Vitamin and Mineral Supplementation in Pregnancy

Due to needs of the baby, the amounts of vitamins and minerals the mother needs to take increase in pregnancy

What are the benefits of vitamins and minerals?

The vitamins and minerals play a significant role in body functions, growth, and development. Due to needs of the baby, the amounts of vitamins and minerals the mother needs to take increase in pregnancy. If such needs are not met sufficiently, the health of both the mother and the baby is affected negatively.

Should I take vitamin and mineral supplements in pregnancy?

When you are on a healthy diet that includes vegetables, fruits, lean red meat, white meat (poultry and fish), fermented dairy products, legumes, and grains, you can take the vitamins and minerals you need naturally through nutrition. However, the lack of folic acid, vitamin D, and iodine is frequent issue in our country. In that case, the use of vitamin and mineral supplements becomes vitally important.

When should I begin to take vitamin and mineral supplements?

Ideally, each woman planning pregnancy should begin to change her diet and take vitamin and mineral supplements before becoming pregnant to optimize mother and child health. The nutritional evaluation and consultancy must be continued during pregnancy and breastfeeding.

Folic Acid

Folic acid is one of the B vitamins and prevents the spina bifida (gap in the spine occurring when the baby's spine and spinal cord do not form fully in the uterus) risk for the fetus. Taking folic acid supplement also reduces the risk of potential postnatal heart diseases and brain tumor development for the baby.

The suggested daily dose is 400 microgram (mcg). Ideally, it is necessary to start taking folic acid in the period when pregnancy is planned and continue to take it until the 13th week of pregnancy. 

In the following cases, your doctor may advise you to take a higher dose (5 mg daily) folic acid: 

• Previous pregnancy that included spina bifida,
• If you or your husband has spina bifida,
• If you take certain medicines for epilepsy,
• If you have celiac disease (lifelong chronic intestinal allergy to gluten) or diabetes,
• If your body mass index is 30 or above (obesity),
• If you have sickle cell anemia (the blood disease in which the red blood cells are shaped like sickle as a result of hemoglobin abnormality) or thalassemia disease (a genetic blood disease)…

Vitamin D

Vitamin D is an indispensable vitamin for everybody. Many people may have vitamin D deficiency for reasons such as failure to take sufficient sunlight or structurally low vitamin D reserves. Taking vitamin D supplement in the pregnancy period is essential for the mother's holistic health and baby's healthy development as well as healthy birth and growth of the baby. With the sufficient vitamin D supplementation, the potential risk of rickets in the babyhood and childhood periods can be decreased. Since vitamin D deficiency is widespread in our country, the Ministry of Health suggests each pregnant woman 1200 IU vitamin D after the week 12 and also in the breastfeeding period.

Iodine

The iodine deficiency constitutes a potential risk of hypothyroidism in the mother and the baby. The World Health Organization (WHO) suggests both pregnant women and breastfeeding women take iodized salt and take 250 mcg iodine. The iodized salt must be stored in a glass jar away from direct sunlight.

Choline

Choline is a type of vitamin B that is transferred in high amounts from the mother to the fetus. The adequate intake of choline is very important for the development of central nervous system. It has positive impact on the babies' cognitive function (intelligence and management functions such as consciousness, memory, perception, abstract thought, judgment) development. Egg, meat, fish, dairy products, kidney bean, Brussels sprout, broccoli, and spinach are good sources of choline. 

Iron

Our body uses iron to produce a substance in the red blood cells, which carries oxygen to organs and tissues. Simultaneously with the blood production increased in the pregnancy period to meet the oxygen need of the fetus, the need for iron doubles. In case of iron deficiency, anemia, and in connection with the anemia, miscarriage, premature birth, postpartum hemorrhage, and fetal underdevelopment can be observed. Severe cases of iron deficiency may also cause maternal deaths. The daily need for iron supplementation is 27 mg. Lean red meat, poultry, fish, dry bean, and green pea are good iron sources. If the iron-rich foods are consumed together with the vitamin C-rich foods like citrus and tomato, the iron is absorbed better. The dairy products like yogurt must not be consumed together with meat products. Milk and dairy products reduce iron absorption.

