At my first appointment with a health care provider during pregnancy I was given a goody bag to “prepare” me for the 9-month journey ahead. The “goodies” included several different prenatal multivitamin samples in beautiful packaging. Most had labels featuring the silhouettes of pregnant women touching their bellies–a good tactic for evoking my desire to provide the best possible nutrition for my baby. Looking through the supplements (each with variable levels of vitamins and minerals might I add) was overwhelming and quite possibly even unnecessary.
A new report published in the journal Drug and Therapeutics Bulletin found that there is no evidence to recommend a prenatal multi-nutrient supplement for all women—with the exception of supplements for folic acid and vitamin D. The researchers found no evidence that supplementing beyond folic acid and vitamin D reduces the risk of pregnancy-related complications including stillbirth, preterm birth, low birth weight or preeclampsia (1).
While I agree that nutritional supplements are not necessary for everyone, following this discovery blindly may have unintended consequences.
For many pregnant women, the prenatal vitamin is their only supplement for folic acid and vitamin D in the convenience of one pill (provided it contains appropriate levels of the nutrients of concern). For those struggling with nausea, it may be preferable to take one vitamin rather than several (anyone with me?).
Secondly, there are a few key nutrients missing in this recommendation that are important for pregnant woman, and may be difficult to obtain through the diet, such as iron and choline. This factor becomes especially true for women with digestive issues or those following vegan, vegetarian or other food-restricted diets.
Finally, even though the pregnancy-related complications mentioned above were not improved by taking a prenatal multivitamin in the study, there may be other health outcomes adversely affected due to poor dietary quality and lack of a quality nutritional supplement.
With that said, women who do eat a diet rich in a variety of nutrient-dense foods, may not need a multivitamin supplement. And for those that could benefit from supplementation, choosing a quality multivitamin* may be possible without all the fancy (and pricey) “bells and whistles.” Your own need for nutritional supplementation during pregnancy is well worth discussing with your health care provider.
Prenatal multivitamin or not, there are a few key nutrients that women should be especially focused on before and during pregnancy for their own health and the health of their growing baby.
Choline:
Epidemiological evidence has shown that women who have high dietary choline intakes around the time of conception have a reduced risk for giving birth to an infant with neural tube defects (2). In addition, adequate dietary choline intake has been shown to support fetal and infant brain development, particularly areas of the brain associated with learning ability and memory.
How Much: 450 mg per day for pregnant women. The recommendation increases even more for women who are breastfeeding at 550 mg per day.
Dietary Sources: Egg yolks are the best source of dietary choline (they pack in 125 mg choline per egg!), but other good sources include liver, salmon, peanuts, wheat germ, brewer’s yeast, soybeans and quinoa.
Super Snack/ Meal Idea: Savory Vegetable Quinoa bowl with a chopped hard-boiled egg.
Folic Acid/ Folate:
Both folate and folic acid are forms of the water-soluble B9 vitamin (folate is found in foods and folic acid is the synthetic version). (2). Clinical research has shown the importance of high folic acid acid before and during pregnancy to reduce the risk of neural tube birth defects (supplementation has demonstrated a 42 to 62% reduction in risk level).
How Much: It is recommended that all women of childbearing age consume 400 mcg/day of folic acid from a quality dietary supplement in addition to the folate found in foods. For women who are pregnant, the recommendation increases to 600 mcg.
Dietary Sources: Dark green leafy vegetables, okra, asparagus, certain fruit (bananas, melons, citrus), legumes, yeast, fortified cereal, mushrooms, liver, legumes, sunflower seeds, fortified orange juice and tomato juice.
Super Snack/ Meal Idea: Spinach salad with asparagus tips, orange slices and sunflower seeds.
Iron:
A few months back I featured an article discussing the health benefits of adequate iron intake during pregnancy. Iron deficiency is associated with many poor health outcomes for both mother and baby including death, low birth weight, impaired cognitive and behavioral development in infants and an increased risk of infection for mothers.
How Much: 27 mg per day during pregnancy.
Dietary Sources: Liver, beans, lentils, tofu, fully-cooked oysters, beef, dark meat chicken, salmon, tuna, dried fruit, blackstrap molasses, pumpkin seeds, cashews and fortified breakfast cereal. *Be sure to consume vegetarian iron sources with a great dietary source of vitamin C to enhance absorption.
Super Snack/ Meal Idea: Curried lentils topped with cooked bell peppers (vitamin C source), golden raisins and cashews.
Vitamin D:
Vitamin D is important during pregnancy to help reduce the risk of preterm labor and preeclampsia, as well as to help support bone growth for your baby (3).
How Much: 600 IU daily for all women 19-50 years of age (regardless of pregnancy). It is not a bad idea to get your vitamin D level tested during pregnancy. This will determine whether or not you may require extra supplementation to boost your levels to an ideal range. Some research has shown that vitamin D3 (cholecalciferol) is more “potent” than vitamin D2 (ergocalciferol). (2).
Dietary Sources: Fatty fish (salmon, tuna, mackerel), liver, egg yolks, cheese (small amounts), fortified dairy products, and mushrooms that have been exposed to sunlight or ultraviolet light (often indicated on the label when purchasing).
Super Snack/ Meal Idea: An omelet jam-packed with a variety of vegetables, cheese and salmon.
To me, the phrase “eating for two” does not mean an increased volume of food, but increased mindfulness about your food. During pregnancy, the nutrition you are getting from your diet is nourishing two, and food choices should be selected wisely on an extra budget of only 250 calories per day. Your healthcare provider and/or Registered Dietitian can help determine if you may need a prenatal multivitamin supplement to fill in any gaps in your diet.
* Quality nutritional supplements are often third-party tested and may be indicated with a USP (United States Pharmacopia) seal. Evaluate potential dietary supplements at consumerlab.com.
Resources:
(1) http://nymag.com/thecut/2016/07/do-i-need-prenatal-vitamins.html#
(2) Natural Medicines Database (2016)
(3) http://americanpregnancy.org/pregnancy-health/vitamin-d-and-pregnancy/
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