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Vitamin Proficiency

A little knowledge about what’s in prenatal vitamins from medical writer Kiersten Feil will do your pregnant body good.

Vitamin Proficiency

If you’re pregnant or are trying to conceive, you’ve heard by now how important nutrition is to meet the needs of your developing baby and maintain your own strength. After all, you are growing a human being! A healthy diet is crucial, and during pregnancy, you need certain nutrients in greater amounts. Your doctor will likely recommend a prenatal vitamin as the best way to ensure you are meeting the particular dietary requirements of this special time.

Still, the myriad choices of prenatal vitamins can be overwhelming: prescription or non-prescription, chewable or pill, tablet or capsule. Not all vitamins contain the same amounts or combinations of nutrients. Most vitamins will have a similar list of nutrients, but there are important differences to look for, including more or less of a particular vitamin or mineral. So read the labels closely to make an informed decision based on your diet and medical history. Fear not if you are one of the many women that experiences nausea from their prenatal vitamins -- you can always experiment to find the option that works best for you.

To help guide you down the daunting prenatal vitamin aisle, here’s a cheat sheet of the most important nutrients you need during pregnancy.

Iron: All prenatal vitamins will contain iron. Iron is especially important in pregnancy to make all that extra blood, which will grow new vessels, the placenta, and the umbilical cord that nourishes your baby. When you add in that your baby is making his own blood, you can see why many women develop anemia (low levels of iron in the blood) during pregnancy. Prenatal vitamins usually contain 30-90mg of iron. Those with higher amounts may contain a gentle laxative, like docusate sodium, since iron can cause constipation. Iron may be partly responsible for nausea associated with vitamins, so you may wish to start with a lower iron vitamin if you do not have a history of anemia. If you start to feel sluggish and low energy, you can try a brand with more iron.

Folic acid: Folic Acid is the most absorbable form of folate, and all prenatal vitamins will contain at least 400 mcg, which is the recommended daily dose for all women of childbearing age. Folic acid is important for preventing very early abnormalities in the baby’s brain and spinal cord (neural tube defects) -- many recommend taking a vitamin with folic acid before you even conceive. If you have had a baby with a neural tube defect, your doctor may advise you to take up to 4mg (4,000 mcg) of folic acid daily. Many prenatal vitamins contain 1mg or more. Taking large doses is not a big concern as your body can get rid of extra. However, it can mask a vitamin B12 deficiency, so very high doses of folic acid should be accompanied by B12 supplementation.

Iodine: You won’t see iodine listed on every prenatal vitamin label, but it’s a crucial component of a good prenatal vitamin and here’s why. Iodine supports good thyroid function, which is necessary for a healthy pregnancy and baby. Severe iodine deficiency in a pregnant woman, although uncommon in the U.S., can cause extensive cognitive and physical impairments in her baby. Seafood, dairy products and iodized salt are the most common dietary sources of iodine, and if you’re not eating these regularly -- or, like me, you have a family history of hypothyroidism -- supplementing is a good bet. The American Thyroid Association recommends supplementing with 150 mcg of iodine (in the form of potassium iodide) daily during pregnancy and breastfeeding. Most of the vitamins on the market that do contain iodine have this amount.

Calcium and Vitamin D: These two nutrients are important for the healthy development of a baby’s bones, teeth, nerves, heart and muscles. Calcium is a building block of teeth and bones, and is also involved in nerve and muscle function. Vitamin D is necessary to absorb calcium from the foods that you eat. The Academy of Nutrition and Dietetics recommends 1,000mg of calcium per day before, during and after pregnancy. A standard prenatal vitamin usually contains 200-300mg, so be sure to make up the difference through diet, or talk to your doctor if you think you are not meeting this requirement. He or she may suggest an additional calcium supplement. Look for a vitamin that contains at least 400 IU of vitamin D (cholecalciferol, or D3, is the most absorbable form). If you’ve received a diagnosis of vitamin D deficiency, the American College of Obstetrics and Gynecology recommends 1,000-2,000 IU per day of vitamin D as a safe upper limit.

Omega-3 Fats: You probably know about the health benefits of omega-3 fats, and in pregnancy, these essential fats are important for your baby’s brain and eye development. Fatty fish like salmon are the best dietary sources, but walnuts, flax seeds and pumpkin seeds contain good amounts of the essential omega-3 fatty acid alpha-linolenic acid. Many prenatal vitamins now include omega-3 fats, like DHA and EPA (the kind found in fish), usually as a separate liquid capsule. If you can afford the extra expense, it’s good insurance against an imperfect diet (and who has a perfect one?).

