Vol 20. N°1. 2019  |  Enero-Marzo de 2019


REVISIÓN - NUTRICIÓN


LA ALIMENTACIÓN VEGETARIANA DURANTE EL EMBARAZO EN EL SIGLO XXI: UN ANÁLISIS DE LA LITERATURA

Autores: MERCEDES BROSA, NADIA CURTI, AGUSTINA BASILIO, JULIA GABRIELLI, LAURA BEATRIZ LÓPEZ


RESUMEN

Introducción: la alimentación vegetariana es una práctica cada vez más frecuente en la población.
Objetivos: esta investigación tuvo la fnalidad de identifcar y analizar las publicaciones desarrolladas en los últimos años que describan los nutrientes que son considerados críticos en las mujeres embarazadas que realizan dietas vegetarianasveganas, y los riesgos que este tipo de alimentación pudiera presentar tanto para la gestante como para la descendencia.
Materiales y métodos: se realizó una investigación de tipo narrativa, de información científca, publicada en relación a la alimentación en embarazadas vegetarianas/veganas. Se utilizaron las bases de datos de Medline, Scielo y Cochrane.
Resultados: se analizaron 29 publicaciones que respondieron a los criterios de búsqueda e incluyeron artículos originales, metaanálisis, artículos de revisión y casos clínicos de diferentes contextos geográfcos publicados desde 2000 hasta 2018 inclusive. La información disponible considera importante monitorear y evaluar la suplementación con vitaminas D y B12, hierro, zinc y ácidos grasos EPA (ácido eicosapentaenoico) y DHA (ácido docosahexaenoico), en las mujeres vegetarianas que cursan un embarazo, dado que las investigaciones llevadas a cabo en los últimos años revelan que en este grupo es frecuente encontrar menores concentraciones de estos nutrientes en comparación con las embarazadas omnívoras. Los estudios sugieren que las embarazadas vegetarianas/veganas tendrían un mayor riesgo de presentar defciencia de vitaminas B12 y hierro que las omnívoras. Varios casos clínicos describen en los hijos de embarazadas vegetarianas con defciencia de vitamina B12 diversos grados de compromiso neurológico. Los niveles de ingesta de magnesio y ácido fólico habitualmente son mayores en las embarazadas vegetarianas que en las omnívoras.
Conclusiones: la información actual sugiere que si la dieta es planeada y desarrollada con asesoramiento profesional para suplementar los nutrientes considerados críticos en el embarazo, las embarazadas vegetarianas-veganas no presentan riesgos nutricionales diferentes a los posibles en las mujeres omnívoras.

Palabras Clave: embarazo; nutrición; alimentación vegetariana; vegana.

