Majority of women are aware that they are suppose to take a pregnancy multivitamin/mineral supplement. Most doctors will also inform patients of this at a preconception appointment or at their first pregnancy consultation, but after that things get a little grey. So lets cover some important aspects to help you choose the best supplement regime for you.
When to start taking a pregnancy multivitamin?
Ideally at least 3-4 months pre-conception or as soon as you find out you are pregnant. A pregnancy multivitamin should be continued throughout pregnancy (if you can tolerate this), up until a few weeks after you finish breastfeeding. If you are not breastfeeding, we recommend taking a pregnancy multivitamin for at least the first 6 weeks post partum to support recovery.
What are some important features I should look for in a pregnancy multivitamin?
> Contains at least 400mg folate in an active form - Folinate Calcium, Folinic acid, Levomefolate Calcium. This gives greater assurance that you can absorb the folate compared to the common inactive artificial form, folic acid.
> Contains the B vitamin Choline - Many common prenatal multivitamins contain no Choline, however this vitamin is essential for pregnancy and has been linked to supporting placenta function, decreasing the risk of gestational diabetes and preeclampsia, along with improving cognitive function in offspring.
> Contains greater than 200ug of iodine, which is an essential micronutrient important for thyroid hormone synthesis and function. Inadequate intake can impact both mother & fetal thyroid health.
> If the product contains iron, ensure it is a non-constipating form E.g Iron Chelate or bisgylcinate. Note on iron: Iron can affect absorption of other nutrients (and vice versa) so avoid high doses in your prenatal and supplement it separately if needed.(ie. Prenatal multivitamin in the morning, iron in the evening).
> Ideally pick a comprehensive vitamin and mineral supplement versus an individual folate supplement. This way you are closer to meeting the increased micronutrient needs during pregnancy and cover any gaps in the diet E.g. contains zinc, selenium etc.
> Products we like (although none are perfect) include Tresos Natal by Eagle, In-Natal by Bioceuticals, Maternity Formula by My Gen Health, Natal Care by Biomedica and Naturo Best fertility & maternity ranges.
Some women struggle to stomach a prenatal due to morning sickness. We find splitting the doses over the day, taking them with meals that contain protein/fat or opting for chewable/powder forms may help (e.g American Brand Seeking Health has a Prenatal proteincpowder that will ship to Australia).
What other supplements should I consider?
We recommend getting tailored advice before you start adding extra supplements in. However some things to consider include:
> Additional vitamin D supplementation - Many studies indicate that the current RDI for vitamin D in pregnancy is inadequate and up to 4000IU has been shown to be safe in pregnancy. This dosage is not found in any Australian prenatal supplements, therefore take note of the amount in yours, get your bloods tested and speak to your dietitian or doctor about additional supplementation . This will help ensure adequate intake to support many aspects of health, particularly your bones and teeth during pregnancy. It is a good idea to have your baseline vitamin D checked as deficiencies at the start of pregnancy are linked to an increased risk of gestational diabetes, pre-term birth, preeclampsia, post natal depression and bacterial vaginosis.
> Omega 3 fatty acids - These are important nutrients in pregnancy, however they are most abundant in fish and seafood, which are often limited in pregnancy due to mercury concerns. DHA, a type of Omega 3, is most notably important for fetal eye, brain and neuron development, and promoting healthy brain function in pregnant and breastfeeding mums. A deficiency in DHA has been linked to ‘baby brain’ and anxiety in women, and developmental delays in babies. The best sources of DHA are animal based foods such as fatty fish, grass fed beef, pasture raised eggs and free range chicken. If you do not consume these foods regularly, supplementation is recommended in fish oil or algae (vegan) form. Have your diet assessed to determine if you would benefit from supplementation. There are some prenatal multivitamins that do contain these omega 3 fatty acids in their formulations , however there are some concerns regarding stability. Therefore, we would prefer to recommend a separate high quality fish oil supplement if needed.
> Additional iron supplementation based on your blood tests and dietary intake. Get advice on how to choose a non-constipating, bioavailable form and take it away from other vitamins if possible.
> Additional choline supplementation based on the amount in your prenatal multivitamin and your dietary intake of foods, such as eggs, pasture raised liver, salmon and lamb.
> Probiotics - Consider certain bacterial strains that are shown to be pregnancy specific, e.g. Lactobacillis rhamosis and Lactobascillus reuteri, which may reduce rates of Strep B.
> Glycine - An amino acid vital for the growth and development of your baby's tissues, bones, organs and DNA, as well as your own tissues, changing circulation, placenta and uterus. Increased requirements during pregnancy can be met via incorporating collagen/gelatin rich foods such as bone broth, slow cooked meats (cooked with bones in), poultry cooked with skin on and supplemental collagen/gelatin.
> Additional magnesium supplements, usually based on symptoms and dietary intake. Magnesium is involved in a large number of bodily functions, impacting metabolic health, blood pressure regulation, blood sugar control, bowel health, stress management and muscle health. Rich food sources include avocado, almonds, cashews, pumpkin seeds, chia seeds, seaweed, green herbs, leafy greens veggies and dark Chocolate (70% +). Supplementation is often very helpful to manage constipation, leg cramps and insomnia. Seek advice on choosing a high quality supplement and do not exceed more than 300mg per day supplemental magnesium during pregnancy.
This blog post is simply about educating women on the role supplements play during their pregnancy journey, where nutrient gaps may lie and why quality is important. Please be in contact for specific advice related to your individual situation. This is not a substitute for any medical advice.