears to be a vulnerable period for fetal health and gestational progress. Conditions restricted to pregnancy, such as gestational hypertension, insulin resistance and diabetes, exhibit exaggerated indications of free radical damage. Antioxidants as well as avoidance of iron excess ameliorate maternal and early fetal damage. In rats both iron deficiency and excess result in free radical mitochondrial damage. Estimates of gestational iron requirements and of the proportion of iron absorbed from different iron supplemental doses suggest that with present supplementation schemes the intestinal mucosal cells are constantly exposed to unabsorbed iron excess and oxidative stress. Unpublished work carried out in Mexico City with nonanemic women at midpregnancy indicates that 60 mg/d of iron increases the risk of hemoconcentration, low birth weight and premature birth and produces a progressive decline in plasma copper. These risks are not observed in women supplemented with 120 mg iron once or twice per week. Studies on the influence of iron supplementation schemes on oxidative stress are needed.

KEY WORDS: • iron • supplementation • pregnancy • oxidative stress

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