Recommendations for routine nutritional supplementation vary in every country/ region. Therefore, local guidance should be followed as advised by healthcare professionals and the local governments.
A healthy balanced diet is the best way to ensure all the nutritional requirements are met. No vitamin or nutritional supplement can replace a healthy balanced diet.
Why the vitamin and other nutritional supplements are advised?
1. Supplements can ensure that the increased daily requirements of some key essential vitamin and mineral are met (in spite of a nutritious diet) to prevent certain pregnancy complications.
2. To treat some nutritional deficiencies during pregnancy.
Always check with your healthcare provider that any vitamin/ nutritional supplement is safe for you to ensure:
1. You are not taking an excessive amount which can cause an overdose/ toxicity;
2. You do not have any medical condition where it is not safe to take any specific supplement.
3. You are taking the right dose of the supplement. In certain medical conditions, you may need to take higher doses of vitamin/ nutritional supplement.
Please remember, if you are on a special diet (eg., vegan diet) then you may need additional nutritional supplements over and above the routine ones.
What vitamin and mineral supplements are advised?
As discussed, the recommendations vary from one country/ region to the other.
For example, in the UK, for an otherwise healthy pregnant woman, the only supplementation of Folic Acid and Vitamin D are advised.
Whereas, in some countries, routine supplementation of iron is recommended.
The commonly advised nutritional supplements are:
400 micrograms of folic acid should be taken every day during pregnancy until 12 weeks. This should be started, ideally, at least one month prior to pregnancy.
Folic acid supplementation can prevent a neural tube defect (such as spina bifida) of the baby.
Neural tube defects develop in the first 28 days of conception. That is why the pre-pregnancy intake of folic acid is so important.
A higher dose of 5 mg folic acid is advisable in the following conditions:
1. any of the biological parents of the baby has a neural tube defect.
2. if there is a family history of neural tube defect in any of the biological parent.
3. any previous baby born with neural tube defect.
4. if the pregnant woman has diabetes or takes anti-epileptic medicines.
Pregnant women should take 10 micrograms of vitamin D supplement every day.
Vitamin D is synthesised in the human skin on exposure to sunlight. Melanin pigmentation of the skin absorbs the sunlight and therefore, reduces the vitamin D production.
For these reasons, vitamin D supplementation is particularly important in the following:
1. Less exposure to sunlight: if the pregnant woman covers her body (such as for religious reasons) while going outside or winter months in countries like the UK.
2. People with dark skin (with high melanin content), such as African, African Caribbean and South Asian origin.
Vitamin D essential for healthy teeth and bones both for the mother and the baby.
World Health Organisation (WHO) recommends daily supplementation of 30-60 mg of elemental iron (300 mg of ferrous sulphate is equivalent to 60 mg of elemental iron) along with folic acid.
This can prevent pregnancy complications such as anaemia, preterm labour, low birth-weight babies and infection after childbirth (‘puerperal sepsis’).
Iron deficiency anaemia of women during pregnancy and breastfeeding is a global health problem.
For pregnant women who consume low dietary calcium, regular calcium supplementation is recommended for them by the WHO to prevent pre-eclampsia.
1.5-2gm of calcium per day (divided into three divided doses) is the recommended supplementation dose.
It is advisable to take calcium and iron supplements several hours apart as prevent absorption of each other.
Is iodine supplementation required?
Routine iodine supplementation is not required during pregnancy and breastfeeding.
WHO and UNICEF recommends pre- and postnatal iodine supplementation in countries/ regions where the iodised salt is accessible in less than 20% of households.
What other vitamin/ minerals are included in over-the-counter supplements?
Vitamins B2, B6, B12, Vitamin C, zinc, copper and many other micronutrients are often added to the prenatal vitamins available in the market.
There is some evidence to suggest that pregnancy supplementation with multiple micronutrients (in addition to iron and folic acid) can reduce low birthweight babies in low and middle-income countries.
However, the WHO does not recommend routine supplementation with multiple micronutrients (vitamins and minerals) during pregnancy.
What other nutritional supplementations should be taken?
Omega 3 fatty acid supplementation is required if the pregnant woman does not eat seafood (such as vegan diet).
Is it safe to take vitamin A supplement during pregnancy?
Unless specifically recommended by healthcare professionals routine vitamin A supplementation should be avoided during pregnancy.
An excessive amount of vitamin A during pregnancy can cause birth defects (in cardiovascular and central nervous systems) and miscarriage.
WHO recommends routine prenatal vitamin A supplementation ONLY in the areas with a high prevalence of vitamin A deficiency, such as South-East Asia and Africa.
Vitamin A deficiency of the mother during pregnancy can lead to night blindness of the child.
Are the prenatal vitamins different from other adult multivitamin tablets?
Always check with the pharmacist that the brand of vitamins you are buying over-the-counter is recommended to be used during pregnancy.
The market is full of different varieties of vitamin, mineral and other nutritional supplements but not all of them are suitable and safe for pregnant women.
For example, prenatal vitamins should not contain retinol (Vitamin A), unless specifically recommended by the healthcare provider.
Moreover, the recommended daily allowances of vitamins and minerals are different during pregnancy compared to other stages of life.
Which brand of multivitamins to buy?
Recommended vitamin and mineral supplements during pregnancy are often provided by the governments as a part of national health programmes, therefore, you may not require to buy.
If you still need to buy, please confirm with your doctor/ midwife that the brand provides all the necessary nutrients in the appropriate dose required for you.
When you should start taking the nutritional supplements?
It is advisable to start some vitamins before pregnancy, such as folic acid.
What are the side effects of prenatal supplements?
Some of the nutrients (such as iron) can cause constipation and stomach upsets. Taking them with meals reduces the side effects.
How to get the supplements if I can’t swallow tablets?
Some nutritional supplements are available in liquid form. Please ask the pharmacist, midwife or doctor for the advice. Fortified food (such as bread and breakfast cereals) is another good source of getting some key nutrients.