Prenatal Supplements: Who, What, When, Why?
Growing a tiny human is no small task - it is a physically demanding process when your body and growing baby needs extra nutrients! This is not a time to skip the good stuff!
If you take anything away, let it be this:
You need more than just folic acid and iodine
Over the counter (OTC) supplements are not good enough (Elevit included!)
Nutrients through food should be your first point of nourishment but it is often not enough to meet demands
Why Take a Prenatal? Will it Make a Difference?
Thankfully today, it is widely recognised and backed up by an increasing body of evidence that taking a prenatal not only improves baby’s health, but also the health of the mother. Benefits include improved likelihood of becoming pregnant and reduce the risk of miscarriage, anxiety, depression, and postpartum depression – which can have a tremendous impacts in the fourth trimester. There is also reduced risk of pregnancy complications including gestational hypertension, preeclampsia, preterm birth, low birth weight babies, birth defects, and stillbirth. We also see lower rates of long-term chronic problems that can affect children later in life, for example, diabetes, and cardiovascular disease, when preconception nutrition is optimised. For this reason, the goal is to ensure that women obtain good nutritional status before, during, after and between pregnancies to optimise their own health and the health of their babies.
When to Start Prenatals and for How Long?
Studies show that many women go into pregnancy already nutrient depleted and then added to this are the naturally increased demands for nutrients in pregnancy. Improving nutritional status before pregnancy can be challenging as at least half of pregnancies in New Zealand are not planned. Even among women planning pregnancy, few seek nutritional advice prior to conception, and most women do not have their first prenatal care visit until well into the first trimester.
Ideally prenatals should be started if possible at least 3-4 months in advance. This is because the egg that will eventually be your tiny human begins its maturation process 3-4 months prior to ovulation and the health during this time significantly influences the health of the foetus, soon to be baby. If you don’t have that opportunity, begin as soon as you know you’ve conceived.
After baby is born, I recommend remaining on your prenatal for at least 3 months, and if you are breastfeeding, at least 12 months, including for a few months after you’ve weaned to replenish your nutrients levels – and if you plan to become pregnant again soon – stay on the prenatal.
Over the Counter vs Practitioner Only Supplements
Over-the-counter (OTC) supplements are becoming increasingly popular, so much so that you can find them in practically all supermarkets and they are widely advertised. The reason that supplements are able to be sold OTC without a practitioner prescription is due to the low dose of the listed nutrients and constituents (possibly rendering the product poorly effective). They are likely to be ineffective in correcting underlying nutritional deficiencies or in providing support in times of increased need, such as in pregnancy.
Practitioner-only supplements means that they require a qualified practitioner to prescribe them (generally a clinical nutritionist or naturopath) as they contain therapeutic doses of nutrients. The therapeutic dose of a product refers to the amount of a nutrient needed to produce a desired outcome i.e. the amount of folate needed during pregnancy to support foetal neural tube development. In clinical practice I utilise Australian practitioner-only products which are governed and regulated by the Therapeutics Goods Administration (TGA) ensuring they are of high quality and have data to support their claims.
Why I Don’t Recommend Elevit
Elevit is the most popular and advertised OTC preconception, prenatal and postnatal supplement to support women through the different stages of pregnancy. Despite its popularity, unfortunately Elevit just doesn’t quite cut it. It is a low dose, OTC product that does not contain some of the nutrients essential to pregnancy and some of the essential nutrients it does contain are in poor forms and less bioavailable (absorbed).
The Issues with Elevit:
Folate: Elevit only contains the synthetic form of folate; folic acid. Women need an absorbable form of folate - which means methyl-folate and not folic acid. Folate is the most talked about nutrient during pregnancy and for good reason! It is required to prevent neural tube defects in developing embryos which occur in the earliest weeks of pregnancy – before many women even know they're pregnant. That's why it's important to begin taking a supplement before you start trying to conceive, if possible.
Choline: Does not contain choline, an imperative nutrient for healthy brain and neural tube development. Choline is as equally important as folate in preventing neural tube defects.
Iron: Contains a form of Iron (ferrous fumarate) which has been shown in studies to be the least tolerable form of iron and most likely to cause gastrointestinal effects such as constipation. Iron may also aggravate the symptoms of morning sickness in some women and routine iron supplementation may not be recommended at all stages of pregnancy which is why individual and tailored prescription is required.
Vitamin B12: Contains the less bioavailable version of Vitamin B12 which similar to folic acid requires extra work for the body to convert it to a compound that is easily used, B12 is essential for brain health and neural tube development.
Vitamin D: Contains a low dose of Vitamin D (500IU). The recommended daily dose of Vitamin D for pregnancy ranges from 1000IU to 2000IU but it is important to have your vitamin D tested to see if you are deficient. Vitamin D is important for foetal bone development, maternal blood pressure regulation, prevention of miscarriage & postnatal depression. Prior to pregnancy, adequate Vitamin D levels improves conception outcomes and healthy follicle development.
Zinc: Contains a form of zinc (zinc sulfate) which is less bioavailable and has been reported to cause gastrointestinal irritation – not ideal for those already experiencing nausea and morning sickness. Zinc plays an important role in the construction of baby’s cells and DNA as well as the foundations for the immune system and reducing poor maternal outcomes.
Copper: Contains 1mg of copper and a very small amount of zinc, overtime this could create a zinc deficiency and copper toxicity in pregnant woman. Copper is essential for the formation of red blood cells, baby’s heart, blood vessels, skeletal and nervous system.
Additional Nutritional Needs
While a practitioner prenatal supplement supplies most of what you need in pregnancy, there is one more that I recommend supplementing with since they are not found in prenatal supplements:
Omega-3 Fatty Acids: Play an essential role in conception, and the formation and development of the oocyte and embryo. Higher intake is associated with better ovarian reserve and higher rates of conception. Your intake of DHA prenatally is also critical for baby’s brain and neurological development and may prevent preterm labor. Research has shown that it can improve stress resilience, including to even severe social stressors, while EPA can prevent prenatal and postpartum depression. I recommend a combined DHA/EPA. This can be prescribed by a practitioner alongside your prenatal supplement.
How to Know Which Prenatal is Right for you?
There isn’t a one size fits all answer as every women is different, pregnancy is different and therefore their needs are different. During the preconception stage many factors will come into the decision process such as addressing any current issues such as restoring depleted nutrients (potentially after hormonal contraception), optimising ovulation and/or restoring hormonal balance, reducing stress and/or managing current conditions such as PCOS or Endometriosis.
If you are pregnant (at any stage) or preparing for pregnancy in the near future and want some advice on supplements and would like to gain access to practitioner-only supplements, you can book in for an express supplement consultation.
If you have any underlying conditions, current health concerns and/or pregnancy complications please book in for an initial consultation to enable us to undergo a thorough health assessment and spend the appropriate time to figure out what is best for you. We will have the chance to chat about pregnancy supplements and you will gain access to practitioner-only supplements.
While the topic of prenatal vitamins can be confusing and overwhelming at times, it should be a simple, informative and empowering part of your pregnancy journey. You deserve to feel supported in the choices you make, knowing you are providing the best nourishment for your health and the health of your developing baby.
I would be honoured to support your journey to and through pregnancy,
Emily x
