Pregnancy Nutrition and the Role of Supplements

Pregnancy Nutrition and the Role of Supplements

Pregnancy is a completely new time in your life. Pregnancy comes with the increased dietary needs for the extra demands on your body. You may be feeling overwhelmed but when it comes to your diet and supplementation it doesn’t have to be.

During pregnancy there are extra demands on your body and these can potentially cause deficiencies if the demands are not met. Due to the increased demand it is common for nutritional deficiencies to get worse and this can lead to poor health outcomes for both you and your baby.  Through the correct use of supplements in pregnancy it may reduce the risk of negative outcomes in some instances. Optivance Mummy Smoothies are designed to give you nutrients that might be missing from your diet.  In Australia, it is recommended that all pregnant women take folic acid, iodine and Vitamin D supplements.

As always, it is important to check with your doctor, midwife or health professional before undertaking supplements to your diet.

 What should I eat during my pregnancy?

There is substantial evidence that shows the benefits of eating healthy and providing the right supplementation can have lasting benefits for your child's health later in life.

There can be  a relatively high incidence of nutritional deficiency exacerbated during pregnancy and this can be caused by consuming foods that are highly processed and if there is a reduced intake of nutrient dense foods. By choosing a healthy and varied diet from the 5 food groups you can make sure you and your baby’s nutritional needs are met to support both your own health and the healthy growth and development of your baby.

A healthy diet consists of both macronutrients  and micronutrients. Macronutrients are the nutrients that our bodies require in large amounts and classified as proteins, carbohydrates and fats. You will find the amounts of these nutrients listed in the nutritional panels of all packaged foods sold in Australia. Whole and cut fresh fruit and vegetables are not required to have a label with this information as it can be readily obtained from dietary food composition databases such as the Australian Food Composition Database.

Micronutrients are the vitamins and minerals found in foods. These can be found in very small amounts compared to the macronutrients however they are equally important to consume.

The table below shows the increased dietary intake required for pregnant women, including for important macronutrients and micronutrients and the foods that are good sources for these nutrients. When you're pregnant, you need more proteins, fats, carbohydrates, vitamins and minerals. 

 Table 1: Foods high in macronutrients  and micronutrients and the increased requirements during pregnancy

Nutrient	Foods	Before Pregnancy	After Pregnancy
Protein	lean beef, chicken, salmon, eggs, peanut butter	0.8 g/kg of body weight. 46 grams/day	1.1g/kg of body weight. 60 grams/day
Fats	salmon, olives, avocados, raw macadamia,cashew nuts, chia and hemp seeds	Focus on quality fats	Focus on quality fats
Fats - Omega 3	salmon,mackerel, herring, anchovies,sardines, chia, hemp, flax seeds	90 mg/day of DHA + EPA	115 mg/day of DHA + EPA
Carbohydrates	Pumpkin, lentils, brown rice, sweet potatoes, potatoes beans, oats, bananas	45-65% of total energy intake	45-65% of total energy intake
Vitamin A	Beta-carotene in orange-colored carrot, sweet potato, squash, and capsicum. Beef liver is high in Vitamin A	700 µg/day	800 µg/day
Vitamin B6	Fish, meat, poultry, eggs, legumes, and nuts	1.3 mg/day	1.9 mg/day
Folic Acid	Legumes, leafy green vegetables, broccoli, asparagus, bok choy, spinach, and avocado	400 µg/day	600 µg/day
Vitamin B12	Animal products such as meat, eggs, dairy, and fish	2.4 µg/day	2.6 µg/day
Vitamin C	Kiwi fruit, citrus fruit, peppers, capsicum. and lightly steamed or raw broccoli and cauliflower	45 mg/day	60 mg/day
Vitamin D	Sun exposure. Cod liver oil	5 µg/day	5 µg/day
Vitamin E	Almonds, sunflower seeds, avocado, spinach, and eggs	7 mg/day	7 mg/day
Calcium	Dairy, nuts, almonds, broccoli, sesame seeds/ tahini, tofu, and tinned fish with bones	1000 mg/day	1000 mg/day
Iodine	Kelp, seaweed, dairy, eggs, and iodized salt	150 µg/day	220 µg/day
Magnesium	Nuts; almonds, brazil cashew, sunflower, pumpkin and hemp, seeds, chickpeas, wheat, quinoa, avocado, legumes, some fish whole grains, dark chocolate/cacao powder	320 mg/day	350 mg/day
Iron	Red meat, liver, oysters, plant source such as legumes, nuts and dark green vegetables is poorly absorbed	18 mg/day	27 mg/day
Zinc	Meat, oysters, legumes, seeds, and nuts	8 mg/day	11 mg/day
Choline	Eggs (yolk), milk, fatty fish, navy beans, broccoli	425 mg/day	440 mg/day

