Prenatal Vitamins and Supplements

  • September
    02

    RECENTLY, MY MOTHER-IN-LAW shared an article and video featured by CBC on the dangers of supplements and herbs.

    They used very broad conclusions such as,

    “If you take a megavitamin you actually can hurt yourself,” said author and University of Pennsylvania infectious disease specialist Dr. Paul Offit. “You actually can increase your risk of cancer, increase your risk of heart disease.”

    What is a MEGAVITAMIN? Which company or ingredients are you taking about? And do you actually think every vitamin is bad?


    The Canadian Paediatric Society recommends,

    • Most healthy women should take a daily multivitamin with 0.4-1.0 mg of folic acid, for at least 2 to 3 months before getting pregnant, throughout pregnancy, and then after birth for as long as they breastfeed.
    • You should take a multivitamin during pregnancy that includes between 16 and 20 mg of iron.
    • You should also take vitamin D, up to 2000 IU/day. Not getting enough vitamin D during pregnancy will affect how much vitamin D your baby has at birth. A baby born to a mother who is vitamin D deficient is more likely to have vitamin D deficiency rickets.

    To read the full resource, please click here.

    Trust.

    It’s important to be able to trust your doctor and know that they are not only looking out for your best interest but being diligent in their research.

    But sometimes, even within the medical community there will be disagreements as science is always changing as we continue to learn more and more each day. Having a health care team that you trust is critical.

    It may be your midwives, your pediatrician, your ObGyn, family doctors or complimentary health practitioner, but they should all be on the same team. YOUR TEAM.

    One of the best things about being a Naturopathic doctor is the ability to read research, recognize flaws and understand medical terminology and biochemistry. Another great advantage is having a wonderful community of health practitioners that I can rely on.

    As someone wanting to get pregnant, prenatal vitamins and DHA fish oil is something I take everyday.

    I’d be shocked to find a doctor who wouldn’t recommend it.

    But it’s still important to ask the following questions for any supplement or medication you are on:

    1. Why am I taking it?
    2. What’s the research behind it?
    3. How is the best way to take it? (dose, timing, with food/ without, powder vs capsule, etc)
    4. Which companies can I trust? Do I have to pick the most expensive one? What if I can only afford the cheaper brands?
    5. How do I store the pills?
    6. For how long do I have to take it for?

    I NEVER recommend self-supplementation, because you never know which supplements will interact with your body, condition or other medications you are taking. Not only could you be taking something bad for your health, but you have no idea about the quality of what is actually inside the bottle.

    A vitamin is not a vitamin.

    Unfortunately, the vitamin in the pretty packaging with a picture of a fit body holding a baby AND is 1/2 the price as the other prenatal vitamins may not be what it says. There are some brands that have something called “Third Party Testing”, which means they take someone who doesn’t have any affiliation with the company to test a random batch of their product to ensure the quality and quantity.

    Basically, they are making sure what is advertised on the label is what’s actually in those pills!

    In this article I will lay out the foundations for these questions when it comes to taking prenatal and DHA fish oil in Canada… some of the companies and supplement standards are different in the USA, so ask your ND or MD about quality control and brand recommendations specific for you.

    1. Why take a prenatal or DHA?

    Eating a clean, health and well-balanced diet is important prenatally and during pregnancy. Unfortunately, the definition of a “healthy diet” is different for everyone and even someone eating huge amount of calories a day might actually have malnutrition.

    Supplements ensure that regardless of your dietary habits, your body is getting the necessary nutrients for healthy fetal development. Of course, current medical conditions, weight, diet, exercise, sleep, stress levels/management, lifestyle habits, chemical exposure and amount of water consumption will all impact mom and baby health.

    Prenatals are important to take a few months leading up to conception to ensure that you are creating an ideal nutrient environment for your baby to thrive.

    Nutrients such as folic acid, iron and vitamin D are important in healthy fetal development.

    And as the baby begins to grow in utero (aka in your uterus), DHA is a fatty acid found in fish oil that supports healthy brain development.

    “Inappropriate diet/nutrition in pregnancy can lead to numerous deficiencies including iron deficiency and may impair placental function and play a role in miscarriage, intrauterine growth restriction, preterm delivery, and preeclampsia.” — [3]

     

    2. What’s the research behind it?

    Folic Acid

    Women with Neural Tube Defect (NTD) often have babies with spina bifida or anencephaly. These are fetal defects of the spine, spinal cord or brain. It has been shown that women with NTD have defects in homocysteine metabolism. Folate (or folic acid) is important in development of the neural tube within the 1st trimester of pregnancy.

    The rapid growth of the neural tube is especially sensitive to folate because of its methyl group metabolism (-CH3) in nucleic acid and amino acid biosynthesis [1].

    Scientific evidence for taking folic acid before the time of conception and during pregnancy prevents many NTDs.

