Working with women for more than 15 years, I am delighted about the current trend, which involves an important stage: preparing for pregnancy. Lately, I see a rapid increase in requests: “doctor, write how to prepare for pregnancy” or “write what vitamins to take during preparation”. Today’s article is dedicated to vitamins and minerals at the stage of pregnancy planning.
Preparing for pregnancy: why take vitamins and minerals
The first reason, and it is the most common, is that the absorption of substances by the intestinal mucosa of a modern person has changed due to constant stress, malnutrition, insufficient or disturbed sleep. Because of this, hypovitaminosis develops.
- Intensive growth;
- Pregnancy, lactation;
- Infections and recovery period;
- Smoking, alcohol abuse;
- Certain medications;
- Diseases of the thyroid gland;
- Diseases of the gastrointestinal tract;
- Severe physical or neuropsychological stress;
- Insufficient intake of vitamins with food (irrational diet, heat processing and storage in the fridge).
Preparing for pregnancy: what vitamins to take
In this article, I will not bore you with a list of all vitamins and minerals. Let’s look at some of them that play an important role in the development of pregnancy and are often lacking when preparing for pregnancy. At the same time, they provide a woman with the most physiological course of future pregnancy.
According to numerous meta-analyses, in particular those published in the Journal of Obstetrics and Gynecology of Canada (JOGC) in 2006, multivitamin complexes with folic acid in the dosage of 400 mcg can indeed reduce the risk of neural tube defects, as well as other malformations. Namely, such as cleft lip and cleft palate, limb defects, heart defects, urinary tract defects. However, although the addition of multiple micronutrients is theoretically better than taking iron and folic acid alone, there is insufficient data to determine the benefits of different formulations of multivitamin complexes for prenatal, pregnant and lactating women.
Folic acid (B9)
Folate reduces the risk of birth defects, in particular neural tube defects (neural tube defects). The group of these defects includes, in addition to spina bifida (non-growth of the vertebral arches), anencephaly, hernia of the meninges, spinal cord and brain (meningocele, meningomyelocele, encephalocele). In addition, the likelihood of developing cleft palate, cardiovascular and urinary anomalies, as well as some types of cancer in children, including leukemia, brain tumors and neuroblastoma, is reduced. Folate deficiency can also cause megaloblastic anemia in women.
Low intake of vitamin B9 is also associated with low mental development index in children, cognitive impairment, increased risk of autism and schizophrenia.
Since neural tube outgrowth occurs before 28 days of intrauterine development, it is important to achieve optimal folic acid levels before pregnancy. Intake of 400 – 500 mcg for 8–12 weeks, i.e. 3 months, is recommended for all women during the planning period. In shorter terms, saturation is possible by increasing the dose – 800 mcg for 4 weeks.
Risk factors affecting the doses of B9 needed
Higher doses are prescribed for women who have a higher risk of neural tube defects in the fetus.
According to the International Federation of Gynecology and Obstetrics (FIGO), this group includes:
- Alcoholism and smoking;
- Increased BMI (> 30 kg/m2);
- Impaired absorption in the gastrointestinal tract;
- Diabetes type 1 or 2 before pregnancy;
- Fetal neural tube defects in previous pregnancies;
- Nutritional restrictions, namely, insufficient consumption of fresh fruits and vegetables;
- Cases of neural tube defects in family history (relatives of 1–2 degrees of kinship);
- Taking drugs with teratogenic effects (carbamazepine, valproic acid, phenytoin, phenobarbital, methotrexate, triamterene, etc.);
- Mutations of the 5-methyltetrahydrofolate reductase (MTHFR) gene in both homozygous and heterozygous variants.
The dose and duration of intake in such cases is prescribed by a doctor, as excess folate adversely affects both the health of the mother and the child.
According to WHO estimates, approximately 35% of the world’s population suffer from iodine deficiency to some extent, which exceeds 2 million people. Insufficient iodine intake leads to inadequate production of thyroid hormones and a number of disorders. Among them are iodine deficiency disorders, including abortion, stillbirth, mental retardation, cretinism, increased neonatal and infant mortality, goiter and hypothyroidism.
Iodine is easily transferred to the fetus and concentrated in it. The synthesis of thyroid hormones begins by 10–12 weeks of pregnancy. They affect the maturation of the developing fetal central nervous system, especially myelination, and cause cognitive impairment. The most severe form is cretinism.
Prevention of iodine deficiency
To prevent deficiency, it is recommended to take at least 150 mcg of iodine per day. In iodine deficiency endemic areas, it is recommended to take 250 mcg for women and 150 mcg for men per day for 3 months.
An alternative to increasing the preventive dosage of iodine may be the use of iodized salt, which should contain 45 mcg of iodine per 1 g of salt. Remember that iodine evaporates during heating.
The daily need is 150 mcg, which is 50 g of seaweed, 100 g of squid, 120 g of shrimps. There is also a high content in chicken eggs, mushrooms, beans, etc.
Every month, women of reproductive age lose an amount of blood that can cause anemia, even if menstruation is moderate. Therefore, almost 60% of women suffer from latent iron deficiency anemia.
Additionally, to blood loss, the deficiency develops with insufficient dietary intake.
During pregnancy, anemia increases the risk of premature birth, low birth weight, maternal and neonatal mortality, purulent-septic complications and bleeding after childbirth. Also, iron deficiency affects the development of fetal nervous tissue due to chronic hypoxia and reduced intensity of energy metabolism.
WHO recommends taking 30-60 mcg of iron for 3 months a year for all menstruating women and adolescent girls, the same dosage is taken 3 months before and during pregnancy to prevent anemia.