 

By including these foods you will help to get all the intake of nutrients you need. In addition, consider limiting your intake of foods and drinks with added sugar. Also limit salt that is non iodised to small amounts.

What do the nutrients in food do for my body when I’m pregnant? 

Protein

Protein is used to form new body cells and tissues. While you are pregnant, you don't need to eat for two. But you do need to eat enough protein to meet both your and your baby's needs.

Folic Acid

Folate is a B vitamin that plays an integral role in DNA synthesis, red blood cell production, and fetal growth and development.

For women who are planning a pregnancy, and during the first 3 months of pregnancy, a daily folic acid supplement of 600 micrograms is recommended, as well as eating foods that are naturally rich in folate or are fortified with folic acid.

Folic acid is the synthetic form of folate found in many supplements. It gets converted into the active form of folate — L-methylfolate — in the body. It is hIghly recommended to supplement with  activated Folate over supplements that contain regular synthetic folic acid. 

It’s recommended to take at least 600 micrograms (mcg) of folate or folic acid per day to reduce the risk of neural tube defects and congenital abnormalities like cleft palate and heart defects.

From five randomized studies including 6,105 women, supplementing with folic acid daily was associated with a reduced risk of neural tube defects. No negative side effects were noted.

Although adequate folate can be obtained through diet, many women don’t eat enough folate-rich foods, making supplementation necessary.

Folic acid (or folate) is a B vitamin. It is used to help make new cells .The cell's need for folate  is higher when cell turnover is increased, such as in fetal development. If a woman has enough folate in her body before she is pregnant, it can help prevent major birth defects in her baby’s brain and spine. These birth defects are called neural tube defects (NTDs) and include spina-bifida. Folate can help reduce the risk of spina bifida by up to 70% and may also reduce the risk of cleft lip and palate. In Australia and New Zealand, folic acid is added to all bread-making flour (except for organic flour) and has been fortified with folic acid since September 2009. One standard slice of bread will supply approximately 40 micrograms (mcg) of folic acid. Green leafy vegetables, whole grains and fruit are also good sources of folic acid. However, the best way to guarantee you get enough folic acid is to take a daily folic acid supplement (opting for an activated form).

Folate is found naturally in green leafy vegetables. It's also added to food, such as bread and breakfast cereals, as folic acid.

You should take at least 600 micrograms of folic acid for at least one month before a planned pregnancy. A baby's growth is very quick in the first weeks of life — often before you know you are pregnant.

Continue taking this supplement for the first 3 months of pregnancy to reduce your baby's risk of neural tube defects such as spina bifida.

Your doctor may recommend a higher dose of folic acid if you:

• have diabetes
• are obese
• take anticonvulsant (epilepsy) medicine
• have a member of your family affected by a neural tube defect
• are at risk of poor food absorption

Iodine

Iodine is an important mineral needed for the production of thyroid hormone, which is important for growth and development. If you don’t have enough iodine intake during pregnancy, it increases your baby’s risk of mental impairment and congenital hypothyroidism (previously known as cretinism).

Iodine deficiency in the community is thought to be increasing due to reduced intake. To address this problem, most bread in Australia contains added iodine. Recommended iodine intake in pregnancy is 220 mcg per day, unless thyroid disease is present. The increased intake can be achieved by use of a pregnancy and lactation vitamin supplement containing iodine. If your doctor is concerned about iodine deficiency, thyroid function tests may be requested. Urine tests for iodine do not provide useful information. If iodine deficiency is diagnosed, supplementation of iodine of up to 500 mcg per day may be required. 

