In Part 7 of our Drugs in Pregnancy series, we’re talking about supplements. You know you need vitamins and minerals (your healthcare provider likely prescribed prenatal vitamin for you). But are other supplements — even ones that seem benign — always a smart swallow when you have a growing baby to consider? It’s a sticky subject, for sure.
Unlike medications, the FDA does not test and monitor the safety or efficacy of supplements. Vitamins and minerals do, however, have at least both an established recommended daily allowance (RDA) and a daily safety limit set by the U.S. Department of Agriculture.
Are Supplements Safe?
The FDA also doesn’t oversee the manufacture of supplements, so there’s no way for a consumer to be certain of what they are purchasing and ingesting. 4 large national retailers were recently found to have sold supplements that did not contain any ingredient as labeled, with some containing ingredients that could cause an allergic reaction.
For most supplements, there’s even less data available when it comes to how they affect pregnancy and lactation. “There’s such a large variation of the composition of what you’re buying, and you can’t be sure of what you are buying that we can’t tell you whether it’s going to be effective or even safe in that sense,” says Lori Wolfe, a certified genetic counselor who advises women about the risks of medication use in pregnancy and while breastfeeding. (Wolfe is also the president of of MotherToBaby, a free, national informational service of the non-profit Organization of Teratology Information Specialists).
Pregnant women are often told to take prenatal vitamins. Most prenatal vitamins contain folate/folic acid, iron, calcium, Vitamin C, zinc, copper, Vitamin B-6, and Vitamin D. Of these, only folate/folic acid, which has been shown to prevent miscarriage and neural tube defects, such as spina bifida and other defects of the brain and spinal cord, is considered necessary and recommended for women of childbearing age, by the World Health Organization, the Institute of Medicine, and the ACOG. The US Recommended Daily Allowance (RDA) for folate during pregnancy is 600 μg/day, or 0.6 mg/day. While most women don’t get enough folic acid in their daily diet, birth defects can only be prevented during the first trimester when a woman might not realize she is pregnant. For this reason, women trying to conceive may want to take a folic acid supplement or eat foods high in folate such as spinach and other dark, leafy greens; cooked lentils; breads and cereals fortified with folic acid; cantaloupe; and eggs.
If you do take a prenatal vitamin, stay below the RDA for each vitamin and don’t combine a prenatal vitamin with other vitamins, minerals or multivitamins to avoid potentially toxic doses. To avoid feeling nauseous, the most common side effect of not just prenatal vitamins, but multivitamins in general, take them with food and before bedtime, rather than on an empty stomach first thing in the morning. Ginger ale and tea made with real ginger can also alleviate nausea.
As always, it’s best to get the nutrients your body and your baby needs through a healthy diet of lean protein, whole grains, and fresh fruits and vegetables. Talk to your doctor before taking any herbal medication or supplement, as some may also interact with other medications you may be taking.