When you’re pregnant, it feels like there’s very little you can eat. No cured meats! No soft cheeses! And definitely no alcohol!
However, it is a prenatal supplement that is recommended for all pregnant women to take.
However, despite their vital role in the health of mothers and babies, these vitamins are unregulated, meaning manufacturers can essentially put in whatever they want.
There are no rules about what nutrients should be included or what the appropriate amounts are.
As a result, the study found that none of the most popular over-the-counter pregnancy supplements provide adequate levels of five key nutrients: folate, iron, vitamin D, calcium, and docosahexaenoic acid (an omega-3 fatty acid).
This is despite the fact that adequate intake of these nutrients is associated with improved health outcomes for both pregnant patients and their children.
With this in mind, Dr. Mary Skorbutakos, a family medicine and nutrition specialist at Eastern Virginia Medical School, set out to research these products.
She found that these tablets, capsules and gummies either did not contain many of the important vitamins needed during pregnancy, or contained insufficient or excessive amounts.
In other words, Dr. Skrutakos conversation“Finding the perfect supplement that contains just the right amount of each nutrient — not too much and not too little — can be difficult, if not impossible.”
Most women think they can get all the nutrients they need from over-the-counter supplements.(iStock)
She gave the example of three nutrients thought to be important for reducing birth defects and ensuring healthy development in babies: folic acid, omega-3 fatty acids and choline.
In fact, folic acid, which reduces the incidence of birth defects by 50 percent, is “the main reason prenatal supplements were developed,” she says.
However, what many pregnant women don’t know is that folic acid can only prevent birth defects if taken by the 28th day of pregnancy.
Simply put, women should start taking pre-pregnancy supplements even before they know they’re pregnant to ensure protection against certain birth defects.
For this reason, the American College of Obstetricians and Gynecologists recommends that women start taking pre-conception supplements at least three months before pregnancy.
But only about one-third of women do so, and that figure drops to just 10 percent for African-American women, Dr. Skorbutakos says.
Yet even women who take supplements early in pregnancy may not get the necessary 400 micrograms of folic acid (the synthetic version of folic acid) because up to 27 percent of preconception supplements contain less than that amount.
However, some supplements contain more than 1 milligram of folic acid — a “potentially dangerous amount that could lead to impaired cognitive development, particularly in language skills,” says Skruvtakos.
Too much folic acid can be dangerous to your unborn baby(iStock)
Regarding omega-3 fatty acids, a US-based nutritionist noted that these act as “building blocks for the construction of the fetal brain” and that around 40% of the human brain is made up of omega-3.
While studies on low intake of omega-3 fatty acids during pregnancy have shown mixed results, Dr Skruvtakos said there appears to be an association between omega-3s and preterm birth, and that increasing intake appears to reduce the risk.
New U.S. guidelines recommend that pregnant women who don’t get enough omega-3 fatty acids on a daily basis should get 600 to 1,000 milligrams of omega-3s per day — amounts that are nearly impossible to get from prenatal supplements.
Of course, the need for supplements is less urgent for patients who eat oily fish such as salmon, mackerel or sardines twice a week, but most Americans don’t consume that much.
This means that 95 percent of pregnant and breastfeeding women in the country are not getting enough omega-3 fatty acids.
Finally, it is alarming that choline, an essential compound that is also important for fetal brain development, is rarely found in women’s diets or supplements.
With the exception of organ meats such as beef liver, few foods contain enough of the nutrient to meet a pregnant woman’s needs, and more than half of pre-pregnancy supplements contain no choline at all.
Dr. Skorbutakos says such supplements are typically taken in amounts far too low, less than 100 milligrams (for comparison, pregnant and breastfeeding women typically need 450 to 550 milligrams per day).
Additionally, some research suggests that consuming even more choline than recommended by guidelines may provide additional benefits.
One study found that doubling the recommended levels late in pregnancy may improve a child’s concentration, while another concluded that quadrupling the recommended levels may help mitigate some of the effects of fetal alcohol syndrome.
Breastfeeding women need even more choline than they do during pregnancy(iStock)
So what can we do?
Dr Skruvtakos stresses that the problem stems from “a lack of education and a lack of incentives”.
“Doctors are taught very little about nutrition in medical school and simply assume that most patients are getting what they need from pre-pregnancy supplements,” she points out.
Additionally, there are no regulatory standards for these products, so there is no incentive to improve them.
“Nobody is mandating these companies to change their formulas, so it’s not a priority for them,” she added.
So, given the inadequacy of most supplements, I strongly encourage anyone who is pregnant or planning to become pregnant to do three things:
- Choose a pre-conception supplement that contains less than the recommended 400 micrograms of folic acid daily, and start taking it three months before you conceive.
- Consider eating oily fish twice 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 (such as eggs, beef, soy, and chicken) and consider taking a choline supplement.
But the reality is that maternity care is woefully inadequate and much more needs to be done to support pregnant women through all stages of birth.
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