Micronutrient Additional Requirements (Vital Substances) in the Pregnancy: Vitamins

Vitamins whose requirements are increased during pregnancy include the fat-soluble vitamins A, C, D, E, K and the water-soluble vitamins B1, B2, B3, B5, B6, B12, biotin and folic acid. The fat-soluble vitamins A, D, E and K can only be optimally absorbed together with fat. Carrots should therefore be eaten as a salad with a vinegar-oil or yogurt dressing, for example. Thus, the absorption of vitamin A and beta-carotene, respectively, occurs in appreciable quantities.

Vitamin A

Function of vitamin A

  • Necessary for the maintenance of skin, cell membranes and skeletal tissue
  • Plays an important role in spermatogenesis (sperm cell formation), androgen and estrogen synthesis, and placental formation and function
  • Key component for the visual process and color vision
  • Growth and organ formation controlled by retinoids formed from vitamin A
  • Reducing the incidence of neural tube defects.
  • Antioxidant protection
  • Maintenance of immune function
  • Iron transport
  • Erythropoiesis (formation of red blood cells/erythrocytes).
  • Myelin synthesis in the nervous system

Sources: Contained in animal foods – liver, butter, cheese, boiled eggs, pasteurized milk, herringCaution!Due to the teratogenic effect of vitamin A to cause malformations and malformations in case of overdose, especially during pregnancy, the vitamin A requirement should also be met through the provitamin A beta-carotene, which is largely contained in plant foods such as parsley, carrots, spinach, kale, beet, apricots, cress as well as broccoli. Only as much vitamin A as the body needs is synthesized from beta-carotene. However, since the carotenoid is fat-soluble, it can only be absorbed by the body if the diet also contains a sufficient amount of fat or oil. However, foods rich in vitamin A should not be completely avoided, since only such foods sufficiently build the child’s vitamin A liver stores [2.1. ].Animal foods should therefore be consumed in small portion sizes during pregnancy – a small portion of 50-75 grams twice a week [2.1. ].If animal liver or other sources of vitamin A are completely avoided, substitution with vitamin A and carotene-containing multivitamins is recommended. If vitamin A is moderately substituted along with folic acid, the likelihood of neural tube defect is reduced.The infant depends exclusively on the mother for its vitamin A supply. Since the infant’s liver stores can only be replenished during pregnancy, they depend on the mother’s supply. An insufficient maternal supply of vitamin A during pregnancy thus involves risks both for embryonic development and for the neonatal period The fetal liver stores can only be inadequately filled if the mother’s vitamin A intake is insufficient, which means that an adequate supply for the newborn cannot be guaranteed. Women should therefore pay attention to their vitamin A intake during pregnancy so that the development of the child is not impaired

Vitamin D

Function of vitamin D

  • Prerequisite for a functioning bone metabolism
  • Affects the absorption of calcium and phosphorus
  • Regulates the calcium and phosphate balance
  • Insulin secretion
  • Cell growth
  • Maintenance of the immune system

Sources: Contained in animal foods – egg, meat, fish, cheese, butter, milk.

Vitamin E

Function of vitamin E

  • As an essential antioxidant for unsaturated fatty acids, it protects the lipids of biological membranes from damage by oxygen radicals
  • Prevents proliferation of free radicals by interrupting its chain reactions.
  • Protects cholesterol from oxidation and thus prevents atherosclerosis (arteriosclerosis, hardening of the arteries)
  • Suppression of oxidation of phospholipids and arachidonic acid in the cell membrane – prevention of rheumatic diseases.
  • Increases the production of cellular and humoral defenses, so that immune function is improved
  • Increases resistance to bacteria

Sources: Contained in vegetable oils, wheat germ oil, peanuts, whole grains, leafy vegetables.

Vitamin K

Function of vitamin K

  • Involvement in the synthesis of clotting factors.
  • Important function in the bone system – controls the activity of bone-forming cells (osteoblasts), thus indispensable for bone health

Sources: Contained primarily in plant foods – spinach, broccoli, lettuce, Brussels sprouts, cauliflower; medium content in meat, offal and fruit; little vitamin K in milk and cheese.

Vitamin K administration to the mother via venous access (parenterally) before birth does not provide benefits because immature infants can synthesize the missing clotting factors in only minimal amounts. Parenteral administration to the mother may even exacerbate the clinical picture of hyperbilirubinemia (high bilirubin concentration in the blood) in the child and result in jaundice (icterus). On the other hand, there is nothing wrong with oral substitution in the last week of pregnancy.