    Non-pregnant women should consume 400 μg of folic acid daily, and pregnant women should consume 600 μg of folic acid daily. Women in intermediate- to high-risk categories for neural tube defects, such as a previous neural tube defect–affected pregnancy, should take 4 to 5 mg of folic acid daily. [1].

    Note: MotherRisk.org recommends pregnant women take 5mg of folic acid per day for the 1st trimester to account for days that the prenatals are missed or forgotten.

    Iron

    In the body, iron (Fe) is essential for blood production.

    “About 70% of your body’s iron is found in the red blood cells of your blood called hemoglobin and in muscle cells called myoglobin. Hemoglobin is essential for transferring oxygen in your blood from the lungs to the tissues. Myoglobin, in muscle cells, accepts, stores, transports and releases oxygen.” — UCSF Medical Center

    And 6% of Fe is involved in protein- enzyme production, neurotransmitters and the immune system. While the remaining 25% is stored iron in the form of “ferritin”.

    If you ever get your blood work done, the lab will measure your ferritin levels to see whether you are iron deficient or in extreme cases, depleted. When your iron stores are low, you will make less hemoglobin and often have signs of anemia:

    • fatigue, low energy, fainting
    • low blood pressure
    • weak muscles
    • pale skin, especially the conjunctiva under the eyes
    • cold hands and feet

    But more specifically with a pregnant woman, a decrease in iron and hemoglobin means less oxygen, red blood cells and nutrients to baby. Iron deficiency in infancy has been shown to cause poor motor skill development [2].

    The average male has 1000mg of ferritin, while women have 300mg, about 6 months worth of stored iron. So if your stores are below 300mg, most likely you will need to start supplementing or eating an iron-rich diet:

    • Beef: liver, ground, roast
    • Turkey
    • Beans and lentils – soy, black, lima, pinto, parbanzo, kidney
    • Raw spinach, swiss chard, mustard greens, leek, dandelion leaves, kale
    • Black strap molasses
    • Grains: whole wheat, amaranth, wheat germ

    For the full list of iron-rich foods and the amount per serving, Click here.

    It’s however important to keep in mind that animal-based iron (haem source) is not absorbed the same as vegetable-based iron (non-haem). So if you are a vegetarian taking a non-haem source of iron and not having great increases in your ferritin levels, it may be time to speak with your primary care physician about changing to a haem-based iron supplement, and possibly checking your vitamin B12 levels as well.

    Healthy pregnancy women should be taking a prenatal vitamin with 16 and 20 mg of iron. For women is iron-deficiency anemia, a separate supplement of haem iron with vitamin C is recommended. Speak with your Naturopathic doctor or MD about the amount to take, based off of your lab work up.

    Note: Iron supplementation can sometimes cause stomach upset and constipation, so it’s always advisable to take 500mg or more of vitamin C along with your iron.

    Vitamin D

    Did you know a review found that 26–98% of at or near-term pregnant women from USA, Australia, the Middle East, and South Asia are vitamin D-deficient, and 66–100% are insufficient [3]!

    Observational studies have found that women with vitamin D levels >37.5 nmol/L in the 1st trimester were 1/2 as likely to have small fetus development, for gestational age [3].

    Vitamin D also supports mom’s bone health, immune adaptation (protective of allergies, type 1 diabetes, and asthma) and mood, while high D levels has shown to enhance bone mineralization in fetus and new born too [3].

    The Canadian Paediatric Society recommends pregnant women take up to 2000 IU/day of Vitamin D, especially during the winter months if you live far from the equator.

    DHA Fish Oil

    Fish oil is a commonly prescribed omega-3 supplement, however normally adults are recommended to take high amounts of EPA:DHA. EPA has an anti-inflammatory and cardio-protective effects on the body, while DHA (docosahexaenoic acid) makes up the structural part of cell membranes, specifically in the central nervous system [4].

    The accumulation of DHA in the fetal brain is mainly during the 3rd trimester and continues at very high rates up to 2 years old for healthy brain development of children [4].

    Omega-3 is an essential fatty acid, which means it can only be obtained through dietary or supplementary forms.

    “Most pregnant women likely do not get enough omega-3 fatty acids because the major dietary source, seafood, is restricted to 2 servings a week. For pregnant women to obtain adequate omega-3 fatty acids, a variety of sources should be consumed:

    • vegetable oils
    • 2 low-mercury fish servings a week, and
    • supplements (fish oil or algae-based docosahexaenoic acid).” — [5]

    While the requirements during pregnancy have not been established, research recommends 300mg of DHA a day, especially during the 3rd trimester and while breastfeeding your infant or up until 2 years of age [5].

     

    3. How is the best way to take it?

    Pill forms of prenatal vitamins and DHA are easiest and most accurate in receiving the exact daily amount of nutrients.

    Often the best way to take your supplements is directly before a meal, but in the case of DHA, taking it with a source of fat helps with absorption. I often take my supplements with a glass of almond milk because of it’s fat content.

