Vitamins and Nutrients in Pregnancy

Question 1

Avoid during Pregnancy

Answer 1

1. Cigarettes
2. Alcohol
3. Illicit drugs
4. Stimulants
5. Vitamin A (at higher doses, >5000 IU)
6. Liver (due to Vit A)
7. Herbal products, supplemental use (5-10% report use in pregnancy): potential for harmful effects; no control over strength, purity; potential for interactions
8. Diet, special diet, skipping meals
9. Iodine excess / deficiency: fetal goiter; deficient iodine (hypothyroidism)
10. Limit certain fish (methylmercury risk)
11. Undercooked or raw fish, meat, etc (parasite risk)

Question 2

Prenatal Vitamin Supplements

Answer 2

1. Various products (Rx, OTC) may not be equivalent/interchangeable; content not standardized
2. Regulation as “supplement”
3. Potential compliance issues - healthy individuals may not appreciate need so
   EDUCATE
4. Adverse effects: Nausea, vomiting, constipation (esp Fe containing), take with food or in evening; constipation - hydration, fiber intake, activity

Question 3

Folic Acid Function

Answer 3

Cell division, DNA synthesis, Neurodevelopment

Question 4

Folic Acid use in pregnancy

Answer 4

1. Start pre-conception (preferably in months before)
2. Neural tube closure at 18-26 days post conception
3. Populations at risk for deficiency (e.g. epilepsy, family history of neural tube defect, etc.)

Question 5

Folic acid Dose

Answer 5

decrease NTD risk: preconception and 1st trimester

-400-800 mcg daily: different doses for certain high risk groups

Question 6

Folic acid adverse effects

Answer 6

Water soluble-few AE; may mask deficiency of Vit B12

Question 7

Iron Funcion

Answer 7

• Hb (70-80% of total body Fe); myoglobin; iron containing enzymes
• Other: transferrin, Ferritin (storage Fe pool)
• Fe from degraded RBCs recycles (120 days)
• Loss largely due to blood loss
• Iron deficiency anemia
• Fe requirements: Increase RBC production

Question 8

Iron use in pregnancy

Answer 8

-Expansion of maternal RBC mass, blood volume; RBC production in fetus

Question 9

Iron Dose

Answer 9

• Determine by Hb and iron status prior

- General pregnancy RDA= 27 mg/day (vs 15-18 mg/d non pregnant)

Question 10

Iron Adverse Effects

Answer 10

-GI: nausea, bloating, constipation, diarrhea, etc., dark stools; CAUTION: overdose can be fatal; leading cause of death in poisonings

Question 11

Oral Iron

Answer 11

• With adequate stores, Fe absorption is decreased
• Dietary: heme form best
• Various (ferrous sulfate, gluconate, fumarate, etc (solid or liquid)
• Ferrous (more easily absorbed) vs ferric
• 10% absorbed
• Vit C increases absorption
• Food decreases absorption (but may help w GI distress initially)

Question 12

Calcium Functions

Answer 12

-Bone, neuronal excitement/NT release, muscle contraction, cardiac action potential, contraction, blood coagulation

Question 13

Calcium in Pregnancy

Answer 13

• Fetal skeletal development (mostly 3rd trimester)
• Maternal skeletal
• Prevention of preeclampsia (more research needed)

Question 14

Calcium Dose

Answer 14

-for preg/lactation: 1000 mg elemental Ca++/day (19-50) yrs

Question 15

Ca Salts Oral

Answer 15

• Forms vary and have differing Ca++ content (calcium carbonate, citrate, etc)
• Common adverse effects include GI esp constipation