Prenatal Vitamins
If you are pregnant or breast feeding your doctor may recommend prenatal
vitamins to supplement your diet. Prenatal vitamins are intended to provide the
additional 30 mg per day of iron required by women during pregnancy in order to
prevent iron deficiency anemia [1] . In addition prenatal vitamins should
contain 400 to 800 micrograms of folic acid to decrease the chances of the
birth defects spina bifida (open spinal cord) and anencephaly (absence of
a major portion of the skull and brain) which occur during the first six
weeks of pregnancy[2]
Beyond Iron and Folic Acid
Whether or not supplements, such as docosahexaenoic
acid (DHA), given to all pregnant and breast feeding women improves pregnancy
outcome or development in their infants is unsettled [3-7] . However, for
some women supplements may be a good idea. For example, additional vitamin B12
might benefit strict vegetarians and women with a history of gastric bypass,
since they are at risk for vitamin B12 deficiency due to low intake and poor
absorption respectively [8]. Women with low calcium intake might decrease their chances of
developing preeclampsia by taking calcium supplements , in addition to their
prenatal vitamins, during pregnancy [9]. Although vitamin D deficiency is
a common problem for most pregnant women, first time mothers, African-American
women, and Hispanic women appear to be at highest risk for vitamin D deficiency
and could benefit from additional vitamin D in their diet or as a supplement.
[22]. Women who are unable to obtain enough iodine from their diet through dairy
products, iodized salt, or fish might benefit from an iodine supplement
{23-25]. Lastly additional choline might help to decrease the chances of the
birth defects spina bifida and anencephaly even in women already receiving
extra folate in their diet [26].
Twins
For twin pregnancies it is recommended that during the first
trimester women take one multivitamin tablet with iron (30 mg) daily. Additional folic acid 1,000 mcg, calcium 1,500 mg , vitamin D 1,000 IU,
magnesium 400 mg, vitamin C 750 mg, and vitamin E 400 IU should be provided daily if not provided
by their multivitamin.
During the second and third trimesters women with twin
pregnancies should take two multivitamin tablets with iron (30 mg)
tablets daily. Calcium intake should be increased to 2,500 mg per day and magnesium
intake should be increased to 800mg. Folic acid, vitamin D, vitamin C, and
vitamin E should be continued at the same amounts as for the first
trimester [27].
See Also:
Nutrition in Twin Pregnancy
Choice of Prenatal Vitamins
The choice of prenatal vitamin will often
depend on patient acceptance and cost. Prenatal vitamins may worsen nausea, abdominal discomfort, and constipation that are common
during pregnancy.
Women who are having severe nausea and vomiting in early pregnancy may need
to temporarily stop taking their prenatal vitamins, or use a vitamin with
decreased or no iron content until their condition improves. Intake of
iron-rich foods should be encouraged. Some dietary sources of iron
include beef, turkey, duck, clams,
chicken, soybeans, fortified cereals, lentils, spinach, lima beans, refried beans, chickpeas, tomatoes, and prune juice [10-13].
Some women who have trouble
swallowing pills have been known to replace their prenatal
vitamin with chewable FlintstonesTM
vitamins. However, as shown in the table below FlintstonesTM
vitamins provide only one half the amount of iron and folic acid as do other
prenatal vitamins. It would be necessary to take two FlintstonesTM
vitamins to meet
the daily recommended amounts for iron and folic acid
[21].
Although taking
two FlintstonesTM
vitamins
would provide
more than the recommended daily intake of vitamin A and several other nutrients,
the amounts of vitamin A and other nutrients would
still be considered to be safe for the mother and fetus [18-20].
On occasion, the additional cost of a name
brand prenatal vitamin may be justified if the brand named version causes less
stomach upset, has a more acceptable taste, or is easier to swallow .
Otherwise, where cost is a concern reputable generic
versions of the more popular brands can provide substantial
savings
[14-21].
