Prenatal supplements fall woefully short in providing crucial nutrition during pregnancy – and most women don’t even know it

Prenatal Supplements Fall Woefully Short in Providing Crucial Nutrition During Pregnancy – and Most Women Don’t Even Know It

The Importance of Prenatal Supplements

If there’s one thing doctors agree on, it’s that all of their pregnant patients should take prenatal supplements. As a result, about 3 in 4 expecting mothers follow their doctor’s advice.

The Lack of Regulation

But even though they’re crucial for the health of mother and baby alike, prenatal supplements are not evaluated for safety and efficacy in the same way that foods and drug products are. There are no rules that require these supplements to contain any nutrients at all, let alone the appropriate doses.

The Reality of Prenatal Supplements

Not surprisingly, research shows that none of the most widely available over-the-counter prenatal supplements – whether they are tablets, capsules, soft gels or gummies – provide adequate levels of five key nutrients: folic acid, iron, vitamin D, calcium, and docosahexaenoic acid (DHA), a member of the family of omega-3 fatty acids.

The Recommended Doses

All of these nutrients are recommended by the American College of Obstetrics and Gynecologists (ACOG), and getting enough of them is associated with improved health outcomes for both pregnant patients and their babies.

Folate: The Central Reason for Prenatal Supplements

Folate, which lowers the rate of birth defects by 50%, is the central reason why prenatal supplements were developed. But folate only prevents birth defects when it’s taken prior to the 28th day of pregnancy. In other words, certain birth defects are prevented only when a woman is taking a prenatal supplement before she knows she’s pregnant.

The Importance of Starting Early

The American College of Obstetrics and Gynecology recommends that women start taking prenatal supplements at least three months prior to pregnancy. However, only about one-third of women do – and just 10% of African American women. For them, the folate intended to prevent birth defects arrives too late.

Folate: The Potential Risks

Even women who do take supplements early in pregnancy might not get the nutrients they need. That includes 400 micrograms of folic acid – a synthetic version of folate – from their daily prenatal supplement. As many as 27% of prenatal supplements contain less than that amount. On the other hand, while rare, it’s not impossible to find products that contain more than 1 milligram of folic acid – a potentially dangerous amount associated with impaired cognitive development, most notably decreased verbal skills.

Omega-3 Fatty Acids: The Building Blocks of the Fetal Brain

After their introduction in the 1980s as a simple multivitamin with a little extra folic acid, prenatal supplements have evolved to deliver an additional nutritional punch. One of those additions, omega-3 fatty acids, serve as building blocks for the construction of the fetal brain. Indeed, 40% of the human brain is comprised of omega-3s.

The Importance of Omega-3s During Pregnancy

One study of rats showed that insufficient intakes of omega-3s during pregnancy resulted in a significant decrease in omega-3 levels in the mother’s brain. While such a study could never be conducted in humans, this suggests mothers may sacrifice omega-3s from their own brain to support their baby’s brain development.

The Link Between Omega-3s and Preterm Birth

However, there does appear to be a link between omega-3s and preterm birth, with increased intakes leading to a decreased risk. Preterm birth – delivery at less than 37 weeks gestation – is on the rise in the U.S. and worldwide, with more than 1 in 10 babies born too early.

The Challenges of Meeting Omega-3 Recommendations

New guidelines recommend that pregnant women who don’t routinely eat enough omega-3 fatty acids should get 600-1,000 milligrams of omega-3s daily. Studies have shown that this is nearly impossible to find in a prenatal supplement. However, patients who eat fatty fish twice weekly – this can be salmon, mackerel, herring, sardines or anchovies – may only need an additional 100-200 milligrams daily of omega-3s during pregnancy. And about 40% of commercial prenatal supplements provide this amount.

Choline: The Missing Nutrient

Choline is also critical for fetal brain development. Its requirement increases during pregnancy to 450 milligrams per day, and even more so during lactation – 550 milligrams per day. With the exception of organ meats, like beef liver, few foods have enough choline to meet that requirement. An egg contains about 150 milligrams of choline, a 3-ounce steak has 117, and a half cup of soybeans has 107.

The Importance of Choline During Pregnancy

Because these are not large amounts, pregnant women need to eat several choline-rich foods daily, and probably need a supplement to meet the recommended amount. However, almost none do: 95% of pregnant women consume inadequate amounts of choline, and more than half of prenatal supplements have no choline. Those that do typically provide far too little of it – less than 100 milligrams.

The Potential Benefits of Choline

What’s more, some research suggests that consuming even more choline than guidelines recommend could offer additional benefits. One study showed that doubling the recommended level in the third trimester of pregnancy may improve a child’s attention span. Another found that some of the effects of fetal alcohol syndrome may be mitigated with quadruple the recommended level of choline.

Solutions

These three examples clearly demonstrate that taking prenatal supplements doesn’t guarantee a nutritionally adequate pregnancy. Part of the problem is a lack of education: Doctors are taught very little in medical school about nutrition, and I’ve observed that most patients just assume they’re getting what they need from their prenatal supplements.

Conclusion

Prenatal supplements are not the panacea for a healthy pregnancy. While they may provide some nutrients, they are not evaluated for safety and efficacy, and many of them do not provide adequate levels of key nutrients. The responsibility falls on pregnant women to educate themselves and take proactive steps to ensure they are getting the nutrients they need. This can be challenging, but it’s crucial for a healthy pregnancy and a healthy baby.

FAQs

Q: What are the key nutrients that prenatal supplements should provide?
A: The key nutrients that prenatal supplements should provide are folic acid, iron, vitamin D, calcium, and docosahexaenoic acid (DHA).

Q: Why is it important to start taking prenatal supplements early?
A: It’s important to start taking prenatal supplements early because some birth defects can only be prevented by taking folic acid prior to the 28th day of pregnancy.

Q: What is the recommended daily intake of omega-3 fatty acids during pregnancy?
A: The recommended daily intake of omega-3 fatty acids during pregnancy is 600-1,000 milligrams.

Q: What are the consequences of not getting enough omega-3 fatty acids during pregnancy?
A: The consequences of not getting enough omega-3 fatty acids during pregnancy include a decreased risk of preterm birth, and potentially impaired cognitive development in the baby.

Q: Why is choline important during pregnancy?
A: Choline is important during pregnancy because it is critical for fetal brain development, and its requirement increases during pregnancy.

Q: What are some foods that are high in choline?
A: Some foods that are high in choline include eggs, soybeans, beef liver, and fish.

Q: Can I get too much choline during pregnancy?
A: Yes, it is possible to get too much choline during pregnancy. However, most prenatal supplements do not provide adequate levels of choline, so it’s unlikely that a woman would get too much choline from a supplement alone.