Estrategias de suplementación nutricional durante el embarazo desde la atención primaria en salud: Una revisión sistemática
Palabras clave:
Atención primaria de salud, Suplementos dietéticos, Micronutrientes, Ácido fólico, Atención prenatal
Resumen
Objetivo: Evaluar e identificar las estrategias de suplementación nutricional durante el embarazo implementadas en la Atención Primaria en Salud (APS) y analizar su efectividad para mejorar la salud materno-fetal. Material y métodos: Revisión sistemática (2020-2025) mediante búsqueda de artículos en PubMed, Web of Science y LILACS. Se incluyeron 12 estudios que evaluaron estrategias o programas de suplementación (hierro, ácido fólico, calcio, multivitamínicos) en gestantes atendidas en entornos comunitarios o de APS, excluyendo investigaciones en hospitales de alta complejidad. Resultados: Las estrategias más exitosas en APS incluyen la educación en salud pública comunitaria, la implementación de paquetes de nutrición mejorados (asesoramiento individualizado, suministro a domicilio y fortificación de alimentos) y la capacitación del personal de salud. Se identificó que la principal barrera para la adherencia son los efectos secundarios (náuseas, estreñimiento). La evidencia demostró que estas estrategias integrales con múltiples micronutrientes reducen significativamente la incidencia de bajo peso al nacer, preeclampsia, anemia y partos prematuros. Conclusión: Las intervenciones nutricionales gestionadas desde la APS son altamente efectivas debido a su accesibilidad y capacidad de seguimiento continuo. El éxito de la suplementación radica en iniciar tempranamente, asegurar el abastecimiento en los centros de salud y brindar educación integral que fomente la adherencia de la gestante al tratamiento para prevenir complicaciones.
Citas
Jaramillo VLM, González ACC. Prácticas alimentarias, conocimientos y suplementación en gestantes usuarias de la Clínica Hospital Municipal de Loja. Metro Ciencia. 2025;33(1):38-52. DOI: https://doi.org/10.47464/MetroCiencia/vol33/1/2025/38-52
Organización Mundial de la Salud (OMS). Recomendaciones de la OMS sobre atención prenatal para una experiencia positiva del embarazo. Ginebra: OMS; 2016. Disponible en: https://www.who.int/es/publications/i/item/WHO-RHR-16.12
Vaca-Pérez DF, Favier-Torres MA. Suplementación con vitaminas, minerales y otros micronutrientes durante el embarazo. Rev Inf Cient. 2023;102:e4027. Disponible en: https://www.redalyc.org/journal/5517/551774301023/html/
Iñiguez Jiménez RM, Cruz Pierard SM, Iñiguez Jiménez SO. Influencia de la suplementación durante el embarazo sobre el desarrollo cognitivo del niño. Vive Rev Salud. 2021;4(11):207-22. Disponible en: https://www.scielo.org.bo/pdf/vrs/v4n11/2664-3243-vrs-4-11-207.pdf
Ancajima JEY, Marchan LEA, Silva GC, Castro PV. Consumo de hierro y vitamina C en gestantes de una comunidad costera del norte del Perú. Rev Esp Nutr Comunitaria. 2025;31(3):6. Disponible en: https://revistanutricioncomunitaria.com/articulo/-consumo-de-hierro-y-vitamina-c-en-gestantes-de-una-comunidad-costera-del-norte-del-peru--669805
Xotlanihua-Gervacio MC, Valenzuela OL, Rodríguez-Ruiz A, Viveros-Contreras R, Balderas-Vázquez C, Méndez-Bolaina E, et al. Los estados hematológico y nutricional se asocian con el desarrollo de preeclampsia en una población mexicana. Nutr Hosp. 2023;40(1):78-87.
