Pregnancy can often feel overwhelming, filled with questions and uncertainties, especially regarding vitamins and supplements. However, navigating this essential aspect of your health does not have to be confusing. If you've done your homework, you likely understand that certain items, such as high mercury seafood, alcohol, and tobacco, are strictly prohibited during pregnancy. You might be surprised to discover that there are also specific vitamins, minerals, and herbal supplements that should be avoided. The landscape of information surrounding which supplements are safe and which are not can be inconsistent, adding to the confusion. But don't worry; we're here to help you make sense of it all.

This article provides an overview of which supplements are generally considered safe during pregnancy, along with insights on why certain supplements should be steered clear of.

Why Consider Supplements During Pregnancy?

Ensuring you receive adequate nutrients is vital at every phase of life, but it becomes particularly essential during pregnancy when you must nourish both yourself and your developing baby.

The Increased Nutritional Demand During Pregnancy

Throughout pregnancy, the requirements for macronutrients—specifically carbohydrates, proteins, and fats—escalate significantly. For instance, a pregnant woman’s protein needs rise from the standard recommendation of approximately 0.36 grams per pound (0.8 grams per kg) of body weight for non-pregnant women to around 0.5 grams per pound (1.1 grams per kg) of body weight. It is crucial to incorporate protein into each meal and snack to meet these heightened needs. Moreover, the demand for micronutrients, such as vitamins, minerals, and trace elements, often surpasses that of macronutrients. While some individuals can fulfill this increased requirement through a carefully curated, nutrient-rich diet, others may find it challenging to do so.

Consequently, vitamin and mineral supplements may become necessary for a variety of reasons, including:

• Nutritional Deficiencies: Some individuals may require supplementation after blood tests reveal a deficiency in certain vitamins or minerals. Rectifying these deficiencies is crucial, as inadequate levels of nutrients like folate have been associated with birth defects.
• Hyperemesis Gravidarum: This serious pregnancy complication manifests as extreme nausea and vomiting, potentially resulting in weight loss and nutrient shortages.
• Dietary Restrictions: Women adhering to specific diets, such as vegans or those with food intolerances and allergies, might need to supplement their intake of vitamins and minerals to avert micronutrient deficiencies.
• Smoking: Although it is imperative for expectant mothers to refrain from smoking during pregnancy, those who do may have heightened requirements for specific nutrients, including vitamin C and folate.
• Multiple Pregnancies: Women expecting more than one child have greater micronutrient needs compared to those carrying a single baby. Supplementation is often necessary to ensure the best nutrition for both the mother and her children.
• Genetic Mutations like MTHFR: The MTHFR gene plays a role in converting folate into its usable form. Pregnant women with this mutation may need to use a specific folate supplement to prevent complications.
• Poor Nutrition: Women who consume insufficient food or choose nutrient-poor options may need to supplement with vitamins and minerals to avoid deficiencies.

Additionally, experts, including those from the American College of Obstetricians and Gynecologists (ACOG), advocate that all pregnant individuals take a prenatal vitamin along with folic acid supplements. This recommendation aims to bridge nutritional gaps and mitigate the risk of developmental issues at birth, such as spina bifida. Depending on your specific situation, be ready to incorporate supplements into your daily regimen as advised by your healthcare provider.

Herbal Supplements: A Cautious Approach

Beyond micronutrients, herbal supplements have gained popularity. A 2019 study indicated that 15.4 percent of pregnant women in the United States utilize herbal supplements; however, not all disclose this information to their healthcare providers. (Research suggests that around 25 percent of herbal supplement users in the U.S. do not inform their doctors.) While certain herbal supplements may be safe during pregnancy, many others could pose risks.

Some herbs may alleviate common pregnancy issues such as nausea and an upset stomach, while others could be detrimental to both mother and child. Regrettably, there is limited research on the effects of herbal supplements in pregnant individuals, leaving much unknown regarding their safety and impact. The best course of action? Ensure your doctor is informed about any changes to your dietary habits and supplement intake.

Safe Supplements During Pregnancy

As with medications, it's crucial that your healthcare provider approves and monitors all micronutrient and herbal supplements to ensure they are necessary and consumed in safe quantities. Always select vitamins from a trustworthy brand that undergoes evaluation by third-party organizations like the United States Pharmacopeia (USP) to guarantee that the products comply with specific safety and quality standards. If you’re unsure about which brands to trust, your local pharmacist can provide valuable insights.