    Sometimes pregnant women may complain of nausea and morning sickness, and if this is the case, I’d try taking your pills just after dinner or just before bed.

     

    4. Which companies can I trust? Do I have to pick the most expensive one? What if I can only afford the cheaper brands?

    Canada and the USA have different regulations for allowing supplements (nutriceuticals, herbal remedies, homeopathics, essential oils). In Canada, all natural health products must have an Natural Product Number (NPN) before it can be legally sold in stores [6].

    The NPN ensures a certain level of research has gone into each of the ingredients being sold. However, it is up to the company to ensure that what is written on the bottle is actually what’s inside their products, but there are safety checks in place.

    But it’s not just about quantity, but also quality. For example,

    • where are the ingredients sourced from?
    • what is the cleanliness of the packing facility?
    • are their fillers added in?
    • are the servings at therapeutic dose?
    • have they tested these products on human research?

    These questions are where of my fears with self-supplementation lie and why “cheap” may be worse for your health than not taking anything at all!

    While researching, I wanted to find out how rigorous the process is to get a supplement into Canada, so I asked some Naturopathic doctors who are actually selling supplements in Canada. Here’s what they had to say.

     

    Q: Do you think the Ontario standards are rigorous enough?

    A: The answer to that question is only answered by the labelled supplement company and the manufacturer. In each lot developed for consumer use, each purchased raw material is required to be tested upon arrival and again following combination.

    Each lot is then tested by NSF (health and safety) or another governing body such as informed-sport, if there is concern for liability when athletes tested by associations like WADA are purchasing.

    It is a matter of how much financial commitment and due diligence each company has concern to investigate each product it supplies. Also it’s important to look into each prepared product within the manufacturing facility, cleaning procedures, product lines procedures and source of raw material as well as mode of transport.

    Also it’s not a provincial regulation, the NPN is Health Canada which is federal. Each product and raw material and its source is required for the achievement of the number. If a dose, manufacturer or source of material is changed the regulatory body must be notified and the supplier may be required to reapply for a new number.

     

    Q: Getting an NPN number is one thing, but ensuring what’s on the label is actually in the supplement is another.

    A: A product with an NPN means that it has met 80-120% label accuracy. The question of “is it what it says it is?” is not a problem in Canada as long as it has an NPN.

    The same can’t be said about the states; that’s where certifications like NSF, NSF Certified for Sport are more important since they don’t have anywhere near the same pre market standards or post market surveillance .

     

    Prenatal Brand Options

    These are common brands that my colleagues have researched and used with their patients. I DON’T RECOMMEND JUST TAKING ANY ONE OF THESE! Please talk with your ND or MD about the best option for YOU.

    Just for you, I’ve written out all the most popular brands along with the following information to make your comparison easier:

    • Number of capsules per serving per day
    • Folic acid per serving and form
    • Iron per serving
    • Vitamin D per serving
    • DHA per serving (if included)
    • Cost per serving (I took the Amazon.com price divided by the number of servings per bottle. This is in USD)
    • Notes (these are notes from mums and health professionals in the MummyCare Community. It’s free to join and you can get all your questions answered in here.)

    Click on the image below to download the Prenatal Brand Comparison chart.

    Prenatal-Brand-Comparison-chart

    Click here to enlarge and print off.

     

    5. How do I store the pills?

    Prenatal vitamins without DHA can be stored in room temperature on your counter or in a cupboard. DHA supplements should be kept in the fridge, unless otherwise stated on the bottle.

    Since DHA is an unstable oil, if you don’t consume it within 3 months of opening the bottle (or past the expiry date) it can potentially be harmful to the body as oils become rancid after time and exposure to light, oxygen and heat. So make sure to check the expiry dates, especially on those “quick sale” items, as they are often ready to expire.

     

    6. For how long do I have to take it for?

    You should start your prenatal vitamins at least 2-3 months before you want to conceive and up until you stop breastfeeding.

    For DHA, it is safe to take throughout the entire pregnancy, but be sure to focus on being diligent for the last trimester until you stop breast feeding. Then you can start giving your baby an oral dose of DHA to support healthy cognitive function and development.

     

    References

    1. http://dralisonchen.wpengine.com/wp-content/uploads/2016/08/FolicAcidNeuralTube.pdf

    2. http://www.ncbi.nlm.nih.gov.subzero.lib.uoguelph.ca/pubmed/26936859

    3. http://www.ncbi.nlm.nih.gov.subzero.lib.uoguelph.ca/pubmed/26956254

    4. http://www.ncbi.nlm.nih.gov.subzero.lib.uoguelph.ca/pubmed/26742060

    5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2621042/

    6. http://www.hc-sc.gc.ca/dhp-mps/prodnatur/about-apropos/index-eng.php


This website is NOT to be used as a diagnostic or treatment tool. Always consult with your Conventional Medical Doctor or Naturopathic Doctor for specific concerns. In cases of medical emergencies visit your nearest hospital or call 9-1-1.