When someone in Aotearoa finds out they're pregnant, one of the first things they do is head to their doctor or midwife to get a prescription for Folic Acid and more recently Iodine. Research shows there are very worthwhile reasons to take these two prenatal supplements.
Getting enough Folic acid is crucial for normal, healthy brain and spinal cord development in the growing fetus. Iodine is also essential for maternal thyroid health and healthy brain growth in utero.
For these reasons, NZ women are prescribed 800 mcg of Folic acid before and during the first three months of pregnancy and 150mcg of Iodine to take throughout pregnancy and breastfeeding. The risks are considered to be low versus the benefits which are immense. However, this is not the whole story. Alongside these basic government funded supplements, pregnant women have a wide range of pregnancy vitamins available to take during pregnancy. So, the question is, how important are prenatal vitamins?
What about prenatal supplements?
Nutrient requirements increase dramatically during pregnancy, which is not surprising considering that an entire new human body is being made - one of life’s great wonders. Uniform supplementation for all women may not always be the best option. Some women find supplements difficult to take if they are experiencing nausea and vomiting during pregnancy. High dose supplements like iron are prescribed if there’s a known deficiency, shown in blood test results.
Given that people have different requirements and physiology, it can mean that a one size fits all approach is not ideal. More and more women want to know what is best for them and their body independent of wider scale supplementation. This may explain why the suggestion to fortify bread with folic acid was rejected by NZ in 2009 even though it seemed like a pragmatic way to dose women immediately prior to pregnancy which is the most vital time.
When should I start taking prenatal vitamins?
The official recommendation is to begin supplementing at least three months before conception. But if you have a surprise pregnancy, don’t be too concerned, you can start as soon as you find out. Your doctor or midwife can also order blood tests to assess your nutrient levels.
Folic acid for pregnancy
Folic acid is the supplement form that has been researched during pregnancy, where folate is the naturally occurring form of folic acid. Healthy fetal development of the neural tube (the brain and spinal cord) during pregnancy depends on sufficient levels of folic acid in the pregnant mother. With our typical western diets many women have trouble absorbing and assimilating folate, and in lots of cases, eating enough in the first place. There’s plenty of research on folic acid supplementation during pregnancy, which is why folic acid supplements have been universally prescribed for pregnant women in NZ.
Natural prenatal vitamins that are sold in New Zealand have a maximum allowable daily amount of 300 mcg of folic acid (or 500 mcg if manufactured in a GMP facility). This is below the recommended daily amount of 800 mcg, however your doctor or midwife will be able to prescribe you additional folic acid to bolster the amount in your organic prenatal vitamins.
Folic acid food sources
Foods that are rich in folate can be a good option to bolster your intake, like green leafy vegetables, nuts and seeds. Supplemental foods are ideal, especially in pregnant women who have higher needs. Ground flaxseed is a good source of naturally occurring folate, with the added benefit of supporting bowel health and being a source of healthy omega-3 fatty acids.
Looking for the best folate supplement for pregnancy?
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Iodine for pregnancy
And then there is iodine. Iodine is critical to the neural development of babies in utero. The New Zealand population is especially at risk of deficiency because of our diet - there are low levels of Iodine in our soil and food sources. To mitigate this risk, iodine was added to salt as a supplement in 1924 and incidence of deficiency reduced significantly. However, due to low sodium diets, increased consumption of processed food made with non-iodised salt as well as the reduction of iodine being used to sterilise milk tankers and dairy processing equipment, iodine deficiency became an issue once again and in 2009 it was mandated to be added to all bread in NZ. Iodine is of value to NZ residents due to our endemic shortage, taking iodine supports thyroid balance in the mother and healthy brain development in the infant. The Iodine max dose 1100 mcg per day.
Food sources of iodine
Another way to get iodine into the body is to eat sea vegetables such as kelp which is considered a super food, iodine can also be found in Himalayan mountain salt and celtic sea salt with kelp. Alternatively, liquid versions of iodine are more easily absorbed and can be easier to take for women who are not keen on swallowing capsules and tablets.
