The Vitamin Dilemma

Do you really need to take a prenatal multisupplement? Depends on how you eat.

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Whatever their expectations, all parents share a common wish: for their babies to be healthy. Fortunately, you can do a lot to ensure the well-being of your newborn. What you consume, researchers say, has a profound impact on her. In fact, in one study mothers who ate nutritionally adequate diets—enough calories, protein and nutrients—gave birth to babies in superior or good health 94 percent of the time. In stark contrast, those with poor diets bore healthy babies just 8 percent of the time. One crucial issue you're facing as a mom-to-be is whether to hedge your nutritional bets by taking prenatal vitamin and mineral supplements. A Shift in Thinking "Years ago, obstetricians gave all pregnant women a vitamin/mineral supplement containing 100 percent of the RDA for all nutrients," says J. Patrick O'Grady, M.D., professor of obstetrics and gynecology at Tufts University School of Medicine and director of obstetrical services at Baystate Medical Center in Springfield, Massachusetts. "Today, official recommendations [from the Food and Nutrition Board] advise women to concentrate on eating a healthy diet that supplies most essential vitamins and minerals, and to supplement iron and folate," says Jennifer Niebyl, M.D., professor and head of obstetrics and gynecology at the University of Iowa College of Medicine in Iowa City. She adds that women who don't eat milk and cheese also need calcium supplements. Indeed, many experts believe that women who take one-size-fits-all prenatal multisupplements may be lulled into a false sense of security, and aren't as likely to focus on improving their eating habits. "Getting a woman to concentrate on eating a healthy diet– with plenty of fruits, vegetables and whole grains as well as good quality protein– does more than ensure that she gets enough of most nutrients," says Niebyl. "In the long run, it also helps prevent cancer and heart disease."

That said, experts still come back to real food versus supplements. Taking just an iron and folic acid pill works only if the expectant mother eats a nutritionally complete diet. However, Niebyl admits, "The reality is that most Americans just don't eat a healthy diet."

A look at the research confirms that. The National Academy of Sciences found that pregnant women typically consume less than the recommended amounts of vitamins B6, D, E and folate and the minerals iron, calcium, magnesium and zinc. Consequently, says O'Grady, many obstetricians continue to prescribe a supplement with all essential nutrients, "just to be on the safe side."

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Vital Elements If you're considering forgoing prenatal multis in favor of cafeteria-style supplementation, make sure you're eating a nutrient-packed prenatal diet and taking supplements of the following indispensable nutrients.

You must get no less than 400 micrograms daily of folic acid, or folate—found in spinach, orange juice, black beans and oatmeal—starting prior to conception if possible. It is critical to the rapidly developing fetus in the first few weeks of pregnancy, often before a woman knows she's pregnant, says Niebyl. Thus, "the U.S. Public Health Service recommends that all women of childbearing potential consume this amount."

Getting sufficient folic acid preconceptionally and in the very earliest days of pregnancy can slash the rate of spina bifida and other neural tube defects by an astonishing 50 to 70 percent and may reduce the risk of premature birth, one of the leading causes of infant illness and death. (In one study, women who consumed less than 240 micrograms were twice as likely to give birth too early.) A deficiency of folate can also cause cleft palate.

Another must-have nutrient is iron, at least 30 milligrams daily, beginning in the second trimester or 13th week of pregnancy. Iron—found in meat, fish, poultry, dark-green leafy vegetables, eggs and whole grains—helps build red blood cells, energy-regulating enzymes and the immune system. If you're advised to take 60 milligrams or more because of anemia, ask your obstetrician about also taking zinc (15 milligrams) and copper (1.5 to 3 milligrams) supplements. (That much iron may interfere with zinc absorption, and taking extra zinc, in turn, may interfere with copper absorption.)

You also need 1,200 milligrams of calcium each day. While it's easy to get this amount from milk, yogurt and cheese (eight ounces of milk has 300 milligrams, a cup of low-fat yogurt, 370, and one ounce of hard cheese, about 200), if you are lactose intolerant or choose not to eat these foods, you must supplement (calcium carbonate is absorbed best). Also supplement 10 micrograms of vitamin D to help absorb and use the calcium. Calcium is critical to the baby's developing bones. "If a woman isn't getting enough calcium, the baby will draw it from the mother's bones, leaving her at risk for [later] developing osteoporosis," adds Niebyl.

A Healthy Balance The best solution is to cover all your bases without overdoing it. First, eat a nutritionally sound diet. Then take a prenatal multisupplement as a safety net. "Practically speaking, the easiest way to get iron and folate is to take a multivitamin/mineral supplement," Niebyl explains. "This boosts nutrient intake to give pregnant women added insurance for the days they don't have a nutritionally balanced diet."

However, there are a few potential pitfalls with supplements you don't face with dietary sources of vitamins and minerals. (One notable example: Supplementing more than 10,000 IUs of vitamin A may cause serious birth defects.) So stick to a prenatal supplement your doctor prescribes, never take more than 100 percent of the RDA for any nutrient, and don't short-change your diet by relying on pills instead of fresh foods. That way, you know you're getting everything your growing baby needs.

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