Pregnancy supplements

The proper role of vitamin supplementation is in the treatment of deficiency in patients who have inadequate intake or absorption, or an increased requirement. In pregnancy, supplementation of certain vitamins may be recommended. The role of vitamins in the body is summarised in Table 1.3. 

Iron supplements are often used to treat iron-deficient anaemia. This might occur through severe haemorrhage, dietary deficiency or malabsorption of iron and in pregnancy. Supplements are usually salts of iron. Iron supplements may be administered orally, or sometimes by injection, in the form of ferrous fumarate, ferrous gluconate, ferrous glycine sulphate and ferrous sulphate. 

Give supplemental folic acid, 1-4 mg daily, to all women of child-bearing potential Use monotherapy whenever possible Use the lowest doses that control seizures Continue pharmacotherapy that best controls seizures prior to pregnancy... 

Administer supplemental vitamin K during the eighth month of pregnancy to women receiving enzyme-inducing antiepileptic drugs... 

A recent consensus panel recommends calcium- or magnesium-containing antacids as first-line therapies for heartburn in pregnancy.21 This recommendation was based on the added benefit of calcium and magnesium supplementation. Avoid antacids containing aluminum hydroxide owing to associations with fetal neurotoxicity.22... 

Folic acid supplementation with 1 mg daily generally is recommended in adult SCD patients, women considering pregnancy, and any SCD patient with chronic hemolysis.6 Because of accelerated erythropoiesis, these patients have an increased need for folic acid. There are conflicting studies in the SCD population, especially among infants and children, but if the child has chronic hemolysis, supplementation is recommended.21... 

Some dietary supplements have no known precautions, while others have many precautions and contraindications. It is recommended that the use of ginseng be avoided in patients with hypertension, psychological imbalances, headaches, heart palpitations, insomnia, asthma, inflammation, infections with high fever, or pregnancy and in children [37]. 

Many dietary supplements should be avoided in pregnancy because they may have emmenagogue activity, promoting menstruation. Some herbs that are considered emmenagogues are feverfew, garlic, and hawthorn [4]. St. John s wort should be avoided in pregnancy due to its emmenagogue and abortifacient properties. 

The advice on vitamins for the general population is that supplementation is unnecessary for a normal diet. However, vitamin deficiency can occur in the elderly (due to poor nutrition, and lack of sunlight) the very young, the malnourished, when food absorption problems exist or when there is an exceptional demand as in pregnancy. Some of the general points about vitamins are ... 

Anti-epileptic drugs, such as phenytoin, carbamazepine and valproate, may lead to neural tube defects if administered during pregnancy. Concurrent administration of folate supplements, such as folic acid, is recommended. 

Folic acid (vitamin Bg) is a conjugate of a pteridine unit, p-aminobenzoic acid, and glutamic acid. Deficiency of folic acid leads to anaemia, and it is also standard practice to provide supplementation during pregnancy to reduce the incidence of spina bifida. 

Oral As a dietary supplement when calcium intake may be inadequate. Conditions that may be associated with calcium deficiency include the following Vitamin D deficiency, sprue, pregnancy and lactation, achlorhydria, chronic diarrhea, hypoparathyroidism, steatorrhea, menopause, renal failure, pancreatitis, hyperphosphatemia, and alkalosis. Some diuretics and anticonvulsants may precipitate hypocalcemia, which may validate calcium replacement therapy. Calcium salt therapy should not preclude the use of other corrective measures intended to treat the underlying cause of calcium depletion. 

Prescribers are advised to consult the package insert of any medication administered concomitantly with hormonal contraceptives, because some medications may decrease the effectiveness of these birth control products. Patients should be prospectively cautioned not to self-medicate with the herbal supplement St. John s wort because a possible interaction has been suggested with hormonal contraceptives based on reports of breakthrough bleeding while on oral contraceptives shortly after starting St. John s wort. Pregnancies have been reported by users of combined hormonal contraceptives who also used some form of St. John s wort. 

Dunstan, J. A., Roper, J., Mitoulas, L., Hartmann, P. E., Simmer, K., and Prescott, S. L. (2004). The effect of supplementation with fish oil during pregnancy on breast milk immunoglobulin A, soluble CD14, cytokine levels and fatty acid composition. Clin. Exp. Allergy 34, 1237-1242. 

In most adults with anemia 100 mg elemental iron per day usually produces an adequate response. Iron supplementation in prophylactic doses of 60 mg of elemental iron daily may be justified, e.g. in pregnancy and lactation. 

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