Taking a good prenatal vitamin is vitally important if you are planning on becoming pregnant, are pregnant or are breastfeeding. However, there are four nutrients that are very important during this time that might not be in your prenatal or may not be present in sufficient quantities. Here’s what I want you to know.
Calcium helps to regulate the constriction and relaxation of blood vessels, which is why it may be particularly important during pregnancy. A review by the prestigious international Cochrane group evaluated 13 trials that involved 15,730 pregnant women and found that supplementing with at least 1,000 mg per day of calcium, starting at approximately 20 weeks of pregnancy, significantly reduced the risk of pregnancy-induced high blood pressure and preeclampsia—a condition that presents with a rapid spike in blood pressure during the last trimester accompanied by swelling and protein in the urine—which can be life-threatening to mother and baby if left untreated. These protective benefits are more pronounced in women who normally have low calcium intake.
Given the horrific news about lead found in the water systems in Flint, Mich., it’s also important to talk about calcium’s role in protecting against lead toxicity. Lead exposure during pregnancy, breastfeeding and early childhood can lead to behavioral problems, lower IQs and learning difficulties. But calcium reduces the amount of lead that is absorbed in the GI tract and prevents it from being released from the skeleton, which is where lead is typically stored in our body.
A study by Harvard researchers examined the effects of calcium on pregnant women, who received either 1,200 mg per day of calcium or placebo beginning in their first trimester. At the end of the study, the women who took calcium had 11 percent lower levels of lead in their blood compared to the women who took the placebo. Similar reductions in lead in breast milk were noted in women taking supplemental calcium.
While the United States has been considered “iodine sufficient” for decades, the most recent large government nutrition study found that women of reproductive age in this country are now borderline iodine insufficient. This is particularly troubling given that low iodine in pregnancy increases the risk for ADHD, lower IQ and mental retardation in babies. The RDA for iodine is 150-290 mcg for adults and the American Thyroid Association now recommends that all pregnant and nursing women take a vitamin that provides 150 mcg of iodine as potassium iodide every day. Unfortunately most prenatal vitamins do not contain iodine.
In 1998, the Institute of Medicine recognized choline as an essential nutrient necessary for the structural integrity of cell membranes, proper liver function, heart health, synthesis of the neurotransmitter acetylcholine, the prevention of birth defects during pregnancy, and the healthy development of the brain and nervous system of young children. But many Americans fail to meet the recommended daily requirement of choline (450 mg/d)…and up to 40 percent of us may have a common gene variation that further increases our need for choline!
Like folic acid, choline may play a role in preventing birth defects and may provide the child life-long protection against anxiety and exaggerated responses to stressors. Given the state of today’s world, even a small degree of protection may prove invaluable. There is very early research that suggests adequate intake of choline during pregnancy and early childhood may promote life-long mental health.
Breastfed babies have a high need for choline in their mothers’ milk to ensure brain development in areas involved with thought and memory. The RDA is 550 mg per day for nursing mothers, though most women fall far short. The FDA requires that choline be included in infant formula, but most prenatal supplements do not contain choline.
During the last trimester of pregnancy, neurological development is very rapid and omega-3s, particularly DHA, are concentrated in the baby’s brain and eyes. Studies show that babies born to women consuming fish/fish oil during pregnancy score higher on tests that assess intelligence, attention and visual acuity. DHA may also reduce the risk of premature birth. Higher maternal intake of DHA may also offer some protection against allergies and asthma in the baby. Babies continue to need a steady supply of DHA for at least the first two years of life to ensure the proper development and function of their central nervous system. DHA is added to infant formula, but the level in breast milk depends exclusively on the mother’s diet.
In 2007, a European committee composed of more than 50 nutritional experts from the Perinatal Lipid Nutrition Group and Early Nutrition Programming unanimously recommended that all pregnant and lactating women consume a minimum of 200 mg of DHA per day. This recommendation was supported by seven international scientific organizations. Eating fatty fish twice a week should provide this level of DHA, but the committee endorsed the use of supplements for women who don’t regularly eat fish. After reviewing the available studies, the committee found no evidence of adverse effects or outcomes for mothers or babies when mothers took up to 1,000 mg per day of DHA.
In spite of the vast evidence of benefit and safety, studies repeatedly show that women in the US and many European countries are not getting anywhere near the recommended levels of DHA in their diets.
Tieraona Low Dog, MD, is a member of Pharmaca’s Integrative Health Advisory Board and author of National Geographic’s Fortify Your Life: Your Guide to Vitamins, Minerals and More.
Council on Environmental Health, Iodine deficiency, pollutant chemicals, and the thyroid: new information on an old problem. Journal of Pediatrics 2014; Jun;133(6):1163-6.
Ettinger AS, et al. Effect of calcium supplementation on blood lead levels in pregnancy: a randomized placebo-controlled trial. Environmental Health Perspectives 2009; Jan;117(1):26-31.
Hofmeyr GJ, et al. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Systematic Reviews 2014; Jun 24;6:CD001059.
Jiang X, et al. Maternal choline supplementation: a nutritional approach for improving offspring health? Trends Endocrinology and Metabolism 2014; May;25(5):263-73.
Koletzko B, et al. Dietary fat intakes for pregnant and lactating women. British Journal of Nutrition 2007; Nov;98(5):873-7