Current Strategies And Interventions
Several strategies exist globally to address micronutrient malnutrition in women and children. Common strategies include diet diversification, biofortification of staple crops, large-scale, targeted, and home fortification . Micronutrient supplementation is another common strategy, often used for short-term, preventive purposes targeting specific at-risk population groups . Micronutrients are ingested in the forms of tablets or other vehicles and bioconverted to their active form. Thus, supplementation is a recommended part of routine antenatal care to overcome complications associated with micronutrient deficiencies during pregnancy, and to support maternal health and fetal development. This review will focus on micronutrient supplementation interventions during pregnancy.
What Type Of Prenatal Vitamins Is Best
Vitamins come in multiple forms: pill, soft-gel capsule and gummies. For some, swallowing and holding down a pill can be difficult especially when youre queasy due to morning sickness. If thats your situation, try a soft-gel capsule or a gummy vitamin. Just remember that gummy vitamins do not contain iron, so you may want an extra iron supplement for that.
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Recommended Folate Intake During Pregnancy
Folate requirements increase during pregnancy. There is a dramatic acceleration in cell division and red blood cell development as the uterus enlarges, the placenta develops, maternal blood volume expands, and the fetus grows . The mother also transfers folate to the fetus . Evidence supports a RDA of 600 mcg DFEs per day to maintain normal folate status during pregnancy .
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Essential Vitamins And Minerals In Pregnancy
Good nutrition in pregnancy is vital for the healthy growth and development of your baby. You need to consume enough nutrients to meet your baby’s needs, as well as your own.
- folate helps prevent neural tube defects, such as spina bifida
- iodine is needed for brain and nervous system development
- iron helps prevent anaemia in the mother, as well as low birth weight in the baby
Vitamin B12 and vitamin D are also particularly important since they support the development of the baby’s nervous system and skeleton . Adequate vitamin C intake also helps improve the adsorption of iron from your diet.
Do I Need To Take Supplements
It’s recommended that all pregnant women in Australia take folic acid and iodine supplements.
However, it’s better to get the other nutrients you need from a healthy diet rather than from supplements. In most cases, eating a variety of nutritious foods should meet both your needs and those of your baby. Check the Australian Dietary Guidelines for more advice.
If you have a known deficiency, your doctor might advise you to take a supplement. For example:
- if you are vegetarian or vegan and not getting adequate vitamin B12
- if you don’t consume enough dairy foods and are not getting much calcium, which is vital for bone health
- if you have a vitamin D deficiency
If you’re not sure whether you need a supplement, talk to your doctor.
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Promoting The Use Of Folic Acid Supplementation
According to Canadian survey data, 58% of women said they took a multivitamin containing folic acid or a folic acid supplement in the three months before becoming pregnant . It has been shown that the use of supplements is influenced by economic status and educational background . For instance, the use of folic acid supplements before pregnancy in Canada was lowest among women in lower-income households, among women with less than high school graduation, and among immigrant mothers . Women with unplanned pregnancies, mothers under the age of 25 and single mothers are also less likely to supplement with folic acid .
Although the majority of Canadian women take folic acid supplements in the three months before pregnancy, continued public health efforts are needed to promote awareness of the importance of folic acid supplementation for all women of childbearing age. To avoid increasing socio-economic inequalities in folic acid use, interventions should provide practical support to vulnerable groups .
What Supplements Do I Need In Pregnancy
A healthy, balanced diet will give you most of the vitamins and minerals you need during pregnancy. Folic acid and vitamin D are so important for your baby, that you should take supplements to make sure you are getting enough.
There is no need to take any other vitamin and mineral supplements unless your GP prescribes them. Some women chose to take a pregnancy multivitamin, which is fine if you choose to do so.
Do not take vitamin A supplements, or any supplements containing vitamin A, as too much could harm your baby.
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Vitamins To Avoid During Pregnancy
During pregnancy you should not take supplements that contain any additional Vitamin A.
You only need a small amount of Vitamin A and youll almost certainly be getting enough from the food you eat already. Because Vitamin A is stored in your body, you can end up storing too much, which may be harmful to your baby.
This is why pregnant women are advised to avoid foods which contain extra high levels of Vitamin A, such as liver or food with liver in it and mackerel.
What Other Vitamins Should I Take
It is important to continue to eat a varied and healthy diet during pregnancy, and although most vitamins and minerals can be obtained through the diet alone, there are instances where you might find taking a supplement useful.
There are other vitamins and minerals which can support you during pregnancy, such as vitamin D, calcium, iron, vitamin C and omega 3.