1. Prenatal Vitamins

Prenatal vitamins are specialized multivitamins designed to satisfy the increased need for micronutrients during pregnancy. They are recommended for use before conception, throughout pregnancy, and during breastfeeding. Research indicates that taking prenatal vitamins can lower the risk of complications such as preterm birth and preeclampsia, a serious condition marked by high blood pressure and potential protein in the urine. While these vitamins are not a substitute for a balanced diet, they can help bridge nutritional gaps by supplying essential micronutrients that are especially vital during pregnancy. Since prenatal vitamins encompass the necessary vitamins and minerals, additional supplementation may not be required unless prescribed by your healthcare provider. These vitamins are commonly recommended by doctors and are also available over-the-counter.

2. Folate (Folic Acid)

Folate is a B vitamin critical for DNA synthesis, red blood cell formation, and fetal growth and development. The synthetic variant, folic acid, is commonly found in supplements and is converted into L-methylfolate, the active form of folate, within the body. It is advised that pregnant women consume a minimum of 400 mcg of folate or folic acid daily to mitigate the risk of neural tube defects and congenital disorders like cleft palate and heart defects. A meta-analysis of five randomized studies involving 6,105 women showed that daily folic acid supplementation significantly reduced the incidence of neural tube defects, with no adverse side effects reported.

Although it is possible to obtain adequate folate through a well-rounded diet, many women fall short of eating enough folate-rich foods, making supplementation essential. Moreover, public health guidelines recommend that all women of childbearing age should consume at least 400 mcg of folate or folic acid daily, as many pregnancies are unplanned, and deficiencies can result in complications very early in gestation. For pregnant women, especially those with MTHFR genetic mutations, a supplement containing L-methylfolate may be advisable to ensure optimal absorption.

3. Iron

The demand for iron significantly rises during pregnancy, with maternal blood volume expanding by approximately 50%. Iron is essential for transporting oxygen and supporting the healthy growth and development of both the baby and the placenta. In Australia, iron deficiency affects about 18% of pregnant women, with approximately 5% suffering from anemia. Anemia during pregnancy is linked to various complications, including preterm delivery, maternal depression, and infant anemia.

The recommended daily intake of iron can typically be met through most prenatal vitamins. However, if you are diagnosed with iron deficiency or anemia, higher doses of iron may be necessary, under the guidance of your healthcare provider. If you are not iron deficient, it is advisable not to exceed the recommended intake to avoid potential side effects, which may include constipation, nausea, and unusually high hemoglobin levels.

4. Vitamin D

This fat-soluble vitamin is essential for immune function, bone health, and cellular processes. A deficiency of vitamin D during pregnancy has been associated with a heightened risk of cesarean delivery, preeclampsia, preterm birth, and gestational diabetes. The current recommendation for vitamin D intake during pregnancy is 600 IU per day; however, some experts argue that the needs may be significantly higher. Consult your healthcare provider for screening and appropriate supplementation recommendations.

5. Magnesium

Magnesium is a vital mineral involved in numerous biochemical reactions within the body, playing crucial roles in immune function, muscle health, and nerve signaling. A deficiency during pregnancy may elevate the risk of chronic high blood pressure and premature labor. Some studies indicate that magnesium supplementation might lower the risk of complications such as fetal growth restriction and preterm birth.

6. Ginger (Adrak)

Ginger root is frequently utilized as both a culinary spice and an herbal remedy. It's well-known for its efficacy in alleviating nausea caused by motion sickness, pregnancy, or chemotherapy. Results from four studies have shown that ginger is safe and effective for managing pregnancy-related nausea and vomiting. Nausea and vomiting are notably prevalent during pregnancy, affecting up to 70-80% of women in their first trimester. While ginger may aid in relieving this common pregnancy discomfort, further research is necessary to determine the optimal dosage. Always consult your healthcare provider before starting any new supplements.

7. Fish Oil

Fish oil is rich in docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), two essential fatty acids crucial for the development of the baby's brain. Supplementing with DHA and EPA during pregnancy may enhance postnatal brain development in infants and reduce the risk of maternal depression, although research findings remain inconclusive. Observational studies have suggested improved cognitive abilities in children whose mothers consumed fish oil during pregnancy; however, controlled trials have not consistently confirmed these benefits.

One study involving 2,399 women found no significant differences in the cognitive performance of infants whose mothers took fish oil capsules containing 800 mg of DHA daily during pregnancy compared to those whose mothers did not. Interestingly, this study indicated that fish oil supplementation did help protect against preterm delivery and may support fetal eye development. Maintaining adequate maternal DHA levels is important for fetal development, and supplementation is generally deemed safe. However, the necessity of fish oil consumption during pregnancy is still debated. To obtain DHA and EPA through dietary sources, aim for two to three servings of low-mercury fish such as salmon, sardines, or pollock each week.

