Welcome back for part 2 of Choosing a Prenatal Supplement (you can read part one here)! In this post we will finish our discussion on prenatal supplement components and what to look for when selecting this important multivitamin from store shelves!
Omega 3
When looking for an omega 3 supplement, you want to make sure it contains two different omega 3 fatty acids: DHA (docosahexaenoic acid) and EPA (eicosopentaenoic acid). DHA is critical for fetal brain development. A pregnant woman’s body will transfer all of the DHA possible across the placenta to the fetus even if this means depleting the mother’s stores entirely. EPA is important in helping to prevent postpartum depression. Finally, omega 3 supplements have been shown to extend gestation and increase birth weight.
In randomized trials using a DHA supplement versus a placebo, the supplement improved infants’ visual acuity and growth as well as helped prevent maternal depression (Maizes, 2013)
When looking at the label, check to see that the fish oil is molecularly distilled, which means that heavy metal and polychlorinated biphenyl (PCB) contaminants that are present in many fish are removed. Look for a supplement with DHA and EPA adding up to 1000 mg and take with the largest meal of the day.
Nutrient dense food sources of DHA and EPA: mackerel, herring, salmon (wild pacific sockeye salmon is best), sardines, trout.
Don’t be fooled by foods such as ground flaxseed, walnuts, chia seeds, and flaxseed oil as being a good source of omega 3. These foods contain the form of omega 3 known as ALA (alpha-linolenic acid), which must be converted in the body into DHA and EPA to have the benefits listed above. Unfortunately, the conversion rate from ALA to DHA/EPA is believed by researchers to be less than 1% in healthy individuals.
A Canadian survey of 176 pregnant women revealed that while 90 percent were taking multivitamins, none were taking the vitamins with omega 3, and only 11 percent were taking separate omega 3 supplements (Maizes, 2013)
Vitamin D
A large percentage of women living in northern latitudes have low vitamin D status, this is a nutrient of significant importance. See my post on vitamin D here for food sources and additional information on the importance of the sunshine vitamin.
There is evidence in animal studies and some from human trials that fertility is impaired if the mother has a low vitamin D level. She will have a harder time getting pregnant and once pregnant, she will have an increased risk of preeclampsia and gestational diabetes (Maizes, 2013)
The Institute of Medicine considers vitamin D doses of up to 4,000 IU/day to be safe. My recommendation to clients is to get his/her vitamin D levels checked based on a supplement dosage of 1000-2000 IU/day and then have levels checked once every 6-12 months after until consistently in the normal range.
It is worth noting that many multivitamins, including prenatal multivitamins, only contain 200 IU of vitamin D. If you already have an inadequate vitamin D status (anything less than 50 ng/L according to the vitamin D council) than 200 IU/day is unlikely to correct this inadequacy.
Nutrient dense food sources of vitamin D: milk, yogurt, egg yolk, salmon, mackerel, herring, trout.
Calcium
Calcium is needed during pregnancy to help with baby’s bone development (particularly in the third trimester) and to keep mother’s bones strong during this time as well. Women need 1,000-1,300 mg of calcium during pregnancy and breastfeeding. I suggest focusing on food first for calcium however, many women struggle to get in enough calcium to meet pregnancy and post-partum needs. If choosing to supplement, it is recommended to split up calcium supplements because we cannot absorb more than approximately 500 mg of calcium at one time.
Nutrient dense food sources of calcium: green vegetables, milk products, salmon, sardines.
Vitamin E
Pregnant women use vitamin E for preventing complications in late in pregnancy due to high blood pressure.
Check the label on your prenatal multivitamin for dl alpha tocopherol. Dl alpha tocopherol is the synthetic form of vitamin E and indicates that the product is poor. What you should see is d-alpha tocopherol or even better, 200-400 IU of mixed tocopherols and tocotrienols. Synthetic forms of vitamin E are generally derived from petroleum products and are not as bioavailable as natural vitamin E.
Vitamin B12
Women at particular risk of low vitamin B12 levels include: vegan or strict vegetarians, women taking proton pump inhibitors or other acid blockers (think TUMS, Rolaids, etc.) or have been on the birth control pill for several years. Women with type 2 diabetes mellitus or polycystic ovarian syndrome who are prescribed metformin are also at risk of low vitamin B12 levels, due to the depletion that this drug causes.
