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Supplements in pregnancy, what to take?

Supplements in pregnancy, what to take?

Published: 13 May, 2022 - Updated: 27 October, 2022 | 6'

Importance of supplements during pregnancy

Pregnancy can be a nutritional challenge, as higher demands for energy, protein, vitamins and minerals are required.7,8,10

The maternal diet must provide adequate amounts of nutrients both for the developing fetus and to keep up its metabolism until the ninth month of pregnancy.

Changes in nutrient intake can affect maternal and newborn health and increase the risk of some diseases in adults.

Therefore, during pregnancy, before conception and afterwards, care and nutrition, together with a healthy lifestyle, are important for the mother-to-be and the proper development of the fetus.

The demand for nutrients is highest during preconception, pregnancy, postpartum and lactation, so a balanced diet can be complemented with food supplements to balance the incremental energy requirement.7,8,10

There are some nutrients, vitamins and natural ingredients that are good for these stages. It is always recommended to check with your doctor, gynaecologist or midwife before taking any supplements.

Essential vitamins and minerals during pregnancy

Scientific evidence has shown that micronutrients that contribute to normal embryonic and foetal development include folic acid (vitamin B9), iron, iodine, calcium, vitamin B12, vitamin D and omega-3 fatty acids.7,8,10

Below are the benefits they provide and why they are among the most recommended, according to the Clinical Practice Guideline on Care in Pregnancy and the Postpartum Period of the Ministry of Health, Social Services and Equality and the European Food Safety Authority (EFSA).6,11

Folic acid during pregnancy (Vitamin B9) 

Suplementación embarazo

Folates are key nutrients that cannot be produced by the body, so they must be taken in through the diet, and their intake is essential during pregnancy.

The relationship between folic acid deficiency during foetal development and the increased risk of neural tube defects (NTDs), one of the most common congenital anomalies that happens between days 21 and 27 of embryonic life and the most commonly known is spina bifida, is well known.7,8,10

To get adequate levels of this vitamin, a balanced diet is recommended, in which green leafy vegetables, fruits, legumes, yeasts, liver, cereals, and nuts are the foods with the highest folic acid content.7

Given the importance of this vitamin, the EFSA has established a daily supplementary intake of folic acid during pregnancy of 400-600 µg for at least one month before and up to three months after pregnancy.6

This intake should therefore be provided throughout pregnancy, daily and continuous, as folic acid does not store up in the body.7

Vitamin D for maternal bone health 

Vitamin D or calciferol contributes to the normal maintenance of bone and muscle function.8

Although its supply is provided by sun exposure and diet, vitamin D deficiency is more common than would be expected, even in sunny countries.

During pregnancy, an appropriate intake of this vitamin is vital for the maintenance of maternal health and proper foetal skeletal growth.7

Deficiency is related to intrauterine growth retardation (IUGR), rickets, tooth enamel abnormalities, among others.

A recent study of more than 300 pregnant women from 14 weeks to the end of pregnancy showed the positive effect of oral vitamin D supplements on the bone health of the mother, by reducing the increase in the bone resorption marker.5

According to EFSA, the vitamin D requirement for pregnant women is 15 µg/day (600 IU)6. During the preconception period the recommendation is 5 micrograms per day.8

Vitamin B12 in pregnancy 

Vitamin B12 plays an important role in folate absorption during pregnancy and is involved in erythropoiesis (production of red blood cells in the body).

Deficiency is linked to an increased risk of spina bifida, impaired cognitive function and megaloblastic anaemia.7,8,10

The daily requirement of this vitamin increases during the gestational period, with EFSA recommending a daily intake in pregnancy and lactation of 4.5 µg/day and 5 µg/day, respectively.6

Vitamin B12 and pregnancy in vegan or vegetarian women

Vitamin B12 is provided only by the intake of foods of animal origin, so deficiency may be more common among vegans and vegetarians.

