Supplements

CALCIUM and Vitamin D

Every pregnant woman needs a minimum of 1000 to 1200 milligrams daily of Calcium, equivalent to about 3 to 4 dairy servings daily. Dairy sources include milk, yogurt, cottage cheese, cheese, tofu, soymilk and ice cream. Supplementation is advised (usually 300 to 600 mg. daily) if this dairy intake is not met.

Many calcium supplements contain calcium carbonate. This is the least expensive form of calcium (Tums, OsCal) but it has low absorption by the body, which can lead to GI side effects such as bloating and gas. We prefer CitraCal and Caltrate calcium.

Most calcium supplements contain Vitamin D, typically 400 to 600 IU (units) per tablet, some contain 1,000 IU. Your PN Vitamin might have some Vitamin D also, maybe 200 to 400 IU. It is okay to take both. A total daily dose of Vitamin D of 1,000 to 2,000 IU is safe and probably not a bad idea!

Milk has Vitamin D, right?

Have you seen the label on a carton of milk that says Vitamin A&D fortified? Don't get me wrong, milk is quite healthy, although organic milk is probably the only version of milk worth drinking. But the amount of Vitamin D is surprisingly low. (Non-fortified milk has close to zero Vitamin D by the way). Most people do not know this, but a single 8 ounce of glass of Vitamin D fortified milk probably has just 80-100 IU of Vitamin D, far lower than the recommended amount. But it sure looks good on the label to say Vitamin D fortified!

IRON

The daily iron requirement for non-pregnant women is about 18 mg. During pregnancy, it is about 30 mg.

We do not routinely put patients on an iron supplement. There is enough iron in most prenatal vitamins and iron can be constipating. However, if your lab tests show anemia, we may ask you to take extra iron.

The body does not absorb most of the iron you swallow. Excess iron comes out in the stool, causing it to turn dark. Iron can also cause GI side effects such as heartburn, indigestion and constipation. It should be taken with meals, usually dinner. We like Slow-Fe, a slow release form of iron. Feo-Sol, Fergon and Fer-In-Sol are other good brands. These are available in the drug store without a prescription.

There are liquid iron preparations that many people prefer to iron pills. One liquid iron we like is called Floravital.  2 teaspoons contains 10 milligrams of iron, so you should take 1 tablespoon (3 teaspoons) a day.

How much iron is in food by the way? A good rule of thumb is that there is about 5 mg of iron in 1/2 cup of green leafy veggies (spinach) or one burger patty or equivalent sized piece of red meat.

DHA

Some evidence suggests a benefit from omega-3 and omega-6 vitamins, found in fish oil or flaxseed oil. The fish oil does not have the mercury risk as does certain fish (read the labels). Nearly all prenatal vitamins are now incorporating DHA (one of the omega-3 fatty acids). Sometimes it is combined into one pill, sometimes it is separate. A typical dose is 250 to 300 mg. of DHA. Some experts are now advising as much as 1,000 mg a day of DHA but this is not widely agreed on.

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