Vitamin B1

Function of vitamin B1

  • Carbohydrate metabolism of the muscular and nervous system.
  • Important for the combustion of macronutrients, such as carbohydrates, proteins and fats.
  • Important coenzyme for energy metabolism
  • Is related to the metabolism of neurotransmitters of the serotonergic, adrenergic, and cholinergic systems in the central nervous system

Sources: Found in cereals, pork, yeast, liver, kidney, walnuts, hazelnuts, cashews, whole grains, oatmeal, legumes, potatoes, asparagus, spinach and kale.

Because of its low storage capacity and high turnover rate, vitamin B1 must be supplied daily in adequate amounts. No vitamin B1 mono-preparation should be used for substitution, since the vitamins of the B group only act in combination. In case of insufficient supply, a significant vitamin B1 reduction occurs in most organs after only 10 days.

Vitamin B2

Function of vitamin B2

  • As a coenzyme of flavoproteins, riboflavin is involved in the overall metabolism
  • Central importance in the respiratory chain and in the metabolism of fatty acids, amino acids, carbohydrates as well as purines.
  • Oxidative metabolism, is responsible for the detoxification of pesticides, drugs and carcinogens, important defense mechanism against tumor cells and bacterial infections.
  • Protection against oxidative stress
  • Prolongs the life of red blood cells

Sources: Foods high in riboflavin are yeast, dairy products, meat and sausage, 30% are contained in whole grain products and cereals.

Note!For substitution, vitamin B2 monopreparation should not be used, because the vitamins of the B group act only in combination.

Vitamin B3

Function of vitamin B3 (niacin).

  • 200 body enzymes are niacin-dependent
  • Biosynthesis of fatty acids and steroids.
  • Carbohydrate metabolism – glucose degradation
  • Responsible for the formation of glucose tolerance factor, which regulates blood glucose levels with insulin.
  • Oxidative protection
  • Health of skin, muscle tissue, nervous system and digestive tract.
  • Essential for the synthesis of proteins in the nucleus – histones associated with DNA and necessary for the repair of DNA breaks.

Sources: Occurs in pork and beef and beef and pork liver, chicken, rabbit meat, salmon, herring, rye, whole grains, peasNote!Niacin must be supplied regularly, because the storage capacity is low. Due to this, marginal deficiency symptoms occur after about 2-4 weeks if the supply is insufficient. A tryptophan-rich diet is a substitute source, since vitamin B3 can be formed from the amino acid tryptophan. Tryptophan can be found in veal, cashews, sunflower seeds, tuna, chicken, beef, and oatmeal, among others. No vitamin B3 monopreparation should be used for substitution, since the vitamins of the B group act only in combination.

Vitamin B5

Function of vitamin B5 (pantothenic acid).

  • Responsible for the synthesis of proteins and amino acids, fatty acids, steroids, hemoproteins, neurotransmitters and vitamins A and D.
  • Energy metabolism
  • Wound healing
  • Significant for all important cell functions

Sources: Found in beef and pork liver and kidney, eggs, brain, herring, muscle meat and oysters.

Since no store is available for this vitamin, care must be taken to ensure adequate, regular intake. No vitamin B5 monopreparation should be used for substitution, since the vitamins of the B group only act in combination.

Vitamin B6

Function of vitamin B6

  • Coenzyme in protein, carbohydrate and fat metabolism of more than 60 enzymes.
  • Ensures cellular and humoral immune defenses
  • Glycogenesis
  • Hemoglobin synthesis
  • Important for the combustion of macronutrients.
  • Prevents nausea

Sources: Occur especially in wheat germ, fish, meat, liver, egg yolk, nuts, whole grains, rice, beans and avocado.

Increased vitamin B6 intake – through food and vital substance supplementation (micronutrients) – especially need women with:

  • Risk pregnancies
  • Diet low in vitamin B6
  • Nicotine or alcohol consumption
  • Obesity (overweight) as well as underweight
  • Anemia (anemia)
  • Eating disorders – anorexia nervosa
  • Gestosis and tardive gestosis
  • Hyperemesis gravidarum – severe nausea of pregnancy.
  • Multiple pregnancies
  • Gestational diabetes (gestational diabetes)

Pregnant women with recent childbirth also have depleted vitamin B6 stores. If women become pregnant at a young age, they should in any case pay attention to a sufficient vitamin B6 supply through food, because during puberty through growth and organ maturation (cell division) folic acid and vitamin B6 and B12 are increasingly consumed. Note!For substitution, no vitamin B6 monopreparation should be used, since the vitamins of the B group act only in combination.

