Vitamins in pregnancy
In pregnancy, we have learned that a woman should not "eat for two" as mothers and grandmothers said until recently, but rather she should. eat twice as much, being careful to take all the vitamins and minerals necessary for herself and her baby. So will you need supplements? No, or at least not for all the vitamins the expectant mother needs. Thanks to a varied and balanced diet, almost all the micronutrients essential for the well-being of the fetus and woman can be obtained, with the only major exception of Vitamin B9, better known as folic acid, whose integration should be planned already before conception. For the other micronutrients, however, the recommendation is to evaluate any deficiencies case by case.
To learn more about the importance of vitamins in pregnancy and mineral salts, we asked the doctor a few questions Angela , nutritionist biologist.
In this article
- nutrition before pregnancy
- folic acid
- vitamin D
- Vitamin B12
- vitamins A, C, E
- mineral salts
The importance of nutrition in the preconception period
To be precise, a healthy and balanced diet, combined with correct lifestyles, should not be adopted only during pregnancy, but already before. The Guidelines for a healthy diet of CREA, the Food and Nutrition Research Center, argue that in the preconception period, correct eating habits and healthy lifestyles are important and determining factors because they reduce fertility problems, improve the course and the pregnancy outcome, reduce the risk of birth defects and so-called adverse reproductive outcomes, and lay the foundation for the baby's health.
"If a woman already starts with good eating habits before pregnancy, the precautions to be taken during gestation are not many" - explains the doctor. In fact, in relation to the most recent scientific evidence, the main recommendations for one woman who wishes to have a baby I'm:
- maintain a normal body weight;
- adopt the Mediterranean diet or a diet that includes a prevalent consumption of foods of plant origin;
- increase the consumption of foods rich in folate;
- consume foods that are a source of iodine and use iodized salt;
- take a vitamin supplement based on folic acid every day.
The latter, in fact, is the only indispensable supplement for all future mothers.Also Read: Getting Pregnant: 10 Things to Do First
Folic acid: yes to supplementation before and during pregnancy
Vitamin B9, or folic acid, is one of the most important micronutrients for the development and health of the fetus. In particular, the compounds naturally present in food are called folate, while with the term folic acid we mean the synthesized molecule that we find in supplements.
What is folic acid used for
In the human body, folates play an important role because they participate in the synthesis of molecules such as DNA, RNA and proteins, in the formation of hemoglobin and are essential for those cells and embryonic tissues. Folic acid also contributes to the development of the baby's nervous system, prevents anemia and neural tube defects (spina bifida, anencephaly, encephalocele). Recent studies suggest benefits associated with folic acid supplementation also for reducing the risk of congenital heart disease and for proper placental development.
Where is folic acid found
Folate, this is their name when we talk about the compounds found naturally in foods, are found in green leafy vegetables, fish, poultry, dairy products and fresh vegetables. As the doctor points out, however, and as the Higher Institute of Health also points out, "dietary folates are sensitive to heat and air and they lose part of their bioavailability before we take them. ”Precisely because we cannot be sure of how much vitamin B9 we supply with our diet, it is important to resort to supplementation.
When to start taking a supplement
The expectant mother's folic acid levels should be adjusted even before the pregnancy begins. For this reason, all national and international guidelines recommend the hiring of 400 μg/die of folic acid in all women who want a child or otherwise do not rule out a pregnancy. It is indeed important to start taking one supplement at least 30 days before conception or, just in case, as soon as you find out you are pregnant and for all the first 3 months of gestation. According to the LARN (reference levels of nutrient and energy intake for the Del Paesena population) a pregnant woman should consume 600 μg / day of folic acid.
In women who have already given birth to children with neural tube defects, are suffering from pre-gestational diabetes or obesity, suffer from malabsorption, take antiepileptic drugs or are familiar with neurological diseases / malformations, folic acid supplementation at the dose of 4-5 mg/day, as also indicated by the recommendations on nutrition in pregnancy.
"This is the only vitamin whose deficiencies are associated with such important risks for the fetus that it integrates a priori, while for the other micronutrients it is necessary to evaluate the situation of the woman on a case by case basis" he concludes.Read also: Spina bifida and neural tube defects: what they are and how to prevent them
Vitamin D, should I take a supplement?
Vitamin D is a somewhat particular vitamin compared to the others because we only take a small amount of it through our diet. The most important amount of vitamin D, in fact, is synthesized by our body thanks toexposure to natural light. It takes about 10-15 minutes a day with at least face and hands uncovered to ensure a good dose of vitamin D.
What is vitamin D used for?
During pregnancy it is important to have good levels of vitamin D because in case of deficiency the risk of gestational diabetes, hypertension, preeclampsia and for the low birth weight fetus increases, as highlighted also in this review published in 2022 by the Cochrane Collaboration. "Its traditional role is to regulate calcium metabolism," explains Dr. Angela. Vitamin D is essential for the absorption of calcium and, in pregnancy, it is very important for mineralization of the skeleton of the fetus.