REFERENCIAS:
1. López L. Suplementación vitamínica y mineral de la embaraza-da. ¿Cuándo es necesaria? Actualización en Nutrición 2009; 10(3):195-202.
2. Sociedad Argentina de Nutrición. Alimentación vegetariana, posición de la Sociedad Argentina de Nutrición. Disponible en: http://www.sanutricion.org.ar/files/upload/files/Alimentacion_Vegetariana_Posicion_SAN.pdf (consulta en el año 2016).
3. Academy of Nutrition and dietetics. Position of the Academy of Nutrition and dietetics: Vegetarian diets. Disponible en: http://unionvegetariana.org/ADA.pdf (consulta en el año 2016).
4. Craig WJ, Mangels AR. Position of the American Dietetic Asso-ciation: Vegetarian diets. American Dietetic Association. J am Diet Assoc 2009; 109(7):1266-82.
5. Encuesta Nacional de Nutrición y Salud. Documento de Resulta-dos. Ministerio de Salud. Argentina. 2007
6. Alwan NA, Greenwood DC, Simpson NA, McArdle HJ, Godfrey KM, Cade JE. Dietary iron intake during early pregnancy and bir-th outcomes in a cohort of British women. Hum Reprod 2011; 26(4): 911-9.
7. Goswmai S, Das KK. Socioeconomic and demographic de-terminants of childhood anemia. J Pediatr (Rio J) 2015; 91(5):471-477.
8. Foster M, Herulah UN, Prasad A, Petocz P, Samman S. Zinc sta-tus of vegetarians during pregnancy: a systematic review of ob-servational studies and meta-analysis of zinc intake. Nutrients 2015; 7(6): 4512-4525.
9. Koebnick C, Hoffman I, Dagnelie P, Heins U, Wickramasinghe S, Ratnayaka I, Gruendel S, Lindemans J, Leitzmann C. Long-term ovo-lacto vegetarian diet imapairs vitamin B-12 status in preg-nant woman. American Society for Nutritional Sciences 2004; 3319-3326.
10. Pawlak R, Lester SE, Babatunde T. The prevalence of cobalamin deficiency among vegetarians assessed by serum vitamin B12: a review of literature. European Journal of Clinical Nutrition 2014; 68: 41-548.
11. Koebnick C, Heins UA, Hoffmann I, Dagnelie PC, Leitzmann C. Folate status during pregnancy in women is improved by long-term high vegetable intake compared with the average western diet. J Nutr 2001; 131(3): 733-739.
12. Katre P, Bhat D, Lubree H, Otiv S, Joshi S, Joglekar C, Rush E, Ya-jnik C. Vitamin B12 and folic acid supplementation and plasma total homocysteine concentrations in pregnant Indian women with low B12 and high folate status. Asia Pac J Clin Nutr 2010; 19(3):335-43.
13. Agarwal N, Chandrakanta, Koonwar S, Madhi AA, Kumar R. Epidemiology and neurodevelopmental correlates of cobalamin deficiency in hospitalized north Indian infants. J Pediatr Neurol Med 2016; 1(1):1-5.
14. Pepper MR, Black MM. B12 in fetal development. Semin Cell Dev Biol 2011; 22(6): 619-23.
15. Guez S, Chiarelli G, Menni F, Salera S, Principi N. Severe vitamin B12 deficiency in an exclusively breastfed 5-month-old Italian infant born to a mother receiving multivitamin supplementation during pregnancy. BMC pediatr 2012; 12:85.
16. Roed C, Skovby F, Lund AM. Severe vitamin B12 deficien-cy in infants breastfed by vegans. Ugeskr Laeger 2009; 171(43):3099-101.
17. Mariani A, Chalies S,Jeziorsky E, Ludwig C, Lalande M, Rodiere M. Consequences of exclusive breast-feeding in vegan mother newborn-case report. Arch Pediatr 2009; 16(11):1461-1463.
18. Bravo P, Ibarra J, Paredes M. Compromiso neurológico y hema-tológico por déficit de vitamina B12 en lactante hijo de madre vegetariana. Rev Chil Pediatr 2015; 85(3):1-8.
19. Wagnon J, Cagnard B, Bridoux-Henno L, Tourtelier Y, Grall JY, Dabadie A. breastfeeding and vegan diet. J Gynecol Obstet Biol Reprod 2005; 34(6): 610-2.
20. Ciani F, Poggi GM, Pasquini E, Donati MA, Zammarchi E. Pro-longed exclusive breast-feeding from vegan mother causing an acute onset of isolated methylmalonic aciduria due to a mild mutase deficiency. Clin Nutr 2000; 19(2): 137-9.
21. Dasgupta A, Saikia U, Sarma D. Status of 25(OH) D levels in pregnancy: a study from the North Eastern part of India. Indian J Endocrinol Metab 2012; 16(2).
22. Brzezinska M, Kucharska A, Sinska B. Vegetarian diets in the nutrition of pregnant and breastfeeding women. Pol Merkur Lekarski 2016; 40(238): 264-268.
23. American College of Obstetricians and Gynecologists Commit-tee on Obstetric Practice. Vitamin D: screening and supplemen-tation during pregnancy. Committee Opinion Nº 495. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011; 118:197-8.
24. Koebnick C, Leitzmann R, García AL, Heins UA, Heuer T, Golf S, Katz N, Hoffmann I, Leitzmann C. Long-term effect of a plant-based diet on magnesium status during pregnancy. Eur J Clin Nutr 2005; 59(2):219-25.
25. Burdge GC, Tan SY, Henry CJ. Long-chain n-3 PUFA in vege-tarian women: a metabolic perspective. J Nutr Sci 2017 nov 23;6: e58.
26. Sanders TA. DHA status of vegetarians. Prostaglandins Leukot Essent Fatty Acids 2009 Aug-Sep; 81(2-3):137-41.
27. Craig L, Jensen R, Voigt T, Prager Y, Zou J, Fraley J, Rozelle M, Turcich A, Llorente R, Anderson W. Effects of maternal doco-sahexaenoic acid intake on visual function and neurodevelop-ment in breastfed term infants. The American Journal of Clinical Nutrition 2005; Vol 82, Issue 1: 125-132.
28. Stuebe AM, Oken E, Gillman MW. Associations of diet and phy-sical activity during pregnancy with risk for excessive gestationa-lweight gain. Am J Obstet Gynecol 2009; 201:58. e1-8.
29. Piccoli GB, Leone F, Attini R, Parisi S, Fassio F, Deagostini MC, Ferraresi M, Clari R, Ghiotto S, Biolcati M, Giuffrida M, Rolfo A, Todros T. Association of low-protein supplemented diets with fetal growth in pregnant women with CKD. CJASN 2014; 9(5): 864-873.
30. Woo KS, Kwok TC, Celermajer DS. Vegan diet, subnormal vita-min B-12 status and cardiovascular health. Nutrients 2014; 6, 3259-3273.
31. North K, Golding J. A maternal vegetarian diet in pregnancy is associated with hypospadias. The ALSPAC Study Team. Avon longitudinal study of pregnancy and childhood. BJU Int 2000 Jan; 85(1):107-13.

