Vitamins & Mineral Supplements in Pregnancy

Whether you are thinking of getting pregnant or are currently pregnant there is one thing for sure and that is that everyone wants to do what is best for their baby. If you walk into any pharmacy, health food shop or even supermarket it can be very difficult to figure out which supplement, if any, you should be taking. Hopefully by the time you have finished reading this article you will be able to make the best decision for you and your baby/ future baby.

1. The most important of all the supplements you need to take is Folic Acid. This is important to help reduce the risk of neural tube defects such as spina bifida & other conditions that can affect the central nervous system. The recommendations are as follows:

• In addition to the folic acid supplement you should continue to include dietary sources of folate such as fruit, vegetables, beans, pulses, fortified breakfast cereals and fortified milks

2. The next important vitamin to supplement is Vitamin D

Did you know your baby’s vitamin D level will be 60% of what your vitamin D level is when it is born, so it’s really important to get this right.

Vitamin D helps with the absorption of calcium from food and may also help the immune system.

The current advice is for all pregnant women to take a supplement of 15 µg (micrograms) (600IU) of vitamin D3 per day, at all times of the year. You can take this as a single supplement or if you chose to take an over-the-counter pregnancy multivitamin most will contain between 10-20µg but always check the label

If there is a history of rickets in a sibling or you have being found to have low vitamin D levels on a blood test your doctor should prescribe you a higher treatment dose

Continue the supplement right through the pregnancy and continue while/if breastfeeding

You should also try to include foods that are rich in vitamin D such as fortified milks, fortified breakfast cereals, eggs and oily fish such as salmon, mackerel, trout, herring or sardines (aim to have oily fish once per week)

3. The third important vitamin that regularly needs supplementing in pregnancy is iron

Iron is crucial during pregnancy because it plays a vital role in the production of red blood cells, which carry oxygen to all parts of the body. During pregnancy, the body requires more iron to support the growth and development of the baby, as well as to increase the mother’s blood volume with requirements increasing progressively after 25 weeks of pregnancy. Low iron levels during pregnancy can lead to iron deficiency anaemia, which can cause fatigue, weakness, and complications for both the mother and the baby.

In pregnancy, a supplement containing 16-20mg of iron, in addition to a diet containing iron rich foods (such as red meat, chicken, fish, green leafy vegetables, breakfast cereals fortified with iron) may reduce the risk of anaemia, in some but not all. Most over-the-counter pregnancy multivitamins will contain this amount of iron, in addition to some other iron only supplements such as: Active iron, Solgar Gentle iron

If your levels are found to be low on a blood test then a higher dose is needed of 100-200mg of elemental iron per day. This needs to be taken as a supplement that contains 305mg ferrous fumarate or 325mg ferrous sulphate e.g. Galfer tablets, Galfer liquid, Ferrograd Folic tablets, Ferrodrad C, taking 1-2 tablets per day. The newer guidelines are advising 1 of these higher dose tablets every second day may be enough for most women and may help improve tolerance of the iron supplement – great news in my opinion!

Tips to help the absorption of iron supplements:

• Take on empty stomach 1 hour before meals
• Take with a source of vitamin C such as fruit juice
• Both tannins in tea & calcium in foods/drinks will reduce absorption so avoid tea and milk at the same time as you are taking the iron supplement

Tips to help with tolerance of iron supplements

• Splitting the dose or choosing a slow release preparation may help (however you may absorb less doing this)
• Be sure to include adequate fibre (wholegrain breads & cereals, fruit & vegetables) & fluids
• If doesn’t tolerate one supplement try alternative one as different brands contain different forms of iron & you may tolerate one better than another

What have I done myself when pregnant?

Well first-off no 2 pregnancies are the same. The one common thing I did during all pregnancies was take folic acid before and during as per the recommendations in addition to vitamin D. I never take any iron supplements in the first trimester & it is best to avoid iron supplements in the first trimester unless your doctor advises you to take them as tolerance can be particularly difficult during this time. All my pregnancies were planned and I usually entered pregnancy having recently had my bloods checked and knew my iron levels and my iron stores were adequate. In my first 2 pregnancies once my consultant advised my haemoglobin levels were starting to drop I started taking an iron supplement every second day (for me this was Ferrograd C as this was the one I was able to tolerate)

In my third pregnancy I became very run down due being sick for a lot of the pregnancy and wasn’t able to have a good variety of food. I noticed my skin, hair and nails becoming really dry and brittle so I started a pregnancy multivitamin from about 26 weeks – I would take the pregnancy multivitamin every second day, which covered me for vitamin D, folic acid and iron. Then the other day I would take my higher dose of iron (is this case Ferrograd C) in addition to separate folic acid and vitamin D, on that day. Again, I only started the higher dose of iron when advised by my consultant to do so as my iron levels were starting to drop below normal levels.

In my 4^th pregnancy when my haemoglobin levels started to drop I started to take my usual Ferrograd C on alternative days and then decided to also introduce a regular pregnancy multivitamin on the other days but for some strange reason I started to feel really nauseous doing this and would start to wretch a few hours after I had taken either of these supplements, despite having always tolerated them in the past. I stopped them for a week and my symptoms settled so decided to retry them and the same thing happened. So I then bought an alternative pregnancy multivitamin and surprisingly tolerated that without any issues. My iron levels started to drop again around 29 weeks which I feel was due to poor dietary iron intake as a recent of multiple illnesses (tummy bugs and chest infections) so I have started back on the higher dose of iron every second day to ensure I am going into the delivery with adequate stores. This is really important as there will always be a certain amount of blood loss during & after the delivery so the better your levels are before delivery the better it will be for you after the baby is born. Also, the baby starts to lay down its iron stores during the last 3 months of the pregnancy and this will be their iron stores for their first 6 months of life, another reason to ensure Mamas levels are good! I did start to wretch again on starting the higher dose of iron so I started taking it with or after food (usually 2 slices of toast and a glass of orange juice in the morning) & this have significantly improved my tolerance of it. While taking it on an empty stomach is the ideal for best absorption I feel it’s better to be taking it with my food and tolerating it, than not taking it at all. I usually hold off on having my cup of tea for about an hour after this & also on the rare morning I feel like cereal with milk I hold off the iron supplement until later in the day and try to take it about 2 hours after a meal and would then wait about an hour before I would be eating something else.

Disclaimer:

The information provided in this blog/newsletter is intended for healthy adults seeking general guidance on nutrition and healthy eating habits. It is important to note that the advice and recommendations provided are not a substitute for personalized, one-to-one advice from a qualified healthcare professional, such as a registered dietitian or physician. It is essential to consider your individual circumstances, preferences, and any specific dietary restrictions or allergies you may have when applying the information provided. We do not assume any liability for the use of the information provided in this newsletter. By accessing and utilizing this information, you acknowledge and agree that you are doing so at your own risk.