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The current state of knowledge in regard to nutritional requirements for pregnant and lactating women and for women who are taking oral contraceptives is reviewed. During pregnancy caloric intake should be moderately increased, and the consumption of 30-60 mg of iron and 800-1200 mg of calcium is recommended. Phosphorus intake should also be increased, but this increase should be balanced by a corresponding increase in calcium intake. Consumption of vitamins A and D should be increased but excessive increases should be avoided. Vitamin E should be slightly increased. The desirability of increasing vitamin K is till a matter of dispute. Pregnant women have a slightly increased need for most water soluble vitamins. Research has adequately demonstrated the need to increase folic acid and B6 consumption. There is some evidence that iodine, chromium, and zinc deficiencies may be teratogenic. Some care should be taken not to overconsume sodium, but the need for stringest restriction is unwarranted. Heavy consumption of alcohol and caffeine should definitely be discouraged during pregnancy. Certain problems experienced by pregnant women, such as nausea, may be managed through nutritional modification. The increased nutritional needs for lactating women can, in most cases, be met by increasing milk consumption by 3-3 1/2 cup/day and by consuming a well balanced diet. The content of maternal milk may to some extent be altered by the consumption patterns of the mothers. Ingestion of certain drugs and chemicals may also alter maternal milk. The use of oral contraceptives apparently affects metabolism, but the consequences of these effects are largely unknown. Oral contraceptive usage generally increases the serum levels of triglycerides, iron, copper, and vitamin A and reduces levels of some B vitamins of vitamin C and of zinc and albumin. These effects vary from woman to woman and at the present time there is no agreement on the need for dietary supplementation. The effects of a variety of drugs on lactating women and the effects of oral contraceptive usage on nutritional status are presented in tabular form.
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PMID:Nutrition during pregnancy, lactation, and oral contraception. 25 28

It is estimated that 10-15 million women use oral contraceptives in the U.S. The 2 types of pills available are combination products containing both an estrogen and progestin, and single entity products with only progestin. Although more side effects are associated with estrogen, combination pills are the preferred prescription. Most often side effects are mild and disappear after continued use or switching to another type of pill. Some of the side effects are nausea; weight gain; chloasma; cervical extrophia and leukorrhea; hypermenorrhea; spotting and breakthrough bleeding; galactorrhea and pituitary tumors; choreiform movement disorder; endometrial cancer; and, hepatic effects. Fetal exposure to exogenous estrogens and progestins has been reported to result in increased risk for the heart and neural tube defects. Teratogenic effects subsequent to discontinuation of OCs does not appear to be a risk. The beneficial side effects of oral contraceptives are that the incidence of menorrhagia, benign breast neoplasm, dysmenorrhea, iron-deficiency anemia, premenstrual tension, acne, and ovarian cysts are lower in OC users. Thryoid diseases may be reduced by OCs.
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PMID:Side effects of oral contraceptives. 50 75

This study examined the relationship between gastrointestinal (GI) symptoms and dietary intake in triathletes. Fifty-five male triathletes (age 31 +/- 6 yrs) were surveyed regarding the most recently completed half Iron Man triathlon. Questions were asked regarding GI symptoms and dietary intake. Fifty-two percent complained of eructation and 48% of flatulence. Other symptoms were abdominal bloating, vomiting urge, vomiting, nausea, stomachache, intestinal cramps, and diarrhea. More symptoms occurred while running than at other times. All individuals who had eaten within 30 min of the start vomited while swimming. Fat and protein intake was greater in those who vomited or had the urge to vomit than in those without these symptoms. Of the former, 93% had consumed a hypertonic beverage. Forty percent of those who drank a hypertonic beverage and only 11% of those who drank an iso- or hypotonic beverage had severe complaints. Four of five individuals with stomachache had consumed a strongly hypertonic beverage. All subjects with intestinal cramps had eaten fiber-rich foods in the prerace meal; only 10% of those without cramps had done so.
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PMID:Gastrointestinal complaints in relation to dietary intake in triathletes. 133 83

