4 types of prenatal care
Prenatal vitamins
Search in article Intro hello friends dr marta perez here welcome to my channel today we're going to discuss a very highly uh one of the most popular questions i ever get and that is what prenatal vitamins should i take and of course you know i'm going to provide education on the why behind prenatal vitamins so don't forget to hit so you don't miss any of my import antarticle and let's get startedokay so honestly questions about prenatal vitamins absolutely fill my inbox it's a really popular question i think part of it is because when you go down the supplement shelf there are tons of different prenatal vitamins there almost every brand has them there's tons on amazon and there's like expensive prenatal vitamins that a lot of companies market directly like through influencers so you're seeing ads for them when you're scrolling through social media okay so first of all when you're talking about a prenatal vitamin or any like supplement these things any pill you take for nutrients it's a supplement and what's the word supplement mean it's supposed to mean to supplement your diet so if you ever read about like daily recommended dosages you'll see the recommended daily allotment meaning what are you supposed to get but that's supposed to include both nutrition and supplementation and the good news is those who have access to high quality nutrition in developed countries often are able to obtain the appropriate amount of vitamins and minerals through nutrition with one important exception and that is folic acid so folic acid is a derivative of Folic acid and why you need it folate which is found in different fruits and vegetables and dietary sources however when randomized controlled trials randomized patients to have folic acid supplementation versus not they found a decrease in neural tube defects neural tube defects include spina bifida and other problems with the brain and nervous system so folic acid supplementation no matter what your diet is the healthiest ever is recommended for all people of childbearing age actually and should be started about a month or three months before attempting pregnancy to make sure your body's reserves are there also because the neural tube forms and closes oftentimes either very early in pregnancy or even before someone might know they're pregnant the recommended amount of folic acid per day is 400 micrograms there are some special conditions that you should actually get a lot more folic acid supplementation up to four milligrams and those conditions are having a seizure disorder on anti-seizure medicines having sickle cell disease or having a history of a prior child affected by a neural tube defect if you have a question or you've heard internet drama about folic acid versus folate supplementation i'm gonna discuss that at the very near the very end so i Is a prenatal vitamin necessary? mentioned that most adults who have uh access to a varied healthy diet of fresh fruits and vegetables in developed countries don't always need supplementation with vitamins in normal life but in pregnancy the requirement for certain vitamins and minerals does go up and not everyone even in the u.s can access fresh fruits and vegetables as well as other healthy foods and so in general the recommendation from acog in the u.s is that people of childbearing age and people planning to become pregnant or who are pregnant do take a prenatal vitamin i have heard people from other european countries say that you know prenatal vitamins aren't recommended in my country only taking folic acid is and you know i think that's fine these are regional recommendations large studies about supplementation with prenatal vitamins has shown benefit to increase pre good pregnancy outcomes in middle and low income countries but there's not been a universal increase in good pregnancy outcomes from prenatal vitamin or multivitamin supplementation in high income countries so the who kind of honestly um hedges a little bit about the need for everyone to take a prenatal vitamin in a developed country but acog does support it i do too i mean i think it's easy enough to take but i will say that it's not something to overly stress about if you're someone who eats a varied and healthy diet before pregnancy even in the first trimester if you're not feeling well you're feeling very nauseated it's hard to get any fresh foods in that's totally fine nutrition and getting adequate stores of vitamins and minerals is not a day-to-day thing it's more kind of global so i tell people don't stress out about perennial vitamins really any of them are fine because like i said almost all of them contain folic acid in the amount recommended if you want to know about some more vitamins and minerals i'm going to discuss them in greater detail Vitamin D now so the first one i'm going to discuss is vitamin d vitamin d is a substance that's obtained through dietary sources and also also through exposure to sunlight on the skin there are populations that are at high risk of vitamin d deficiency those people are people with dark skin tones people who live in in northern far northern or far southern hemispheres or have winters where they're inside and not a lot of exposure to sunlight and possibly other like nutritional deficiencies so vitamin d is a really important vitamin for both the health of the pregnant person and for the fetus and vitamin d deficiency is actually pretty common there is no established amount of vitamin d in pregnancy that is deficient versus not deficient and so there's no indication to test everyone for vitamin d in pregnancy most prenatal vitamins do have some vitamin d in them a few hundred international units per day and the total recommended income intake of vitamin d is about 600 international units per day for pregnant people but if you suspect that you either knew you had vitamin d deficiency in the past or you're one of the high risk groups it's worth considering if you want to take extra vitamin d supplementation it is presumed to be safe in pregnancy to take up to 1 000 to 2000 international units per day without any harm vitamin d has also been batted around as like an answer specifically to some pregnancy complications and there are some ongoing clinical trials but so far there's been no additional benefit of extra vitamin d supplementation in terms of just pregnancy outcomes the next vitamin DHA mineral is dha so dha is a specific type of omega-3 fatty acid it's really important in the neurologic development of fetuses dha is found in seafood it is definitely recommended to eat about 12 ounces per week of seafood that is high in dha and low in mercury that's about three to four servings per week and you can see this recommendation in both acog and the cdc and the fda a lot of patients feel hesitant about eating seafood and pregnancy because they think about mercury what is the dangers of mercury but i really like this i'm gonna show this flyer from the fda there's really most fish and most common fish are pretty low in mercury the recommended amount of dha per day in pregnancy is about 200 to 300 milligrams now even though i said that the only thing i really recommend is making sure you get folic acid i do have a little special plug for dha too i do think it's beneficial to have a dha supplement in your prenatal or maybe take it separately and that's because i don't know