---

VEGETARIAN FOOD DURING PREGNANCY IN THE 21ST CENTURY: AN ANALYSIS OF LITERATURE

SUMMARY

Introduction: vegetarian feeding is an increasingly common practice in the population.
Objectives: this research aimed to identify and analyze the publications carried out in recent years that describe nutrients that are considered critical in pregnant women who perform vegetarian-vegan diets, and the risks that this type of feeding could present both for the pregnant woman and for the offspring.
Materials and methods: a narrative-type investigation of scientifc information published in relation to food in vegetarian/vegan pregnant women was carried out. The Medline, Scielo, and Cochrane databases were used.
Results: we analyzed 29 publications that responded to the search criteria and included original articles, meta-analyzes, review articles and clinical cases from different geographical contexts published from 2000 to 2018 inclusive. The available information considers important to monitor and evaluate the supplementation with vitamins D and B12, iron, zinc and fatty acids EPA and DHA, in vegetarian women who are pregnant, since the investigations carried out in recent years reveal that in this group of pregnant women lower concentrations of these nutrients are frequent, compared with omnivores pregnant. Studies suggest that pregnant vegetarians/vegans have a higher risk of vitamin B12 and iron defciency than omnivores. Several clinical cases describe varying degrees of neurological impairments in children of pregnant vegetarians with vitamin B12 defciency. Magnesium and folic acid intake are usually higher in vegetarian pregnant women than in pregnant women with omnivores practices.
Conclusions: current information suggests that if the diet is planned and carried out with professional advice in order to supplement the nutrients considered critical in pregnancy, pregnant vegetarian-vegans do not present nutritional risks different from those possible in omnivorous women.

Keywords: pregnancy; nutrition; vegetarian; vegan.


DESCARGAR TEXTO COMPLETO EN PDF