Fifty pregnant women with a hemoglobin between > 10 and < or = 12 g/100 ml during the second three months of pregnancy participated in a non-comparative clinical trial intended to evaluate, during a one month treatment period, the acceptability and effectiveness of an iron supplement (Bio-fer), combined with a high iron diet. Gastric discomfort regressed (present in 11 and 3 women before and after treatment) (p < 0.05), the same applying to constipation (p < 0.05) (present in 17 and 8 women before and after treatment). Reasons for abandoning treatment were nausea (n = 2) and vertigo (n = 1). Anemia or deficiency, evaluated on the basis of hemoglobin and iron-binding capacity levels, improved or stabilised in 34 patients out of 47 (72.3%). Hemoglobin increased (p < 0.0001) on average from 11.4 +/- 0.6 to 11.7 +/- 0.8 g/100 ml.
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PMID:[Efficacy and tolerance of a dietary iron supplement (Bio-fer) in pregnancy anemia]. 148 77

The cause of the degeneration of dopamine-containing cells in the zona compacta of the substantia nigra in Parkinson's disease remains unknown. The ability of the selective nigral toxin 1-methyl-4-phenyl-1,2,3,6 tetrahydropyridine (MPTP) (via its metabolite MPP+) to destroy nigral dopamine cells selectively by inhibiting complex I of the mitochondrial energy chain may provide a clue. Indeed, recent studies of post-mortem brain tissue have suggested the presence of an on-going toxic process in the substantia nigra in Parkinson's disease leading to excess lipid peroxidation. This appears also to involve a disruption of mitochondrial function since mitochondrial superoxide dismutase activity is increased and there is impairment of complex I. These changes may in turn relate to a selective increase in the total iron content of substantia nigra coupled to a generalised decrease in brain ferritin content. Piribedil is used in the symptomatic treatment of Parkinson's disease and is particularly effective against tremor. Piribedil (and its metabolites) acts as a dopamine D-2 receptor agonist. However, in our studies in contrast to other dopamine agonists, in vivo piribedil interacts with dopamine receptors in the substantia nigra and nucleus accumbens but not those in the striatum. In patients with Parkinson's disease the beneficial effects of piribedil may be limited by nausea and drowsiness. Indeed, in MPTP-treated primates piribedil reverses motor deficits but marked side-effects occur. However, pre-treatment with the peripheral dopamine receptor antagonist domperidone prevents the unwanted effects and piribedil produces a profound and longer-lasting reversal of all components of the motor syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Parkinson's disease: pathological mechanisms and actions of piribedil. 163 7

Eleven patients with beta thalassemia major were entered into the trial of the oral chelator 1,2-dimethyl-3-hydroxypyrid-4-one (L1). Their ages ranged from 17 to 26 years (mean +/- SD, 22.3 +/- 2.7). Six were male and five were female. L1 was administered at an initial daily dose of 42.5 to 60 mg/kg as a single dose. After 4 weeks, the dose was increased to 85 to 119 (102 +/- 10.7) mg/kg for 191 to 352 days divided into either two or four doses daily, except for one patient who developed agranulocytosis after 11 weeks and was taken off the trial. Initial serum ferritin values in the remaining 10 patients ranged between 1,000 and 9,580 (5,549 +/- 3,333) micrograms/L and at end of the trial their mean serum ferritin was significantly lower (4,126 +/- 2,278; P less than .05 using the paired t-test). Urinary iron excretion at a daily dose of 85 to 119 mg/kg administered as two divided doses ranged between 0.14 and 0.82 (0.44 +/- 0.26) mg/kg/24 h. In three patients, the four doses per day schedule caused substantially more iron excretion than the same total dose divided into two. During the course of the trial, several possible adverse effects have been encountered. One patient (female, aged 20) developed agranulocytosis 11 weeks after starting treatment and 6 weeks after beginning treatment with a daily dose of 105 mg/kg. This patient's neutrophil count recovered spontaneously 7 weeks after the discontinuation of L1. A decrease in serum zinc levels to subnormal levels was observed in four patients with symptoms of dry skin, with an itchy scaly rash in two that was associated with low serum zinc levels that responded to zinc therapy. Urinary zinc levels ranged from 4.7 to 23.4 (13 +/- 5.5) mumol/24 h and were above 9 mumol/24 h (upper limit of normal) in eight patients. Mild nausea occurred in three patients and transient diarrhea in a fourth. Mild musculoskeletal symptoms occurred in three patients but settled without discontinuation of L1 therapy in two and with temporary discontinuation of L1 in the third. A transient increase in serum aspartate transaminase was also noted in five patients, but serum aspartate transaminase levels subsequently decreased in all of them. No cardiovascular, neurologic, renal, or retinal toxicities were demonstrable. These results confirm that L1 is an effective oral iron chelator. Further clinical trials are needed to determine the incidence and severity of adverse effects.
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PMID:Efficacy and possible adverse effects of the oral iron chelator 1,2-dimethyl-3-hydroxypyrid-4-one (L1) in thalassemia major. 846 82