Attention Deficit Hyperactivity Disorder
In a population-based registry study of 850 women and their children born in 19881989, Strom et al. found no indication that maternal 25D concentrations < 50 nmol/L versus 5075 nmol/L at gestational week 30 were associated with higher risk of attention deficit hyperactivity disorder disorder, defined as prescription of psychostimulant medication, among offspring during 22 years of follow-up. On the contrary, by analysing data from 1,650 mother-child pairs embedded in the INMA birth cohort in Spain, Morales et al. found that the number of ADHD-like symptoms in preschoolers aged 45 decreased by 11% per 10 ng/mL increment of maternal 25D3 at 13 weeks of gestation. The inverse association was observed in the inattention subscale as well as in the hyperactivity-impulsivity subscale. Consistently, results from the Greek Rhea birth cohort have also shown that higher maternal levels of vitamin D in early pregnancy is associated with reduced hyperactivity-impulsivity symptoms and total ADHD-like symptoms in offspring at age 4.
Vitamin D Supplementation During Pregnancy And Preterm Birth
Recent meta-analyses of observational studies also support that vitamin D insufficiency is associated with risk of PTB: PTB RR 1.24 , PTB RR 1.36 , PTB RR 1.83 , PTB RR 1.86 . With regard to spontaneous abortion and stillbirth, the available evidence suggests that there is no association with low vitamin D levels .
With respect to meta-analyses from intervention studies, data from three RCTs involving 477 women in the Cochrane review confirmed that vitamin D supplementation during pregnancy is associated with a reduced risk of PTB compared to no intervention or placebo , and with a decreased risk of low birth weight . According to other recent meta-analyses , vitamin D is related to a lower risk of small for gestational age, although no association is observed for PTB . In addition, a significant dose-response effect has been found on birth weight in trials in which the mean baseline 25D was 3050 nmol/L , but no effect is detected in RCTs with mean 25D < 30 nmol/L .
The possible biological mechanisms of vitamin D involved in the prevention of PTB are presumably related to its immunomodulatory capacity during embryo implantation , calcium homeostasis in the endometrium for the maintenance of pregnancy , as well as its role in the prevention of infection during pregnancy .
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Continued Supplementation Throughout Pregnancy
Canadian survey data show that it is difficult for most women of childbearing age to consume enough folate from diet alone to meet their pregnancy needs. Over 75% of non-pregnant/non-breastfeeding women aged 19 – 50 have intakes less than the Estimated Average Requirement Footnote 10 for pregnancy, 520 mcg of DFEs . To meet folate needs during pregnancy, women should consume a varied diet that provides dietary folate , and continue taking a multivitamin containing 400 mcg of folic acid throughout their pregnancy.
Supplements To Avoid While Pregnant Or Breastfeeding
While the vitamins and supplements above are generally considered safe for pregnant and nursing mothers, others should be avoided.
Certain vitamins, plants, and herbs can potentially be harmful while pregnant or breastfeeding. Thats why you must always let your doctor know about any supplements you take.
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What Are Prenatal Vitamins
Prenatal vitamins are multivitamins for pregnant women or women who are trying to get pregnant. Compared to a regular multivitamin, they have more of some nutrients that you need during pregnancy. Your health care provider may prescribe a prenatal vitamin for you, or you can buy them over the counter without a prescription. Take a prenatal vitamin every day during pregnancy. If youre planning to get pregnant, start taking prenatal vitamins before you get pregnant.
Your body uses vitamins, minerals and other nutrients in food to strong and healthy. During pregnancy, your growing baby gets all necessary nutrients from you. So you may need more during pregnancy than you did before. If youre pregnant with multiples , you may need more nutrients than if youre pregnant with one baby. Your prenatal vitamin contains the right amount of nutrients you need during pregnancy.
If youre a vegetarian, have food allergies or cant eat certain foods, your provider may want you to take a supplement to help you get more of certain nutrients. A supplement is a product you take to make up for certain nutrients that you dont get enough of in foods you eat. For example, your provider may recommend that you take a vitamin supplement to help you get more vitamin D, iron or calcium.
Advising On The Upper Limits Of Folic Acid Supplementation
High doses of folic acid can hide signs of vitamin B12 deficiency. They can also bring on or accelerate neurological complications associated with B12 deficiency . As well, women who have low vitamin B12 status are at higher risk for NTD . The prevalence of vitamin B12 deficiency in women of childbearing age is considered very low . However, some studies suggest that more women in this life stage group may have low vitamin B12 status than expected . Women who do not or infrequently consume foods of animal origin and do not take a vitamin B12 containing supplement are most likely to have deficient or marginal vitamin B12 status .
Emerging data also suggest there may be additional health risks associated with taking folic acid, including the development of colon cancer when preneoplastic cells are present . It is important that health care professionals do not advise higher doses of folic acid than is recommended in this document, unless duly warranted.