Helpful Hint: Once you’re taking your prenatal vitamin regularly, make sure you are not getting supplemental doses of vitamins from other sources like drinks and energy bars. Some vitamins can be toxic to your baby if taken in high doses, especially vitamin A in its retinol form. Any extra vitamin A should always be in the form of beta carotene, which is converted to active vitamin A in your body when it’s needed, and therefore not toxic. When it comes to vitamins and minerals, getting enough is important, but more is usually not better.

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    There are steps parents can take to keep their children as healthy as possible.

    When wildfires struck the West Coast in September 2020, there was a lot for parents to worry about. For parents of children with asthma, though, the danger could be even greater. "There are more than 400 toxins that are present in wildfire smoke. That can activate the immune system in ways that aren't helpful by both causing an inflammatory response and distracting the immune system from fighting infection," says Amy Oro, MD, a pediatrician at Stanford Children's Health. "When smoke enters into the lungs, it causes irritation and muscle spasms of the smooth muscle that is around the small breathing tubes in the lungs. This can lead to difficulty with breathing and wheezing. It's really difficult on the lungs."

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    Especially when the air quality index reaches dangerous levels, it's best to stay indoors as much as possible. You can find out your area's AQI at AirNow.gov. An under 50 rating is the safest, but between 100-150 is considered unhealthy for sensitive groups, such as children with asthma. "If you're being told to stay indoors, listen. If you can, keep the windows and doors closed," Oro says.

    Do your best to filter the air.

    According to Oro, a HEPA filter is your best bet to effectively clean pollutants from the air. Many homes are equipped with a built-in HEPA filter in their air conditioning systems, but you can also get a canister filter. Oro says her family (her husband and children all suffer from asthma) also made use of a hack from the New York Times and built their own filter by duct taping a HEPA furnace filter to the front of a box fan. "It was pretty disgusting what we accumulated in the first 20 hours in our fan," she says.

    Avoid letting your child play outside or overly exert themselves in open air.

    "Unfortunately, cloth masks don't do very much [to protect you from the smoke pollution]," Oro says. "You really need an N95 mask, and most of those have been allocated toward essential workers." To keep at-risk children safer, Oro recommends avoiding brisk exercise outdoors. Instead, set up an indoor obstacle course or challenge your family to jumping jacks periodically to keep everyone moving safely.

    Know the difference between smoke exposure and COVID-19.

    "COVID-19 can have a lot of the same symptoms—dry cough, sore throat, shortness of breath and chest pain could overlap. But what COVID and other viruses generally cause are fever, chills, vomiting, diarrhea and body aches. Those would tell you it's not just smoke exposure," Oro says. When a child has been exposed to smoke, they often complain of a "scrape" in their throat, burning eyes, cough, shortness of breath, chest pain or wheezing. If the child has asthma, parents should watch for a flare of symptoms, such as coughing, wheezing or a tight sensation in their chest.

    Unfortunately, not much is known about long-term exposure to wildfire smoke on a healthy or compromised immune system, but elevated levels of air pollution have been associated with increased COVID-19 rates. That's because whenever there's an issue with your immune system, it distracts your immune system from fighting infections and you have a harder time fighting off viruses. Limiting your exposure to wildfire smoke is your best bet to keep immune systems strong.

    Have a plan in place if you think your child is suffering from smoke exposure.

    Whatever type of medication your child takes for asthma, make sure you have it on-hand and that your child is keeping up with regular doses. Contact your child's pediatrician, especially if your area has a hazardous air quality—they may want to adjust your child's medication schedule or dosage to prevent an attack. Oro also recommends that, if your child has asthma, it might be helpful to have a stethoscope or even a pulse oximeter at home to help diagnose issues with your pediatrician through telehealth.

    Most importantly, don't panic.

    In some cases, social distancing and distance learning due to COVID may be helping to keep sensitive groups like children with asthma safer. Oro says wildfires in past years have generally resulted in more ER visits for children, but the most recent fires haven't seen the same results. "A lot of what we've seen is that the smoke really adversely affects adults, especially older adults over 65," Oro says. "Children tend to be really resilient."

    This article was sponsored by Stanford Children's Health. Thank you for supporting the brands that support Motherly and mamas.

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