What is worth supplementing during pregnancy?

Pregnancy is a very demanding period in a woman's life. Her body is working at top speed and must provide nutrients to the developing baby, but also to herself. For this reason, future mothers choose multivitamin complexes for pregnant women to supplement their diet . Very often, the criterion for choosing such a product is the longest possible list of its active ingredients. However, in the case of vitamins for pregnant women, it is worth being especially careful about what we take . A long list of vitamins and minerals does not mean that all of them will be absorbed. And their excess can also be harmful. In addition, not all items found in popular prenatal supplements have proven clinical effectiveness. So how to choose the right supplement?

The Gynecological Society recommends that pregnant women supplement only a few ingredients.

WHO and most scientific societies around the world believe that there are no grounds for all pregnant women to take vitamin preparations with many ingredients ¹ . Doctors and scientists emphasize that the main source of vitamins and minerals should be a varied diet . However, taking into account the conditions in our country and the specificity of society, the Polish Society of Gynecologists and Obstetricians (PTGiP) recommends supplementation with some ingredients: folic acid, vitamin D, polyunsaturated fatty acids and iodine . Supplementing them with the diet in the right amount during pregnancy is very difficult.

Folic acid (vitamin B9).

Folates are important for the development of a child's nervous system . It is recommended to take them before getting pregnant. Vitamin B9 reduces the risk of fetal impairment and related pregnancy complications and miscarriages by as much as 70% ² . Humans cannot produce or store this ingredient on their own. That's why supplementing your diet with folate is so important. We write folate because the term "folic acid" may be misleading. There is no such substance in nature. Folic acid is a synthetic invention that may not be absorbed by up to 60% of people ³ . The natural and bioavailable form for everyone is folates, or active folic acid . PTGiP recommends taking 400-600 mg of vitamin B9 daily during pregnancy. It is worth adding that folate supplements also differ in terms of bioavailability. At this point, the newest and most bioavailable form is Quatrefolic. You will find out why it is a safer alternative to "traditional" folic acid here.

Vitamin D.

Nowadays, you no longer need to convince anyone of the benefits of vitamin D3 supplementation. It cannot be supplemented and maintained at the appropriate level either through diet or sunbathing. You will read why in this article . Vitamin D is even more important during pregnancy. Its deficiency may be related to miscarriages, especially if they occur several times in the same woman ⁴ . Vitamin D has a particularly positive effect on the course of pregnancy if it is taken from the very beginning ⁵ . It may reduce the risk of preeclampsia (preeclampsia), gestational diabetes, postpartum hemorrhage and low birth weight ⁶ . PTGiP recommends taking 1,500-2,000 IU of vitamin D3 daily during pregnancy. And if you want to find out why vitamin D3 from lanolin, widely used in dietary supplements, is not the best choice, see here.

Iodine.

Iodine deficiency during pregnancy may cause thyroid disease, both in the mother and the fetus. If there is a catastrophically low level of this element in a woman's body, it may lead to disturbances in the development of the child's brain, damage to the central nervous system, mental retardation, hearing loss and deafness in newborns. In case of significant iodine deficiency, the risk of miscarriages and premature births also increases ⁷ . The demand for this element during pregnancy increases by about 1.5 times. At least half of pregnant women in Poland may be deficient in it ⁸ . On the other hand, an overdose of iodine also has serious side effects . Poisoning with this element may even lead to cardiac arrest and coma ⁹ . Therefore, the safe dose of iodine that PTGiP recommends supplementing during pregnancy for women without a history of thyroid disease is 150-200 mcg of iodine per day. Women with thyroid diseases should consult their doctor about iodine intake and its dose.

Omega-3 polyunsaturated fatty acids.

Omega-3 fatty acids are widely known for their impact on immunity, mood and sleep. They help maintain the condition of the heart and brain ^10,11 . An adequate supply of these acids during pregnancy (from food and supplements) is necessary for the cells and neurons of the fetus to develop properly. This is the basis for the development of the child's eyesight and its subsequent psychomotor development ¹² . By receiving the necessary dose of Omega-3 during pregnancy, the future mother also benefits - the risk of depression, preeclampsia and premature birth is reduced ^{13,14,15,16,17} . Many people believe that eating fish alone is enough to provide an adequate dose of polyunsaturated acids. However, eating fish in such quantities (e.g. 2 portions of salmon a day) for this to actually occur may be dangerous due to the contamination of fish and seafood with mercury, dioxins and other compounds. Heavy metals are particularly dangerous for a developing child. Moreover, Omega-3 fatty acids can come not only from fish. Contrary to popular belief, they are produced by algae that fish eat. You can read more about the advantages of Omega-3 acids from algae over those from fish here . The Polish Society of Gynecologists and Obstetricians recommends supplementing pregnant women with at least 200 mg of DHA (a type of Omega-3 acids) daily.

Why is iron not on the list of supplements recommended for all pregnant women?

Iron is a very important mineral for a woman's health, especially during pregnancy. It is necessary for the proper development of the child's brain, fetal weight gain and the development of pregnancy itself ¹⁸ . However, by taking iron without necessity, just in case, a pregnant woman risks her health . Oversupply of iron may cause the development of insulin resistance and gestational diabetes ¹⁹ and preeclampsia (preeclampsia) ²⁰ . Therefore, most scientific societies in the world recommend taking this mineral only if its deficiency is actually confirmed by research ²¹ .

What else is worth supplementing during pregnancy?

Existing scientific evidence also suggests that pregnant women may benefit from choline and vitamin B12 supplements ^22,33 . Providing these ingredients from food in appropriate doses is very complicated. Especially if we limit animal products in our diet. The demand for these ingredients additionally increases in the first weeks after conception ^24,25,26 . During this period, vitamin B12 helps maintain pregnancy ^27.28 . When a baby's brain begins to develop, choline and vitamin B12 are involved in this process ²⁹ . Their deficiency may contribute to neurological and metabolic diseases . Choline and vitamin B12 also help the future mother sleep better at night ³⁰ and maintain a good mood during the day ³¹ .

Will doses higher than recommended for pregnant women be more effective?

As you can see, the Polish Society of Gynecologists and Obstetricians has determined the appropriate doses of ingredients for supplementation based on scientific evidence . The daily amounts of iodine, vitamin D, Omega-3 acids and folic acid prescribed for pregnant women are considered effective and safe . This means that there is no reason to increase these doses in the hope of a better effect. In some cases, an oversupply of ingredients can be very dangerous to health. In others, researchers saw no significant benefit from increasing the dose compared to the recommended dose. This means that when choosing a dietary supplement for pregnant women, it is worth looking not only at the list of active ingredients , but also at their individual amounts . It is not worth forgetting about fillers. The shorter the list , the better. You can read about what else is worth considering to choose a high-quality dietary supplement here.

Bibliography:

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7. As above.
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23. “Dietary reference values: EFSA publishes advice on choline”, European Food Safety Authority, August 17, 2016.
24. As above.
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