supplement in pregnancy

Question 1

What folic acid supplementation is recommended?

Why?

Answer 1

The recommended dose of folic acid is at least 0.4mg daily to aid the prevention
of neural tube defects (NTD).
It should be taken from 1 month before pregnancy and for the first trimester.
Where there is a known increased risk of NTD or a risk of malabsorption, a 5mg
daily dose is recommended.

Question 2

Who should get B12 supplementation in pregnancy?

Answer 2

Vegetarians and vegans should be supplemented with Vitamin B12 in pregnancy
and lactation. The RDI of B12 in pregnancy is 2.6 mcg/day. The RDI of B12 during lactation is 2.8 mcg/day.

Question 3

How to decide what doses of Vit D to give?

Answer 3

Pregnant women with Vitamin D level below 50nmol/L
For pregnant women with levels 30–49 nmol/L, commence 1,000 IU (25μg)/day.

Pregnant women with levels < 30 nmol/L should commence 2,000 IU
(50μg)/day.

Repeat the Vitamin D level at 28 weeks gestation.

Pregnant women with Vitamin D level above 50nmol/L
These women should take 400 iu Vitamin D daily as part of a pregnancy
multivitamin

Question 4

Who gets Vit K supplemetation?

Answer 4

Vitamin K should be administered in late pregnancy to women with proven
cholestasis of pregnancy, due to reduced Vitamin K absorption.

AEDS 10-20 mg late in pregnancy

Question 5

Shall we just given everyone iron?

Answer 5

Routine iron supplementation is not recommended in every pregnancy. All women
should have their haemoglobin level checked at the first antenatal visit and again
at approximately 28 weeks’ gestation and any anaemia investigated and treated.

Question 6

What is the recommended calcium intake in pregnancy?

Who should get it?

Answer 6

The recommended dietary intake of calcium per day for pregnant women is
1300mg (ages 14-18 years) and 1000mg (19-50 years).
If the woman avoids dairy in her usual diet and does not consume alternative high
calcium foods, she should take a calcium supplementation of at least 1000mg
per day.

Question 7

Iodine and when?

Answer 7

Women who are pregnant, breast feeding or considering pregnancy should take
an iodine supplement of 150 micrograms each day.

Question 8

Who should take omega 3 fatty acids?

Answer 8

Women whose dietary intake of Omega-3 fatty acids is low, for example those
who eat very little seafood, should consider a dietary supplementation which may
be obtained from fish oil and some commercially available pregnancy
supplements

Question 9

Who should get higher doses folic acid?

Answer 9

Obese BMI over 30
AEDs by either parent,
prev child with NTD / FHx
Diabetes

Woman with other risk factors like haemolytic anaemia and multiple pregnancy should have the Hb monitored and treated if evidence of folate deficiency

Question 10

What does B12 deficiency result in in fetuses ?

Answer 10

Untreated

maternal B12 deficiency has been reported to cause neurological sequelae in exclusively breast fed infants

Question 11

What does the MTHFR mutation do?

How to prevent its affects?

Answer 11

Hyperhomocysteinaemia is the commonest of the thrombophilias with approximately 1.5% of the
population being homozygous for the MTHFR mutation and 25% heterozygous. The thrombophilic
tendency is minimised by an adequacy of folate, riboflavin, B6 and B12. In the absence of any screening for this condition, some clinicians advise that all women should ensure an adequate intake of these
vitamins.

Question 12

Who is at risk of vitamin D deficiency?

Answer 12

(i) those with reduced sunlight skin exposure e.g. veiled women,
(ii) those who use
sunscreen on a regular basis,
(iii) dark-skinned women,
(iv) mothers of infants with rickets and
(v) women
with a BMI >30.

Question 13

What are the effects of low Vit D?

Answer 13

Vitamin D deficiency in the neonate and the infant is associated with impaired skeletal development and an increased incidence of hypocalcaemic seizures.

From the mother’s perspective Vitamin D deficiency is known to be an important risk factor for the development of osteoporosis in later life.

Question 14

When to screen for iron deficiency anaemia?

Answer 14

booking and 28/40

Question 15

What is the benefit for calcium supplementation?

Answer 15

A Cochrane Systematic review has reported a benefit of calcium
supplementation, of at least 1000mg/day during pregnancy, in reducing the incidence of hypertensive
disorders and preterm labour. The effect on pre-eclampsia was greater for women with low baseline
calcium intake

Question 16

Where is omega 3?

Answer 16

vegetable oils and seafood.

Seafood is the
richest source of the most biologically active Omega-3 fatty acids, docosahexaenoic acid (DHA) and
eicosapentaenoic acid (EPA

Question 17

What is the down side of eating too much fish?

What are the serving recommendations?

Answer 17

While there are many nutritional benefits from eating fish in pregnancy, concerns have been raised
regarding the intake of environmental pollutants, particularly mercury. This concern has prompted
guidelines from Food Standards Australia New Zealand to recommend no more than 2-3 serves (150g /
serve) of fish per week for pregnant women. Further, for large long living fish there are additional
restrictions advised, for example one serve of shark per fortnight is recommended, with no other fish intake
for the fortnight

Question 18

What will fish oil help with?

Answer 18

maybe neurodevelopmental outcomes and reduction of PTB

No conclusive evidence of benefit using fish oil supplements in pregnancy is yet confirmed and further
meta-analysis and well powered, high quality trials are needed