8. Probiotics

With growing awareness of gut health, many expectant mothers are turning to probiotics. Probiotics are live microorganisms believed to provide benefits for digestive health. Numerous studies have indicated that probiotics are safe during pregnancy, with minimal risk of adverse effects, aside from an extremely low chance of infection related to probiotic use. Additionally, research suggests that probiotics may lower the risk of gestational diabetes, postpartum depression, and infant skin conditions like eczema and dermatitis. Ongoing research is exploring the role of probiotics in maternal and fetal health, and further discoveries are anticipated.

9. Choline

Choline plays a crucial role in brain development for the baby and helps prevent abnormalities of the brain and spinal cord. The current recommended daily intake of choline during pregnancy is considered insufficient, with some experts suggesting that a target closer to 550 mg is more appropriate.

It's worth noting that prenatal vitamins frequently lack choline, so a separate supplement may be advised by your healthcare provider.

Supplements to Avoid During Pregnancy

While many micronutrients and herbal supplements are beneficial for pregnant women, there are several that should be limited or completely avoided. It is crucial to consult with your healthcare provider before introducing any additional supplements beyond your prenatal vitamins.

1. Vitamin A

Vitamin A is commonly included in prenatal vitamins due to its vital role in fetal vision development and immune system function. However, excessive intake of vitamin A can pose risks. As a fat-soluble vitamin, it is stored in the liver, leading to potential toxicity and damaging effects on health, including liver damage and the risk of birth defects. Research indicates that high levels of vitamin A during pregnancy can lead to congenital birth abnormalities. Given the adequate amounts typically obtained from prenatal vitamins and food sources, extra supplementation is not necessary.

2. Vitamin E

This fat-soluble vitamin is essential for numerous bodily functions, including gene expression and immune response. Despite its importance, additional supplementation of vitamin E is discouraged. Studies have not demonstrated any positive effects on maternal or infant health from extra vitamin E and may instead heighten the risk of complications such as abdominal pain and premature rupture of the amniotic sac.

3. Black Cohosh

Belonging to the buttercup family, black cohosh is a plant utilized for various reasons, including alleviating hot flashes and menstrual cramps. However, its use during pregnancy is unsafe as it may trigger uterine contractions, risking preterm labor. Moreover, there are reports of liver damage associated with black cohosh in certain individuals.

4. Goldenseal

Goldenseal is a plant often taken as a dietary supplement to combat respiratory issues and diarrhea, yet its safety and efficacy remain inadequately researched. This herb contains berberine, which can exacerbate jaundice in newborns and may lead to kernicterus, a rare and potentially fatal type of brain damage. Therefore, it is advisable to completely avoid goldenseal during pregnancy.

5. Dong Quai

Dong quai, a root with a long history of use in traditional Chinese medicine, is often employed for various health concerns, from menstrual cramps to hypertension. However, the evidence supporting its safety and effectiveness is insufficient. Its potential to stimulate uterine contractions raises concerns about the risk of miscarriage, making it best to steer clear of dong quai during pregnancy.

6. Yohimbe

Derived from the bark of an African tree, yohimbe is touted as a herbal solution for conditions such as erectile dysfunction and obesity. This supplement should never be taken during pregnancy due to its association with serious side effects, including high blood pressure, heart attacks, and seizures.

7. Other Herbal Supplements Considered Unsafe During Pregnancy

It is prudent to avoid the following herbal supplements:

• saw palmetto
• tansy
• red clover
• angelica
• yarrow
• wormwood
• blue cohosh
• pennyroyal
• ephedra
• mugwort

The Bottom Line

Pregnancy is a crucial period of growth and development, making health and nutrition essential priorities for expectant mothers. The primary goal is to provide the best care for the little one. While certain supplements can offer benefits during this time, others may pose significant risks for both the mother and her baby. It's important to note that while supplementing with specific vitamins and minerals can help address nutritional deficiencies, these supplements should never be considered a substitute for a well-balanced diet and a healthy lifestyle. To promote a healthy pregnancy for both you and your baby, focus on nourishing your body with nutrient-rich foods, maintain a regular exercise routine, ensure adequate sleep, and manage stress effectively. Though there are situations where supplements may be necessary and beneficial, it is crucial to consult with your healthcare provider about appropriate dosages, safety, and any potential risks or advantages.