Are pregnancy supplements necessary?

Must-haves

Even before you become pregnant, you should start thinking about your diet. “There are some nutrients which are absolutely recommended. The three most important ones are folic acid, iron and iodine,” says Ms Willis.

Folic acid

If you’re planning on getting pregnant you should start doubling your folic acid intake. “Folic acid is proven to help prevent neural tube defects, such as spina bifida, and you should commence at least one month prior to conception and continue for a minimum of three months into the pregnancy,” says Ms Willis.

According to Ms du Heaume, “Folate can be found in a wide variety of foods including leafy green vegetables, fruit and whole grains, and in Australia, our bread and cereals are fortified with folic acid.” She recommends aiming for five serves of vegetables and two serves of fruit per day and reminds us that, “Folic acid is water soluble, so to help preserve it you should avoid boiling vegetables in water and over-cooking them. Instead, try steaming or microwaving vegetables.”

Ms Willis recommends, “a dose of 400-500mcg for most women, but if there is a risk of malabsorption or an increased risk of neural tube defects a 5mg daily dose is recommended.” There are a number of factors that increase the risk of a neural tube defect, they include:

• A close family history of neural tube defects
• If you’re obese
• If you have insulin-dependent diabetes (not gestational diabetes)
• If you take certain anti-epileptic medications

Iron

Available from both plant and animal sources, iron is important to help prevent anaemia, and in pregnancy, a woman usually needs extra iron due to red blood cell development in the foetus and an increase in maternal blood volume. Ms Willis recommends asking your doctor to perform a blood test in the early stages of your pregnancy. “That way you’ll know if you need to take a therapeutic dose, which is about 80-100mg of elemental iron, or a maintenance dose of iron, which is 5-20mg of elemental iron,” she says.

Ms du Heaume says the way iron is absorbed by the body differs by food group. “Animal sources of iron are more easily absorbed in the body than plant sources, and it’s a good idea to eat your plant iron sources with vitamin C rich foods, such as oranges, tomato or capsicums,” she says. Ms du Haume also suggests discussing your iron needs with your healthcare professional as iron supplements may be needed by some women, but too much iron can be detrimental.

Animal sources of iron

• Red meat
• Poultry
• Fish
• Eggs, always cooked

Plant sources of iron

• Dried beans and lentils
• Green leafy vegetables
• Wholegrain bread and cereals
• Nuts
• Seeds

Drinks like tea, coffee, and soft drinks can reduce the way your body absorbs iron from plant foods. If you choose to drink these, it’s best to have them between meals so you can get the most out of your iron-rich foods.

Iodine

It may come as a surprise, but according to Ms Willis, “Studies indicate that up to 50 percent of pregnant women in Australia may be iodine deficient, which is worrying as iodine is essential for the development of the baby’s brain, hand-eye coordination and hearing development.

“Some studies also suggest iodine deficiency may lead to reduced intelligence and IQ.

 “The recommended daily intake of iodine in pregnant and breastfeeding women is 250mcg which will usually require a supplement containing at least 150mcg of iodine,” she says.

Foods rich in iodine include seafood and seaweed, nori sheets, meat and dairy products. Ms du Heaume recommends, “Women with pre-existing thyroid conditions should consult their doctor before taking iodine supplements.”

The 'maybe' supplements

Depending on current dietary intakes, Ms Willis advises that women may benefit from the following additional supplements:

Probiotics

 “There’s a growing body of evidence that suggests taking a probiotic containing Lactobacillus rhamnosus GG (LGG) during pregnancy and breastfeeding can reduce the risk of the baby developing atopic allergies, such as eczema, by as much as 50 percent, which is particularly important in families where one or more family members suffer from eczema, hay fever or asthma. When combined with other specific Lactobacillus and Bifidobacterium strains a probiotic may also assist in the development of a healthy immune system and balanced intestinal microflora in the newborn. Importantly, your pharmacist should be able to advise you on products containing the clinically trialled strains,” says Ms Willis.

Ms du Heaume advises, “It’s during the birth when mothers actually pass on bacterial diversity to their baby.”

Probiotic foods include live culture yoghurt, fermented vegetables such as sauerkraut and kimchi, kombucha tea, kefir (a fermented milk) and miso soup made from fermented grains.

Omega 3 fatty acids

Omega 3 fatty acids are critical for foetal and infant visual and neurodevelopment. Ms Willis warns, “There’s some evidence to suggest that low omega 3 may result in preterm labour, pre-eclampsia and lower birth weight babies.” With low omega 3 levels common among Western women, Ms du Heaume suggests consuming fish two to three times per week with oily fish, in particular, an excellent source of omega 3.

 “Women should try to limit some fish, as they are known to contain higher levels of mercury. An occasional meal of the higher mercury fish should not cause concern as it is the potential build-up of mercury in the mother’s blood from regular consumption that increases risk,” says Ms du Heaume. Here are the recommended serving sizes according to the Food Standards Australia New Zealand guidelines¹:

• Limiting to one serve (150g) per fortnight: billfish (swordfish, broadbill and marlin) and shark (flake), with no other fish eaten in that fortnight; or
• Limiting to one serve (150g) per week: orange roughy (deep sea perch) or catfish, with no other fish eaten that week; or
• Eating two to three serves per week of any other fish or seafood (for example, salmon or tuna).