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Vitamin Supplementation in Pregnancy

Most women know that they should take a pre-natal vitamin when they are pregnant, but they may not know what the components of the vitamin are or why they are important. 

Folic Acid:

Neural tube defects are the second most common congenital malformation and are associated with high morbidity and mortality.  Folic acid is crucial for cell division because it plays an important role in the synthesis of nucleic and amino acids.  Folate deficiency therefore inhibits  cell turnover during a crucial point in the closure of the neural tube, resulting in incomplete formation.  The clinical manifestations of neural tube defects range from fetal death to mild spina bifida; however, randomized controlled trials consistently show that folic acid supplementation decreases their occurrence rate by 50-70%. 

The U.S. Preventive Task Force recommends 0.4 mg-0.8 mg per day and because neural tube development and closure occur in the first four or five weeks of pregnancy, supplementation should begin at least a month prior to conception.  Ideally all women of child-bearing age and potential should take a folic acid supplement because many pregnancies are not planned.  Due to genetic components, women who have had a previous pregnancy affected by a neural tube defect are at higher risk with future pregnancies; therefore they are advised to take a higher dose of 4 mg per day starting at least a month before conception.  Women with seizure disorders and who are taking certain medications are also advised to take the higher dose of 4 mg per day.

Iron:

Iron is necessary for both fetal/placental development and to increase the maternal concentration.  During pregnancy, the mother’s blood volume increases resulting in a lower concentration of red cells.  Therefore, iron is necessary to increase the maternal red cell mass as well as for the development of the fetus and placenta.  Experts recommend an increase in iron consumption by 15 mg/day for all pregnant women, which is achieved with a simple prenatal vitamin.  Women who have iron deficiency anemia, which is defined as hemoglobin less than 11, warrant an additional iron supplement of 30 to 120 mg per day until the anemia is corrected.

Vitamin C:

Adequate vitamin C increases the absorption of iron.  The recommended amount for pregnant women is 80 mg per day for ages 18 and under or 85 mg per day for ages 19 and older.

Vitamin A:

Can be teratogenic (cancer-causing) in doses higher than 10,000 IU per day.  If your prenatal vitamin contains Vitamin A, the quantity is safe, but most women do not need additional supplementation.

Calcium:

Prenatal vitamins don not typically contain a lot of calcium and that is because the calcium requirement is actually the same for non-pregnant, pregnant, and lactating women.  Fetal skeletal development requires about 30 g of calcium, which is mostly utilized in the third trimester when the bones are hardening.  This is actually a relatively small proportion of the maternal calcium stores.  The current recommendation is 1000 mg per day for women 19-50 or 1300 mg per day for women 14-18.

Vitamin D:

Many people are deficient in vitamin D.  The current recommendation is not to test for deficiency but to simply supplement with 600 IU per day.

Omega-3 Fatty Acids:

DHA is a necessary structural component of the brain and eye.  The DHA recommendation is 200 mg per day and is primarily found in fish and fish oil supplements.  However, fish and fish oil supplements can also contain mercury, which is known to be harmful to the fetal brain.  Therefore, the best way to obtain DHA is to eat two servings of low-mercury fish like salmon, shrimp, tuna, or catfish two times per week.

Multi-vitamin:

This includes all of the vitamins and minerals in your pre-natal supplement.  They are especially important for women with multiple gestation, smokers, adolescents, vegetarians, drug users, and women with medical conditions like lactose intolerance and crohn’s disease where absorption of nutrients from food is impaired.

Do not use the fact that you are taking supplements as an excuse to eat mostly junk.  Vitamins and minerals are often more easily absorbed from food, and nutritious calories provide more energy, a more constant blood sugar, and an overall feeling of well-being compared to empty calories.

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