Studies regarding the risks and benefits of fish during pregnancy can often seem contradictory. It is the retinol form of Vitamin A that is associated with teratogenic effects, not the carotenoid version found in food sources such as carrots.
The maximal supplement in pregnancy is 8000 IU/day.
Women with iron deficiency, defined by a ferritin level 10,000 IU/day) have been associated with cranial-facial (face, palate, ears) and cardiac birth defects. Vitamin C supplements can assist with iron absorption, whereas milk and tea can inhibit iron supplementation. A standard prenatal vitamin contains 27 mg of elemental iron. Iron supplements have routinely been recommended in pregnancy because iron needs nearly double during pregnancy. Deficiencies in folate have been associated with megaloblastic anemia in pregnancy, though not with other pregnancy outcomes such as preterm birth or stillbirths. 5 Women with a history of a neural tube defect in a prior pregnancy should take a higher dose (4mg) of folic acid daily for subsequent pregnancies. 4 In order to reduce the risk for neural tube defects in their offspring, women are recommended to take folic acid from fortified food or supplements daily in addition to consuming a diet rich in food sources of folate. 4 Since the FDA mandate, blood folate levels have increased and neural tube defects have declined. Notably, folic acid supplements (400-800μg daily) taken prior to conception can reduce the risk for neural tube defects in the fetus. Folate requirements increase during pregnancy as a result of rapidly dividing cells related to fetal growth. Folate-rich food sources are citrus fruits, dark-green leafy vegetables, nuts, and liver. As mandated by the Food and Drug Administration, commonly fortified foods include bread, cereal, and pasta. Folic acid is the form used in most vitamin supplements and food fortification. Other discussions on these topics will include multiple gestations, obesity in pregnancy, pregnancies after bariatric surgery, special diets, and common exposures during pregnancy.įolic acid is the synthetic form of the naturally occurring B vitamin, folate. In this chapter, the maternal physiological adaptations as well as macronutrient and micronutrient requirements during pregnancy and lactation will be reviewed. A nutritionist or registered dietitian can help facilitate dietary counseling and interventions. In addition, many of the recommendations are geared for uncomplicated pregnancies, so adjustments need to be made when complications, such as gestational diabetes, arise. Furthermore, an individualized approach to nutritional counseling that considers a woman’s access to food, socioeconomic status, race-ethnicity and cultural food choices, and body mass index (BMI) is recommended. Physicians and other healthcare providers need to be cognizant of nutritional needs during pregnancy, as they differ significantly compared to non-pregnant populations. A woman’s nutritional status not only influences her health, but also pregnancy outcomes and the health of her fetus-neonate. Nutrition counseling is a cornerstone of prenatal care for all women during pregnancy.