Supplement Use in pregnancy

Question 1

When is Day 1 of pregnancy?

Answer 1

Day 1 of pregnancy is the first day of the woman’s LAST MENSES

Question 2

When is the most susceptible time for fetal development

Answer 2

week 3-4 in pregnancy

CNS, heart and brain development here

Question 3

When is neural tube fusing process finish?

Answer 3

Complete 28 days after conception.. Women know they’re pregnancy 6 weeks in

Question 4

Explain the 2 types of neural tube defects

Answer 4

Spina Bifida
- a cleft/split opening in the back part of the spinal vertebrae
- Commonly meningocele: opening in spine allows spinal cord to be exposed

Anencephaly
- Cephalic end of neural tube fails to close
- leads to major absence of brain/skill/scalp portions

Question 5

What are risk factors for NTDs (3)

Answer 5

1) genetics: up to 3rd degree relative with history NTD

2) environmental:
- diet
- smoking, alcohol
- GI absorption
- diabetes type I or II
- kidney dialysis
- drug interactions
- low socioeconomic status

3) Drugs
- Carbamezpine
- Phenytoin
- Phenobarbital
- Methotrexate
- metformin
- Sodium valporate
- Sulfasalazine

Question 6

Differentiate between folic acid and folate. From where? Bioavailability?

Answer 6

Folic acid: from supplements B9
- 100% bioavailable

Folate: from food (brocoli, spinich, peanuts, beans)
- 50% bioavailable

Question 7

What does the SOGC recommend for all women 12-45 who could become pregnant in vitamin (3)

Answer 7

Take oral multivitamin that includes
- folic acid
- 2.6mg B12
- 16-20 mg iron

**do not take 2 multivitamins to achieve needed dose

Question 8

What is the criteria for LOW risk level. Folic acid recommendation SOGC?

Answer 8

Criteria
- No family history

Recommendation
0.4mg/day MV + folate rich diet
- 3 months before conception
- 4-6 weeks post birth or until breastfeed stops

Question 9

What is the criteria for MODERATE risk level. Folic acid recommendation SOGC?

Answer 9

Criteria
- Family History
- Co-morbidities (GI, diabetes)
- some drug interactions

Recommendation
1mg daily MV + folate rich diet
- 3 months before conception & first trimester
0.4mg/day reduced
- until post birth or when breastfeeding stops

Question 10

What is the criteria for HIGH risk level. Folic acid recommendation SOGC?

Answer 10

Criteria
- PERSONAL history or relative that has it
- Antifolate drug interactions
- Medical condition affecting folate levels (obesity)
- Adherence issues

Recommendation 2 options
1. 4-5mg supplement 3 months before conception and first trimester
- decrease to 0.4 mg till post-birth or when breastfeeding stops

2. Use pre-conception assessment of maternal serum folic acid to determine appropriate dose

Question 11

When to give high dose OTC folic acid? Dose?

Answer 11

If on any drugs that reduce absorption

1 multivitamin (1mg) + 3 x 1mg tabs

Question 12

What vitamins/supplements should you NOT use during pregnancy (6)

Answer 12

Vit C
VIt E
Omega-3

High dose Vit A: teratogeneic
High dose of caffeine (>300mg/day): risk of miscarrige
Cannabis

Question 13

What supplements should you use in pregnancy? why? dose? (3)

Answer 13

Iron: 16-20 mg iron MV
- prevent IDA

Vit D: 600+IU/day
- can inc chances of pregnancy + live birth

Calcium: 1000mg for 18yo or 1300mg for 19+ get it from food first - only supplement if deficient
- low calcium can decease bone mass in mother/fetus