Passende Bildauswahl !

1. Training Passende Bildauswahl! Essential nutrients for your health

2. What is a Food Supplement?

3. Content Key message Introduction Product information Key benefits Target group Posology & administration Ingredients Folic acid DHA (Docosahexaenoicacid) Other micronutrients Complementary treatment References

4. 1. Key message • A pregnancy is one of the most fascinating things that a woman will ever experience. • The 40 weeks of pregnancy leading up to the baby’s birth are full of fascinating milestones and physical transformations of both mother and child. • To support a healthy development of the unborn child in the womb as well as during breastfeeding after birth it is important that the mother is sufficiently supplied with all important nutrients. provides all nutrients that are important for a healthy development of the child during the second and third trimester and after birth during breastfeeding.

5. 2. Introduction • A pregnancy is divided into three stages, called trimesters:first trimester, second trimester and third trimester. • During each trimester, different changes take place in a pregnant woman’s body as well as in the developing fetus. 4 1 2 3 5 6 7 8 9 Month 1. Trimester 2. Trimester 3. Trimester

6. 2. Introduction • Weeks 1 & 2: Getting ready! • Week 3: Fertilization • Week 4: Implantation • Week 5: Hormone levels increase • Week 6: The neural tube closes • Week 7: Baby’s head develops • Week 8: Baby’s nose forms • Week 9: Baby’s toes appear • Week 10: Baby’s elbows bend • Week 11: Baby’s genitals develop • Week 12: Baby’s fingernails form 1. Trimester 1 1 2 3 Month

7. 2. Introduction • Week 13: Urine forms • Week 14: Baby’s sex becoming apparent • Week 15: Baby’s scalp pattern develops • Week 16: Baby’s eyes move • Week 17:Baby’s toenails develop • Week 18: Baby begins to hear • Week 19: Baby develops protective coating • Week 20: The halfway point • Week 21: Baby can suck his or her thumb • Week 22: Baby’s hair becomes visible • Week 23: Fingerprints and footprints form • Week 24: Baby’s skin is wrinkled • Week 25: Baby responds to your voice • Week 26: Baby’s lungs develop • Week 27: 2nd trimester ends 2. Trimester2 4 5 6 Month

8. 2. Introduction • Week 28: Baby’s eyes partially open • Week 29: Baby kicks and stretches • Week 30: Baby’s hair grows • Week 31: Baby’s rapid weight gain begins • Week 32:Baby practices breathing • Week 33: Baby detects light • Week 34: Baby’s fingernails grow • Week 35: Baby’s skin is pink and smooth • Week 36: Baby takes up most of the amniotic sac • Week 37: Baby might turn head first • Week 38: Baby’s toenails grow • Week 39: Baby’s chest is prominent • Week 40: The due date arrives! 3. Trimester 3 7 8 9 Month

9. 3. Product information During 2nd and 3rd trimesterandduringbreast-feeding

10. 3. Product information During 2nd and 3rd trimesterandduringbreast-feeding

11. 4. Key benefits • Very good compliance – only 1 tablet & 1 capsule per day • 1 tablet & 1 capsule a day contain the recommended daily intake of folic acid, DHA (docosahexaenoic acid), vitamins and other micronutrients for a healthy child and mother 4 • DHA ensures the normal brain and eye development of the foetus and breastfed infant 5 • Safe and controlled – high quality, mercury free DHA

12. 5. Target group • provides folic acid, DHA and all important vitamins for • women after the first 12 weeks of pregnancyand • lactating women until the end of breastfeeding

13. 6. Posology & administration • INTAKE • The recommended intake is 1 tablet and 1 capsule per day taken • with a meal and plenty of liquid. • DURATION OF INTAKE • prenatal+DHA Denk is recommended for women from the 13th week of pregnancy until the end of breastfeeding. • A sufficient supply with DHA during pregnancy and lactation is important for a healthy brain and eye development of the fetus and breastfed infant.