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How to choose the best pregnancy vitamins
What often gets missed in our push to get pregnant women taking Folic acid and Iodine is that there are a range of other supplements that are hugely valuable to take during pregnancy. So, what are the best pregnancy supplements?
What are the best prenatal vitamins and supplements?
Prenatal Multivitamins that have a balanced range of nutrients help provide a variety of vitamins and minerals, which is preferable to taking high doses of single nutrients. The great thing about prenatal multivitamins is that they save the hassle of remembering to take multiple supplements. Make sure you choose a pregnancy specific one that has doses directly relative to the RDI recommendations for pregnant and breastfeeding women. Even the best women's multivitamin won't be as targeted for pregnancy as a specialised prenatal multivitamin. If you suffer from reflux during pregnancy, your best option is to take your prenatal vitamins with a meal, for more info on this check out Spilling the facts on reflux in pregnancy.
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What are the benefits of prenatal vitamins?
We know that Folic acid and Iodine both have very compelling research showing that supplementation supports positive outcomes for both mum and baby. Research shows that other nutrients (as well as folic acid and iodine) support both maternal and fetal health throughout the pre-conception, pregnancy, and breastfeeding stages of reproduction.
The expectation is that as time goes on and the same studies are conducted on supplementation with other nutrients during pregnancy, measurable study results will mean a greater number of nutrients will also be added to the official recommendation.
Probiotics for pregnancy
A good probiotic taken during pregnancy has been shown to support healthy skin in infants after birth. Probiotic supplements for pregnancy also support gut health in the mother, a healthy gut supports uptake of available nutrients via the intestines. Find pregnancy friendly probiotics here.
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Vitamin D for pregnancy
Likewise, studies in New Zealand have investigated the importance of Vitamin D during pregnancy and breastfeeding. Healthy maternal vitamin D levels support healthy fetal development, including skin health as well as maternal health throughout the pregnancy. Sunshine is nice, but it’s important to realise that due to our latitude, getting adequate levels of Vitamin D via sun exposure can be a challenge for most kiwis. If you’re interested in pregnancy skin health check out How to get rid of stretch marks after pregnancy.
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Magnesium for pregnancy
Magnesium is another underestimated supplement, with studies showing it supports relaxed and comfortable muscles and the queasiness of early pregnancy. Very importantly it also supports healthy blood pressure already within the normal range. For women who have issues swallowing tablets (and magnesium ones are big) there are magnesium powders or even better, magnesium can be taken transdermally via a good old fashioned Epsom salts bath.
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Iron for pregnancy
Iron is another concern for pregnant women, the maintenance of good iron levels is often a balancing act between getting enough and not taking too much and as a result getting hit with digestive issues and constipation. Fortunately, there are a range of options for women who don’t tolerate iron supplementation well. The first being, to take a good maintenance dose of Vitamin C which assists in the absorption of dietary iron. Liposomal Vitamin C is the most readily assimilated form of Vitamin C and comes in a convenient liquid form which makes it easy to take. Nettle tea is a mainstay of traditional pregnancy support as it is rich in iron and vitamin C, a symbiotic approach. It’s easy to drink and avoids more pill popping.
Women who are still struggling to maintain reasonable iron levels might want to investigate other liquid options like Spatone or Floradix. These options can help support healthy iron levels and energy levels while also being gentle on the gut and less likely to cause constipation, which can be a common side effect of some forms of iron. Taking an iron supplement can often lead to lead to darker coloured stool, so don’t be alarmed if you notice a dark green or blackish hue after a number two, if you’re currently supplementing with this essential mineral.
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Navigating what supplements are beneficial to each individual is going to take a little research, knowing what option is best for you can be hard. Hopefully this article has made things a little less tricky. Obviously before changing your supplementation protocol it would pay to speak to your LMC (Lead Maternity Carer) and follow their advice.
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