Importance of supplementation during pregnancy
Pregnancy can be nutritionally challenging, requiring increased demands for energy, protein, vitamins and minerals. The maternal diet must provide adequate amounts of nutrients both for the developing foetus and to maintain its metabolism until the ninth month of pregnancy. Changes in nutrient intake can affect maternal and foetal health and increase the risk of certain diseases in adulthood.
Therefore, during pregnancy, before conception and afterwards, care and nutrition, together with a healthy lifestyle, are essential for the mother-to-be and the proper development of the foetus.
The demand for nutrients is highest during preconception, pregnancy, postpartum and lactation, so a balanced diet can be supplemented with food supplements to balance the incremental energy requirement.
There are certain nutrients, vitamins and natural ingredients that are beneficial during these stages. It is always advisable to consult a medical professional, gynaecologist or midwife before taking any supplements.
Essential vitamins and minerals during pregnancy
Scientific evidence has shown that micronutrients that promote normal embryonic and foetal development include folic acid (vitamin B9), iron, iodine, calcium, vitamin B12, vitamin D and omega-3 fatty acids.
The benefits they provide and why they are among the most recommended, according to the Clinical Practice Guide on Care in Pregnancy and the Postpartum Period of the Ministry of Health, Social Services and Equality and the European Food Safety Authority (EFSA), are detailed below.
Folic acid during pregnancy (Vitamin B9)
Folates are essential nutrients, which cannot be synthesised by the body, and must therefore be incorporated through the diet, and their intake is essential during pregnancy.
The relationship between folic acid deficiency during foetal development and the increased risk of neural tube defects (NTD), one of the most common congenital anomalies that occurs between days 21 and 27 of embryonic life and the most commonly known is spina bifida, is well known.
To obtain adequate levels of this vitamin, a balanced diet is recommended, in which green leafy vegetables, fruits, legumes, yeasts, liver, cereals and nuts are the foods with the highest folic acid content.
Given the importance of this vitamin, EFSA has defined a daily supplementary intake of folic acid during pregnancy of 400-600 µg for at least one month before and up to three months after conception. Therefore, this supplementation should be maintained throughout pregnancy, on a daily and uninterrupted basis, as this vitamin does not accumulate in the body.
Vitamin D for maternal bone health
Vitamin D or calciferol contributes to the normal maintenance of bone and muscle function. Although its supply is provided by sun exposure and diet, vitamin D deficiency is more common than would be expected, even in sunny countries.
During pregnancy, an adequate supply of this vitamin is essential to maintain maternal health and proper foetal skeletal growth. Deficiency is associated with intrauterine growth retardation (IUGR), rickets, and changes in tooth enamel, among others.
A recent study of more than 300 pregnant women from 14 weeks to the end of pregnancy demonstrated the positive effect of oral vitamin D supplementation on maternal bone health by reducing the increase in the bone resorption marker.5
According to EFSA, the vitamin D requirement for pregnant women is 15 µg/day (600 IU). During the preconception period the recommendation is 5 micrograms per day.
Vitamin B12 in pregnancy
Vitamin B12 plays an important role in folate absorption during pregnancy and is involved in erythropoiesis (production of red blood cells in the body). Deficiency is associated with an increased risk of spina bifida, impaired cognitive function and megaloblastic anaemia.
The daily requirement of this vitamin increases during the gestational period, with EFSA recommending a daily intake in pregnancy and lactation of 4.5 µg/day and 5 µg/day, respectively.
Iodine supplementation during pregnancy
Iodine is an essential nutrient that contributes to normal cognitive and nervous system function and to the normal production of thyroid hormones, which are necessary for proper brain and mental development throughout foetal and neonatal life.
According to the WHO (World Health Organisation), iodine deficiency is the leading cause of preventable brain damage worldwide.
Through the mother, the foetus receives maternal thyroid hormones, and its supply is particularly sensitive during weeks 10-12 of pregnancy. Deficiencies can have an irreversible impact on the child’s neurological development in the first half of pregnancy.
Due to the above, it is important to ensure adequate levels during pregnancy, bearing in mind that in Spain the prevalence of hypothyroidism is 9.1%, with a prevalence of 14.4% in women.
Iodine intake should be taken daily, as folates are not stored in the body. Several scientific societies, together with the EFSA, have decided that iodine intake should be increased during pregnancy and lactation, for example, by using iodised salt and a supplement of 200 µg/day of iodine.
Iron supplementation for women
Throughout pregnancy, most women will experience haematological changes, with iron deficiency anaemia (iron deficiency anaemia) being the most common nutritional deficiency in pregnant women (40%).
Iron deficiency during pregnancy has been linked to prematurity and reduced physical and neurological development of newborns, as iron contributes to the normal cognitive development of children.In the second and third trimester of pregnancy, a negative iron balance is common, so in addition to an iron-rich diet, extra iron supplementation is very positive.
Thus, during the second half of pregnancy in women without a history of iron deficiency and with adequate iron reserves, oral supplementation with low doses of iron, specifically 7-16 mg/day, is recommended. According to EFSA, such supplementation can also be prolonged during the lactation period.
Omega 3 in pregnancy
Omega 3 fatty acids play an energetic and metabolic reserve role in the body. Specifically, the omega-3 polyunsaturated fatty acids EPA and DHA support normal growth and brain development and, since they are not synthesised in the body, they must be supplied through the diet in foods such as fish, fish oils, milk and cultured seaweed.
An adequate supply of omega-3s in children and adults helps prevent deficiency states and chronic diseases.
During pregnancy and lactation, the omega-3 requirements of the foetus or infant are almost entirely dependent on the mother.
Studies have shown that both the foetus and newborns demand amounts of Omega 3 that exceed the intake of most pregnant and lactating women, highlighting a potential shortage for both mother and baby. This demonstrates the importance of improving maternal omega-3 status during pregnancy and lactation, which can be done through omega-3 supplementation.
Following evaluation of the benefit of omega-3 intake during pregnancy, nutrition experts, obstetricians and neonatologists concluded at the “European Consensus Conference on the Recommendation of Polyunsaturated Fatty Acids for Pregnant and Lactating Mothers” that the daily intake of omega-3 polyunsaturated fatty acids should be increased by 200 mg DHA/day during pregnancy and lactation.
Thus, and in accordance with EFSA, the following recommendations are established for pregnant or conceiving and breastfeeding women.
- 250 mg/day DHA and EPA + 100-200 mg/day DHA (Omega-3).
- 0.5% Alpha-linolenic acid (Omega 3) of total energy intake.
- 4% linoleic acid (Omega 6) of total energy intake.
Calcium in pregnancy
Calcium is the most abundant mineral in humans, because it is found as part of our bone structure and contributes to normal muscle function and neurotransmission. The adaptive physiological changes that occur during pregnancy (e.g. increased efficiency of absorption to facilitate delivery from the mother to the foetus) are largely independent of maternal calcium intake.
Consequently, the EFSA expert panel concludes that no additional calcium supplementation is required in pregnant and lactating women, as the recommended daily intake (750 – 860 mg/day) is covered through the diet with 2-3 servings of calcium-rich foods such as cheese, milk and non-dairy sources. In case of calcium supplementation during pregnancy, a physician should be consulted.
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