Smith TJ, et al. Nutrition and health-seeking practices during pregnancy and lactation and potential strategies to increase micronutrient intakes among women in northern Lao PDR. J Nutr Sci. 2022;11. DOI: https://doi.org/10.1017/jns.2022.94
Ali SA, Ali SA, Razzaq S, Khowaja N, Gutkind S, Raheman FU, et al. Predictors of iron consumption for at least 90 days during pregnancy: Findings from National Demographic Health Survey, Pakistan (2017-2018). BMC Pregnancy Childbirth. 2021;21(1). DOI: https://doi.org/10.1186/s12884-021-03825-2
Hoang MA, Kroeun H, Klemm R, Sen Gupta A, Rem N, Meng S, et al. Adherence and acceptability of multiple micronutrient supplementation during pregnancy: Study protocol for a cluster-randomized non-inferiority trial in Cambodia. Trials. 2024;25(1). DOI: https://doi.org/10.1186/s13063-023-07891-z
Abate BB, Kumsa H, Kibret GA, Wodaynew T, Habtie TE, Kassa M, et al. Preconception Folic Acid and Multivitamin Supplementation for the Prevention of Neural Tube Defect: An Umbrella Review of Systematic Review and Meta-analysis. Neuroepidemiology. 2025; 59(4): 412-425. DOI: https://doi.org/10.1159/000539803
Lee ACC, Workneh F, Kang Y, Yibeltal K, Fasil N, Tsegaye S, et al. The impact of enhancing nutrition and antenatal infection treatment on birth outcomes in Amhara, Ethiopia: A pragmatic factorial, cluster-randomised clinical effectiveness study. BMJ Glob Health. 2025;10(6). DOI: https://doi.org/10.1136/bmjgh-2024-016264
Cormick G, Moraa H, Zahroh RI, Allotey J, Rocha T, Peña-Rosas JP, et al. Factors affecting the implementation of calcium supplementation strategies during pregnancy to prevent pre-eclampsia: A mixed-methods systematic review. BMJ Open. 2023;13(12). DOI: https://doi.org/10.1136/bmjopen-2022-070677
Ota E, da Silva Lopes K, Middleton P, Flenady V, Wariki WMV, Rahman MO, et al. Antenatal interventions for preventing stillbirth, fetal loss and perinatal death: An overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2020;12(12):CD009599. DOI: https://doi.org/10.1002/14651858.cd009599.pub2
Njiru H, Njogu E, Gitahi MW, Kabiru E. Effectiveness of public health education on the uptake of iron and folic acid supplements among pregnant women: A stepped wedge cluster randomised trial. BMJ Open. 2022;12(9). DOI: https://doi.org/10.1136/bmjopen-2022-063615
Pereira RJ, Coqueiro KTO, Anjos FCQS. Ingestão de nutrientes por gestantes da atenção básica no Tocantins. Rev Ciênc Plural. 2021;8(1):e25585.
Smith ER, Gomes F, Adu-Afarwuah S, Aguayo VM, Arifeen SE, Bhutta ZA, et al. Contribution of Maternal Adherence to the Effect of Multiple Micronutrient Supplementation During Pregnancy: A Systematic Review and Individual Participant Data Meta-analysis. 2025; 16(7): 100455. DOI: https://doi.org/10.1016/j.advnut.2025.100455
Labonté JM, Hoang MA, Panicker A, Kroeun H, Sokchea M, Sambo S, et al. Exploring factors affecting adherence to multiple micronutrient supplementation during pregnancy in Cambodia: A qualitative analysis. 2024; 21(1): e13745. DOI: https://doi.org/10.1111/mcn.13745
Chokor FA, Eussen SJPM, Crone M, Abdulmalik M, Ayoub J, Zgheib P, et al. Vitamin D deficiency and supplementation in pregnancy. Randomized Controlled Trial. 2009; 70 (5): 685-90. DOI: https://doi.org/10.1111/j.1365-2265.2008.03403.x
Fekade A, Teketelew B, Aynalem M. Hemoglobin response to iron-folic acid supplementation and associated factors among anemic pregnant women attending the University of Gondar Comprehensive Specialized Hospital ANC ward Northwest, Ethiopia 2023: A longitudinal follow up study. PLoS One. 2025; 71(2). DOI: https://doi.org/10.1371/journal.pone.0331599
Nunes M, et al. Nutrition, mental health and violence: from pregnancy to postpartum Cohort of women attending primary care units in Southern Brazil--ECCAGE study. BMC Psychiatry. 2010; 10(1): 66. DOI: https://doi.org/10.1186/1471-244x-10-66
Sandall J, et al. Midwife continuity of care models versus other models of care for childbearing women. Cochrane Database Syst Rev. 2024; 4(4): CCD004667. DOI: https://doi.org/10.1002/14651858.cd004667.pub6
Rizk J, et al. Assessing Health Care Providers' Knowledge and Practices of Nutrition during Pregnancy in Lebanon: A Cross-Sectional Study. Medicina (Kaunas). 2023; 59(8): 1471. DOI: https://doi.org/10.3390/medicina59081471