Vitamin B12

Function of vitamin B12

  • Coenzyme for various enzymes including DNA formation, red blood cell formation and regeneration.
  • Coenzyme in carbohydrate and fat metabolism.
  • Synthesis of myelin, the protective layer of peripheral nerve cords in the brain and spinal cord.
  • DNA synthesis, essential for cell division and reproduction.
  • Antioxidant effect

Sources: Occur exclusively in animal products – offal, such as liver, kidney and heart, meat, yeast, herring, salmon, dairy products and eggs.

Increased additional demand for vitamin B12 during pregnancy occurs due to increased metabolic demands, increased maternal red blood cell production and weight gain. Fetoplacental growth alone removes about 0.2 µg daily from the mother’s stores. Compared to the mother’s blood, newborns have 2- to 3-fold higher blood concentrations of vitamin B12. Supplementation with vitamin B12 is particularly necessary in strict vegetarians Increased vitamin B12 intake – via diet and vital substance supplementation (micronutrients) – is particularly needed by women with:

  • High-risk pregnancies
  • Pregnant women with a recent delivery
  • Diet low in vitamin B12 – vegans
  • Nicotine or alcohol consumption
  • Obesity (overweight) as well as underweight
  • Anemia (anemia)
  • Eating disorders – anorexia nervosa
  • Gestosis and tardive gestosis
  • Hyperemesis gravidarum – severe nausea of pregnancy.
  • Multiple pregnancies
  • Gestational diabetes (gestational diabetes)

If women become pregnant at a young age, they should in any case pay attention to an adequate vitamin B12 intake through food, because during puberty through growth and organ maturation (cell division) folic acid as well as vitamin B6 and B12 are increasingly consumed. Like all B vitamins, vitamin B12 exerts its effect best in combination with the others.An unphysiologically high substitution is not advisable, since the absorption rate of vitamin B12 decreases with increasing intake.

Biotin

Function of biotin

Involved in several metabolic processes essential for life, such as:

  • The new formation of glucose in the cell – gluconeogenesis in the liver and kidneys.
  • Glucose synthesis (formation of glucose) – energy supply.
  • Leucine catabolism
  • Fatty acid synthesis

Sources: Occurrence in yeast, liver, soy and beans, walnuts, chicken eggs, cauliflower, mushrooms and lentils.

Due to the short storage possibility, it is necessary to pay attention to a regular physiological intake, because the self-synthesis in the intestine is not sufficient to maintain health.

Folic acid

Function of folic acid – also known as vitamin B9.

  • DNA synthesis
  • Protein biosynthesis
  • Homocysteine degradation
  • Formation of red blood cells, amino acids and nucleic acids
  • Essential for cell division and formation, reproduction and growth.
  • Significance in nerve metabolism

Sources: Found in leafy vegetables, asparagus, tomatoes, cucumbers, cereals, beef and pork liver, chicken egg yolk and walnuts – Folates from animal products are often better absorbed than folates from plant products.

Folic acid plays a crucial role in pregnancy. Folic acid requirements double due to the 30% increase in red blood cell formation in the mother. The increased folate requirement of the fetus, the growth of the placenta, the increased anabolic functions and the weight gain make the increased folic acid intake of the pregnant mother urgently necessary. Since the folic acid transport from the mother via the placenta to the fetus is enormously increased, the folic acid concentration in the blood of the unborn child is usually 6 to 8 times higher than in the mother. The level of folic acid in the red blood cells is about twice as high in the child as in the mother [2.2]. The increased fetal folate concentration results from a specific system in the umbilical cord blood, which transports folic acid into the fetus against a concentration gradient and accumulates it there to a greater extent. Since the body has only very limited folate stores, the body’s own reserves are quickly depleted. An additional vitamin B9 supply in the form of folic acid substitution is therefore of considerable importance, especially during pregnancy. The recommended daily dose is 400 µg. Other reasons for additional folic acid supplementation throughout pregnancy:

  • Decreased amounts of folic acid in various fruits and vegetables.
  • Increasing leaching of vitamin B9 from soils as a result of increased heavy metal contamination
  • Emergence of significant folic acid losses during preparation due to heat and oxygen.
  • Due to the water solubility, folic acid is also lost in the washing or cooking water

Increased folic acid substitutions need especially women with:

  • Risk pregnancy (risk pregnancy).
  • Pregnant woman with recent delivery
  • Previous pregnancies with neural tube defects* .
  • Multiple gravidity (multiple pregnancy).
  • Diet low in folic acid
  • Nicotine* or alcohol consumption
  • Obesity (overweight)* as well as underweight
  • Anemia
  • Diabetes mellitus*
  • Eating disorders – anorexia nervosa (anorexia)
  • Gestational diabetes (gestational diabetes)
  • Gestosis and late gestosis
  • Hyperemesis gravidarum – severe nausea of pregnancy.
  • Malabsorption disorders (inadequate absorption of substrates from the food pulp)* .
  • Permanent intake of antiepileptic drugs or antifolate drugs* (substances that block the action of folic acid) such as cytostatics (drugs used in cancer therapy; methotrexate, pemetrexed, amonipterin), anti-infective drugs (pyrimethamine, trimethoprim) and sulfonamides (group of antibiotics)

* In this context, the recommended daily dose is 5 mg. In folic acid deficiency conditions, folic acid should be taken from 2 months before conception until the completion of the first trimester (third of pregnancy), if necessary longer. If women become pregnant at a young age, they should definitely ensure adequate folic acid intake through diet as well as supplementation, since folic acid as well as vitamins B6 and B12 are increasingly consumed during puberty due to growth and organ maturation (cell division).

Vitamin C

Function of vitamin C

  • Strong reducing agent
  • Involved in electron transport of hydoxylation reactions.
  • Cofactor in carnitine synthesis
  • Antioxidant protection, inactivation of oxygen radicals, prevents lipid peroxidation.
  • Detoxification of toxic metabolites and drugs
  • Prevents the formation of carcinogenic nitrosamines
  • Important for collagen biosynthesis
  • Conversion of folic acid into the active form (tetrahydrofolic acid).
  • Regenerates vitamin E when exposed to radicals, increases iron absorption.
  • Improves the ability of muscles to burn fat for the purpose of energy production
  • Essential for the biological activity of hormones of the nervous system, such as TRH, CRH, gastrin or bombesin.
  • Immunoregulatory

Sources: Vitamin C content is particularly high in freshly picked fruits and vegetables – rose hips, sea buckthorn juice, currants, peppers, broccoli, kiwi, strawberries, oranges, red and white cabbage.

In case of high vitamin C deficiencies, carnitine must be additionally substituted. Table – Need for vitamins

Vitamin Deficiency symptoms – effects on the mother Deficiency symptoms – effects on the fetus or infant, respectively
Vitamin A
  • High protein intake increases the need
  • Uterine mucosal (uterine lining)and placental development disorders
  • Fertility disorders
  • Anemia (anemia)

Increased risk of

Overdoses lead to

  • Reduction of vitamin A liver reserve

Increased risk of

  • Premature and stillbirths
  • Birth defects
  • Low birth weight

Overdoses at intakes above 1 million IU per day result in malformations of varying degrees, such as.

  • Cleft lip and palate
  • Malformations of the skull and face, heart, central nervous system, extremities, gastrointestinal and genitourinary tract, in the area of the auditory organ.
  • Disorders in the development of the skeletal system
  • Deficiency of choline and vitamin E may increase the toxic effects of vitamin A overdose
Vitamin D Loss of minerals from bones – spine, pelvis, extremities – results in

  • Hypocalcemia (calcium deficiency).
  • Decreased bone density
  • Bone pain and spontaneous fractures – Osteomalacia (bone softening).
  • Deformities
  • Muscle weakness, especially at the hips and pelvis
  • Increased risk of later osteoporosis
  • Loss of hearing, ringing in the ears.
  • Disturbed immune system with repeated infections.
  • Increased risk of colon and breast cancer
  • Reduced mineralization
  • Decrease in calcium transport in the placenta.
  • Hypocalcemia (calcium deficiency).
  • Impairment of the development of bones and teeth.
  • Bone bending, disturbances in the longitudinal growth of bones – formation of rickets.

