Why are prenatal supplements important?
Pregnant people have a lot of responsibilities. Why should supplementation be a priority?
I was watching a Tik Tok earlier of a woman talking while doing her makeup. She was talking about how her husband had said something like: you can always tell when someone is or has been a mom. She asked him “why?” He responded, “Because of their unfiltered love.” That is a beautiful sentiment that, upon reflection, holds for the moms in my life. All parents hold unfiltered love, and the pregnant ones, in particular, can show that love through the act of caring for themselves. One essential consideration parents must make is their diet and any dietary supplements taken.
I will always be a proponent of looking to add to the diet when addressing deficiencies for healthy, non-pregnant individuals. When directed by a medical team, supplements are sometimes necessary and can be immensely beneficial. During pregnancy, for example, the requirements for nutrients such as iron, folate, and iodine are increased. (1) This increase in necessary intake can often be challenging for some pregnant people (especially if nausea or vomiting is a concern). In these situations especially, supplementation can be vital to keeping the parent and the baby healthy throughout pregnancy. Most healthcare providers will suggest looking for a prenatal multi-nutrient supplement containing calcium, vitamin D, vitamin C, vitamin A, E, B vitamins, zinc, and iodine. (2) Supplements have many benefits for parents and babies in addition to addressing deficiencies, though deficiencies are important to consider. Deficiencies are especially important to pay attention to if the pregnant person has a history of deficiencies before pregnancy, if they become pregnant during adolescence, or if there are less than six months between pregnancies. (3) Ensuring adequate pre-conception nutrient reserves are also an important supplement usage consideration.3 Supplementation can also help ensure positive pregnancy outcomes. For example, vitamin D adequacy is important to help the body absorb and store calcium and phosphorous in the bones, with bone growth and the health of both baby and parent being a critical considerations during pregnancy. (4) Supplementation of vitamin D in pregnant individuals led to significantly higher vitamin D levels in the body at term, indicating that supplementation during pregnancy can help ensure micronutrient adequacy. (5) In addition to the benefits for the parent, vitamin D supplementation has been shown to improve infant growth and reduce the risk of small for gestational age infants.5 Omega-3 fatty acids are an essential nutrient for cell functioning, including the structure of the cells, and are essential for eye and brain function.6 Omega-3 supplementation during pregnancy may reduce the risk of preterm and early preterm birth, perinatal fatality, and neonatal care admission.7 Interestingly, omega-3 fatty acid supplementation during pregnancy and postpartum may offer a small positive effect on postpartum depression when taken along with pharmacological and psychological treatment. (8) Another important concern for many people who menstruate, and especially for pregnant people, is iron deficiency, which can lead to iron deficiency anemia. (9) Supplementation during pregnancy when no iron deficiency has been diagnosed has been shown to reduce maternal anemia by 70% and reduce iron deficiency at term by 57%. (10) These significant reductions in deficiency and anemia are critical, as iron is essential for properly functioning red blood cells and other processes. Ensuring iron adequacy before birth is also critical to protect against blood loss complications during and after birth.
Hypertension and preeclampsia are other serious complications during pregnancy that can have devastating effects on the baby and parent. Iron-containing micronutrient supplements have been associated with a reduced risk of pregnancy-induced hypertension compared to folic acid supplements alone. (11) Additionally, multivitamin supplements containing folic acid have been shown to decrease the risk of preeclampsia during pregnancy significantly. (12) This may indicate that taking a micronutrient containing vitamins (like folic acid and others) and minerals (like iron) during pregnancy may be beneficial in reducing the risk of hypertension and preeclampsia. One study found that choline supplementation at twice the recommended level (930 mg choline/ day) during the third trimester improved cognitive benefits for the offspring when tested up until 13 months. (13) These findings demonstrate just how complex supplementation can be and how beneficial appropriate supplementation during pregnancy may be in the long run for both baby and parent.