Fenta EH, et al. Landscape analysis of nutrition services at Primary Health Care Units (PHCUs) in four districts of Ethiopia. PLoS One. 2020; 15(12): e0243240. DOI: https://doi.org/10.1371/journal.pone.0243240
Hasan AM, et al. Opportunities and challenges in delivering maternal and child nutrition services through public primary health care facilities in urban Bangladesh: a qualitative inquiry. BMC Health Serv Res. 2023; 23(1): 1172. DOI: https://doi.org/10.1186/s12913-023-10094-6
Anne FI, et al. Quality of nutrition services in primary health care facilities of Dhaka city: State of nutrition mainstreaming in urban Bangladesh. PLoS One. 2022; 17(12): e0278621. DOI: https://doi.org/10.1371/journal.pone.0278621
Organización Mundial de la Salud (OMS). Recomendaciones de la OMS sobre atención prenatal para una experiencia positiva del embarazo. Ginebra: OMS; 2016. Disponible en: https://www.who.int/es/publications/i/item/WHO-RHR-16.12
Vaca-Pérez DF, Favier-Torres MA. Suplementación con vitaminas, minerales y otros micronutrientes durante el embarazo. Rev Inf Cient. 2023;102:e4027. Disponible en: https://www.redalyc.org/journal/5517/551774301023/html/
Iñiguez Jiménez RM, Cruz Pierard SM, Iñiguez Jiménez SO. Influencia de la suplementación durante el embarazo sobre el desarrollo cognitivo del niño. Vive Rev Salud. 2021;4(11):207-22. Disponible en: https://www.scielo.org.bo/pdf/vrs/v4n11/2664-3243-vrs-4-11-207.pdf
Ancajima JEY, Marchan LEA, Silva GC, Castro PV. Consumo de hierro y vitamina C en gestantes de una comunidad costera del norte del Perú. Rev Esp Nutr Comunitaria. 2025;31(3):6. Disponible en: https://revistanutricioncomunitaria.com/articulo/-consumo-de-hierro-y-vitamina-c-en-gestantes-de-una-comunidad-costera-del-norte-del-peru--669805
Xotlanihua-Gervacio MC, Valenzuela OL, Rodríguez-Ruiz A, Viveros-Contreras R, Balderas-Vázquez C, Méndez-Bolaina E, et al. Los estados hematológico y nutricional se asocian con el desarrollo de preeclampsia en una población mexicana. Nutr Hosp. 2023;40(1):78-87.
Smith TJ, et al. Nutrition and health-seeking practices during pregnancy and lactation and potential strategies to increase micronutrient intakes among women in northern Lao PDR. J Nutr Sci. 2022;11. DOI: https://doi.org/10.1017/jns.2022.94
Ali SA, Ali SA, Razzaq S, Khowaja N, Gutkind S, Raheman FU, et al. Predictors of iron consumption for at least 90 days during pregnancy: Findings from National Demographic Health Survey, Pakistan (2017-2018). BMC Pregnancy Childbirth. 2021;21(1). DOI: https://doi.org/10.1186/s12884-021-03825-2
Hoang MA, Kroeun H, Klemm R, Sen Gupta A, Rem N, Meng S, et al. Adherence and acceptability of multiple micronutrient supplementation during pregnancy: Study protocol for a cluster-randomized non-inferiority trial in Cambodia. Trials. 2024;25(1). DOI: https://doi.org/10.1186/s13063-023-07891-z
Abate BB, Kumsa H, Kibret GA, Wodaynew T, Habtie TE, Kassa M, et al. Preconception Folic Acid and Multivitamin Supplementation for the Prevention of Neural Tube Defect: An Umbrella Review of Systematic Review and Meta-analysis. Neuroepidemiology. 2025; 59(4): 412-425. DOI: https://doi.org/10.1159/000539803
Lee ACC, Workneh F, Kang Y, Yibeltal K, Fasil N, Tsegaye S, et al. The impact of enhancing nutrition and antenatal infection treatment on birth outcomes in Amhara, Ethiopia: A pragmatic factorial, cluster-randomised clinical effectiveness study. BMJ Glob Health. 2025;10(6). DOI: https://doi.org/10.1136/bmjgh-2024-016264
Cormick G, Moraa H, Zahroh RI, Allotey J, Rocha T, Peña-Rosas JP, et al. Factors affecting the implementation of calcium supplementation strategies during pregnancy to prevent pre-eclampsia: A mixed-methods systematic review. BMJ Open. 2023;13(12). DOI: https://doi.org/10.1136/bmjopen-2022-070677
Ota E, da Silva Lopes K, Middleton P, Flenady V, Wariki WMV, Rahman MO, et al. Antenatal interventions for preventing stillbirth, fetal loss and perinatal death: An overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2020;12(12):CD009599. DOI: https://doi.org/10.1002/14651858.cd009599.pub2
Njiru H, Njogu E, Gitahi MW, Kabiru E. Effectiveness of public health education on the uptake of iron and folic acid supplements among pregnant women: A stepped wedge cluster randomised trial. BMJ Open. 2022;12(9). DOI: https://doi.org/10.1136/bmjopen-2022-063615
Pereira RJ, Coqueiro KTO, Anjos FCQS. Ingestão de nutrientes por gestantes da atenção básica no Tocantins. Rev Ciênc Plural. 2021;8(1):e25585.
