Kathleen M. Zelman, MPH, RD, LD
When you're expecting, you want to do everything possible to give your baby the healthiest head start. You read all the What to Expect books, watch your diet, and carefully follow the advice your doctor gives you at every prenatal care visit. Part of that advice might be to take prenatal vitamins, but do you know why your doctor is recommending these vitamins, or what they can do to help your growing baby?
Here's a quick primer on prenatal vitamins, which vitamins and supplements you need, and why you need them.
Technically, you don't need to take prenatal vitamins if you're eating a healthy, well-rounded diet. But there are a few nutrients that even the best diet can't provide enough of right now. "Even for a woman who eats a "perfect" diet, it is nearly impossible to get some of the nutrients in the amounts needed during pregnancy, such as iron and folic acid," Bridget Swinney, MS, RD, author of Eating Expectantly explains in an email interview. For women who don't eat all their greens, prenatal vitamins are a kind of "insurance policy," providing them with the nutrients they may be missing from diet alone, says Swinney, who is also a spokesperson for the Texas Dietetic Association.
You need more iron right now to nourish your baby and because your blood volume expands during pregnancy. Iron is an essential component of hemoglobin, the substance that carries oxygen in your blood. If your diet doesn't include enough iron-rich foods, like red meat, egg yolks, and dark leafy greens, your body will pull it from the reserves in your bone marrow, but you may not have enough stores on hand to supply both you and your baby.
"Many women enter a pregnancy with little or no storage iron in the bone marrow," says Roy Pitkin, MD, professor emeritus of obstetrics and gynecology at UCLA. "If they do not get enough in diet then they can become anemic." Iron is especially important during the last trimester of pregnancy, when the baby's needs are the greatest, says Pitkin, who also chaired the National Academy of Sciences' Committee on Nutritional Status During Pregnancy and Lactation.
Folic acid is the other essential pregnancy vitamin. It's absolutely critical for cell division, and for preventing neural tube birth defects such as spina bifida and anencephaly. The catch with folic acid is that, for it to help your growing baby, you need to start taking it at least one month, preferably longer, before you get pregnant and throughout your pregnancy. That's why health experts recommend that all women of childbearing age take daily multivitamins containing at least 400 micrograms of folic acid because pregnancies aren't always planned.
Taking multivitamins even before you get pregnant is a good way to prep your body to nourish your baby. "A multivitamin-mineral supplement (with about 100 percent of the Daily Value) is a nice addition to a healthy diet to get the body in shape for pregnancy," Swinney says. "It's also a great idea for dads-to-be, because sperm quality also depends on good nutrition!"
You could take multivitamins during pregnancy, but you might be skimping on some of the nutrients you need in larger amounts during these nine months. "A prenatal vitamin has the amount of nutrients that more closely match the nutrient needs of a pregnant woman," says Swinney. "Some may also have things that regular multivitamins don't have, like DHA [an omega-3 fatty acid] and choline, which are particularly important for fetal brain development."
You can buy prenatal vitamins right over the counter at your local pharmacy or get a prescription from your ob-gyn. What's the difference? Price, for one. You'll typically pay more for prescription prenatal vitamins. Yet they do supply an extra vitamin and mineral boost. "Prescription prenatals tend to have more vitamins and minerals included, or more of certain nutrients than an over-the-counter brand," Swinney says. You may find more folic acid (1,000 micrograms instead of the 400 micrograms in over-the-counter versions) and iron in prescription prenatal vitamins and supplements, as well as added nutrients like iodine, choline, magnesium, and copper.
The other difference is purely psychological, Pitkin says. "If a doctor says, 'This is really important to take. I'm going to write you a prescription,' you accept it as something more important." In other words, you're more likely to actually take your vitamins if they're part of your prescribed prenatal care.
You won't find much of a difference when you compare the labels of different prenatal vitamins. "They're all pretty much the same. It's a pretty standard formula," Pitkin says.
Here are some of the vitamins and minerals and amounts you'll find in prenatal vitamins, and why your baby needs them:
Why You Need It
Builds strong bones and teeth
Develops memory and learning center in the brain
Promotes brain development
Enables cell division and prevents neural tube birth defects
Important for proper brain development
Helps with the production of new blood cells to accommodate increased blood volume during pregnancy
600 IU or more
Builds strong bones and teeth, and used for making hormones
Generally, prenatal vitamins are very safe. Many of the vitamins in them, including vitamin C and the B vitamins, are water soluble, which means your body will flush out any extra you consume. Where you do need to watch that the vitamin doesn't exceed the recommended daily allowance for pregnant women is with the fat-soluble vitamins: A, D, E, and K. Because your body does store these vitamins, it is possible to get more than you need.
Too much of a good thing is never a smart idea. Don't pop handfuls of vitamins and supplements and then eat nutritional bars, because you could overdose on certain nutrients. Let your doctor know about all of the vitamins and supplements you're taking so that he or she can help you keep track of them.
Prenatal vitamins can cause some minor side effects like constipation and nausea, which can already be issues during pregnancy. The first three months of your pregnancy, when you need the folic acid in your prenatal vitamin the most, is also when you feel the worst. The very idea of swallowing a pill when you've got terrible morning sickness can set your stomach rolling. "If your nausea is worse in the morning when you get up, don't take it when you get up. Take it before bed or with food," Pitkin advises. You can also try a liquid or chewable prenatal vitamin if it's easier for you to take. If constipation is a problem, add fiber to your diet by eating more fruits, vegetables, and whole grains.
Just because you're popping a prenatal vitamin every morning, don't think your diet is off the hook. Prenatal vitamins are no substitute for three healthy meals. They don't contain the protein calories, or all of the nutrients you and your baby need during this time.
"Even the best prenatal vitamins don't have every single nutrient found in food," Swinney says. "There are hundreds of antioxidants found in food that aren't in vitamins. Also, prenatal vitamins don't contain much calcium, so calcium-rich foods like milk and yogurt are a must." Eat a variety of fruits, vegetables, whole-grains, dairy, and protein to ensure you're getting everything you and your baby need, and then you can think of your prenatal supplement as an added nutrient bonus.
SOURCES:Roy Pitkin, MD, emeritus professor of obstetrics and gynecology, UCLA.March of Dimes: "Take folic acid before you're pregnant."Rakel, R. Textbook of Family Medicine, 7th ed, Saunders Elsevier, 2007.Bridget Swinney, MS, RD, author, Eating Expectantly; spokesperson, Texas Dietetic Association.American Pregnancy Association: "Nutrient Guidelines."Public Health Nutrition, December 2007; vol 10: pp 1606-1611.
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