By Neil Levin, CCN, DANLA, Nutrition Education Manager. Beyond a prenatal multiple vitamin, read about the vitamins and minerals that pregnant women and nursing mothers may also want to take.

When it comes to the nutritional needs of pregnant women, nursing mothers, and women that may become pregnant, more cautions are the norm. This almost excessive cautiousness in warning women to stay away from many common and ordinarily quite safe products, including dietary supplements, is certainly understandable. An important factor in this concern is that many supplements and their active ingredients simply have not been adequately tested on pregnant or lactating women, if at all, so the safety of those products in terms of fetal and infant exposures may be still unknown.

The Institute of Medicine (IOM) at the National Institutes for Health (NIH) determines both a Recommended Daily Allowance (RDA) and a tolerable upper limit (UL) of intake for numerous vitamins and minerals. The RDAs are set at a level that prevents deficiency diseases and symptoms for most people. ULs are set at a level that excludes almost all side effects in the general population. Not all vitamins and minerals have RDAs or ULs, and other types of supplements such as herbs or antioxidants typically do not have RDAs or ULs. The more modern terms for RDAs are Dietary Reference Intakes (DRIs) and Daily Values (DV). For most vitamins and minerals there are recommended levels for both adult and teen pregnant and breastfeeding women. (1)

There are certain dietary supplements that pregnant and breastfeeding women should be taking, such as a prenatal multivitamin to assure adequate nutrition for the mom or mom-to-be who is truly “eating for two.” These products provide essential vitamins and minerals in forms and at levels specifically recommended for pregnant/lactating women. Prenatal vitamins provide vitamins A, B, C, D and E, plus minerals. These may be at optimal levels for these women, but look closely at the Supplement Facts label panel to see if a formula provides all of the recommended levels of essential vitamins and minerals; many formulas do not provide all of these nutrients at recommended levels, prompting the use of additional products.

Beyond a prenatal multiple vitamin formula, which vitamins and minerals might pregnant women and nursing mothers want to take separately? Here are some of the likely ones:

  • Vitamin C  (2)
    • Adult women typically need at least 75 mg per day. But pregnant women need 85 mg and nursing mothers need 120 mg daily as a minimum. Smokers (smoking is not recommended!) should add 35 mg to these numbers.
    • The RDA for most adults is 60 mg per day, so some formulas don’t provide enough for pregnant/lactating women.
    • Too much vitamin C might cause diarrhea, nausea and stomach cramps; the tolerable upper limit (UL) for vitamin C (based on these symptoms) is 2,000 mg a day for adult women.
  • Vitamin D (3)
    • Pregnant and breastfeeding teens and women require at least 600 IU daily. Many formulas have only 400 IU or less.
    • Many experts suggest that most people take 1,000 to 2,000 IU daily.
    • The UL is 4,000 IU daily.
  • Calcium (4)
    • Look closely at your prenatal supplement. Some provide enough calcium, but many do not. Why not? Because providing the daily recommended allowance of calcium (often with additional magnesium) typically adds several capsules or tablets to the number suggested to be taken daily and will never be in a one per day formula.
    • The RDA for pregnant and breastfeeding adult women is 1,000 mg daily, but that goes up to 1,300 mg if a pregnant/lactating teen from 14-18 years old.
    • How much is too much? The UL is 2,500 mg daily for pregnant and breastfeeding adults (3,000 for teens). Most formulas suggest taking 1,000-1,500 mg daily.
  • Folic acid (Folate) (5)
    • This B vitamin is essential for early fetal development. Ordinary multiple vitamins typically do not provide enough for pregnant/nursing women, though prenatal vitamin formulas usually do.
    • The government recommends that all women of childbearing age take supplements providing 400 mcg of folic acid daily.
    • The RDA for pregnant women is 600 mcg daily; for lactating women 500 mcg (these are not commonly found product doses).
    • The UL of folic acid is 1,000 mcg daily for all adults; 800 mcg for pregnant/nursing teens.
  • Fish Oil or Algae (DHA) (6)
    • Omega-3 fatty acids, especially the long-chain fatty acid DHA, are important for fetal development.
    • The standard Western diet is deficient in essential omega-3 fats.
    • Pregnant women may become depleted because the fetus takes omega-3 fats from the mother to aid in nervous system development.
    • Omega-3 fats are also used to make breast milk.
    • Adequate omega-3 levels are associated with healthy pregnancies and healthy mood.
    • Fish oil or algae oil supplements typically contain far lower levels of heavy metals and other environmental toxins than a serving of fish.

These dietary supplements require special caution for pregnant and nursing mothers:

  • Vitamin A (7)
    • It is important to note that Beta-Carotene is essentially non-toxic while “pre-formed” Vitamin A (retinol, retinyl palmitate, etc) in higher doses is NOT recommended for pregnant women.
    • The IOM set an upper limit (UL) for Vitamin A of 10,000 IU daily for adults over age 18, with no variation due to age, gender, or pregnancy/lactation. However, pregnant women have a risk of birth defects at high doses.
    • The IOM has not set a UL for Beta-Carotene, as the supplement lacks any history of significant side effects in the scientific/medical literature. Beta-carotene can be taken in higher amounts than pre-formed Vitamin A.
  • Herbs that claim to have an effect on hormone levels should be used only under direct supervision of, and approval by, a physician
    • Black Cohosh, Vitex, Dong Quai are some examples.
  • Natural Progesterone Cream
    • Should only be used by a pregnant or breastfeeding woman under physician’s orders.
      • Your physician may prescribe this for you under certain medical conditions.
      •  Do not use unless prescribed by your physician!
  • Any dietary supplement with a label warning that pregnant or lactating women should not use it unless recommended by their physician.

Tell your doctor, pharmacist, and other health care providers about any dietary supplements and medicines you take or want to take. They can tell you if those dietary supplements might interact or interfere with your prescription or over-the-counter medicines or if the medicines might affect how your body uses nutrients. They can also advise as to which dietary supplements they consider safe and appropriate for you as a pregnant or breastfeeding woman.

References:

  1. See the USDA National Agricultural Library website.
  2. See “Vitamin C Quick Facts” on the Office of Dietary Supplements website.
  3. See “Vitamin D Quick Facts” on the Office of Dietary Supplements website.
  4. See “Calcium Quick Facts” on the Office of Dietary Supplements website.
  5. See “Folate Health” on the Office of Dietary Supplements website.
  6. See “Omega 3 Fish Oil” on the American Pregnancy Association website.
  7. See “Vitamin A Health” on the Office of Dietary Supplements website.

 Posted March 23, 2011.