A balanced vegan or vegetarian diet with vitamin B12 supplements, especially in the pregnancy period when vitamin B12 needs increase, ensures a well-planned, safe and healthy diet.2

Iodine supplementation during pregnancy

Iodine is an essential nutrient that contributes to normal cognitive and nervous system function and to the normal production of thyroid hormones, which are necessary for proper brain and mental development throughout foetal and neonatal life.

According to the WHO (World Health Organisation), iodine deficiency is the leading cause of preventable brain damage worldwide.3

Through the mother, the foetus receives maternal thyroid hormones, and its supply is particularly sensitive during weeks 10-12 of pregnancy.10

Deficiencies can have an irreversible impact on the neurological development of the child in the first half of pregnancy.

Due to the above, it is important to ensure adequate levels during pregnancy, taking into account that in Spain the prevalence of hypothyroidism is 9.1%, while in women it is 14.4%.9

Iodine intake should be taken daily, as folates are not stored in the body.7,8. A number of scientific societies, together with the EFSA, have decided that iodine intake should be increased during pregnancy and lactation, for example, by using iodised salt and a supplement of 200 µg/day of iodine.4,6

Iron supplements for pregnant women

Throughout pregnancy, most women will suffer from haematological changes, with iron deficiency anaemia (iron deficiency anaemia) being the most common nutritional deficiency in pregnant women (40%).

Iron deficiency during pregnancy has been linked to prematurity and reduced physical and neurological development of newborns,10 as iron contributes to the normal cognitive development of children.7,8

In the second and third trimester of pregnancy, a negative iron balance is common, so along with an iron-rich diet, extra iron supplements are a good option.

During the second half of pregnancy, in women with no history of iron deficiency and with adequate iron reserves, oral supplements with low doses of iron8 , specifically 7-16 mg/day, are recommended.

According to EFSA, such supplementation can also be taken during the breastfeeding period.6

Omega 3 in pregnancy

Omega 3 fatty acids play an energetic and metabolic reserve role in the body. Specifically, the omega-3 polyunsaturated fatty acids EPA and DHA support normal growth and brain development and, since they are not synthesised in the body, they must be supplied through the diet in foods such as fish, fish oils, milk and cultured seaweed.

An adequate intake of omega-3s in children and adults helps prevent deficiency states and chronic diseases.1,7,8

During pregnancy and lactation, the omega-3 needs of the foetus or infant are almost always dependent on the mother.

Studies have shown that both the foetus and newborns require amounts of Omega 3 that are higher than the intake of most pregnant and lactating women, indicating a possible deficiency for both the mother and the baby.

This shows the importance of improving maternal omega-3 status during pregnancy and lactation, which can be done through omega-3 supplements.

Having studied the benefit of omega-3 intake during pregnancy, nutrition experts, obstetricians and neonatologists agreed at the "European Consensus Conference on the Recommendation of Polyunsaturated Fatty Acids for Pregnant and Lactating Mothers" that the daily intake of omega-3 polyunsaturated fatty acids should be increased by 200 mg DHA/day during pregnancy and lactation.8

Therefore, according to EFSA, the following recommendations are made for pregnant and breastfeeding women6:

  • 250 mg/day DHA and EPA + 100-200 mg/day DHA (Omega 3).
  • 0.5% Alpha-linolenic acid (Omega 3) of total energy intake.
  • 4% linoleic acid (Omega 6) of total energy intake.

Calcium in pregnancy

Calcium is the most common mineral in humans because it is found as part of our bone structure and contributes to normal muscle function and neurotransmission.6

The adaptive physiological changes that happen during pregnancy (e.g. increased efficiency of absorption to facilitate delivery from the mother to the foetus) are largely independent of maternal calcium intake.

Therefore, the EFSA expert panel recommends that no additional calcium supplementation is needed in pregnant and lactating women, as the recommended daily intake (750 - 860 mg/day) is provided through the diet with 2-3 servings of calcium-rich foods such as cheese, milk and non-dairy sources.6,8 In case of calcium supplements during pregnancy, a doctor should be contacted.