Vitamin B12 is essential during pregnancy for DNA synthesis and low levels of this vitamin increases risks of repeated miscarriage and birth defects.
The recommended daily intake of vitamin B12 is 2.4 mcg during perception and 2.6 mcg during pregnancy. You may notice that many vitamin B12 supplements on store shelves are quite high in comparison to the recommended dietary allowance. This is due to the fact that absorption of 100% of what is in the supplement does not occur. For example, a supplement with 1,000 mcg of oral vitamin B12 leads to absorption of about 20 mcg.
Nutrient dense food sources of vitamin B12: animal meat (particularly organ meat), fish, milk products and fortified almond milk, nutritional yeast.
Additional vitamins and trace minerals
Trace minerals in a multivitamin should include copper, zinc, magnesium, potassium, and calcium.
Just remember: taking a supplement never takes the place of consuming nutrient dense foods. Think of a supplement as what it is - a supplement to your currently awesome, nutrient dense diet.
Until next time nutrient seekers..
Yours in health,
Kristin
Sources
https://umm.edu/health/medical/altmed/supplement/alphalinolenic-acid
https://www.vitamindcouncil.org/about-vitamin-d/testing-for-vitamin-d/
http://healthybabycode.com/why-you-cant-get-vitamin-a-from-eating-vegetables
http://www.drweil.com/drw/u/ART02809/vitamin-b9-folate.html
Maizes V (2013). Be fruitful: the essential guide to maximizing fertility and giving birth to a healthy child.
This past May I was very fortunate to have had the opportunity to attend the Nutrition and Health Conference put on by the Arizona Centre for Integrative Medicine where I was first introduced to the work of medical doctor Victoria Maizes. Dr. Maizes focuses much of her work on fertility, environmental toxins and their impact on the body and women’s ability to conceive.
After returning home and diving into research on environmental toxins and infertility I has the opportunity to share this information with my first client who had been struggling to conceive for the past 3 years. We worked together on reducing her exposure to environmental toxins through skincare products, food storage containers and bottles, as well as avoiding inorganic foods that fall into the “dirty dozen” category (more about that later). My client informs me a few months later that she is pregnant. Coincidence? You might think. However, the research is extremely strong in this area and I hope to share it all with you over the coming months.
Okay, let’s start at the beginning. Taking a prenatal multivitamin is important for many different reasons and I would like to share not only the importance of taking a prenatal vitamin if you are a woman of childbearing age but what exactly to look for and why each nutrient is important. As a big believer in food first, this is definitely one area where I feel a safety net associated with taking a prenatal multivitamin is important.
Below are some of the top reasons why taking a prenatal multivitamin is important:
•Taking a multivitamin may assist with conception
-According to the Nurses Health Study, the longest running study on women’s health, taking a multivitamin helps women conceive. In addition, women in the study who took a multivitamin had a third lower risk of developing ovulatory infertility, compared with women who did not take a multivitamin. Researchers in the study estimated that 20% of all ovulatory infertility cases would be avoided if women took a multivitamin (Maizes, 2013)
•Taking a multivitamin reduces the risk of birth defects in your baby
-It is estimated that protection against birth defects ranges from 25-50% for neural tube defects, cardiovascular defects, limb defects, cleft palate, and urinary tract anomalies (Maizes, 2013)
•Taking a multivitamin lowers the risk of miscarriage
-Research done in 2007 showed that multivitamin supplementation in the first trimester of pregnancy was linked to a 50% decreased risk of miscarriage (Maizes, 2013)
The Child Autism Risks from Genetics and Environment (CHARGE) study, a Northern California case-controlled study, examined the impact of maternal prenatal vitamin consumption in 276 children with autism and 269 children with typical development. According to the study, the women who began taking prenatal vitamins 3 months prior to conception and up to 1 month into pregnancy had a 38% reduced risk of autism in their children, compared to mothers who did not begin taking a multivitamin until later in their pregnancy.
What should I be looking for?
My first recommendations are to look for a food-based supplement and one that is free from unnecessary additives. Some of the unnecessary additives I am referring to are:
•FD&C Yellow #5 (Tartrazine) Lake
•FD&C Yellow # 6 Lake
•FD&C Blue #2 Lake
•Hydroxypropyl methylcellulose
(I’ll talk more about these additives in a future post – for now, I suggest avoiding them if possible)
Vitamin A
Vitamin A is needed for developing vision and immune function of the fetus.