The pharmacology, pharmacokinetics, clinical efficacy, adverse effects, and dosage and administration of succimer when used for the treatment of lead poisoning are reviewed. Succimer is an orally active, heavy-metal chelating agent that forms stable, water-soluble complexes with lead; it also chelates other toxic heavy metals, such as arsenic and mercury. It is a designated orphan drug that is indicated for the treatment of lead poisoning, specifically in children with blood lead concentrations higher than 45 micrograms/dL. Succimer reverses the adverse metabolic effects of lead on heme synthesis while increasing urinary lead output without adversely affecting essential mineral excretion at the recommended dosage regimen. The rebound in lead concentrations that can occur after short courses of chelating therapies (caused by redistribution of lead from bone stores) may require frequent and multiple courses of chelation therapy. The most common adverse effects reported in clinical trials of succimer in children and adults were nausea, vomiting, diarrhea, appetite loss, and loose stools; these effects may be related to the drug's unpleasant mercaptan odor. There are no known drug interactions between succimer and other drugs, including iron supplements, although data are limited. The recommended initial dosage in children is 10 mg/kg or 350 mg/sq m every eight hours for five days. The dosage is then reduced to 10 mg/kg or 350 mg/sq m every 12 hours for an additional two weeks. Clinical studies indicate that succimer is relatively selective for lead and effectively lowers blood lead concentrations. Although clinical experience is limited, an oral lead chelator may offer advantages over currently available agents.
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PMID:Succimer, an oral lead chelator. 166 40

The tolerability of supplemental iron in the chelated form of bis-glycino iron II was compared with that of ferrous sulfate in a randomized, double-blind, cross-over trial. Both iron formulations were prepared to deliver 50 mg elemental iron in each capsule; the capsules for both formulations were identical in appearance and weight. Each supplement was taken once daily before breakfast for two weeks. The incidence and severity of adverse side effects were not statistically different for the two preparations. However, of the 38 women evaluated, 14 (37%) experienced moderate-to-severe side effects only while taking the sulfate formulation compared to eight (21%) who experienced similar side effects only while taking the chelate formulation; the remaining 16 women had the same symptom profile with both preparations. This tendency for the chelate to be better tolerated was observed for the symptoms of bloating, constipation, and nausea. In addition, a significant (P less than 0.05) number of women preferred the chelate to the sulfate formulation. This preference appeared to be related to the lower number of side effects experienced with the chelate.
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PMID:Tolerability of iron: a comparison of bis-glycino iron II and ferrous sulfate. 179 18

A gastric delivery system (GDS) for iron supplementation was evaluated. Radioisotopic studies in 9 volunteers demonstrated a three-fold higher absorption of GDS iron compared with ferrous sulphate elixir. A double-blind placebo controlled trial was done in 200 women to compare the gastrointestinal side-effects associated with 50 mg iron daily given either as GDS or conventional ferrous sulphate. The conventional preparation was associated with a significantly higher frequency of nausea and anorexia, whereas there were no significant differences in reported side-effects between subjects receiving GDS or placebo. A single GDS capsule daily provides the same amount of absorbed iron as conventional ferrous sulphate given three times daily, and does not produce gastrointestinal side-effects.
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PMID:Gastric delivery system for iron supplementation. 197 72

Even though ingestion of chewable iron preparations is much more common, treatment recommendations for iron overdose are usually based on experience with nonchewable preparations. To determine the optimal time to measure serum iron concentrations, five volunteers were given chewable iron in 5 mg/kg and 10 mg/kg doses and their serum iron concentrations monitored. Peak levels occurred at 4.2 and 4.5 hours, respectively, after ingestion, and levels drawn at 3 hours were within 90% of the peak. Nausea and headache were experienced by all volunteers, and serum iron exceeded baseline total iron binding capacity in two subjects at the 10 mg/kg dose. In minor iron overdose resulting from the ingestion of chewable vitamins, serum iron concentrations measured between 3 and 7 hours (95% confidence level of peak concentrations) may be adequate in assessing the peak serum iron concentration.
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PMID:Absorption of iron after experimental overdose of chewable vitamins. 198 44


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