Overdoses lead to

Vitamin E
  • Lack of protection against radical attack and lipid peroxidation.
  • Decreased immune response
  • Disease of muscle cells due to inflammation of muscle tissue – myopathies.
  • Shrinkage as well as weakening of the muscles
  • Disease of the peripheral nervous system, neurological disorders, disorders in neuromuscular information transmission – neuropathies.
  • Reduced number and lifetime of red blood cells.
  • Birth defect
  • Spontaneous placental abruption
  • Shortened life span of red blood cells
  • Anemia (anemia)
  • Impairment of blood vessels leads to bleeding
  • Disturbances in neuromuscular information transmission.
  • Chronic obstructive pulmonary disease (COPD) – shortness of breath.
  • Cerebral hemorrhage

Increased risk of

  • Premature and stillbirths
  • Birth defects
  • Low birth weight
Vitamin K Blood coagulation disorders leading to

  • Hemorrhage into tissues and organs
  • Bleeding from body orifices
  • Small amounts of blood in the stool can cause

Decreased activity of osteoblasts leads to.

  • Increased urinary calcium excretion.
  • Severe bone deformities
There is a vitamin K deficiency due to

  • The lack of vitamin K production in the bacterially unpopulated infantile intestine.
  • The insufficient vitamin K uptake from the mother
  • Placenta is not permeable to vitamin K
  • Decreased synthesis of clotting factors
  • Decreased prothrombin levels – dropping to 20-40% of the adult norm.
  • Prolonged prothrombin time – 19-22 seconds, normal 13 seconds.
  • Even with adequate intake, immature children can synthesize the missing clotting factors in only minimal amounts
  • Blood clotting disorders

In newborns

  • Gastrointestinal bleeding
  • Blood leakage from body orifices and navel
Vitamin B1 Central and peripheral nervous system disorders leading to

  • Nerve disease in the extremities
  • Diseases the muscles
  • Muscle pain, wasting and weakness, involuntary muscle twitching.
  • Hyperexcitability of the heart muscle, decrease in cardiac output – tachycardia.
  • Palpitations and heart failure, shortness of breath.
  • Memory loss
  • Sleep disturbances
  • General state of weakness
  • Decreased production of antibodies during infections
  • Impaired collagen synthesis resulting in poor wound healing.
  • Severe thiamine deficiency with disturbance of nerve function and cardiac insufficiency – beriberi.
  • Skeletal muscle wasting
  • Increased risk of cardiac dysfunction and failure.
Vitamin B2

Increased risk of

  • Light sensitivity (photophobia), increased burning tears, lens clouding and cataract (cataract).
  • Anemia
  • Disturbed absorption and mobilization of iron
  • Impaired niacin synthesis
  • Impaired conversion of vitamin B6 to active forms
Niacin

Neurological disorders, such as.

Complaints of the digestive tract, such as.

  • Loss of appetite
  • Decreased release of digestive juices
  • Gastric dilation and swelling
  • Flatulence, vomiting and diarrhea
  • Pain or numbness of the extremities
  • Impaired conversion of folic acid to tetrahydrofolic acid.
  • Impaired conversion of vitamins B2 and B6 to active forms
  • Increased risk of sudden infant death syndrome
Vitamin B6
  • Insomnia, nervous disorders, sensitivity disorders.
  • Impaired response of white blood cells to inflammation.
  • Decreased production of antibodies
  • Impairment of cellular and humoral immune defenses.
  • Muscle twitching, convulsions
  • States of confusion, headaches
  • Nausea
  • Reduction of DNA synthesis – limited replication – and cell division.
  • Oxidative damage leads to base remodeling in DNA – cytosine to uracil.
  • This mutation cannot be reversed by the absence of vitamin B6 – uracil pairs with adenine
  • Information transfer of the gene is suppressed

Disorders of protein biosynthesis and cell division in turn lead to disorders of the central nervous system – neural tube defects.

  • Closure of the neural tube has not occurred or has occurred only partially with the consequence of incomplete attachment of the spinal canal and the brain, respectively – anencephaly.
  • Such a malformation in the area of the spinal cord leads to the formation of spina bifida – in this case, part of the spine is open
Vitamin B12
  • Decreased vision and blind spots
  • Functional folic acid deficiency
  • Weakened antioxidant protective system

Blood count

  • Megaloblastic anemia (anemia).
  • Anemia decreases the ability to concentrate, leads to fatigue, weakness and shortness of breath
  • Impaired growth of white blood cells weakens the immune system
  • Risk of bleeding due to reduced production of platelets.