Where is vitamin D found
With food we can contribute more or less to 10-20% of the requirement of vitamin D. "We can find good quantities of this vitamin in blue fish which also contains omega 3, an important nutrient for the fetus, in salmon and eggs, leafy vegetables and avocado ", as well as clearly in fortified products, such as breakfast cereals.
How much vitamin D does an expectant mother need
In pregnancy, according to the latest revision of the LARN, it is recommended to take 15 micrograms per day, equal to 600 International Units (IU). The value considers both the dietary intake and that derived from exposure to sunlight.
NICE, the UK's National Institute for Healthcare and Care Excellence recommends supplementation of 10 μg / day of vitamin D during pregnancy and breastfeeding for all women. However, vitamin D supplementation in Del Paese does not appear to be necessary in all women and can be recommended, after a case-by-case evaluation, only in those at risk of hypovitaminosis.12 PHOTOS
Vitamin D, in which foods it is foundgo to the gallery
Vitamin D is essential in various stages of life and is so important that supplementation with specific supplements is often recommended. Obviously the sources ...
Vitamin B12, essential for vegan and vegetarian mothers
"Although the need for vitamin B12 does not increase much in pregnancy (from 2,4 μg / day in women of childbearing age to 2,6 μg / day during gestation), it is necessary to cover the requirement indicated by the LARN" suggests Dr. .ssa.
What is vitamin B12 used for
A deficiency in vitamin B12, also called cobalamin, increases the risk of spina bifida and other neural tube defects and may be associated with an increased risk of miscarriage, as indicated in this study published in the American Journal of Obstetrics and Gynecology. .
Where is vitamin B21 found
The main sources of B12 are foods of animal origin such as meat (liver in particular), shellfish and dairy products. For this reason, mothers-to-be who follow a vegan and vegetarian diet must take a supplement of vitamin B12, as also indicated by the Scientific Society of Vegetarian Nutrition and by the main guidelines on nutrition.
Those listed so far are the main deficiencies that can be found in pregnancy and that need to be corrected as soon as possible for the well-being of the mother and her baby.
The other vitamins (A, C, E)
"Outside of folic acid, vitamin D and vitamin B12 it is unlikely that there are any specific deficiencies, unless the expectant mother is in a condition of malnutrition"He explains. Nevertheless, it is important to follow a varied and balanced diet to take all the micronutrients useful for the health of the mother and for the correct development of the fetus.
Vitamin A can be taken in two forms: as retinoids through foods of animal origin (liver, dairy products, fish liver oil), or as carotenoids, found mainly in fruit and vegetables. As we have seen, excluding folic acid, vitamin B12 and vitamin D, it is unlikely that there is a deficiency of a specific nutrient. For this reason, more than a possible vitamin A deficiency, we should be concerned about its excess, which could be caused by inadequate use of dietary supplements. Scientific evidence shows that an excess of vitamin A may have instead teratogenic effects, with higher incidence of brain, spine and heart valve malformations, as highlighted in this study published in the journal Nutrition Bulletin.
Vitamin C, known to all to be an important one ally of the immune system, promotes the intestinal absorption of non-heme iron (iron of vegetable origin) and contributes to the synthesis of collagen, a component of bones and cartilages. In pregnancy it is crucial for it brain development and the formation of collagen in the child, and can be obtained thanks to the consumption of fruits and vegetables such as kiwis, citrus fruits, strawberries, peppers, broccoli, tomatoes, etc. Better to prefer steaming or cooking with a little water to avoid losing most of the vitamin. Vitamin C supplementation, unless your doctor prescribes it, is not recommended because it can promote the risk of haemolysis, oxidative damage and premature birth in the baby.
Vitamin E is known for its potent antioxidant action. Its task is to counteract the formation of free radicals, thus preventing cellular aging and the formation of pathologies such as tumors, but not only. Vitamin E is important for the proper development of the fetus and to prevent preeclampsia (or gestosis) in pregnancy. With a normal intake of dried fruit and extra virgin olive oil we can take an adequate amount for the well-being of the mother and child.
Vitamin A, C and E do not need to be supplemented, unless otherwise indicated by the doctor, precisely because they can be taken safely through food. We remind you that the SIGO (Del Paesena Society of Gynecology and Obstetrics) recommendations on nutrition in pregnancy and during lactation do not recommend the supplementation of any vitamin during pregnancy except folic acid, unless there is a proven nutritional deficiency.
Multivitamins, yes or no?
Some gynecologists may advise mothers-to-be to use a multivitamin supplement during pregnancy, but what does the scientific evidence say about it? Are they really useful or are they too much expense?
