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| |    Prenatal Vitamins by Elisa Ross, MD and Marjorie Greenfield, M.D. reviewed and revised by Marjorie Greenfield, M.D. Newly expectant mothers often want to get started on vitamin supplements right away. Many worry that it will hurt the baby if they are too nauseated to take a vitamin, or if they didn't find out about their pregnancies until they were a few months along. But what do prenatal vitamins really accomplish? And which of their components are the most important? Folic acid Early in pregnancy, the only component of a multi- or prenatal vitamin that most mothers-to-be really need is folic acid (or folate). Women who are taking extra folic acid when they conceive lower their chances of having a baby with an incomplete spinal column (also known as a neural tube defect or spina bifida). For this protection to take effect, the folic acid has to be present in the first four weeks of fetal development, two of which happen before a woman even realizes that she is pregnant (you don't know until after you miss your first period, which usually occurs about two weeks after conception). That's why it is recommended that all women of childbearing age take either an over-the-counter vitamin containing folic acid or a plain folic acid supplement every day. This is true even if they're not planning on getting pregnant. About half of all pregnancies aren't planned, so being ready at all times is a good idea. Folic acid is added to many breads and pastas, and is naturally found in many dark green or orange fruits and vegetables. Studies have found that taking a daily supplement offers more of the protective effect than getting the same amount in the form of food. Therefore, even women who eat a healthy diet may benefit from a supplement. The protective dose of folate is found in most regular vitamins (such as One-a-Day or Centrum) or in two chewable children's vitamins. The dose may be written 0.4 mg, 400 ug, or 400 mcg. Mothers at extra risk for having a baby with a spinal defect usually will be told to take 10 times the recommended dose of folic acid. This 4 mg dose is only recommended for women who have had family members with spina bifida or are on drugs that increase their risk, such as some epilepsy medicines. This high dose of folate has not been shown to benefit those at average risk. Other vitamins and minerals Babies are excellent nutrition magnets! Drawing upon their mothers' bodies, they usually help themselves to everything that they need. Therefore, for most babies, extra vitamins are a bonus, not a necessity. Most mothers, however, do benefit from extra iron and calcium, which can be started later in the pregnancy. Do I need extra vitamins?Scientific studies have not shown that vitamin supplementation with prenatal vitamins throughout pregnancy benefits babies, except in a few circumstances. Nevertheless, prenatal vitamins also have never been shown to harm developing babies either, unless used in megadosages. Who should take vitamins? Women who have long-term poor eating habits or are on a restricted diet, or those who know that they need to supplement a specific nutrient because of an existing medical condition or treatment should take a vitamin. Women who are carrying twins or have closely spaced pregnancies should get extra iron, and women with sickle cell anemia need extra folate. Interestingly, being on a vitamin before becoming pregnant may diminish morning sickness. Women who have had severe nausea or vomiting in pregnancy should consider starting a vitamin before conception. For healthy women who eat balanced diets, it is reasonable to think of vitamin supplements as an insurance policy against the unlikely chance that they are not getting enough of one of the many nutrients recommended for pregnancy. What if I'm too nauseated to take vitamins and minerals? If you are having difficulty getting vitamins down, talk to your practitioner about whether or not they are important in your specific situation. Vitamins themselves have been known to cause constipation and gas. While taking vitamins before pregnancy may help with morning sickness, taking them at the beginning of pregnancy can make nausea worse. After the fourth week of embryonic development (which is the sixth week from the last period), when the spinal column closes, there is no particular need for extra vitamins. It is reasonable at that point to stop taking vitamins until the nausea has passed. If you really want to take some sort of vitamin, a children's chewable kind sometimes goes down easier. The downside to vitamin supplementation It's unhealthy to take more than one multivitamin a day. If you need more of a specific nutrient, take an extra amount of that ingredient only. It is not true that if a small dose of something is good for mother and baby, more is better. For example, there is some evidence that birth defects are more common among babies exposed to large doses of vitamin A. Most vitamin A in natural food sources and in multivitamin tablets is in the form of beta carotene. This form is not harmful. But a daily dose of more than 25,000 U of regular (that is, non-beta-carotene form) vitamin A has been associated with some birth defects. The only source of such high doses, other than in supplements, is in some animal livers. Therefore, it's wise not to eat too much liver early in pregnancy. Natural isn't always better Because many supplements are categorized as food, they are not regulated by the FDA like medications are, and it is hard to be certain what is in them. It may sound strange, but vitamins from a laboratory are probably "purer" than those that are "purified" from nature. For instance, is calcium from oyster shells really better? Oysters are from the bottom of potentially polluted waters. So while the idea of taking vitamins derived from natural sources may have a certain appeal, it's probably smart to be wary of such products, especially when you're pregnant.
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