Iodine is important for your baby's brain development. An iodine supplementation of 150 micrograms  per day is recommended pre-pregnancy, during pregnancy and while breastfeeding.

Iodine is an essential nutrient for fetal growth and development, which may be widely misunderstood by the general population. Iodine is required for thyroid hormone synthesis, and delivery of thyroxine via the placenta is essential until fetal synthesis is sufficient at approximately 17–19 weeks gestation.  Even subclinical hypothyroidism can double the risk of miscarriage and neonatal death. Reduced maternal thyroid function and maternal iodine deficiency have been associated, in a number of large-scale studies, with impaired neurodevelopment, cognitive development, behavioral issues, learning skills, and intelligence quotient in children.

Given these important findings, there has been much debate as to whether broad guidelines recommending iodine supplementation in pregnancy should be issued. Some countries, such as Australia and New Zealand, recommend a supplement intake of 150 micrograms per day for all pregnant women.

Vitamin D

Vitamin D is essential for your baby’s growth and development and your own health during pregnancy. Vitamin D is important for bone health and for optimal pregnancy outcomes for you and your baby.

Vitamin D is needed for the body to absorb and use calcium. Vitamin D deficiency is now common in Australia, affecting over 30% of adults.

This fat-soluble vitamin is important for immune function, bone health, and cell division. Vitamin D deficiency during pregnancy has been linked to an increased risk of cesarean section, preeclampsia, preterm birth, and gestational diabetes.

We get most of our vitamin D from the sun. Ultraviolet (UV) radiation from the sun produces vitamin D in the skin and is the best natural source of vitamin D. Only a small amount of our vitamin D intake comes from our diet – from foods such as eggs, oily fish, margarine and milks fortified with vitamin D.

Women who are at most risk of vitamin D deficiency:

• have dark coloured skin
• wear covering or concealing clothing for religious or other reasons
• spend much time indoors.

You may need a blood test at the beginning of your pregnancy to assess your vitamin D levels. If so, your doctor (GP) will arrange this. Depending on your results, you might need to take vitamin D supplements. During the winter months, it can be more difficult to 

obtain enough vitamin D. Consider talking to your GP about your vitamin D levels before pregnancy or early in your pregnancy to make sure you begin pregnancy with optimal vitamin D.

If you are considering taking vitamin D or any other supplements during pregnancy, always discuss it with your GP first. It is not beneficial to take vitamin D supplements if you do not need them.

Iron

Iron losses are reduced during pregnancy, because the woman is no longer menstruating. However, this is not enough to offset the needs of the developing baby. It is important for pregnant women to eat iron-rich foods every day, such as meat, chicken, seafood, dried beans and lentils, and green leafy vegetables.

Animal sources of iron are readily absorbed by the body. Iron from plant sources is not absorbed as easily, but absorption is helped when these foods are eaten together with foods that contain vitamin C (such as oranges). This is important for women who follow a vegetarian diet.

The recommended daily intake (RDI) of iron during pregnancy is 27 milligrams a day (9 milligrams a day more than for non-pregnant women). Iron deficiency during pregnancy is common in Australia, and iron supplements may be needed by some women. It is important to discuss your need for supplements with your doctor, as iron can be toxic (poisonous) in large amounts.

In your second and third trimesters, you will have increasing iron demands.

In the second and third trimester of pregnancy, there are increasing iron demands due to an expanded red cell volume and demands of the developing baby and placenta. Iron supplementation is not necessary in every pregnancy. 

The need for iron increases significantly during pregnancy, as maternal blood volume increases by about 45 percent.

Iron is critical for oxygen transport and healthy growth and development of your baby and the placenta.

Iron supports the development of the placenta and fetus. Iron helps your body make blood to supply oxygen to the fetus. Iron also helps prevent anemia, a condition in which blood has a low number of healthy red blood cells.

Prevalence of iron deficiency is difficult to estimate given that there is poor distinction in some studies between iron-deficiency anemia and other forms of anemia. The World Health Organisation (WHO) estimates the prevalence of anemia worldwide to be 41.8% in pregnancy, with approximately half of these cases attributed to iron deficiency. Iron-deficiency anemia during the first 2 trimesters in pregnancy is a risk factor for preterm labor and low birth weight and predicts iron deficiency in infants. A Cochrane review of the evidence has shown that iron supplementation can restore sufficiency and resolve anemia, but the evidence is unclear for other maternal or neonatal outcomes. 

