Prenatal supplements are inadequate to provide important nutrients during pregnancy, and most women are unaware of this.

But despite their critical importance to the health of mothers and babies, prenatal supplements aren’t evaluated for safety and effectiveness like foods and drugs. There are no regulations requiring that these supplements contain any nutrients, let alone that they contain the right amounts.

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Not surprisingly, research has found that over-the-counter pre-pregnancy supplements (whether they come as tablets, capsules, softgels, or gummies) don’t contain adequate amounts of five key nutrients: folate, iron, vitamin D, calcium, and docosahexaenoic acid, an omega-3 fatty acid.

All of these nutrients are recommended by the American College of Obstetricians and Gynecologists, and getting enough of them can improve the health of pregnant women and their babies.

As a family medicine resident with a PhD in Nutrition, I began researching these products after my patients began asking me about them. I found that these products were missing many of the important nutrients needed during pregnancy, while other supplements either contained too little or too much.

Folic acid

Folic acid, which reduces birth defect rates by 50%, is the main reason prenatal supplements were developed.

However, folic acid only prevents birth defects if taken by day 28 of pregnancy. In other words, certain birth defects are only prevented if a woman takes the preconception supplement before she knows she is pregnant.

For this reason, the American College of Obstetricians and Gynecologists recommends that women start taking prenatal supplements at least three months before pregnancy.

Yet only about one-third of women and only 10 percent of African-American women actually take folic acid, and for many of them, it’s too late to start taking it to prevent birth defects.

Even women who take supplements early in pregnancy may not be getting the nutrients they need. This includes the 400 micrograms of folic acid (a synthetic version of folate) found in daily preconception supplements. 27 percent of preconception supplements contain less than that amount.

Meanwhile, although it is rare, it is not impossible to find products with more than 1 milligram of folic acid — a potentially dangerous amount that has been linked to impaired cognitive development, particularly impaired language skills.

Omega-3 fatty acids

Since their introduction in the 1980s as simple multivitamins with a dash of folic acid, prenatal supplements have evolved to offer additional nutrients, including omega-3 fatty acids, which act as building blocks for the developing fetal brain. In fact, 40% of the human brain is made up of omega-3s.

One rat study showed that inadequate omega-3 intake during pregnancy significantly reduced omega-3 levels in the mother’s brain. Although such studies are impossible to conduct in humans, this suggests that mothers may be sacrificing omega-3s from their own brains to support their baby’s brain development.

However, other studies looking at the association between low levels of omega-3 fatty acids and postnatal depression, child intelligence, and other important outcomes have produced mixed results.

However, there appears to be an association between omega-3s and preterm birth, with increased intake associated with reduced risk. Preterm births (birth before 37 weeks of pregnancy) are on the rise in the United States and around the world, with more than 1 in 10 babies being born preterm.

The new guidelines recommend that pregnant women who don’t normally consume enough omega-3 fatty acids should get 600 to 1,000 milligrams of omega-3s each day — a level that’s nearly impossible to get from a prenatal supplement, according to research.

However, patients who eat oily fish (such as salmon, mackerel, herring, sardines, or anchovies) two times a week may only need to take an additional 100 to 200 milligrams of omega-3 fatty acids per day during pregnancy. About 40 percent of over-the-counter preconception supplements contain this amount.

However, most Americans eat oily fish less than twice a week, meaning 95% of pregnant and breastfeeding women in the U.S. don’t get enough omega-3s. Many women avoid fish during pregnancy due to concerns about mercury, but oily fish that contain omega-3s are low in mercury and aren’t among the types of fish to avoid during pregnancy.

Colin

Choline is also essential for fetal brain development. Choline requirements increase to 450 milligrams per day during pregnancy and further to 550 milligrams per day during breastfeeding.

Aside from organ meats such as beef liver, few foods contain enough choline to meet this need. One egg has about 150 milligrams of choline, a 3-ounce steak has 117 milligrams, and half a cup of soybeans has 107 milligrams. Salmon, broccoli, Brussels sprouts, cauliflower, green peas, and kidney beans also contain choline.

These aren’t large amounts, so pregnant women should eat several choline-rich foods each day and may need supplements to meet the recommended amounts.

But apparently, most aren’t: 95% of pregnant women don’t get enough choline, more than half of pre-pregnancy supplements don’t contain choline, and those that do contain it only in very low amounts, usually less than 100 milligrams.

Additionally, some research suggests that consuming even more choline than recommended by guidelines may provide additional benefits.

One study suggests that doubling the recommended amount late in pregnancy may improve a child’s concentration, and another found that consuming four times the recommended amount of choline may mitigate some of the effects of fetal alcohol syndrome.

solution

These three examples clearly demonstrate that taking preconception supplements does not guarantee a nutritionally adequate pregnancy.

Part of the problem is a lack of education: doctors are taught very little about nutrition in medical school, and it’s my observation that most patients simply assume they’re getting what they need from pre-conception supplements.

There are no regulatory standards for these products, so there is no incentive to improve them, and since there is no one to mandate that these companies change their formulations, it is not a priority for them.

My intention here is not to deny the credibility of these products, but rather to show that they are not enough.

Finding the best supplements that contain just the right amount of each nutrient – not too much, not too little – can be difficult, if not impossible. Even price is no indicator of quality.

To ensure you get enough of these nutrients, people who are pregnant or planning to become pregnant should do three things:

• Choose a preconception supplement that contains less than or equal to the recommended daily allowance of 400 micrograms of folic acid, and start taking it three months before you become pregnant.

• Consider eating oily fish two times a week and taking a 100-200 milligram omega-3 fatty acid supplement daily. If you don’t eat oily fish regularly, take a 600-1,000 milligram supplement.

• Measure your current intake of choline-rich foods and consider taking a choline supplement if you are deficient.

Getting good nutrition during pregnancy takes a lot of effort, and it may seem like you have to do it alone.

I offer my patients a helpful guide to understanding their nutritional needs during pregnancy, which helps provide them with the information they need to overcome any prenatal supplement shortfalls.

Mary Skorbutakos, Family Medicine Resident and Nutrition Specialist, Eastern Virginia Medical School

This article is republished from The Conversation under a Creative Commons license. Read the original article.