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Global Intelligence Quotient Or Cognitive Development
Overall, 9 studies have evaluated the association of prenatal vitamin D status with global IQ or child cognitive development . Seven studies did not find any association between prenatal vitamin D levels and global IQ or cognitive development at preschool and school age . However, Keim et al. reported a positive association between both maternal and cord blood 25D concentration and IQ at age 7, but the effect estimates were very small. Morales et al. showed that at 14 months of age, infants of mothers with 25D concentrations in the first trimester of pregnancy > 30 ng/mL had higher cognitive scores in comparison with those of mothers with 25D3 concentrations < 20 ng/mL. Furthermore, a Chinese cohort study observed an inverted-Ushaped relation between neonatal vitamin D status and cognitive score in toddlers .
Selecting A Multivitamin Containing Folic Acid
For women who can become pregnant, health care professionals play an important role in motivating them to use supplements . To ensure proper use of multivitamin supplements:
- Use the ‘Key messages on folate for women of childbearing age‘ to write or talk about folic acid supplementation during the childbearing years.
- Encourage women to look for a multivitaminFootnote 13 that provides 400 mcg of folic acid per daily dose. The product should also include vitamin B12.
- Advise women that prenatal supplements contain higher amounts of nutrients than are usually needed by women who are not pregnant. A non-prenatal multivitamin supplement is often enough. Following this advice can help women avoid taking excessive amounts of nutrients over time.
- Ensure that women look for a Drug Identification Number or Natural Product Number on the product label showing that the product is government-approved for safety, efficacy, and quality.
- Emphasize the importance of reading product labels. Some supplements may include cautionary notes about their use during pregnancy and breastfeeding.
- Caution women not to take more than one daily dose. This will help women not go over the Tolerable Upper Intake Level for vitamin AFootnote 14, which is 3,000 mcg retinol activity equivalent or 10,000 IU.
- Remind women to keep all supplements stored out of reach of young children.
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When Do I Need To Start Taking Pregnancy Vitamins
If you’re trying to conceive, start taking folic acid, or start taking it as soon as you find out you are pregnant. Your baby’s spine develops in the first 12 weeks of pregnancy, and initially you may not even know you’re pregnant yet, so it’s best to take folic acid as soon as you start trying for a baby to be make sure you are covered during this period. Your GP will advise you on when to start taking any other pregnancy vitamins, if it turns out you need them.
In some cases, your doctor will give you a prescription and you may be eligible for free vitamins from Healthy Start. Otherwise, you can simply buy what your GP recommends over the counter in your local pharmacy or supermarket.
Other Supplements In Pregnancy
Other than folic acid, iodine and any supplement prescribed for you by your doctor, there is limited evidence to support the use of supplements during pregnancy.
Emerging research has shown that omega-3 supplements during pregnancy might help reduce the risk of premature birth, and that probiotics might help control blood glucose levels in pregnancy. But it’s not clear whether the benefits of taking these supplements outweigh any possible harms. Until there is better evidence available, it’s best to avoid them â particularly in the first trimester of pregnancy.
Because nutritional supplements are classed as ‘complementary medicines’, they are not scrutinised or regulated as much as other medicines.
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Not Getting Enough Folate
Because the body has a high demand for folate, women may not get enough of this nutrient during their childbearing years . Women who are at higher risk include those who:
- are not taking the recommended folic acid supplement,
- are on restricted diets ,
- have a lower socio-economic status, and
- are experiencing food insecurityFootnote 5.
Supplements To Take During Pregnancy
In addition to the vitamins and nutrients discussed above, here are two of the best supplements to take while pregnant.
OMEGA-3 FATTY ACIDS
Doctors will often encourage their pregnant patients to take a fish oil supplement. Heres why.
Why theyre important: Omega-3 fatty acid stores tend to deplete quickly throughout pregnancy. Fortunately, omega-3 fatty acids provide DHA, one of its most biologically active acids.
DHA can help ease the risk for an early preterm birth . Additionally, low DHA levels can influence changes in brain function. Consequently, this can lead to genetic variations, decreased learning abilities, and impaired vision.
The benefits of taking omega-3 fatty acid extend to postnatal nutrition, too. Researchers suggest that rapid depletion of fatty acids during pregnancy and breastfeeding can contribute to the baby blues. In turn, taking this healthy omega can have a positive influence on maternal well-being.
Food sources of omega-3 fatty acids include:
- cold-water fish
- plant oils
The ACOG recommends that pregnant and breastfeeding women eat at least two servings of fish or shellfish per week. However, pay special attention to avoid raw or undercooked fish. Additionally, you should also avoid fish with high mercury levels while pregnant.
That said, talk to your doctor about incorporating a high-quality fish oil supplement into your prenatal plan if you suspect youre getting enough DHA.
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How To Take Vitamins During Pregnancy
You shouldnt miss a day without taking vitamins, as this will affect your babys optimal development. Its recommended that you take them in the morning with orange juice or another citrus fruit to aid their absorption. If you notice your stomach is upset after taking them, try to take them with food.
As we mentioned above, its essential that your doctor prescribes the correct amounts of vitamins for you to take. Avoid self-medication, because you could endanger not only your health, but your babys too.