Table 1. Comparison Of the Content of Some Vitamins Commonly
Taken During Pregnancy
Nutrient |
units |
FlintstonesTM
Complete
|
Centrum
Materna® |
Nature Made® Multi Prenatal |
Stuart
Prenatal® |
DRI * Pregnancy
19 to 50 years
|
Vitamin A
(as
Beta-Carotene) |
mcg RAE
(IU)
|
150 (1000) |
375 (2500) |
600 (4000) |
600 (4000) |
770 (2564) |
Vitamin A |
600 (2000) |
300 (1000) |
|
|
Vitamin E |
IU (mg) |
30 (30) |
30 (30) |
11 (11) |
30 (30) |
15 (15) |
Vitamin C |
mg |
60 |
85 |
100 |
120 |
85 |
Folic Acid |
mcg |
400 |
1000 |
800 |
800 |
600 |
Vitamin B1
(thiamine) |
mg |
1.5 |
1.4 |
1.5 |
1.8 |
1.4 |
Vitamin B2
(riboflavin) |
mg |
1.7 |
1.4 |
1.7 |
1.7 |
1.4 |
Niacin |
mg |
15 |
18 |
18 |
20 |
18 |
Vitamin B6
(pyridoxine) |
mg |
2 |
1.9 |
2.6 |
2.6 |
1.9 |
Vitamin B12
(cyanocobalamin) |
mcg |
6 |
2.6 |
4 |
8 |
2.6 |
Vitamin D
(cholecalciferol) |
IU (mcg) |
400 (10) |
400 (10) |
400 (10) |
400 (10) |
200 (5) |
Biotin |
mcg |
40 |
30 |
|
|
30 |
Choline |
mg |
38 |
|
|
|
450 |
Pantothenic Acid |
mg |
10 |
6 |
|
|
6 |
Calcium |
mg |
100 |
250 |
250 |
200 |
1000 |
Iodine |
mcg |
150 |
220 |
|
|
220 |
Magnesium |
mg |
20 |
50 |
|
|
360 |
Iron |
mg |
18 |
27 |
27 |
28 |
27 |
Copper |
mcg |
2000 |
1000 |
|
|
1000 |
Zinc |
mg |
12 |
7.5 |
25 |
25 |
11 |
Chromium |
mcg |
|
30 |
|
|
30 |
Manganese |
mg |
|
2 |
|
|
2 |
Molybdenum |
mcg |
|
50 |
|
|
50 |
Selenium |
mcg |
|
30 |
|
|
60 |
*DRI= Daily Reference Intake;
3.33 IU Vitamin A = 1 mcg RAE ; 6.66 IU beta carotene from supplement = 1mcg RAE
REFERENCES:
1. Recommendations to prevent and control iron deficiency in the United States. Centers for Disease Control and Prevention. MMWR Recomm Rep
1998;47(RR-3):1–29.PMID:9563847
2.
U.S. Preventive Services Task Force.Folic acid for the prevention of neural tube
defects: U.S. Preventive Services Task Force recommendation statement. Ann
Intern Med. 2009 May 5;150(9):626-31.PMID:19414842
3.Shah PS, Ohlsson A; Knowledge Synthesis Group on Determinants of Low Birth
Weight and Preterm Births.
Effects of prenatal multimicronutrient supplementation on pregnancy outcomes: a
meta-analysis. CMAJ. 2009 Jun 9;180(12):E99-108.
PMID:19506270
4.Haider BA, Bhutta ZA.Multiple-micronutrient supplementation for women during
pregnancy.Cochrane Database Syst Rev. 2006 Oct 18;(4):CD004905.PMID:17054223
5. Rumbold A, Middleton P, Crowther CA.Vitamin supplementation for preventing miscarriage.Cochrane Database Syst Rev. 2005 Apr 18;(2):CD004073.
PMID:15846697
6.Jensen CL, et al. Effects of Early Maternal Docosahexaenoic Acid Intake on
Neuropsychological Status and Visual Acuity at Five Years of Age of Breast-Fed
Term Infants. J Pediatr. 2010 Jul 22. PMID:20655543
7. Gale CR, Marriott LD, Martyn CN, Limond J, Inskip HM, Godfrey KM, Law CM,
Cooper C, West C, Robinson SM; Group for the Southampton Women's Survey Study.