Calcium

Calcium is important in pregnancy and in breastfeeding for your baby's growth and breast milk production. Despite increased requirements, there is no need for extra calcium supplementation beyond the normal recommended dietary intake, while pregnant or breastfeeding. This is because your body adapts to make more efficient use of your own calcium.

Do I need to take a multivitamin in pregnancy?

A multivitamin is a mix of different vitamins and minerals, usually taken as a tablet. Some multivitamins are designed especially for pregnant women and will cover most of your vitamin needs.

Formulations vary, so check the label to make sure you will be getting what you need.

Multivitamins are not a substitute for a balanced diet. It's important to eat healthily even if you're taking prenatal multivitamins.

If you're pregnant, only take multivitamins that are designed for use in pregnancy.

The role of calcium in bone mineralization is well known and this is widely recognized as an important consideration in pregnancy for both fetal bone mineralization and to prevent a reduction in maternal bone density in pregnancy and postpartum. 

What about other vitamins?

Your body only needs a small amount of each nutrient, and higher amounts are not necessarily better. In fact, consuming more than you need can sometimes cause harm.

Vitamin A

Vitamin A is an essential fat-soluble nutrient. Supplements usually provide vitamin A as retinyl esters, which are pre-formed fat soluble and readily converted to retinol. Care should be taken to ensure there is not excessive intake of vitamin A in this form (retinol), as this may increase the risk of birth defects in pregnancy. However, beta-carotene is the plant form of vitamin A and is not associated with birth defects. The best way to get adequate vitamin A in pregnancy is from food such as meat, fish, leafy vegetables. orange coloured vegetables (eg carrots, pumpkin) and dairy products. 

Optivance Mummy Smoothies only contain beta-carotene (mixed carotenes) as  the form of Vitamin A which ensures you do not overdose on Vitamin A. We have a more detailed article on our Optivance website on Vitamin A and why carotenes are safe.

It's also best to avoid foods that may be very high in preformed fat-soluble  vitamin A, including liver and pâté.

Vitamin A is likely the most controversial supplement in pregnancy and has largely been avoided by pregnant women and omitted from supplement formulations or replaced with beta-carotene owing to perceived risk of teratogenicity. 

Vitamin C

Vitamin C is found in a wide variety of fruits and vegetables. A balanced diet can give you all the vitamin C you need. Enough vitamin C helps improve the absorption of iron from your diet.

Clinical studies do not support routine supplementation with vitamin C for the prevention of important pregnancy outcomes such as fetal growth, preeclampsia, preterm birth, or fetal or neonatal death. It is possible that vitamin C supplementation may reduce the risk of premature rupture of the membranes, as has been observed in a small number of observational and intervention studies. Supplementation with 100 milligrams, a conservative dose, has also been shown to reduce the risk of urinary tract infection in pregnancy.

Kristy’s favorite sources are whole food derived from acerola cherry, rosehips, camu camu and kakadu plum. 

Vitamin B12

Vitamin B12 is important as it supports the development of your baby's nervous system.

Vitamin B12 is really important during pregnancy because it helps with the methylation cycle, ensuring there's enough folate for making DNA and helping cells grow. If you're low on Vitamin B12, it can cause problems like miscarriage, preeclampsia, low birth weight, and developmental issues in the baby, such as neural tube defects. It can also affect the baby's nervous system development.

A common sign of Vitamin B12 deficiency is macrocytic anemia, which can often show up in routine blood tests during pregnancy. However, since folate supplements can fix this type of anemia, a Vitamin B12 deficiency might go unnoticed, even though it's still there. This is sometimes called "masking a B12 deficiency."

Since pregnant women are usually advised to take folic acid and some may take high amounts, it's important to also check Vitamin B12 levels. Low Vitamin B12 and high folate levels during pregnancy can increase the risk of developing diabetes for the mother and lead to low birth weight, insulin resistance, and weight issues for the child later in life. So, it might be a good idea to have your Vitamin B12 levels checked during pregnancy or even before getting pregnant.

