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Dietary supplements

Dietary supplements such as folic acid and iron are important for a healthy pregnancy. Some dietary supplements can cause side effects and harm to the mother or unborn child. Pregnant women should discuss all dietary supplements with their health care professional to determine the appropriate dosage and which supplements are safe during pregnancy.

Caution should be taken before consuming dietary supplements while pregnant as dietary supplements are considered "foods" rather than medications and are not regulated for safety and efficacy by the FDA.

Folic Acid

Example of a neural tube defect: Spina Bifida

World Health Organization (WHO) recommends both folic acid and iron supplements during pregnancy. Many countries such as the USA, Canada, Chile, and Costa Rica have fortified foods with folic acid and have seen a reduced incidence of Neural tube defect (NTD).

The CDC recommends that all women of child-barring age receive 400 mcg of folic acid supplement (even if they are not planning on getting pregnant). Women who have already had an NTD-affected pregnancy and are planning to become pregnant again should receive 4000mcg each day for a month before and for the first 3 months of pregnancy. The recommendation came from a study conducted by the British Medical Research Council (MRC) Vitamin Study Group from July 1983 to April 1991 involving 33 centers (17 of which in the UK and the remaining 16 in 6 different countries) that compared pregnancy outcomes of folic acid and other vitamins interventions with placebo. That study found a risk reduction of 71% of NTD-affected pregnancies in groups receiving folic acid when compared to groups receiving placebo. In the study, there were 4 intervention groups, group A received 4mg of folic acid; Group B received a multivitamin that contained folic acid; Group C placebo and Group D received a multivitamin without folic acid. In the groups that received folic acid, 6 out of 593 (1%) infants and fetuses had NTD reoccurrence compared to the groups that received no folic acid, which had 21 infants and fetuses with NTD out of 602 (3.5%). There were no significant benefit found in the vitamin intervention groups.

Iron

Main articles: Iron deficiency and Iron-deficiency anemia

Iron deficiency is common in pregnancy, with the highest occurrence rate during the third trimester as iron demand increases to support the placenta, fetal development and the iron stores for the first six months after birth. Low iron levels can cause fatigue, reduced work capacity, cardiovascular stress, lower resistance to infection and iron deficiency anemia. Iron deficiency anemia in pregnancy can lead to an increased risk of premature delivery, low birth weight and increased risk of perinatal mortality.

The Recommended Dietary Allowance (RDA) suggests 27 mg of iron a day which would account for normal iron losses, iron used by the fetus and related tissues during gestation and increased maternal hemoglobin mass changes. WHO recommends taking supplements of 30-60 mg of elemental iron a day throughout pregnancy for all pregnant individuals. Iron demand depends on individual specific factors and risk of deficiency; for specific dose recommendations, individuals should discuss with their doctors.

Dietary sources of iron include meat, paltry, fish, eggs, legumes, vegetables, fruits, grains, nuts and iron-fortified grain products. Eating at least one source of vitamin C with each meal is also recommended, as it can help increase iron absorption. Examples of vitamin C sources include broccoli, cantaloupe, citrus fruits and their juices, kiwis, mangos, potatoes, strawberries, sweet peppers, tomatoes, and tomato sauce. On the contrary, caffeine, calcium supplements and antacids should be separated from meals and iron supplements by 1-2 hours as they can decrease iron absorption.