14. 7. Ingredients • Facilitates the sufficient supply of certain micronutritions that are essential for the development of a healthy child. **norecommendationavailable

15. 7. Ingredients For the baby6 For the mother6 • Folatefor… • healthyneuraltubedevelopment • bloodformation • healthyplacentaandumbilicalcord • DHAfor normal brainandeyedevelopment • Vitamin B2 andB6support the productionoffunctionalredbloodcells • Vitamin C for a healthyimmune system • Thiamine to supportenergy-metabolismand strong nerves • Pantothenicacidfor mental performanceandreductionoftiredness

16. 8. Folic acid Globally, it is estimated that approximately 300,000 babies are born each year with neural tube defects. 7, 8About half of these cases are thought to be related to inadequate folic acid intake by the mother. 8 • Neural tube defects are common birth defects which include: • 1) SPINA BIFIDA 9, 10, 11 • The vertebrae surrounding the spinal cord does not close properly during the first 28 days after fertilization => Spinal cord is exposed • A majority of babies born with this condition grows to • adulthood with various degrees of disability (paralysis, inability to control bowel and bladder function). • 2) ANENCEPHALY 11 • Anencephaly is a condition in which most or all of the brain is absent. • Infants with this condition die shortly after birth

17. 8. Folic acid Folic acidis a B-vitamin thatplays an importantrole in neuraltubedevelopmentandhas also otherimportantfunctions in the human‘sbody: Essential role of folic acid in other physiological functions 12 • DNA synthesis, DNA repair, DNA methylation • Co-factor in biological reactions • Cell division and growth • Production of red blood cells  Prevention of anaemia • Essential for brain functions (mental and emotional health) Other risks linked to folic acid deficiency 13, 14 • Higher risks of heart attacks and stroke • Higher risk of some cancers (e.g. stomach cancer) • Cell division and growth • Considerable decrease in male sperm count and fertility • Higher risk of developing clinical depression

18. 8. Folic acid • Humans cannot synthesize folate “de novo” 15 • Special foods help to obtain the recommended amount of folic acid 15 • leafy, dark green vegetables • citrus fruits and juices, berries • legumes (dried beans and peas) • whole grains, breakfast cereals • rice, pasta Excessive cooking can remove or destroy folate contained in food (Folic acid is heat labile!) …

19. 8. Folic acid • Synthetic folic acid is better absorbed than folate from foods(1 µg food folate = 0.5 µg supplement folic acid) 16 • Even if a women keeps to a well balanced diet, she may not get the extra folic acid she needs to prevent birth defects 17, 18 • An additional folate intake during lactation is necessary to replace folate secreted in human milk and to maintain folate status. 400 µg folic acid Essential Vitamins DHA A daily amount of at least 400 µg of folic acid from the 13th week of pregnancy until the end of breastfeeding is recommended. 19, 20 +

20. 8. Folic acid • contains 400 µg folic acid • Neural tube formation is already complete (28 days after conception, which is round about pregnancy week 6) 1 • However: it is recommended to continue taking folic after the 12th week of pregnancy until the end of breastfeeding: “Patients with no personal health risks, planned pregnancy and good compliance require a daily supplementation with folic acid (400 - 1000 µg) for at least 2-3 months before conception and throughout pregnancyand the postpartum period (4 - 6 weeks and as long as breastfeeding continues)” 19 “All women of childbearing age should obtain 400 µg/d of folic acid from dietary supplements and/or fortified foods in addition to the folate present in a varied diet.” 20

21. 8. Folic acid A daily amount of at least 600 µg of folic acid, three months prior conception and during the first three months of pregnancy, is recommended. 18 800 µg folic acid Essential Vitamins + • Forthisreason, Denk Pharmadeveloped • with800 µg folicacidfor • womenplanning a pregnancyand • women in the first 12 weeksofpregnancy

22. 9. DHA (Docosahexaenoicacid) • What is DHA? • Docosahexaenoic acid (DHA) is an important long-chain omega-3 fatty 21, 22acid • Natural sources of DHA • Seafood (salmon, sardines, shrimps) and algea21, 22 • Role of DHA • DHA is a major is a structural constituent of membranes specifically in the central nervous system. 22, 5 • Its accumulation in the fetal brain takes place mainly during the last trimester of pregnancy and continues at very high rates up to the end of the second year of life. 5 • This is also the time when the brain and the eyes needs especially high amounts of DHA. 23

23. 9. DHA (Docosahexaenoicacid) • The DHA source of the baby is the MOTHER • DHA is ultimately derived from the mother by placental transfer and later by lactation. • The delivery of DHA to the child is dependent on the DHA level of the mother. • Since the endogenous formation of DHA is low, it is important that a pregnant women is supplied with DHA in a sufficient amount to support the child’s brain development. 5, 24 • → Fish consumption may contain mercury contamination and should therefore be limited to 2 seafood servings a week folic acid 200 mg DHA Essential Vitamins + A daily amount of 200 mg DHA is recommended during pregnancy and lactation by several guidelines. 24, 25, 26