The daily need is 14 mg. This is 100 g of seaweed or lentils, 200 g of beef liver, also found in high concentrations in nuts.
Fat-soluble vitamin D is involved in the metabolism of calcium and phosphorus. It is necessary for healthy bones, muscle contraction, nerve conduction and general cell functioning.
This vitamin enters the body with food (for example, fatty fish, egg yolk, liver), and is also synthesized in the skin from solar radiation. According to the recommendations of the U.S. National Institute of Health, for sufficient production of vitamin D, it is necessary to be exposed to the sun from 10 to 15 hours at least 2 times a week. In addition, the synthesis is negatively affected by age, dark skin tone, the use of sunscreen.
According to the Cochrane review, the use of vitamin D reduces the risk of pre-eclampsia, gestational diabetes, low birth weight and the risk of severe postpartum bleeding.
According to the AJGP 2018 recommendations on pregravid preparation, vitamin D is not prescribed for preventive purposes. Deficiency is determined by the amount of vitamin in the blood, and the dosage depends on this. In other cases, it is important to adjust the diet and spend more time in the sun.
The daily need is 10 mcg, that is 50 g of mackerel or salmon, 100 g of tuna, 150 g of eggs.
Another representative of fat-soluble vitamins, which are important for eye health, immune function, growth and development of the fetus. However, due to its biochemical properties, it easily penetrates the placenta and can accumulate. Although normal fetal development requires adequate intake of vitamin A, too high levels are associated with miscarriage and birth defects affecting the central nervous system and the development of the craniofacial, cardiovascular and thymus systems.
Therefore, it is recommended to limit the intake to 3000 IU per day and to stop taking retinol-containing products at least one month before planning pregnancy.
To maintain a sufficient level of vitamin A, it is important to eat fish, eggs, liver, fruits and vegetable – carrots, pumpkin, broccoli, peaches, melon.
The daily need is 1000 mg or 50 g of carrots, 100 g of eggs, 15 g of beef liver, 200 g of dried apricots.
Preparing for pregnancy and other vitamins
Calcium. The daily need is 1000 mg, that is 150 g of ricotta or feta cheese. High calcium content is also in cheeses with fat content of 45%-50%, sesame seeds, almonds, sunflower seeds.
Vitamin C. The daily need is 70 mg/day – 1 orange, 100 g of strawberries or broccoli, or 1 kiwi.
Vitamin B12. Daily requirement is 3 mcg – 100 g of tuna, 50 g of beef liver. Contained in large quantities in animal liver, fish, fermented dairy products such as cheese and yogurt. For vegans and vegetarians, it is recommended to establish regular intake.
Preparing for pregnancy – summary
I want to share my opinion right away: multivitamin complexes are still for the lazy. It is important to take only vitamins that are in deficit in a particular woman. Of course, you can buy multivitamin complexes for pregravid preparation, and pharmacists in any pharmacy will be happy to help you buy it. However, it is important to remember about side effects and disorders of the gastrointestinal tract, which are likely to develop in everyone.
There is such a consultation with a gynecologist – pre-gravid preparation. After reading this article, you have gained a lot of knowledge, but my advice is to consult a gynecologist not only for the selection of multivitamin complexes. Foremost, to get to know your doctor with whom you are planning a pregnancy. In addition, the specialist can identify individual deficiencies and risks of complications during pregnancy, the possibility of their prevention.
How often to have sex while planning pregnancy, read in my article and get rid of myths.
I tell about vitamins that are important in preparing for pregnancy in this article.
You can also take my course on how to prepare for pregnancy – WeMakeFamily. Preparing for pregnancy.
I’m eager to file all of these courses in English, just send me a request to email@example.com.
Contact the Lior Medical Center for help if you feel any symptoms, or better – for routine examinations. This is the best way to identify the problem at an early stage and prevent complications.
Pregnancy planning is an important and crucial step because quality preparing for conceiving a child will ensure a calm pregnancy that will bring a positive and pleasant experience, as well as increase the chances of having a healthy baby.
💕 to everyone
With love, your Natalia Silina,
doctor of gynecologist-endocrinologist,
UNICEF and UNFPA expert on sexuality education
- World Health Organization. Meeting to develop a global consensus on preconception care to reduce maternal and childhood mortality and morbidity: 2012 Feb 6–7 meeting report. Geneva (CH): WHO; 2013
- Edwina Dorney, Kirsten I Black. Preconception care. Australian Journal of General Practice, July 2018
- Family-Centred Maternity and Newborn Care: National Guidelines Chapter 2: Preconception care. Public Health Agency of Canada, December 2017
- American College of Obstetricians and Gynecologists. Prepregnancy Counseling. Fertility and Sterility, January 2019
- Professor Judith Stephenson, FFPH, Dr Nicola Heslehurst, PhD. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet, May 2018
- Zohra S Lassi, Ayesha M Imam. Preconception care: caffeine, smoking, alcohol, drugs and other environmental chemical. Reproductive Health, September 2014
- Paula M. Gardiner, MD, MPH Lauren Nelson. The clinical content of preconception care: nutrition and dietary supplements.AJOG, December 2018
- R. Douglas Wilson, MD, Calgary AB, Pre-conception Folic Acid and Multivitamin supplementation for the primary and secondary prevention of neural tube defects and other folic acid-sensitive congenital anomalies.SOGC, May 2015
- Goh Y.I., Bollano E. Prenatal multivitamin supplementation and rates of congenital anomalies: a meta-analysis. Journal of Obstetric and Gynecology Can, 2006
- Allen L.H.Multiple micronutrients in pregnancy and lactation: an overview.The American Journal of Clinical Nutrition, 2005