Animal forms of vitamin A are called preformed vitamin A – they are more easily absorbed and used within the body in comparison to vitamin A coming from fruits and vegetables. The type of vitamin A coming from plant sources is known as the pro-vitamin A carotenoids.
Be cautious – It is possible to get too much vitamin A (particularly when taking supplements), which can increase the risk of birth defects.
Maximum dosage of 2500 IU/day. However, if the form of vitamin A on the label says beta-carotene, the maximum dosage increases to 15,000 IU/day (pre-pregnancy) and 5,000 IU/day during pregnancy since less then 10% of carotenoids are converted to the active form of vitamin A within the body.
“Vitamin A is found in significant amounts only in animal products like liver and grass-fed dairy. You’d have to eat a huge amount of beta-carotene from plants to meet vitamin A requirements during pregnancy. For example, 3 ounces of beef liver contains 27,000 IU of vitamin A. To get the same amount of vitamin A from plants (assuming a 3% conversion of beta-carotene to vitamin A), you’d have to eat 4.4 pounds of cooked carrots, 40 pounds of raw carrots, and 50 cups of cooked kale” (Chris Kresser, Healthy Baby Code)
Iron
The National Health and Nutrition Examination Survey study showed that 9-16% of women between the ages of 12 and 49 are iron deficient. In addition, only 20% of fertile women have adequate iron reserve of 500 mg. Iron is stored in our body but as women, we lose a significant amount of iron during menstruation and childbirth.
Having inadequate iron status prior to and during pregnancy can have a significant impact on fetal development by reducing infant growth rate. If iron deficiency is present prior to conception, this can impact the development of the placenta during early pregnancy.
"According to the Nurses’ Health Study, women who took iron supplements had a 40% lower risk of ovulatory infertility than those who did not take iron supplements” (Maizes, 2013)
Recommended daily iron intake per day is 18 grams for women during the preconception stages, and 27 mg per day for pregnant women.
Nutrient dense food sources of iron: Most bioavailable form of iron is red meat.
One of the side effects of many iron supplements is constipation. Trying to avoid this unpleasant side effect is one of the reasons why many women avoid iron supplementation. Using food-based iron supplements of iron bisglycinate can reduce the constipating effect of iron. See here (https://www.thorne.com/products/dp/iron-bisglycinate) for an iron supplement from a supplement company I trust.
Iodine
Iodine is essential within the body in the production of thyroid hormone and helping to prevent brain damage. Iodine deficiency is linked to miscarriage and stillbirths.
The recommended daily allowance for iodine is 150 mcg prenatally and 200 mcg while pregnant and breastfeeding.
Food sources of iodine:
Milk, egg yolks, saltwater fish, sesame seeds, asparagus, garlic, spinach, mushrooms, seaweed, dulse, kelp, lima beans.
Folate
Folate is a critical nutrient during preconception and pregnancy. Folate is required for the synthesis of DNA and cell division. Unfortunately, 90% of women do not get sufficient folate from their diets alone. Due to the importance of folate in the development of a healthy baby and prevention of neural tube defects, it is recommended by multiple professional organizations that women of childbearing age take 400 mcg of folic acid per day. However, there is some controversy around this folic acid recommendation, as supplemental folic acid can mask symptoms of pernicious anemia (anemia linked to vitamin B12 deficiency). The emphasis on folic acid for women of childbearing age regardless of whether or not you plan to become pregnant is related to the fact that beginning to supplement with folic acid at 8-12 weeks into pregnancy is too late.
Although we discuss folic acid (the common synthetic form of folate) more than the food source of folate, there is a difference between the two. Folate in its natural form is better utilized within the body compared to folic acid. Look for folate on the label not as folic acid, rather “folate”, “5-methyl-tetrahydrofolate”, “L-methylfolate” or “Metfolin”.
Nutrient dense food sources of folate: leafy green vegetables, liver, legumes.
Although this is not the end of my list, I will end today’s long-winded blog post here. Be sure to check out “Part 2” for a continuation on prenatal supplements and discussions of omega 3, vitamin D, calcium, vitamin E, vitamin B12 and trace minerals.
Yours in health,
Kristin