When women in NZ find out they are pregnant, one of the first things they do is head to the doctors office and get a prescription for Folic Acid and more recently Iodine. There are really good reasons for these two supplements. Folic acid helps to prevent neural tube defects and Iodine adjusts deficiency which may result in slowed mental and motor development in infants. Alongside these basic government funded supplements, pregnant women have a wide range of pregnancy specific multivitamins available to take during pregnancy. So the question is, how important are these supplements?
To prevent Spina bifida and Cretinism, NZ women are prescribed 800ug of Folic acid before and during the first 3 months of pregnancy and 150mcg of Iodine to take throughout pregnancy and breastfeeding. The risk is considered to be low versus the benefits which are immense. However, this is not the whole story. How do we navigate supplementation in a way which reduces risk, but also acknowledges that people have individual needs?
Uniform supplementation for all women is not always going to be effective. Some women find supplements difficult to take as they can cause nausea and vomiting during pregnancy. B Vitamins in particular have been known to cause nausea issues. Other supplements can cause constipation, such as iron – and 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 timeframe to prevent neural tube defects.
With our westernised diets many women have trouble absorbing and assimilating folate, let alone eating enough in the first place. Deficiency during pregnancy can lead to neural tube defects in the developing infant and studies have shown that supplementation of up to 0.4mg of Folic acid reduce risk by 36%. This is why folic acid supplements have been universally prescribed for pregnant women in NZ.
While we all know that folate is something that is essential in the forming of a baby, it is vital that we make a distinction between folate and folic acid which is the synthetic variation. Current science is having a hard time explaining why folate helps prevent neural tube defects and as such we don’t know enough about folic acid (the synthetic counterpart) supplementation to truly say if it is risk free or essential.
Folate in its natural form is generally a part of our diet and as such is accepted well by the body, it is less bioavailable than folic acid, but the flipside is that folic acid is unable to be utilised effectively by approximately 40% of the population due to MTHFR disorders. The high doses of folic acid used to combat this, results in very high levels of circulating un-metabolised folic acid. It’s been theorised that a one size fits all folic acid protocol results in tongue ties and labial adhesions in developing babies. These may seem like small things but tongue ties can affect breastfeeding and the ability to thrive in infants not to mention dental health and speech. Folic acid intake can also mask Vitamin B12 deficiency.
So what options are available to people who don’t want to supplement with synthetic folic acid? Foods that are rich in folate can be a good option. Supplemental foods are ideal, especially in pregnant women who have higher needs. Flax fibre is a good source of naturally occurring folate, with the added benefit of improving bowel health. Another option is folinic acid which is a more metabolically active form of folic acid as it bypasses one of the steps to convert into a usable source. This source is even more effective as it is taken with probiotics that support the uptake process and mitigate the possible negative effects.
Multivitamins that have a balanced range of nutrients can help prevent imbalances caused by heavy dosing of single nutrients. Look for ones that utilise folinic acid. The great thing about 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.
And then there is iodine. Iodine is critical to the neural development of babies, severe deficiency can result in cretinism in developing infants and thyroid disorder such as goitre in general population. The New Zealand population is especially at risk because of our diet and because 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 1938 and incidence of goitre reduced significantly. However, due to low sodium diets or increased consumption of processed food made with non-iodised salt as well as the cessation of iodine being used to sterilise milk tankers and dairy processing equipment, iodine deficiency has become an issue once again. Particularly since many pregnant women avoid seafood as part of their listeria avoidance protocol. Iodine is of value to NZ residents due to our endemic shortage, taking iodine can help reduce risk of thyroid issues in the mother as well as brain issues in the infant.
Another way to get iodine into the body other than rote supplementation is to eat sea vegetables such as kelp which is another 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 have a strong aversion to swallowing.
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.
For example, a good probiotic taken during pregnancy has been shown to reduce risk of allergy in the developing baby as well as improving gut health in the mother and facilitating better uptake of available nutrients via the colon. Likewise, a study in New Zealand is investigating the importance of Vitamin D during pregnancy and breastfeeding. Previous studies have linked mid to high doses of up to 4000iu daily to lower the risk factor for pre-eclampsia and preterm birth as well as reduction of asthma in the developing baby. 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.
Magnesium is another underestimated supplement, with studies showing it reduces incidence of leg cramping and nausea and very importantly it also helps to manage blood pressure and helps prevent gestational diabetes. 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.
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. Sodium Ascorbate is the most readily assimilated and palatable form of Vitamin C and comes in a convenient powder 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 maintain energy levels without causing gut issues.
Obviously before changing your supplementation protocol it would pay to speak to your LMC (Lead Maternity Carer), but taking a different approach can be worthwhile for overall health. 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.
By Sian Hannagan
Natural Mum on the Cheap
HealthPost note: Unfortunately there are hardly any Folinic Acid/Folate supplements available in the New Zealand market. Hopefully this will change. We would like to source this product. Please let us know if you are aware of a quality brand here.
Solgar Prenatal Nutrients has been formulated specifically for women before, during and after pregnancy, to support the health of both mother and baby. Waihi Bush Flax Fibre Original is milled from the certified organic de-fatted flax seed, Linum usitatissimum (Linseed). It is an excellent source of of folate. Both are available for secure order from our online shop.
You may also be interested in the Nutrient Needs for Preconception, Pregnancy & Breastfeeding article.
A meta-analysis on what levels of Folic acid reduce risk of neural tube defects and by what percentage. http://ajcn.nutrition.org/content/85/1/285S.full
Folate absorption in women with a history of Neural tube defects. http://ajcn.nutrition.org/content/72/1/154.full
Probiotics and pregnancy. http://www.jacionline.org/article/S0091-6749(02)25194-5/fulltext
Vitamin D deficiency in pregnancy. https://www.thieme-connect.com/ejournals/abstract/10.1055/s-0030-1262505
Potential risks of folic acid. http://www.ncbi.nlm.nih.gov/pubmed/18038944
Magnesium during pregnancy. http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.1988.tb06839.x/abstract
Magnesium and pregnancy induced hypertension. http://onlinelibrary.wiley.com/doi/10.3109/00016349109007158/abstract
Vitamin C and iron absorption. http://ajcn.nutrition.org/content/30/2/235.short
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