Prenatal Vitamins: A Primer
By: Dr. Obikoya

A prenatal supplement is a vitamin and mineral supplement you can take daily to make sure you're getting the right amount of certain important nutrients during pregnancy. Unfortunately, though, since the Food and Drug Administration doesn't regulate what goes into supplements, there are no set standards for what should be in them. It is, therefore, up to you and your doctor to make sure you choose one that's safe and appropriate for you.

Do you really need prenatal vitamins? Fifty percent of birth defects can be prevented by pregnant women taking prenatal vitamins before pregnancy. The quantity of folic acid required by the fetus cannot be obtained by diet alone. By taking vitamins as early as three months prior to becoming pregnant, you are ensuring the health and well being of your future baby.

What should you look for in prenatal vitamins? You should in general look for one that has more of folic acid and iron thank you can get from your diet. Just as important is that it should not have more than the recommended amounts of other nutrients. This is particularly so of vitamin A. Too much vitamin A made from animal products can cause birth defects. Ensure you are taking a prenatal vitamin or a multi-vitamin with under 10,000 IU of vitamin A.

This is one reason that most prenatal supplements contain vitamin A at least partly in the form of beta-carotene, a nutrient that you get from fruits and vegetables that converts to vitamin A in the body. Unlike vitamin A from animal products, which has been known to cause birth defects when taken in high doses just before conception or during pregnancy, beta-carotene is not toxic in high doses.

Also too much iron in a prenatal vitamin will be poorly absorbed. So, check on its amount in the supplement you plan to buy too.

Your doctor may recommend that you start taking a prenatal supplement at your first prenatal checkup. If so, you may be given a prescription for a particular prenatal vitamin or just suggest that you buy a particular over-the-counter brand at the drugstore. If you do take a prenatal supplement, make sure you're not taking any other vitamin or mineral supplement along with it unless your doctor so recommends.

Ask your doctor to prescribe a daily prenatal multivitamin that contains the recommended amounts of vitamins and minerals you need for a healthy pregnancy. Folic acid is especially important. You need 600 micrograms daily, because it helps prevent neural-tube defects such as spina bifida. Consider raking calcium supplements if you can't make the quota of at least 1,000 milligrams a day. And steer clear of herbs and other botanicals, as their safety remains to be proven during pregnancy and lactation.

If you're taking vitamin supplements to try to prevent birth defects, you may not be getting what you pay for. Back in 1997, a researcher at the University of Maryland at Baltimore found that just three of nine prenatal multivitamins he tested released enough folic acid to meet recommended standards, and some greatly missed the mark. To be sure you get enough folic acid daily, buy supplements with a USP symbol on the label and take them with food to enhance absorption unless directed otherwise by your doctor.

The use of 0.4 mg folic acid from 3 months before conception has been shown to reduce the risk of neural tube defects by 73%. No reduction has been shown in women who start folic acid after 6 weeks' gestation. It is, therefore, important that you start folic acid supplementation well before you become pregnant.

If you're healthy and you eat a very balanced diet and has no specific risk factors, some will say you need not take a prenatal supplement but that you need to take 400 micrograms (mcg) of folic acid a day plus that you get in your diet is not contended. Indeed, it is recommended that you start doing so at least a month before you become pregnant and during your first trimester.

Since half of all pregnancies are unplanned, the U.S. Public Health Service recommends that all women of childbearing age take 400 mcg of folic acid a day because there is research evidence research that this can reduce the risk of neural tube defects in your baby by up to 70 percent.

Most prenatal supplement contain between 600 and 1,000 mcg of folic acid. You can get your folic acid from a separate folic acid supplement. If you've previously had a baby with neural tube defects, you'll need to take 4,000 mcg, or 4 milligrams, of this vitamin each day starting at least a month before you become pregnant.

Because most women don't get enough iron in their diet, prenatal vitamins can ensure that you do. You need to have enough iron in your body to meet its increased needs during pregnancy. It is recommended you take 27 mg of iron per day during pregnancy, 50 percent more than you need when you're not. Most prenatal supplements contain between 27 and 60 mg.

Your body makes a lot more blood when you're pregnant to support your growing baby, and as a result, the iron stores in your blood can get quite low. To avoid getting iron-deficiency anemia during pregnancy, most women need to take a supplement. For some women, the amount in their prenatal supplement is enough, but others may need to take even more during pregnancy. Ask your doctor to tell you just how much you need. Your prenatal blood work will guide your doctor in doing so.

Unlike with folic acid, except you are anemic before getting pregnant, you should wait until you are pregnant or even until you're through your first trimester to take extra iron, since high doses of the mineral can make nausea and constipation worse. Women with iron-deficiency anemia are usually advised to take between 60 and 120 mg of supplemental iron each day in addition to a prenatal supplement.

Women with certain health issues, dietary restrictions, or pregnancy complications need to take a prenatal supplement, including folic acid and iron. This group of women includes vegetarians and vegans, women who are lactose-intolerant or have certain other food intolerances, smokers and women who abuse other substances, women who are having twins or higher multiples, and women with certain blood disorders and certain chronic illnesses.