There are all sorts of multivitamin supplements aimed at pregnant women, but what should you take during your pregnancy, if anything at all? LUCY TAYLOR asks the experts.
You’re expecting a little one and you want to do the best for your own health and the health of your baby. So should you be taking food supplements? It turns out to be a trickier question than you might think. There’s one exception, of course, which is that all women should take 400 micrograms of folic acid daily before pregnancy and throughout the first 12 weeks of pregnancy to reduce the risk of defects in the baby’s spinal cord. The Department of Health and Children also advises that all sexually active women of child bearing age should take a folic acid supplement. But what about other vitamins and minerals? It seems that not all the experts are in agreement on this issue. Dr Dan McCartney of the Irish Nutrition and Dietetic Institute and a lecturer in nutrition and dietetics in DIT says: “Obviously, it is ideal to get enough nutrients during pregnancy from food sources, but taking a supplement can be a pragmatic response to a lack of certain vitamins and minerals. Supplements are a lot more valuable for people on poor quality diets [which are] deficient in different minerals. ” Professor Cecily Begley, Chair of Nursing and Midwifery at Trinity College Dublin says: “There should be no need for pregnant women to take supplements if their diet is good with five or more fruit and veg [servings] a day, enough protein and carbohydrates and sufficient calcium. All the studies done in this area show no real difference in outcomes.”
Special groups
According to Dr McCartney, women who fall into a number of special groups might benefit from supplements. These include vegetarians and vegans; teenage mums –who need extra calcium as they are often still growing themselves; women with malabsorptive disorders such as Crohn’s disease; women with untreated coeliac disease; women with metabolic conditions such as diabetes and those who have food intolerances. For women who do not eat much red meat, anaemia can be a problem and their GP may prescribe an iron supplement. All pregnant women undergo a blood test at their booking in
appointment in hospital and this will reveal if they need an iron supplement. “Iron deficiency should be treated on a diagnosis basis by prescription, and iron supplements should not be taken on a willy nilly basis,” says Dr McCartney.
Vitamin D supplementation (10 micrograms per day) is recommended in the later stages of pregnancy for woman who are vulnerable to low vitamin D levels
Calcium and vitamin D
So what kinds of supplements are useful for pregnant women who might need to take them? According to Prof Begley: “Women whose diet contains less than 900mg of calcium per day should take a supplement of 1g calcium. You can get 900mg by eating 40g cheese (300mg), one yoghurt (210mg) and two glasses of milk (480mg). Sardines are also very high in calcium (100g has 500mg calcium).” Prof Begley adds: “Vitamin D supplementation (10 micrograms per day) is recommended in the later stages of pregnancy for women who are vulnerable to low vitamin D levels. For example, dark-skinned women; those who wear total cover-up clothing and therefore have less exposure to sunlight; those with a diet low in vitamin D (no oily fish, eggs, meat, vitamin D-fortified margarine or breakfast cereal), and women with a BMI of more than 30.” One supplement to avoid, according to Dr McCartney, is vitamin A. “The advice on vitamin A is confusing because it appears in some combined supplements, and yet women are told not to eat liver or pâté during pregnancy because it contains vitamin A,” he says. “As a rule, most women should not take a supplement during pregnancy if it contains Vitamin A.” According to Dr McCartney, omega 3 fish oils can be beneficial during pregnancy. “Roughly 30 per cent of people in Ireland don’t eat fish and others don’t eat enough fish, and women are often discouraged from eating oily fish during pregnancy. If you want to take an omega3 supplement, you need to make sure it does not contain vitamin A. Cod liver oil, for example, has omega 3 and vitamin D but also vitamin A, so it should not be taken during pregnancy. Look for an omega 3 separate supplement.” A new generation of combined pregnancy supplements are now available in pharmacies, but Prof Begley says: “These are not a good idea as you maybe taking in more than you need of one vitamin, and this could actually be harmful to you or your baby. Vitamin A is especially harmful in excess and can cause damage to the baby’s organs. You could ask your midwife, GP or obstetrician for advice about specific supplements if you think
you need them.”
Multiple pregnancies
For women expecting twins it’s doubly important to think about nutrition, so what do the experts think about supplements in this case? “Bearing in mind that your two babies together only weigh about a quarter more than a single baby, the nutritional needs are only slightly raised,” says Prof Begley, adding: “However, any woman expecting twins will be advised individually by her midwife and obstetrician as to what she needs.” According to Dr McCartney: “Logically, if you are mineralising two foetal skeletons rather than one, this will have implications for calcium and vitamin D levels in the mum’s body. It is not an issue of a baby not having enough, as babies will always take what they need from mum, but more an issue for the woman to make sure she doesn’t develop osteoporosis later in life.” Are there any cases in which pregnancy supplements could be dangerous for pregnant women or their unborn babies? Dr Mary Flynn, Chief Specialist in Public Health Nutrition at the Food Safety Authority of Ireland says: “This issue is wide and complex. We advise that, apart from folic acid, pregnant women in Ireland should not take anything else unless specifically directed to do so by their doctor.” And here’s food for thought. Prof Begley says that many women may not know that those who take extra vitamins before, or just after, getting pregnant are more likely to have a multiple pregnancy.
