Ask the Pharmacist – Supplements during pregnancy

Q. I am expecting my first baby and am unsure of what I could and should be taking/consuming during my pregnancy. Can you provide me with some guidance?

A. First off, congratulations on your pregnancy. Having a baby can be an exciting time for many, but it can also be a time of worry and uncertainty filled with many questions. Your growing baby/fetus within you will require specific nutrients to ensure proper development so let’s begin by answering this question in regards to supplements. Two very important ones to discuss are folic acid and iron.

Folic acid is one of the B vitamins (vitamin B9) and is the synthetic form of folate. Folic acid is involved in the formation of your red blood cells as well as for healthy cell growth. A lower than optimum folic acid level during pregnancy may increase your risk of neural tube defects in your fetus resulting in abnormalities in the brain and spinal cord of your fetus such as spina bifida. To reduce this risk, ensure you are taking an adequate amount of folic acid during the length of your pregnancy and ideally for at least three months prior to becoming pregnant. The natural form, folate, can be found in dark green leafy vegetables (think of spinach, romaine lettuce, kale and broccoli), beans, peas, lentils, nuts and some fruits (oranges, lemons, bananas, melons).

The recommended dose of folic acid before and during pregnancy is 400 micrograms which, not surprisingly, can be found in prenatal vitamins on the market.

Pregnant or not, iron is responsible for the development of red blood cells which in turn are responsible for carrying and delivering oxygen throughout your body. That helps explain why we may feel tired and fatigued when we have a low amount of iron in our body.

When you are pregnant, your body requires more iron to be able to fulfill your own demand plus the extra demand to supply oxygen to your baby. Proper iron stores in your body will help prevent iron deficiency anemia and thereby reduce fatigue and weakness. If iron deficiency anemia sets in and is left untreated, you are putting yourself at risk of a premature birth (before 37 weeks gestation), a low birth rate baby and possibly postpartum (after delivery) depression.

The recommended dose of iron during pregnancy is 27 milligrams per day which can be found in most prenatal vitamins. Some great food sources of iron include whole grain foods, red meat such as lean beef and pork, dried fruit, beans, green leafy vegetables. If you are staying away from red meats or you are vegetarian or vegan, you can still able to get the recommended daily intake from non red meat options. Often, pregnant women with low iron may find themselves craving unusual foods and sending their loved ones out on an errand with strict orders to not return unless equipped with the craved item. However, if you find yourself craving non-food options such as dirt, clay, ice, laundry detergent etc., do not eat these non-food items and seek help immediately. This could be a sign of a medical condition called pica and needs to be addressed for both yours and your baby’s health.

Calcium is another important mineral that pregnant women should ensure they have an adequate amount of in their diet or supplements. Calcium helps your body build strong bones and strong teeth. Your baby that is growing inside your body also needs calcium for proper development while in the womb and will take it from your supply. It is important to ensure an adequate supply of calcium both before and during pregnancy. If you neglect your own calcium intake, your body will find the calcium your baby needs from the calcium supply that is stored in your bones. Therefore, not only do you want to ensure your calcium intake during pregnancy is appropriate but also want to ensure your pre-pregnancy calcium intake is sufficient to reduce the risk of skeletal harm.

It is recommended to have around 1000 milligrams to 1300 milligrams of calcium which can be achieved by including four servings of dairy products in your diet each day. If you are avoiding dairy, not to worry, there are still plenty of non-dairy choices that have calcium. Some examples of calcium rich foods are cheese, milk (note that non-dairy options may also contain calcium), dark leafy greens, fortified cereals, fish, fortified orange juice, and almonds to name a few.

Now is a good time to discuss vitamin D. Vitamin D works with the calcium to help support your baby’s developing teeth, bones, skin and eyes. It has also been shown that pregnant women that supplemented with vitamin D also had a reduced risk of pre-eclampsia (serious pregnancy complication which includes high blood pressure). Another study with pregnant women supplementing with 4000 international units of vitamin D during pregnancy showed a reduced risk of cesarian sections and pre-term delivery.

Since the main natural source of vitamin D is from our exposure to the sun, it is difficult to generalize specific requirements of supplements. We may also get vitamin D from foods such as fortified milk and some fish. This discrepancy is shown in the suggestions between various scholars. The Canadian Academy of Pediatrics suggest women supplement with 2000 international units daily while they are pregnant and breastfeeding whereas the American College of Obstetricians and Gynecologists suggests supplementing with 1000 to 2000 international units of vitamin D.

Omega-3 fatty acids contain docosahexaenoic acid (DHA) which are beneficial for the developing brain, eyes and nervous system. The recommended dose of DHA for pregnant women is 200 milligrams daily PLUS the amount in your prenatal vitamin so be sure your prenatal vitamin includes DHA. To supplement the amount in your vitamin, you can find DHA in low mercury fatty fish (salmon, herring, sardines), omega-3 enriched eggs, walnuts, chia seeds and cooked shellfish.

In summary, ensure you are taking a prenatal supplement which should include folic acid and iron as well as calcium, vitamin D and DHA. The best time to start taking these prenatal supplements is before you plan to start your family. That being said, sometimes surprises happen when we least expect it and therefore you should start taking them right away. Since prenatal supplements are high in iron, some women complain of nausea and/or vomiting due to the supplement. Taking your supplement after your largest meal of the day (for many of us this is supper) can help alleviate this. Another common side effect of iron is constipation. It is best to be proactive and ensure you are drinking plenty of fluids, increase the fibre in your diet and keep physically active.

If you are still having issues with tolerating your prenatal supplement you can try a different brand. Some women are fine with one brand and not others. Stay tuned in the coming weeks for other helpful tips and what you should and should not consume during pregnancy for various ailments.

For more information on this or any other health topic, contact your pharmacist.