Planning for a Healthy Pregnancy (Part 4)

We’re in the home stretch now, almost ready to start trying for a baby. You’ve quit the bad stuff and attained a healthy weight. You’ve gotten pre-existing conditions under control. And you’ve gotten immunizations and dental care out of the way. Now, all you need to do is head down to the supplement aisle of your nearest drugstore and…

…and stare blankly at the thousands of options that meet your eye.

What on earth should you be taking before you try to conceive?

6. Start taking a vitamin

There are lots of opinions on the value of vitamin supplementation or the lack thereof. The standard professional response to the question of “should I be taking a vitamin?” is that “the best source of vitamins and minerals is a healthy diet.” And that’s absolutely right.

Unfortunately, a lot of us don’t eat a healthy diet. Which is why a whole spate of other professionals respond with “a good multivitamin is good nutritional insurance.”

So what’s a hoping-to-become-pregnant woman to do?

Well, there is one nutrient for which we know supplementation is absolutely beneficial. All women who are capable of becoming pregnant (whether they’re actively trying or not) should ensure that they are getting 400 mcg of folic acid, either from fortified foods or from supplements.

Folic acid is essential for a baby’s brain or spinal cord development, but the most important weeks for this development are before you miss your first period – which means you need to make sure you’re getting enough folic acid BEFORE you get pregnant.

It’s possible that you don’t need a supplement to get even this – if you religiously eat breakfast cereal or a sandwich daily and your daily intake from fortified foods equals 100% of the Daily Value (check the nutrition facts panel on your cereal and bread), you can breathe a sigh of relief. But if you don’t currently eat 100% every single day, you should be taking a supplement that contains 400-800 mcg of folic acid.

That’s all you really need for the prepregnancy period, unless you have reason to suspect that you have a nutritional deficiency. (For my part, I knew that I should probably take my known Vitamin D deficiency more seriously since I’d be hurting not just myself but potentially a growing baby by staying deficient.)

But it might be worthwhile to also look into what your increasing needs will be during pregnancy and incorporate those supplements in now.

The three nutrients that are worth looking at are 1) iodine, 2) iron, and 3) calcium.

Iodine is a mineral that is very important for thyroid function – and thyroid controls our rate of metabolism and therefore baby’s rate of growth. Iodine needs are increased during pregnancy from 150 mcg to 220 mcg per day. The majority of the iodine in our diets (especially for those of us who live far from the sea and don’t eat seaweed :-P) comes from iodized salt. During pregnancy, you would need to be eating 3/4 tsp of iodized salt daily to get enough. If you’re a really liberal salter, you might be okay – but if, like me, you use little salt in your cooking and don’t usually salt at the table, you’re probably not getting enough. While I do recommend making sure that the salt you DO use is iodized (I had to switch mine since Daniel and I somehow managed to end up with some non-iodized salt that I’d been trying fruitlessly to use up), I don’t recommend that you start salting things more. While a small portion of the population could handle additional salt, the majority of us get way too much sodium from the processed foods we eat – but this salt generally doesn’t contain any iodine. So, to make sure you’ll be getting enough iodine during pregnancy, I recommend looking for a multivitamin that contains both that 400-800 mcg of folic acid AND 100% of the daily value for iodine (that’ll be 150 mcg).

Iron is a tricky one. The research is mixed regarding the benefits or drawbacks of iron supplementation during pregnancy – and the evidence is currently insufficient to recommend that all pregnant women take an iron supplement. On the other hand, iron-deficiency during pregnancy is one of the most common preventable pregnancy complications. If you have been diagnosed with anemia in the past, it might be a good idea to ask your doctor about checking your hemoglobin before you conceive and treating anemia now. If you suspect that your iron intake is low, you could do a three day food diary and check out how close your current intake comes to the daily value. Check labels to see if your daily intake comes up to 100% of the Daily Value. If you’re usually getting 100%, don’t fret unless your doctor tells you otherwise. But if you’re generally getting less than 75% of the Daily Value, it might be worthwhile to include iron in your supplement.

Calcium is the third nutrient that some women may not get quite enough of during pregnancy. If you’re a milk drinker who currently drinks 3 cups (24 oz, not 3 glasses) of milk a day, you probably don’t need to worry. But if you only have milk in your cereal, you may not be getting enough calcium. Like iron and folic acid, though, calcium values are listed on the nutrition facts labels. So, do that three day food diary, count up your calcium intake. If you’re usually getting less than 75% of the daily value, you might want to consider supplementing some calcium as well.

Now that you know what your supplement should contain, it’s time to choose your supplements.

I generally recommend starting with a multivitamin that contains at least 400 mcg folic acid and 150 mcg iodine. If your daily intake of iron and calcium is less than 75% of the daily value, go ahead and look for a supplement that contains 100% of the daily value for iron and at least 20% of the daily value for calcium. If you already have anemia or if your calcium intake is less than 50% of the daily value, it’s probably better than you choose a multivitamin without extra calcium and iron and choose to supplement those separately instead. It’s also important to note what the multivitamin should NOT contain. It should NOT have any more than 100% of Vitamins A, D, E, and K (the four fat soluble vitamins can build up in your body and lead to toxicity – and Vitamin A, in particular, can be very dangerous for a growing baby) and it should NOT have any herbal additives.

If you’re most women, that one multivitamin should be all you need for the preconception period and during pregnancy. You should NOT take any additional vitamin, mineral, or herbal supplements unless they are prescribed by your doctor.

If you were anemic before pregnancy, your doctor will likely give you directions for how to supplement. Generally, iron-deficiency anemia is treated with a ferrous sulfate supplement containing 65 mg iron once or twice a day. You should take these as the doctor recommends, keeping in mind that “twice a day” does not mean “two pills a day.” Your body can only absorb a certain amount of iron at a time, so taking two pills at a time means one will probably just go right through. Take the iron pill with a little bit of 100% fruit juice (which contains extra vitamin C) to help you absorb the iron better.

If your intake of calcium is very low (less than 50%), you should probably be taking a separate calcium supplement. Choose calcium carbonate or calcium citrate (NOT oyster shell calcium, which can be contaminated) in a dose that will bring you up to 100% of the daily value for calcium. The calcium in the supplement will be best absorbed if it contains no more than 500 mg of calcium in each dose, and if it is accompanied by some vitamin D. I do recommend trying to keep your daily intake of Vitamin D from supplements below 2000 IU daily unless you have a documented Vitamin D deficiency and are taking Vitamin D under the supervision of a doctor – so check the labels of both the multivitamin and the calcium and make sure your daily intake will be less than 2000 IU.

In my case, I ended up with a generic men’s over 60 one-a-day multivitamin (which contains 400 mcg folic acid and 150 mcg iodine), a iron supplement (65 mg iron), and a calcium supplement (600 mg calcium and 500 IU vitamin D-yep, I know I’m losing 100 mg worth of calcium, but it’s actually cheaper for me to flush that extra 100 mg than to buy a smaller dose). I’m taking the iron primarily because the men’s one-a-day doesn’t contain iron, not because I have preexisting anemia. If I were having constipation with the iron supplement (as many women do, but I am not so far), I would take it only every other day (since it contains a little over double the daily requirement.) I take the multivitamin with breakfast, the calcium at lunch, the iron at supper, and a second calcium (actually used to correct my vitamin D deficiency, not so much for the extra calcium) right before bed.

Most of you should be able to get away with just a multivitamin – so you can breathe a sigh of relief!

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And now, at last we’re done planning and ready to START TRYING!!!