Everything You Need to Know About Prenatal Vitamins
US News & WORLD Report 18 June 2015
Pop quiz: What inspires a woman to live healthfully? An Instagram account filled with fitspirational photos and quotes? An upcoming vacation requiring a beach body? A healthy cookbook?
From what Dr. Diana Ramos sees in her work as an OB-GYN from Los Angeles, California, the answer is none of the above. It’s pregnancy.
“I do not see women more motivated to take care of themselves than pregnant women,” says Ramos, an associate clinical professor in Obstetrics and Gynecology at the Keck University of Southern California School of Medicine. “They’re motivated to make sure they do the right thing.”
Part of doing the right thing, she says, is taking a prenatal vitamin. Though they’re no substitute for a healthy diet, the pills (or gels or chews) contain an important mix of vitamins and minerals that are in high demand in a pregnant body – and tough to get enough of through diet alone.
By taking supplements, says registered dietitian Tamara Melton, “we can prevent a lot of different disorders and diseases that could affect the baby later on in their life.” Folic acid, for one, helps prevent birth defects such as spina bifida and congenital heart disease, while iron helps a woman’s body deliver enough oxygen to the baby.
Here’s what else you need to know about prenatal vitamins if you have a baby on the way:
1. Your body’s not the same as your pregnant friends.
The American Congress of Obstetricians and Gynecologists recommends that all pregnant women take 600 micrograms of folic acid and 27 milligrams of iron daily. Other than those two nutrients, however, what other supplements you need – if any – depends on factors such as your natural body chemistry, diet and health history. “We’re all different,” says Melton, founder of LaCarte Wellness, a wellness consultation firm in Atlanta.
That said, many prenatal vitamins contain calcium, vitamins A, C, D, B6 and B12. Ask your health care provider for a blood test to determine if you need a supplement that contains more or less of any or all of those nutrients. Some pregnant women do not consume enough vitamin D, for instance, since it’s found in some fish like tuna that should be limited during pregnancy.
Even pregnant women with an A-plus nutritional report card should opt for a complete prenatal vitamin to cover any gaps in their diets, Melton says. “It’s kind of like insurance,” she says. You want it just in case.
2. ‘Pre’-natal is a misnomer.
Prenatal vitamins are actually pre-prenatal, too. Folic acid, in particular, is important to take at least one month prior to pregnancy, since many diseases it helps prevent develop before a pregnancy test even turns positive. At this stage, the American College of Obstetricians and Gynecologists recommends a 400 microgram daily dose.
“Every single cell in our body that is dividing uses folic acid – our hair, our nails, our heart, our brain,” says Ramos, noting that folic acid supplements are so important they’re covered by the Affordable Care Act. “Now if you have a baby that’s being formed, you’ve got a lot more of cell formation and cell development.” An added bonus? Your hair and nails will likely benefit, too, she says.
Prenatal vitamins can also be considered postnatal vitamins since they boost your breast milk’s nutritional content and can even help ward off postpartum mood issues, according to the American Pregnancy Association, which recommends the brand Prenatal Oxylent. “In those hectic first few weeks with a newborn, many moms don’t eat as healthfully as they would like to,” Melton says. On top of that, it’s the time when the baby is usually taking in the most breast milk. Continuing to take a prenatal is added “insurance” that both you and your baby are getting the nutrients you need, Melton says.
3. Addicted to smoothies? Fess up.
Did you know that Odwalla, the smoothie brand, adds vitamins and minerals to its products above and beyond what’s naturally in the ingredients? It’s part of the draw with smoothies, cold-pressed juices and other hot health foods.
While that’s all well and good, it’s important to keep count of such added nutrients – as well as any herbal supplements you’re taking – since consuming them with prenatal vitamins could overload you on some. While excess water-soluble vitamins such as folate and vitamin C will generally be excreted through urine, fat-soluble vitamins, including A, D, E and K, are easier to overdose on. Too much vitamin A, for instance, can result in bone and birth defects, Melton says. “People think, ‘the more, the better,’ but that’s not necessarily true,” she says. What is true? The more you tell your provider about what you put in your mouth every day, the better. He or she can make recommendations based on what you’re already getting and any potential interactions.
4. Be a scrupulous shopper.
Unlike over-the-counter medications, nutritional supplements including prenatal vitamins are not regulated like drugs by the U.S. Food and Drug Administration. “Somebody could literally make this in their basement and then sell it because it’s considered food,” Melton says. “That’s extremely unsafe if you’re pregnant.” She recommends buying generics from established stores like Target or sticking to other large, well-recognized brands. You can also opt for a brand that has volunteered to be evaluated by a third party like the U.S. Pharmacopeial Convention, a nonprofit that helps set standards for dietary supplements, Melton says.
No matter which brand you choose, make sure the vitamins contain 100 percent of the daily value you need. Gummy vitamins, for instance, can be tempting for women who have morning sickness, but they rarely pack as much iron or other nutrients, Melton says. “You’ll find that out by looking at the label.”
5. Side effects may fight you, but you can win.
Here’s the bad news: Prenatal vitamins can cause nausea or aggravate morning sickness. Even worse, some women stop taking vitamins to appease their tummies. “It just becomes a vicious cycle” of not eating because you’re sick and getting sick because you’re taking vitamins without eating, Ramos says. “If you find a prenatal vitamin that’s easy to tolerate, I think that’s the first important step.”
Next, be sure to take your vitamins with a bit of food and drink – yogurt and smoothies tend to go down well, Melton says – and try splitting your dose between the morning and night.
Still feeling queasy? Take the iron supplement when you’re feeling the least sick or cut it completely without adjusting your folate intake, Ramos suggests. Once nausea subsides, try adding iron back in. But beware: Almost every woman experiences constipation from iron, Ramos says. To combat it, drink plenty of water and eat lots of fiber. Prunes can also help, she says, but “a balanced diet will really help.”
6. It’s ‘supplement’ – not ‘substitute.’
Remember: Supplements are just that – supplements, not substitutes. “A prenatal vitamin is not to replace an unhealthy diet; it’s to supplement a healthy diet,” Melton says. In fact, they’re formulated with a healthy diet in mind, says Melton, who supports the 80/20 rule, or eating healthfully 80 percent of the time. A diet rich in citrus fruits, dark leafy greens, beans, salmon, and fortified whole grains and milk can help pregnant women meet most of their nutritional requirements.
If you want more guidance on what that diet should look like, Ramos recommends going to the U.S. Department of Agriculture’s ChooseMyPlate.govsite, which outlines pregnant women’s nutritional needs and how to meet them. And don’t forget your daily dose of exercise. “Just move,” Ramos says. “Walking is the easiest and simplest way to be able to do that.”