Gastrointestinal tract

  • Tissue atrophy and inflammation of the mucous membranes.
  • Rough, burning tongue
  • Reduced absorption of nutrients and vital substances (macro- and micronutrients).
  • Loss of appetite, weight loss

Neurological disorders

  • Numbness and tingling of extremities, loss of sensation of touch, vibration and pain.
  • Poor coordination of the muscles, muscle atrophy.
  • Unsteady gait
  • Spinal cord damage

Psychiatric disorders

  • Memory disorders, confusion, depression
  • Aggressiveness, states of agitation, psychosis.
  • Reduction of DNA synthesis – limited replication – and cell division.
  • Oxidative damage leads to base remodeling in DNA – cytosine to uracil.
  • This mutation then can not be reversed by the absence of vitamin B6 – uracil pairs with adenine
  • Information transfer of the gene is suppressed
  • Disruption of protein biosynthesis and cell division in turn lead to

Disorders of the central nervous system – neural tube defects.

  • Closure of the neural tube has not occurred or has occurred only partially with the consequence of incomplete attachment of the spinal canal and the brain, respectively – anencephaly.
  • Such a malformation in the area of the spinal cord leads to the formation of spina bifida – in this case, part of the spine is open
Folic acid Mucosal changes in the mouth, intestines, and urogenital tract lead to

  • Indigestion – diarrhea
  • Reduced absorption of nutrients and vital substances (macro and micronutrients).
  • Weight loss

Blood count disorders

  • Anemia leads to rapid fatigue, shortness of breath, decreased ability to concentrate, general weakness.

Impaired formation of white blood cells leads to.

  • Reduction of the immune response to infections.
  • Decreased antibody formation
  • Risk of bleeding due to decreased production of platelets

Elevated homocysteine levels increase the risk for

  • Atherosclerosis
  • Coronary artery disease (CAD)

Neurological and psychiatric disorders, such as.

  • Memory impairment
  • Depression
  • Aggressiveness
  • Irritability
Disturbances in DNA synthesis-restricted replication-and decreased cell proliferation increase the risk for

  • Fetal anomalies and gestosis.
  • Malformations, developmental disorders
  • Growth retardation
  • Bone marrow alteration

Disorders of protein biosynthesis and cell division lead to disorders of the central nervous system – neural tube defects.

  • Closure of the neural tube has not occurred or has occurred only partially with the consequence of incomplete attachment of the spinal canal and the brain, respectively – anencephaly.
  • Such a malformation in the area of the spinal cord leads to the formation of spina bifida – in this case, part of the spine is open

Increased risk of

  • Spontaneous miscarriages
  • Birth defects
  • Low birth weight
Pantothenic acid
  • Fatigue, headache, palpitations, insensitivity, insomnia.
  • Gastrointestinal disorders, stomach pain, vomiting.
  • Physical weakness
  • Weakened immune system
  • Decreased effect of antibodies
  • Poor wound healing
  • Uncoordinated movements
  • Muscle pain
  • Numbness and burning in the lower legs and ankle pain
  • Impaired vitamin A and D synthesis.
Biotin
  • Massive fatigue, drowsiness, loss of appetite, depression, anxiety.
  • Stomach pain and vomiting
  • Muscle pain, sensory disturbances
  • Temporary dizziness
  • Numbness and tingling in the extremities
Vitamin C Weakness of blood vessels leads to

  • Abnormal bleeding
  • Mucosal bleeding
  • Hemorrhage into the muscles associated with weakness in heavily used muscles
  • Inflamed as well as bleeding gums (gingivitis).
  • Joint stiffness and pain
  • Poor wound healing

Carnitine deficit leads to

  • Symptoms of exhaustion, fatigue, indifference, irritability, depression.
  • Increased need for sleep, decreased performance.
  • Weakness of the immune system with increased risk of infection
  • Decreased oxidation protection increases the risk of heart disease, stroke (apoplexy)
Increased risk of vitamin C deficiency disease – Möller-Barlow disease in infancy with symptoms such as.

  • Large bruises (hematomas).
  • Pathological bone fractures associated with severe pain
  • Wincing after every slightest touch – “jumping jack phenomenon”.
  • Stagnation of growth