As a result of the complexity of supplementation, heightened concern for toxicity and contamination, and confusion surrounding what is needed/ how much/ etc. during pregnancy, it is essential that every pregnant individual speaks to a registered dietitian or their medical team before starting or stopping any supplement or medication. Always express any concerns surrounding a prescribed supplement or curiosity around additional supplements. Many studies have shown the benefits of appropriate supplementation, but there are dangers as well. It is essential that every decision made about supplements be made following a thorough conversation with a medical provider and be in line with personal comfort levels.
So, what makes a supplement a “good choice”? I will cover that next!
Until then, Listen to Laney (if you want)!
References
Department of Health & Human Services. Pregnancy and Diet. Better Health Channel. https://www.betterhealth.vic.gov.au/health/healthyliving/pregnancy-and-diet. Published August 14, 2000. Accessed March 6, 2023.
Mayo Clinic Staff. Prenatal vitamins: Why they matter, how to choose. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/prenatal-vitamins/art-20046945#:~:text=Beyond%20checking%20for%20folic%20acid,B%20vitamins%2C%20zinc%20and%20iodine. Published April 19, 2022. Accessed March 6, 2023.
Dean SV, Lassi ZS, Imam AM, Bhutta ZA. Preconception care: nutritional risks and interventions. Reprod Health. 2014;11 Suppl 3(Suppl 3):S3. doi:10.1186/1742-4755-11-S3-S3
Vitamin D. The Nutrition Source. https://www.hsph.harvard.edu/nutritionsource/vitamin-d/#:~:text=It%20is%20a%20fat%2Dsoluble,control%20infections%20and%20reduce%20inflammation. Published November 14, 2022. Accessed March 6, 2023.
Palacios C, De-Regil LM, Lombardo LK, Peña-Rosas JP. Vitamin D supplementation during pregnancy: Updated meta-analysis on maternal outcomes. J Steroid Biochem Mol Biol. 2016;164:148-155. doi:10.1016/j.jsbmb.2016.02.008
Omega-3 fatty acids & the important role they play. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/17290-omega-3-fatty-acids. Published November 17, 2022. Accessed March 6, 2023.
Middleton P, Gomersall JC, Gould JF, Shepherd E, Olsen SF, Makrides M. Omega-3 fatty acid addition during pregnancy. Cochrane Database Syst Rev. 2018;11(11):CD003402. Published 2018 Nov 15. doi:10.1002/14651858.CD003402.pub3
Mocking RJT, Steijn K, Roos C, et al. Omega-3 Fatty Acid Supplementation for Perinatal Depression: A Meta-Analysis. J Clin Psychiatry. 2020;81(5):19r13106. Published 2020 Sep 1. doi:10.4088/JCP.19r13106
Peña-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell T. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev. 2015;2015(7):CD004736. Published 2015 Jul 22. doi:10.1002/14651858.CD004736.pub5
Peña-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell T. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev. 2015;2015(7):CD004736. Published 2015 Jul 22. doi:10.1002/14651858.CD004736.pub5
Chen S, Li N, Mei Z, et al. Micronutrient supplementation during pregnancy and the risk of pregnancy-induced hypertension: A randomized clinical trial. Clin Nutr. 2019;38(1):146-151. doi:10.1016/j.clnu.2018.01.029
Liu C, Liu C, Wang Q, Zhang Z. Supplementation of folic acid in pregnancy and the risk of preeclampsia and gestational hypertension: a meta-analysis. Arch Gynecol Obstet. 2018;298(4):697-704. doi:10.1007/s00404-018-4823-4
Caudill MA, Strupp BJ, Muscalu L, Nevins JEH, Canfield RL. Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed: a randomized, double-blind, controlled feeding study. FASEB J. 2018;32(4):2172-2180. doi:10.1096/fj.201700692RR
Myth: Women with gestational diabetes can’t have sugar
Pregnancy can be a scary and uncertain time for many women. Not only are women expected to maintain their own health, but they are also responsible for their growing child’s. The stress and anxiety are only exacerbated when many women are told they have “failed” their oral glucose tolerance test (OGTT). An OGTT is the generally accepted method for diagnosis of gestational diabetes (McIntyre et al 2019). Gestational diabetes is one of the most common pregnancy complications, affecting up to 18% of pregnant women (McIntyre et al 2019). Gestational diabetes is not well understood by the public while simultaneously affecting a large proportion of them, leading to many myths and misunderstandings. A common myth is that women diagnosed with gestational diabetes cannot have sugar or desserts. This idea is wrong! As with everything, a healthy diet with gestational diabetes is all about moderation and balance.