Breastfeeding, the use of docosahexaenoic acid-fortified formulas in infancy
and neuropsychological function in childhood.Arch Dis Child. 2010
Mar;95(3):174-9. Epub 2010 Feb 4.PMID:20133326
8.
Andrès E, Federici L, Affenberger S, Vidal-Alaball J, Loukili NH, Zimmer J, et
al. B12 deficiency: a look beyond pernicious anemia. J Fam Pract 2007;56:537-42.PMID:17605945
9. Hofmeyr GJ, Calcium supplementation during pregnancy for preventing
hypertensive disorders and related problems. Cochrane Database Syst Rev. 2010
Aug 4;8:CD001059.PMID:20687064
10. Nguyen P,et al Predictors of prenatal multivitamin adherence in pregnant
women.J Clin Pharmacol. 2009 Jun;49(6):735-42. Epub 2009 Apr 22.PMID:19386624
11. Gill SK, et al. The effectiveness of discontinuing iron-containing prenatal
multivitamins on reducing the severity of nausea and vomiting of pregnancy. J
Obstet Gynaecol. 2009 Jan;29(1):13-6. PMID:19280488
12. Zhou SJ, Gibson RA, Crowther CA, Makrides M. Should we lower the dose of iron when treating anaemia in pregnancy? A randomized dose-response trial. Eur J Clin
Nutr. 2007 Oct 10. PMID: PMID:17928802
13. Souza AI, et al.Adherence and side effects of three ferrous sulfate treatment regimens on anemic pregnant women in clinical trials..Cad Saude Publica. 2009 Jun;25(6):1225-33.
PMID:19503953
14.Product label Flintstones Complete. Bayer HealthCare LLC.http://www.flintstonesvitamins.com/complete/index.html#ingredients
15.Materna product label
http://www.materna.ca/About/Default.asp
16.Product label Stuart Prenatal
http://www.naturemade.com/ProductDatabase/prd_prod.asp?productid=182
17. Product label http://www.stuartprenatal.com/preconception_formula.html
18.
Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium,
Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001)
Food and Nutrition Board (FNB) Institute of Medicine (IOM)2001
http://www.nap.edu/catalog.php?record_id=10026
19. Dietary Reference Intakes for Calcium, Phosphorous, Magnesium, Vitamin D,
and Fluoride (1997); http://www.nap.edu/catalog.php?record_id=5776
20. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6,
Folate, Vitamin B12, Pantothenic
Acid, Biotin, and Choline (1998); Dietary Reference Intakes for Vitamin C,
Vitamin E, Selenium, and Carotenoids (2000);
http://www.nap.edu/catalog.php?record_id=6015
21. National Academy of Sciences
http://www.iom.edu/Global/News%20Announcements/~/media/Files/Activity%20Files/Nutrition/DRIs/DRISummaryListing2.ash
22. Johnson DD, et al. Vitamin D Deficiency and Insufficiency is Common during Pregnancy.Am J Perinatol. 2010 Jul 16. PMID:20640974
23. Gallego G, et al. Iodine deficiency in Australia: is iodine supplementation
for pregnant and lactating women warranted?
Med J Aust. 2010 Apr 19;192(8):461-3.PMID:20402611
24. Limbert E, et al. Iodine intake in Portuguese pregnant women. Results of a
countrywide study.Eur J Endocrinol. 2010 Jul 19. PMID:20643757
25. Perrine CG, et al. Some subgroups of reproductive age women in the United
States may be at risk for iodine deficiency.
J Nutr. 2010 Aug;140(8):1489-94. PMID:20554903
26. Shaw GM, et al. Choline and risk of neural tube defects in a
folate-fortified population. Epidemiology. 2009 Sep;20(5):714-9. PMID:19593156
27. Goodnight W, et al. Optimal nutrition for improved twin pregnancy outcome.
Obstet Gynecol. 2009 Nov;114(5):1121-34. PMID: 20168116 |
|