Vitamin B6

Adequate supply of vitamin B6 in pregnancy plays an important role in neural development, synthesis of fetal neurotransmitters, and fetal metabolism. Poor vitamin B6 status has been shown to correlate with reduced conception rates and increased risk of early pregnancy loss.

Magnesium

Magnesium is a mineral involved in hundreds of chemical reactions in your body. It plays critical roles in immune, muscle, and nerve function.

Deficiency in this mineral during pregnancy may increase the risk of chronic hypertension and premature labor.

Some studies suggest that supplementing with magnesium may reduce the risk of complications like fetal growth restriction and preterm birth.

Magnesium may inhibit preterm uterine contractions via calcium antagonism, and deficiency has been associated with increased risk of preterm labor or preterm birth. Via this mechanism, magnesium supplementation may also be helpful for leg cramps. 

Zinc

Zinc is required for the activity of over 300 enzymes and is essential for life, growth, and development. Zinc-dependent enzymes and zinc-finger transcription factors play a critical role in deoxyribonucleic acid replication, cell proliferation, and gene transcription. Zinc deficiency can impair child growth and development, increasing risk of retardation or SGA and influencing the phenotype such that many features of fetal alcohol syndrome can be related to the impaired zinc metabolism caused by alcohol. Zinc deficiency in neonates may increase risk for infection and cause dermatitis. Early neonatal brain development is especially sensitive to zinc deficiency.

 Omega-3 

Fish oil contains docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), two essential fatty acids that are important for baby’s eye and brain development.

Supplementing with DHA and EPA in pregnancy might boost post-pregnancy brain development in your baby and decrease maternal depression, though research on this topic isn’t conclusive.

Although observational studies have shown improved cognitive function in the children of women who were supplemented with fish oil during pregnancy, several controlled studies have failed to show a consistent benefit.

For example, one 2010 study involving 2,399 women found no difference in the cognitive function of infants whose mothers had supplemented them with fish oil capsules containing 800 mg of DHA per day during pregnancy, compared with infants whose mothers did not.

This study also found that supplementing with fish oil did not affect maternal depression.

However, the study did find that supplementing with fish oil protected against preterm delivery, and some evidence suggests that fish oil may benefit your baby’s eye development.

Maternal DHA levels are important for proper fetal development and supplementing is considered safe. The jury is still out on whether taking fish oil during pregnancy is necessary.

To get DHA and EPA through food, it’s encouraged to consume two to three servings of low-mercury fish like salmon or sardines per week.

Omega- 3 supplements during pregnancy may lower your risk of premature birth.

Omega-3 fatty acids are essential in many aspects of health and play an important structural role in cell membranes. A large number of studies have linked optimal omega-3 intake with positive fetal and maternal outcomes. Docosahexaenoic acid (DHA), in particular, is a critical component of cell membranes in the brain and retina and is essential for fetal development; fetal DHA accretion is markedly increased in the third trimester. Maternal omega-3 supplementation has been shown to improve short- and long-term neurodevelopment and visual acuity.  In several reviews and meta-analyses, supplementation has also been shown to increase birth weight and length of gestation and reduce risk of early or preterm delivery.  

Probiotics

Given increased general awareness of gut health, many parents-to-be turn to probiotics.

Probiotics are living microorganisms that are thought to benefit digestive health.

Many studies have shown that probiotics are safe to take.

Additionally, several studies have shown that supplementing with probiotics may reduce the risk of gestational diabetes, postpartum depression, and infant eczema and dermatitis.

Research on probiotic use in pregnancy is ongoing, and more about the role of probiotics in maternal and fetal health is sure to be discovered.

Choline

Choline plays a vital role in baby’s brain development and helps to prevent abnormalities of the brain and spine. The current recommended daily allowance of choline during pregnancy is 450 milligrams. Choline plays a vital role in baby’s brain development and helps to prevent abnormalities of the brain and spine.

Brown B, Wright C. Safety and efficacy of supplements in pregnancy. Nutr Rev. 2020 Oct 1;78(10):813-826. doi: 10.1093/nutrit/nuz101. Erratum in: Nutr Rev. 2020 Sep 1;78(9):782. doi: 10.1093/nutrit/nuaa009. PMID: 31925443; PMCID: PMC7558284.