Many people assume that a diagnosis of gestational diabetes automatically aligns with adopting a low-carbohydrate diet. A low-carbohydrate diet consists of less than 45% of daily caloric intake coming from carbohydrates (Mahajan et al 2019). Controversial evidence surrounds this dietary approach, and recent studies conflict with conventional advice to lower carbohydrate intake (Mahajan et al 2019). One study found that a higher carbohydrate diet contributed to lower fasting glucose, less insulin resistance, and reduced inflammation (Hernandez et al 2018). This study also highlighted that the quality of the carbohydrate eaten, namely complex carbohydrates, is more important to consider for blood sugar control (Mahajan et al 2019). Additionally, a low carbohydrate diet, a potentially major change from a mother’s typical diet, can contribute to anxiety and stress which can negatively impact pregnancy outcomes (Mahajan et al 2019). It is important to consider creating balance in the diet over reducing carbohydrate intake. Even modest reductions in carbohydrates can potentially lead to an imbalance in macronutrient intake and a reduction in overall energy intake (Mahajan et al 2019). During pregnancy, decreased energy intake is rarely recommended and can put the mother and child in danger (Hernandez et al 2018).
Mothers diagnosed with gestational diabetes should consider positive lifestyle changes rather than restricting carbohydrate intake (Rasmussen et al 2020). A healthy and balanced diet should result in appropriate weight gain for the mother and fetus, regardless of glucose tolerance (Rasmussen et al 2020). Additionally, the ideal diet for management of gestational diabetes includes adequate carbohydrates, fat, protein, fiber, and micronutrients (Rasmussen et al 2020). Physical activity is a significant component involved in the control of glucose levels as well, as it has been shown to improve glucose and insulin levels in pregnant women in the short and long term (Rasmussen et al 2020). Moderate intensity exercise 3-4 times per week for women with gestational diabetes is recommended to help balance glucose levels following meals(Rasmussen et al 2020). Overall, a healthy balanced diet, relationship to food, and exercise is recommended to manage gestational diabetes while glucose restriction is not recommended. Pregnancy is tough enough as it is, and restricting carbohydrates following diagnosis of gestational diabetes may only make it more difficult!
Reviewed by: Jessica Strosahl, UGA Dietetic Intern
References
Hernandez TL, Mande A, Barbour LA. Nutrition therapy within and beyond gestational diabetes. Diabetes Res Clin Pract 2018;145:39-50.
Mahajan A, Donovan LE, Vallee R, Yamamoto JM. Evidenced-based nutrition for gestational diabetes mellitus. Curr Diab Rep 2019;19(10):94.
McIntyre HD, Catalano P, Zhang C, Desoye G, Mathiesen ER, Damm P. Gestational diabetes mellitus. Nat Rev Dis Primers 2019; 5(1), 47: 1-19.
Rasmussen L, Poulsen CW, Kampmann U, Smedegaard SB, Ovesen PG, Fuglsang J. Diet and healthy lifestyle in the management of gestational diabetes mellitus. Nutrients 2020;12(10):3050.
How to eat intuitive for two
Original posting at Vickery Wellness.
