Why are prenatal supplements important?

Written By Laney Jones

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



  1. 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. 

  2. 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. 

  3. 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

  4. 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. 

  5. 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

  6. 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. 

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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



Laney Jones
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