about you guys when i'm pregnant i have a little bit of an aversion to it it's really hard to eat it so i do think that adding dha to a supplement is helpful unless you're someone who like loves seafood and eats it constantly and it you know that isn't affected by pregnancy and then i think you're probably fine without the dha supplement Iron another one i wanted to talk about was iron iron deficiency is probably the most common nutritional deficiency and it's the most common cause for anemia among pregnant people the other reason i want to talk about iron is because gummy vitamins prenatal vitamins often don't contain iron and that may be fine please talk to your doctor they can always we check for anemia in both the first and the third trimester and for some people we may check more often if you're someone who can't tolerate a prenatal vitamin except gummies and they don't contain iron talk to your doctor they may recommend taking a separate iron supplement iron supplements can be very constipating and that can be very problematic because pregnancy is already very constipating so you can actually get iron supplementation via the iv as Choline well choline is like the new hot micronutrient i swear i see more talk about choline than like any other micronutrient on social media and i will say you know what i think it lives up to the hype so choline is a micronutrient that it can be involved in cognitive and neural development of a fetus it's found in a variety of foods um pretty commonly including eggs poultry seafood the recommended amount of choline per day is 450 milligrams per day and there was a study called the enhanced study that surveyed americans in depth about their dietary habits and in that study the pregnant patients their average reported amount of choline per day was about 319 milligrams per day so they were short by about 130 milligrams per day most prenatal vitamins do contain choline though to fix that gap between diet and recommended amount so you can think about your diet you can look at your prenatal vitamin and you can decide whether or not you think you're getting enough choline i'm gonna be honest for me as an ob gyn doctor eggs are very popular in my household for breakfast i really like eggs for breakfast i tolerated them very well in the first trimester too i don't take a separate choline supplementation i think i get enough through the diet but it is something that i would consider and look Iodine into all right another big one to think about is iodine so iodine is very important for thyroid development and most people get adequate amounts of iodine in developed countries however more recently there has been concerns about pregnant people maybe not reaching the recommended amount of iodine and that's actually because we've moved from using table salt that contains iodine on purpose to help with nutritional deficiencies in developed countries into using you know more fancy salts like sea salt that actually don't contain iodine so whereas we don't recommend that pregnant people start eating more salt than they already would if you have the salt that's in your kitchen that you cook with when you're pregnant you should think about changing out the sea salt to actually use salt that's made with iodine the next one i'm going to Vitamin B12 for pregnant vegans talk about is vitamin b12 so vitamin b12 is important for some people actually for supplementation so vitamin b12 is a really important vitamin for a variety of functions for both you and the fetus and it is found almost exclusively in animal products eggs dairy and meat itself so vegetarians may get a limited amount of it if they don't eat a lot of those products and vegans certainly are at risk for a vitamin b12 deficiency fortunately this is very common knowledge i feel like among the vegan and plant-based community and supplementation is usually well-known it's something i usually screen my patients for the first prenatal care visit so if i have a patient who follows a vegan diet one that is safe for pregnancy there is no recommendation that i get to change the diet but i do recommend adding a b12 supplement okay so there are i could go over like every single nutrient but i just wanted to hit some of the high points of the ones that we think about and why i will say i Summary on prenatal vitamins don't obsess over reading the back of vitamins i don't want you to stress about prenatal vitamins as well i do think it's empowering to just have extra information about both nutrition and prenatal vitamins but the most important thing is going to be making sure there's at least 400 micrograms of folic acid if you're an average risk individual the other really important point about prenatal vitamins is like more is not better so whereas we don't want people to be deficient in these vitamins and minerals we also know that some of them if taken in excess can actually be toxic so vitamin a is an example of that so if someone needs more vitamins or minerals or supplementation there should be an individual supplementation and not taking two or three prenatal vitamins or something per day because they contain all these vitamins and we don't want to overdo it on any of them so all right i said i Controversies on folic acid versus folate in prenatal vitamins would go over the controversy about folic acid and folate several of my colleagues who are on social media really have deep dived this and i will link some really helpful long very scientific articles and resources that they have linked okay Which prenatal vitamin I TAKE and my BIG announcement! in summary my quick announcement um i don't even like to tell people which prenatal vitamin i take because i really do feel like most brands they contain 400 micrograms of full acid per day and they're sufficient but if you really want to know i will show you the one i take and yes that is currently take i am at the end of my 19th week of pregnancy with my second baby this is my pregnancy announcement and the prenatal vitamin i take is this one nature made prenatal multi and dha i'm not sponsored i just picked this off the shelf probably during my last pregnancy i think i took this one the last pregnancy too it doesn't really make me nauseous i do take it at night before bed sometimes i forget to take it especially when i'm on nights at work and i try to remember to take it in the morning before i go to sleep it's okay nutrition everything is more than just a day-to-day thing it's kind of a global thing so anyways i hope this article was really helpful even if you skipped through the middle part because it gets kind of dense but please leave questions about prenatal vitamins in the comments again i'm not going to get fully into the folic at foley debate so if your questions about that access the resources that i shared and anyways you can come see me on instagram to talk about my pregnancy too we'll see how many people watch this article and really get it don't forget to article every friday going over educational content to make this the happiest and healthiest pregnancy for you and i am right there with you second trimester way better than first if you want more information about first trimester i'm gonna link my article from my last pregnancy where i talked more about first trimester symptoms and i hope this was helpful i'll see you next week.
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