5 Tips for how to practice intuitive eating during pregnancy
Listen to your body
While there are definitely times when medical expertise from your doctors and dietitian should be followed to a ‘tee,’ there are also some exceptions to this approach. Some that come to mind are cases of gestational diabetes, preeclampsia, and other diagnosed disorders or deficiencies. But, there are also times that you can trust your body to know your needs! This is the first key step to practicing intuitive eating during pregnancy.
Most of us have been taught to ignore what our body is telling us. This can be especially true for those of us who have a history with diet culture. Hunger and fullness cues can be difficult to listen to, but it is always worth it to try. Your body can be its own advocate, and your “weird” cravings could be a message that your body is missing something it desperately needs.
For example, a craving for chocolate could mean you are low in magnesium. Consider listening to your body and seeing the changes in your mood, confidence, and energy levels that arise.
Remind your support system of your needs, including your need for a judgment-free pregnancy
You are the only one growing a second human, so you are the only one that gets to have an opinion about your choices!
Be sure to be proactive in setting boundaries with your partner, friends, parents, and others. You are allowed to ask for no comments on what you eat or how your body is changing! Your body is your own. Your comfort is your priority. You deserve to pay attention to what you are feeling and what you want without the perspective of others.
Mealtime can be stressful, challenging, and confusing even without the input of others. Care for yourself like you will care for your child, and be gentle. Consider creating boundaries with those closest to you about your need for a judgment and comment-free pregnancy. While it may take a village to raise your child, it only takes you to grow them!
Prioritize your health and comfort above fitting into a pregnancy standard
Every day, each of us is bombarded with examples of what “perfect” looks like on TV, social media, and even around us. It can be difficult to tune these expectations out and focus on our own growth and comfort.
The struggles of comparison certainly do not stop once we are pregnant, in fact, they can often get worse because you are protecting your child as well. These expectations can be about how much weight you gain, how much you exercise, how clean your house is, or how happy you seem.
The issue is, every pregnancy looks and feels differently. What one woman experiences is drastically different from every other woman out there. How can common standards be expected when every pregnancy is unique? The most important standard is that you prioritize your and your growing child’s health and comfort.
If you want to move your body, and you safely can, you should! Try to focus less on what others are doing and more on how you feel. Focusing on yourself is the best way to approach intuitive eating at any life stage.
Allow yourself space for emotions around mealtime
Mealtime can be a stressful and emotional time when you are pregnant. If you experienced nausea during your pregnancy, this may be especially difficult. Guilt surrounding your food choices and quantities can be a major factor in creating anxiety and confusion. The goal may be neutrality toward your body and food, but a great step is simply allowing yourself to feel what you feel! Life, especially during major periods of change, can feel out of your control.
Many people turn toward their diet as a way of creating stability and control over something in their lives. While this can feel beneficial in the short term, it can often end up creating even more stress and anxiety in the long run. Try allowing yourself the freedom to feel and express yourself!
Be patient with yourself when practicing intuitive eating during pregnancy
Patience.
It is easier said than done and requires practice (and patience, ha!). Even if this is not your first pregnancy, it may feel like it is. No one knows everything, and it takes time to learn. You will make mistakes, and you most likely will find yourself falling into harmful self-talk and reverting to past diet culture patterns. Be kind to yourself during those times. Remind yourself why you wanted freedom from diets and freedom from rules. Allow yourself to continue to learn and change with your body.
You deserve the same level of respect and patience as your children will receive. Try finding a mantra that reminds you to approach yourself with kindness, like “you are enough”!
Being a parent is a selfless act that requires your heart, soul, patience, and attention. It requires hard work and sacrifices every day. You have to also take care of yourself throughout in order to give your children what they need. Remember to allow room for mistakes and to have compassion for yourself while you learn and are challenged. Believe in yourself and your body. It will tell you what it requires, just like your baby will if you’re listening. It is possible to practice intuitive eating during pregnancy and you are already an incredible parent, so be kind to yourself!