Smith ER, Gomes F, Adu-Afarwuah S, Aguayo VM, Arifeen SE, Bhutta ZA, et al. Contribution of Maternal Adherence to the Effect of Multiple Micronutrient Supplementation During Pregnancy: A Systematic Review and Individual Participant Data Meta-analysis. 2025; 16(7): 100455. DOI: https://doi.org/10.1016/j.advnut.2025.100455
Labonté JM, Hoang MA, Panicker A, Kroeun H, Sokchea M, Sambo S, et al. Exploring factors affecting adherence to multiple micronutrient supplementation during pregnancy in Cambodia: A qualitative analysis. 2024; 21(1): e13745. DOI: https://doi.org/10.1111/mcn.13745
Chokor FA, Eussen SJPM, Crone M, Abdulmalik M, Ayoub J, Zgheib P, et al. Vitamin D deficiency and supplementation in pregnancy. Randomized Controlled Trial. 2009; 70 (5): 685-90. DOI: https://doi.org/10.1111/j.1365-2265.2008.03403.x
Fekade A, Teketelew B, Aynalem M. Hemoglobin response to iron-folic acid supplementation and associated factors among anemic pregnant women attending the University of Gondar Comprehensive Specialized Hospital ANC ward Northwest, Ethiopia 2023: A longitudinal follow up study. PLoS One. 2025; 71(2). DOI: https://doi.org/10.1371/journal.pone.0331599
Nunes M, et al. Nutrition, mental health and violence: from pregnancy to postpartum Cohort of women attending primary care units in Southern Brazil--ECCAGE study. BMC Psychiatry. 2010; 10(1): 66. DOI: https://doi.org/10.1186/1471-244x-10-66
Sandall J, et al. Midwife continuity of care models versus other models of care for childbearing women. Cochrane Database Syst Rev. 2024; 4(4): CCD004667. DOI: https://doi.org/10.1002/14651858.cd004667.pub6
Rizk J, et al. Assessing Health Care Providers' Knowledge and Practices of Nutrition during Pregnancy in Lebanon: A Cross-Sectional Study. Medicina (Kaunas). 2023; 59(8): 1471. DOI: https://doi.org/10.3390/medicina59081471
Fenta EH, et al. Landscape analysis of nutrition services at Primary Health Care Units (PHCUs) in four districts of Ethiopia. PLoS One. 2020; 15(12): e0243240. DOI: https://doi.org/10.1371/journal.pone.0243240
Hasan AM, et al. Opportunities and challenges in delivering maternal and child nutrition services through public primary health care facilities in urban Bangladesh: a qualitative inquiry. BMC Health Serv Res. 2023; 23(1): 1172. DOI: https://doi.org/10.1186/s12913-023-10094-6
Anne FI, et al. Quality of nutrition services in primary health care facilities of Dhaka city: State of nutrition mainstreaming in urban Bangladesh. PLoS One. 2022; 17(12): e0278621. DOI: https://doi.org/10.1371/journal.pone.0278621
Publicado
2026-03-11
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