Calcium

Calcium constitutes the bone and dental structures of the fetus. Including also the pregnant women at the age of 19 and above, all women must take 1,000 mg calcium a day. It is suggested that the mother takes calcium with foods. The dairy products like skimmed milk, kephir, cheese, and yogurt are good calcium sources. If you have difficulty in digesting the dairy products, you can take calcium from broccoli and dark green leafy vegetables. 

Omega-3

The Omega-3 fatty acids constitute a fat type that exists naturally in numerous species of fish. They play a significantly important role in the development of the fetus' brain. In order to obtain the maximum benefit from the Omega-3 fatty acid, the women must eat at least two portions of fish a week before and during pregnancy, and in the breastfeeding period. If the pregnant women are unable to eat fish, they are recommended taking minimum 200-300 mg Omega-3 fatty acid supplement in triglyceride form at 3/2 EPA/DHA ratio.

Vitamin K

Vitamin K is necessary for normal blood coagulation. Since their vitamin K levels are too low, the newborn babies are at the risk of bleeding. In order to prevent this, your baby will be given vitamin K after the birth. If it is not specifically considered that your baby is at the risk of bleeding, you do not need to take vitamin K supplements during pregnancy.

Vitamin A

Excessive vitamin A might damage the nervous system development of the fetus. Therefore, it is necessary to avoid the supplements that include more than 700 microgram of vitamin A during pregnancy. Besides, it is necessary not to consume liver and the foods that include liver products in which the vitamin A levels are high.

Vitamin E

The vitamin E that has antioxidant features is available in various foods including fats and oils, meat, egg, and leafy vegetables. It is a rare thing to observe vitamin E deficiency due to its abundance in the diet. However, in cases such as cholestatic liver disease, pancreatic insufficiency, fat absorption disorders, and nutrition disorders, vitamin E deficiency can be observed. If there is not any condition that causes vitamin E deficiency, you do not need to take vitamin E supplements during your pregnancy.

Vitamin B Supplements (except folic acid)

There are 8 types of vitamin B: B1, B2, B3, B5, B6, B7, B9, and B12. In case of its deficiency, weakness, fatigue, forgetfulness, and anemia can be observed. Since the need for the vitamin B12 increases more than need for the other group B vitamins during pregnancy, the vitamin B12 deficiency is widespread. The vitamin B12 deficiency is associated with both the premature births and the births with low birth weight. Pyridoxine (vitamin B6) that is an important group B vitamin helps to reduce your nausea-vomiting complaints in the early periods of your pregnancy.

The recommended Dietary Reference Intakes (DRI) and the tolerable Upper Intake Levels (UL) for pregnant women and breastfeeding women

	DRI		UL for pregnant and breastfeeding women
	For pregnant women	For breastfeeding women
Fat-soluble vitamins
Vitamin A	770 mcg	1300 mcg	3000 mcg
Vitamin D	600 IU (15mcg)	600 IU (15 mcg)	4000 IU (100 mcg)
Vitamin E	15 mg	19 mg	1000 mg
Vitamin K	90 mcg	90 mcg	No sufficient data
Water-soluble vitamins
Vitamin C	85 mg	120 mg	2000 mg
Thiamine	1.4 mg	1.4 mg	No sufficient data
Riboflavin	1.4 mg	1.6 mg	No sufficient data
Niacin	18 mg	17 mg	35 mg
Vitamin B6	1.9 mg	2 mg	100 mg
Folic acid	600 mcg	500 mcg	1000 mcg
Vitamin B12	2.6 mcg	2.8 mcg	No sufficient data
Minerals
Calcium	1000 mg	1000 mg	2500 mg
Phosphor	700 mg	700 mg	4000 mg
Iron	27 mg	9 mg	45 mg
Zinc	11 mg	12 mg	40 mg
Iodine	220 mg	290 mcg	1100 mcg
Selenium	60 mg	70 mcg	400 mcg