Immunity & Pregnancy: Unique and Complex

Pregnancy is one of the most exciting and happy experiences in a woman's life. Taking care of the mother and baby is essential throughout the pregnancy. During this period, the immune system is naturally suppressed so that the mother's body does not reject the baby and can accommodate the growing fetus. Attack by virus/bacteria or any other pathogen during such a sensitive period is an unfavourable situation.

Pregnant women are said to be more prone to diseases and infections, so an expecting mother must do everything it takes to have excellent immunity. An expecting mother with weak immunity is at risk for infections and other conditions mentioned in the figure below.

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Unwanted negative effects of low immunity during pregnancy

Increased Demand for Macronutrients & Micronutrients

During pregnancy, a woman's macronutrient and micronutrient intake need to grow significantly. Not only the mother, but the fetus also requires them. Macronutrients including carbohydrates, proteins, and fats are needed for the proper growth of the fetus. Micronutrients include vitamins and minerals in smaller quantities. When these are not supplied in adequate quantity, pregnant women have a higher risk of falling sick.

How a Viral Infection Affects the Fetus and the Pregnancy Outcome

Viral infections that can reach the fetus by crossing the placenta might have a dangerous outcome. Even in the absence of placental transmission, the fetus could be adversely affected by the maternal immune response to the infection. There is a paucity of evidence that viral infections lead to preterm labour. Strong clinical data is indicating that children of mothers exposed to certain infectious microorganisms during pregnancy have a significantly higher risk of neurological disorders (including psychiatric disorders).

Pregnancy & Immunity

In general, our immune system is like a barrier it protects us from illness, germs, and toxins by providing resistance to those infections. Without the body`s defence mechanism the functioning of organs and overall health can be compromised. During pregnancy, the expecting mother's immune system is rapidly changing. The maternal immune system plays a critical role in establishing, maintaining, and completing a healthy pregnancy. There is a modulation of the immune system which leads to differential responses depending not only on the type of bacteria/virus or fungi but on the stage of the pregnancy.

Strengthen Immunity to Maintain Healthy Pregnancy:

Moderate physical activity
Stay hydrated
Reduce stress
Get enough sleep
Eat a nutritious diet
Dietary or supplemented intake of essential micronutrients.

Should All Pregnant Women Take Supplements?

All pregnant women have prescribed supplements such as folic acid, vitamins, and iron but those suffering from the following need additional supplementation.

Nutrient deficiency
Nausea & vomiting
Dietary restrictions
Multiple pregnancies
Poor diet
Genetic mutations
Pre-eclampsia

Supplements Considered Safe During Pregnancy

1. Vitamin C

It supports growth, bone strength, wound healing, immune system, absorption of iron.

RDA: 60 mg/day for pregnant women; 80 mg/day for lactating women.

2. Vitamin D

It keeps teeth, bones, and muscles healthy. RDA: 1000-2000 IU / day 12th week onwards.

3. Calcium

Required for proper development of bones of the fetus and prevent osteoporosis in the mother. RDA: 1 g/ day starting from 14th week for pregnant and lactating women

4. Iron

During pregnancy, the mother supplies blood and oxygen to the fetus, so the demand for iron becomes twice as before to keep up with the increase in blood supply.

RDA: 35 mg/day for pregnant women; 21 mg/day for lactating women

5. Zinc

It is responsible for the production, repair, and functioning of DNA. It also relieves symptoms of the common cold. RDA: 12 mg/day for pregnant and lactating women.

6. Magnesium

Deficiency in this mineral during pregnancy may increase the risk of chronic hypertension and premature labour. Some studies suggest that supplementing with magnesium may reduce the risk of complications like fetal growth restriction and preterm birth. RDA: 310 mg/day for pregnant and lactating women.

7. Iodine

It is necessary for fetal growth and development especially the brain. RDA: 250 mcg /day

8. Selenium

It decreases the risk of thyroid function abnormalities for women after pregnancy. RDA: 60 mcg/day for pregnant women; 70 mcg for lactating women.

9. Folic acid

It is required for preventing birth defects of the brain and spinal cord. RDA: 500 mcg/day for pregnant women; 300 mcg/day for lactating women

10. Ginger

1g/ day of fresh ginger root is used to treat nausea and vomiting.

11. Garlic

It increases glutathione in pregnant women

12. Probiotics:

For maintaining a healthy gut and may reduce the risk of some infections.

To conclude, pregnancy is a dynamic state; with different mechanisms of immunity varying on the stage of pregnancy. Fighting infections and strengthening immunity is important during such a sensitive period. Nutraceuticals provide the prevention or treatment of diseases through dietary supplementation. These become highly important during pregnancy to prevent conditions secondary to nutrient deficiency. The most well-known nutritional supplements regularly prescribed in pregnancy include folic acid, iron, calcium, Vitamin D, iodine, zinc, selenium, magnesium, and also vitamin C for pregnancy and lactating mothers.

References:

2. Schütz L.F. et al. (2017) Application of Nutraceuticals in Pregnancy Complications: Does Epigenetics Play a Role?. In: Patel V., Preedy V. (eds) Handbook of Nutrition, Diet, and Epigenetics. Springer, Cham

3. Morelli SS, Mandal M, Goldsmith LT, Kashani BN, Ponzio NM. The maternal immune system during pregnancy and its influence on fetal development. Res Rep Biol. 2015 Oct;6:171-89

4. Medical News Today. What happens to the immune system during pregnancy. Healthline Media.

5. World Health Organization. Vitamin D supplementation in pregnant women.

6. Mithal A, Kalra S. Vitamin D supplementation in pregnancy. Indian journal of endocrinology and metabolism. 2014 Sep;18(5):593

7. Stanisiere J, Mousset PY, Lafay S. How safe is ginger rhizome for decreasing nausea and vomiting in women during early pregnancy?. Foods. 2018 Apr;7(4):50.

8. Dante G, Pedrielli G, Annessi E, Facchinetti F. Herb remedies during pregnancy: a systematic review of controlled clinical trials. The Journal of Maternal-Fetal & Neonatal Medicine. 2013 Feb 1;26(3):306-12.

9. Majumder A, Jaiswal A, Chatterjee S. Prevalence of iodine deficiency among pregnant and lactating women: experience in Kolkata. Indian journal of endocrinology and metabolism. 2014 Jul;18(4):486

10. Aalami-Harandi R, Karamali M, Asemi Z. The favorable effects of garlic intake on metabolic profiles, hs-CRP, biomarkers of oxidative stress, and pregnancy outcomes in pregnant women at risk for pre-eclampsia: a randomized, double-blind, placebo-controlled trial. The Journal of Maternal-Fetal & Neonatal Medicine. 2015 Nov 22;28(17):2020-7.

11. Baldassarre ME, Palladino V, Amoruso A, Pindinelli S, Mastromarino P, Fanelli M, Di Mauro A, Laforgia N. Rationale of probiotic supplementation during pregnancy and neonatal period. Nutrients. 2018 Nov;10(11):1693

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