There are a range of expensive vitamin supplements sold for women either planning a pregnancy or during pregnancy, many of which contain a wide range of vitamins and minerals that are not actually needed or useful to most women. With so many to choose from, it can be confusing to know which are potentially beneficial to you and your baby.
It is certainly not a case of ‘the more the merrier’ when it comes to supplementing your diet, as some vitamins and minerals can be harmful if taken in excess amounts, particularly at key stages of your baby’s development. This blog aims to provide an overview of the current recommendations.
The advice is aimed at the general population, so if you have a specific medical condition you may want to seek additional clarification on whether your nutritional needs will be different to this.
Supplements recommended in pregnancy
There are just two key nutrients that we know to be beneficial to most women to supplement during pregnancy. These are Folic acid and Vitamin D.
- If you are planning to get pregnant, it’s a good idea to take a daily 400µg (mcg) folic acid supplement, and as soon as you find out you’re expecting, it is strongly advised. Folic acid is needed before pregnancy and in the first few weeks of pregnancy to prevent neural tube defects, and may help to prevent cleft lip and palate. In later pregnancy, folic acid is needed to prevent anaemia. While it is possible to get enough folic acid from the diet if you eat well (good sources of folic acid include green leafy vegetables, pulses and wholegrain or fortified cereals) it is recommended that all women take a supplement for at least the first 12 weeks of pregnancy. For those women who have poor or erratic diets, it is prudent to continue taking this supplement throughout pregnancy.
- Note that if you have any family history of neural tube defects (spina bifida or anencephaly), if you are taking certain anti-epileptic drugs, are diabetic, have coeliac disease or are obese, you are likely to be advised to take a higher-dose supplement of folic acid of about 5 milligrams (mg) a day during the first 12 weeks. Check with your GP or midwife if you think this might apply to you.
- It is also recommended that all pregnant women take a 10µg (mcg) Vitamin D supplement whilst pregnant. Vitamin D is very important for bone development in both the pregnant woman and the child, but needs cannot be met through diet alone. Most adults make the majority of their vitamin D through the action of summer sunlight on the skin, but this is usually insufficient to see them through the winter months and dietary sources are limited. Women who are at highest risk of low vitamin D status include those who have darker skin, who rarely go outside, who cover their skin with clothing or sunscreen, who avoid animal foods or who have a very poor or very low-fat diet.
No other vitamin or mineral supplementation is routinely advised in pregnancy unless your usual health screens indicate a deficiency, which is sometimes the case with Iron or Vitamin B12. Your GP can direct you with the correct dose to take in these cases. You should be able to obtain all of the nutrition your baby needs from a varied and balanced diet.
- For those who dislike oily fish you may consider taking a fish oil supplement in order to provide a source of Omega-3 essential fatty acids (DHA & EPA). Fish oil supplements have been reported to be safe and generally well tolerated in pregnancy so should be fine to take for most women. However, be aware that fish oil supplements are not suitable for women with intra-uterine bleeding and other bleeding disorders, or women taking blood thinners due to the potential for increased bleeding during delivery.
- Cod liver oil supplements should be avoided by pregnant women as they contain Vitamin A (retinol). High intakes of this vitamin in supplement form can be dangerous for the developing foetus. For the same reason, take care to avoid any general multivitamins (i.e. not tailored for pregnancy) that contain Vitamin A (retinol).
Selecting the Correct Dosage
This can be a bit confusing. When checking labels for doses, micrograms may also be written as mcg or µg but this all means the same thing. Vitamin D supplements are often marked in IU (international units) rather than micrograms. 400 IU is equivalent to 10 micrograms.
Due to the reduced range of foods in the vegan diet, and the increased requirements of some nutrients in pregnancy, supplementation of other nutrients will be wise. The Vegan Society produces a supplement called Veg1 which contains riboflavin, vitamin B6, folic acid (200µg), vitamin B12 (25µg), vitamin D (20µg), iodine (150µg) and selenium. This supplement is suitable for pregnant women, but does not contain enough folic acid (as it contains 200µg rather than the required 400µg) so it should be taken with an additional 200µg folic acid supplement (those available off the shelf in a local pharmacy are usually suitable for vegans).
What about Herbal Supplements?
It is recommended that pregnant women should avoid using the following herbs due to documented adverse effects:
- blue cohosh
- calendula (Marigold)
- dong quai
- licorice (as a herb)
- black cohosh
- chaste tree (Chasteberry)
- evening primrose oil – pregnancy only; safe during lactation
- ginseng – during first trimester; caution advised during later stages of pregnancy and during lactation
- labrador tea
- senna – long-term, frequent or high doses; in the short-term, small amounts safe during pregnancy and lactation
- St. John’s wort
- tea tree oil.
Additionally, the consumption of the following herbs in pregnancy should be limited to the amount commonly found in foods or consumed in moderation as an herbal beverage (two to three cups per day). Supplements of these herbs (tablets, capsules or extracts) are not recommended due to potential adverse effects:
- bitter orange/orange peel
- red raspberry leaf
- rose hip
There is insufficient information on the following herbs to be able to recommend their use, and as such it is probably better to steer clear of them in supplemental form (tablets, capsules or extracts) as well:
- Japanese mint
- red bush tea (Rooibos tea)
- lemon balm
- wild yam
Supermarkets and pharmacies sell own brand vitamin supplements with both 400µg of Folic acid and 10µg of Vitamin D, which work out at around 5p a day. They are also cheap to buy separately in the correct doses. Putting the money you would have spent on an expensive branded supplement towards some fruit, veg, nuts or milk for your diet will do yourself and your baby much more good nutritionally.
Carly Atkinson is a Registered Dietitian with 14 years post-graduate experience working in the NHS and an MSc in Advanced Dietetic Practice. She currently runs workshops in Cheltenham for parents and carers on Weaning and Fussy Eating, and delivers training and menu guidance to Early Years Settings. Her aim is to provide evidence-based, accessible and practical information on infant nutrition to parents and carers to provide the best start for the children they care for. You can find out more at facebook.com/babybrightstart or babybrightstart.com