In 2022, an important meta-analysis on the role of supplements in pregnancy which states that the only fundamental supplement in pregnancy is folic acid - 400 micrograms per day to be taken before conception - and vitamin D may also be useful in some situations. Beyond this, however, there is no valid scientific data to advise pregnant women or those planning to become pregnant to take multivitamin supplements. The Pregnancy Nutrition Guidelines from SIGO, AOGOI and AGUI also state that supplementation with multivitamins is not recommended in pregnant women to improve maternal and perinatal outcomes. Instead, it is better to focus on the promotion of one healthy eating and a correct lifestyle.Read also: Multivitamin supplements in pregnancy: too much expense?
Mineral salts: how much does the requirement increase?
Finally, in a balanced diet, mineral salts cannot be missing, which contribute to the processes during pregnancy growth of the child. "The need for mineral salts such as iron, calcium and iodine increases much more than the need for some vitamins and it is important for mothers to be careful to take in adequate quantities of these micronutrients," says the doctor.
The iron requirement in pregnancy, according to the indications of the Del Paesena Society of Human Nutrition (SINU), goes from 18 to 27 mg / day. To introduce enough of it, you need to pay a little more attention to nutrition.
Good amounts of iron are found in:
But even the plant sources iron should be considered, among these we find:
- green leafy vegetables.
With the only difference that it is non-eme iron, i.e. less bioavailable. To enhance its absorption, just introduce one in the meal source of vitamin C, the simplest example is that of lemon sprinkled in water. Precisely because of this lower bioavailability "in women who follow a totally, or almost totally, vegetable diet, it is appropriate to keep ferritin levels in the blood under control to avoid an iron deficiency", says Dr.
Iron deficiency in pregnancy leads to a form of anemia called gestational iron deficiency anemia. As reported in the Nutrition Guidelines in Pregnancy and Lactation, an iron deficiency during gestation can impair the growth and development of the fetus, increase the risk of preterm and low birth birth weight, but not only. When anemia develops, the blood does not carry the normal amounts of oxygen initially causing it mild symptoms such as tiredness, weakness, paleness. If the anemia worsens, the fetus may not receive the amount of oxygen needed for the normal growth and development, especially of the brain. Also according to what is reported in the Guidelines on nutrition during pregnancy and lactation, inadequate iron levels during pregnancy are associated with an increase in cardiovascular risk for the unborn child in adulthood. Me too'post-partum embarrassments seems to correlate with insufficient iron intake. In the event of a deficiency, your doctor will prescribe a supplement.Read also: Iron in pregnancy: the need doubles
Calcium is essential for bones and teeth, but not only. "Football - he explains - is also a regulator of blood pressure and its deficiency during pregnancy may be associated with an increased risk of preeclampsia. "The need for calcium in pregnancy increases from 1000 to 1200 mg/day and it is possible to satisfy it not only through milk and derivatives, but also thanks to vegetables, dried fruit and water. The latter, in fact, especially if of the natural effervescent type, can help to reach the daily calcium requirement.
For future vegan mothers, a useful tip is to choose products such as vegetable drinks and vegetable yoghurt fortified with calcium and perhaps also with vitamin D which plays an essential role in calcium metabolism.
Read also: The need for calcium increases during pregnancy
Too often underestimated, iodine is essential for health and too little of it is consumed in Del Paese. Iodine is important for it development of the nervous system of the fetus and that is why the expectant mother should undertake to take it in adequate quantities. The Del Paesena Society of Human Nutrition recommends the introduction of 200 μg / day of iodine. "To get enough, a woman must consume fish 2-3 times a week, preferably blue fish because it is also rich in omega 3, and use only iodized salt" - explains Dr. Angela - "in this way you avoid run into a deficiency and therefore having to take a supplement ".
In pregnancy, iodine deficiency can be associated with neonatal hypothyroidism, especially for preterm births, risk of miscarriage, increased prenatal mortality, neurodevelopmental disorders and risk of congenital anomalies.Read also: Iodine in pregnancy: why it must not be missing in a mother's diet
If you think your diet is deficient in one or more of the micronutrients listed above, before taking any supplement always talk to your doctor who will be able to verify the presence or absence of a possible deficiency. The "do it yourself", especially during a delicate period such as pregnancy, can also be very dangerous.
Sources used for the article:
- advice from Dr. Angela, nutritionist biologist
- LARN - Reference levels of intake for the Del Paesena population: VITAMINS, Del Paesena Society for Human Nutrition, 2022
- Guidelines for healthy eating, Food and Nutrition Research Center, 2022
- Recommendations on nutrition during pregnancy and lactation, SIGO, AOGOI, AGUI, 2022
- Nutrition and pregnancy, National Institute of Health
- Recommendation for the reduction of the risk of congenital defects, Network Del Paeseno Folic Acid Promotion for the primary prevention of congenital defects
- pregnancy feeding
- pregnancy diet
- Dietary Supplements