While many women expect prescription prenatal vitamins, research has shown that they are not necessary for women who eat well. (Nutrition information on a balanced diet during pregnancy is available at: www.evergreenobgyn.com/pages/pdfs/chap2Selfcare.pdf) However, if you are in the habit of taking a multivitamin, or have already purchased prenatal vitamins, it is safe to continue taking them. Vegetarians should take a daily multivitamin.

Remember: no vitamin or supplement is a substitute for eating right during pregnancy, and certain vitamins can be harmful to the fetus if taken in amounts that are too large. Vitamins can cause nausea and constipation, especially in early pregnancy. If this happens, you should discontinue them.

FOLIC ACID

Folic acid (or folate) is a B vitamin. Supplementation before conception, and through the first 4 weeks after conception is important because this decreases the risk of having a baby with spina bifida and other neural tube defects. Additional folic acid is not necessary after 4 weeks beyond conception in women who eat well.

Needed in very large amounts during pregnancy, so much so that even a well-balanced diet will not provide enough. Daily iron supplements (in addition to any vitamins you might be taking) are recommended for everyone, starting at about 16 weeks of pregnancy.

Some types of iron can cause constipation or indigestion. The one least likely to do this is polysaccharide iron, 150mg daily. Brand name versions are expensive, so be sure to ask the pharmacist for the generic equivalent, which should cost about $14 for 100 tablets. Next best is carbonyl iron 50mg daily. We do not recommend other iron preparations—they can cause more side effects, may not be absorbed well, and can be toxic if a child accidentally swallows them.

Calcium can block iron absorption, so be sure to avoid taking iron supplements with dairy products, calcium-containing multivitamins, calcium-fortified juice, or antacids. Don’t take iron with Metamucil type products, tea, or coffee. Avoid taking thyroid medication within 2 hours before or after iron supplements.

1200 mg of calcium per day is needed. It is not difficult to get this in your diet, and women who eat well do not need to supplement. Please read the section on diet in our prenatal booklet. If you are unable to consume the recommended 4 dairy exchanges per day, you can use over-the-counter supplements so that your total daily intake is 1200mg. Tums contains 200mg, Tums EX contains 300, and Tums Ultra contains 400.

This is an omega-3 fatty acid which is potentially important for development of fetal brain and eyes. Evidence is preliminary, but it has recently been recommended by some nutritionists that pregnant and breastfeeding women consume 300 mg of DHA per day through dietary sources or supplements.

Low mercury species of fish are good sources of DHA (salmon, cod, halibut, sole, flounder, shrimp, canned light tuna, herring, trout). Eating 12 ounces (2 average meals) per week of low mercury fish and shellfish is recommended in pregnancy. DHA-fortified eggs and nutrition bars (such as Oh Mama!) are alternative dietary sources.

DHA supplements can be in the form of fish oil, or capsules made from vegetarian sources. However, it is important to choose brands verified safe by U.S. Pharmacopeia. In fish oils capsules, these brands include: Berkley & Jensen, Equaline, Kirkland Signature, Nature Made, and Nutriplus (www.usp.org). Safe brands made from vegetable sources include Neuromins DHA (www.DHADepot.com), and O-Mega-Zen-3 (www.Nutru.com).

DHA supplementation should be started at 16 weeks, when you start your iron supplements. Be sure to comsider the amount of DHA per capsule: you may need to take two or three capsules daily to get the recommended 300 mg.