24. 10. Other micronutrients Contribution to maintaining a normal energy metabolism. 27 Vitamin B2 Pantothenic acid Vitamin B1 Biotin Niacin Vitamin B6 Reduction of tiredness und fatigue. 27 Vitamin B12 Protection from oxidative stress. 27 Vitamin E Support of the immune system and increase of iron resorption. 27 Vitamin C

25. 11. Complementary treatment FOR FATHERS- TO-BE FOR MOTHERS-TO-BE

26. 12. References 1 Mayo Clinic (2018): Pregnancy week by week. Fetal development: The 1st trimester. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/prenatal-care/art-20045302 2 Mayo Clinic (2018): Pregnancy week by week. Fetal development: The 2nd trimester. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/fetal-development/art-20046151 3 Mayo Clinic (2018): Pregnancy week by week. Fetal development: The 3rd trimester. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/fetal-development/art-20045997 4 Greenberg JA (2008): Omega-3 Fatty Acid Supplementation During Pregnancy. Rev Obstet Gynecol. 1(4): 162-169. 5Lauritzen L (2016): DHA effects in brain development and function. Nutrients. 8 (6). doi:10.3390/nu8010006 6 European Commission (2012): Commission Regulation (EU) 432/2012. 7 Zaganjor I (2016): Describing the Prevalence of Neural Tube Defects Worldwide. PLOS one. 8 Christianson A (2006): March of dimes. Global report on birth defects. 9 Centers for Disease Control and Prevention (2017): Spina Bifida. Basics. https://www.cdc.gov/ncbddd/spinabifida/facts.html

27. 12. References 10Eunice Kennedy Shriver National Institute of Child Health and Human Development (2017): Neural Tube Defects: Condition Information. https://www.nichd.nih.gov/health/topics/ntds/conditioninfo/default 11 Mayo Clinic (2018): Spina bifida. https://www.mayoclinic.org/diseases-conditions/spina-bifida/symptoms-causes/syc-20377860 12 Berg MJ (1999): The importance of folic acid. J GendSpecif Med. 2 (3): 24-28. 13 Nordqvist C (2017): What to know about folic acid. Med News Today. http://www.medicalnewstoday.com/articles/219853.php 14 National Institutes of Health (2018): Folate. Dietary Supplement fact Sheet. https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/ 15 National Institutes of Health (2018): Folate. Dietary Supplement fact Sheet. https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/ 16 National Institutes of Health (2018): Folate. Dietary Supplement fact Sheet. https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/ 17Werler MM (1999): Achieving a public health recommendation for preventing neural tube defects with folic acid. Am J Public Health. 89 (11): 1637-1640. 18 Lamers Y (2011) Folate recommendation for pregnancy, lactation, and infancy. Ann NutrMetab. 59: 32-37.

28. 12. References 19 Wilson RD (2007): Pre-conceptional vitamin/folic acid supplementation 2007: the use of folic acid in combination with multivitamin supplement for the prevention of neural tube defects and other congenital anomalies. J ObstetGynaecol Can. 29 (12): 1003-1013. 20 Institute of Medicine. Food and Nutrition Board (1998): Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin and Choline. Washington, DC, National Academy Press. 21 National Institutes of Health (2018): Omega-3 Fatty Acids. Fact Sheet for Health Professionals. 22 Coletta JM (2010): Omega-3 Fatty Acids and Pregnancy. Rev Obstet Gynecol. 3 (4): 163–171. 23 Nagel G (2016): Omega-3-Fettsäuren. Onmeda.de. 24Koletzko B (2008): The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations. J Perinat Med. 36 (1): 5-14. 25 EFSA Journal (2010) Scientific Opinion on Dietary Reference Values for fats, including saturated fatty acids, polyunsaturated fatty acids, monounsaturated fatty acids, trans fatty acids, and cholesterol. 8 (3) 1461 26 Deutsche Gesellschaft für Ernährung e.V. (2016): Regelmäßig Fisch auf den Tisch! 27 European Commission (2012): Commission Regulation (EU) 432/2012.

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