Prenatal Vitamins: the ABCs

Obtaining early and routine prenatal care is essential to the health and well-being of women who are pregnant and their unborn children, as well as women planning to become pregnant. Throughout pregnancy, adequate nutrition and prenatal vitamin supplementation are essential to the additional energy needs of mothers-to-be and the development of their unborn babies. Pharmacists are in a pivotal position to increase awareness regarding the significance of routine prenatal care, and to serve as a patient resource for the selection and proper use of prenatal vitamin supplements.

PRENATAL CARE

Complete prenatal care includes establishing good nutrition and healthy habits, before conception, maintaining them during pregnancy, and having routine prenatal exams throughout pregnancy. According to the US Department of Health and Human Services Office of Women’s Health, babies born to mothers who do not receive prenatal care are 3 times more likely to have a low birth weight.¹ This agency provides women with various measures they can employ prior to conception and throughout pregnancy to promote their health and that of their unborn children.1 Examples of these measures follow:

• Take at least 400 to 800 mcg of folic acid daily, at least 3 months before conception, to decrease the risk of birth defects of the brain and the spine
• If you have a preexisting medical condition, discuss conception with your primary health care provider (PHCP)
• Cease use of alcohol and tobacco
• Avoid contact with toxic or harmful chemicals and materials
• Because some medications, as well as dietary and herbal supplements, are harmful to take during pregnancy, discuss all of these products with your PHCP to determine if any should be discontinued
• Make sure all your vaccinations are up-to-date

FORMULATIONS OF PRENATAL VITAMIN SUPPLEMENTS

Prenatal vitamins are available in prescription and OTC forms. Patients should be encouraged to consult their PHCP about which option will suit their individual nutritional needs. PHCPs often suggest a specific brand of prenatal vitamin supplement. These formulations provide nutrients essential to proper fetal development and should be used in conjunction with a healthy diet.¹

Prenatal vitamins contain key nutrients, such as folic acid (folate), calcium, iron, and docosahexaenoic acid (DHA; an omega- 3 fatty acid).² Other minerals and vitamins (eg, vitamins C, D, and E, and B vitamins) may also be included (Table 1).² Many prenatal vitamins are formulated with omega-3 fatty acids to aid in fetal brain and eye development.^2,3 Pregnant women should obtain at least 200 mg of DHA daily.³

According to the American College of Obstetricians and Gynecologists (ACOG), during pregnancy, women need higher amounts of folic acid and iron.⁴ Women should take folic acid before and during pregnancy. Folic acid has a key role in cell division, DNA production, and the development of the brain and the spinal cord.⁵ Women need folic acid daily to help prevent major neurologic birth defects called neural tube defects.⁴ Current dietary guidelines recommend that pregnant women obtain at least 600 mcg of folic acid daily from all sources.⁴ Because it may be difficult for women to obtain folic acid via diet alone, ACOG recommends that all pregnant women and women planning to conceive take a daily vitamin that contains the recommended amount of folic acid.⁴ In addition, the recommended daily dose of iron during pregnancy is 27 mcg, and all women, including pregnant women 19 years and older, should obtain at least 1000 mg of calcium daily.⁴

PATIENT COUNSELING

Pharmacists can help patients select OTC prenatal vitamins and educate them on their proper use. Ideally, prenatal vitamins should be taken on an empty stomach with water; however, patients who experience nausea while taking prenatal vitamins should try taking them at bedtime and with a light snack. Patients should be advised to immediately consult their PHCP if they experience extreme nausea and/or vomiting. Because the iron in some prenatal vitamins may cause constipation, pharmacists should recommend measures to prevent or decrease constipation, including the following:

• Always stay hydrated
• Include more fiber in your diet
• Ask your PHCP about using a stool softener

To avoid potential product contraindications or interactions, patients should inform their PHCP of all prescription and OTC medications and nutritional supplements they are taking. Patients should also be advised to never take medications or nutritional supplements without first consulting their PHCP. Patients should always take vitamin supplements from reputable manufacturers.

Patients with preexisting medical conditions should always be referred to their PHCP before taking a supplement, to ensure that its use is appropriate. Pharmacists should remind patients to eat a balanced diet, maintain a healthy weight, exercise regularly, get an adequate amount of rest, and continue routine visits with their PHCP. Pharmacists can direct patients to excellent patient resources on proper prenatal care (Table 3).

Ms. Terrie is a clinical pharmacist and medical writer based in Haymarket, Virginia.

References

• Prenatal care fact sheet. United States Department of Health and Human Services Office of Women’s Heath website. http://womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.html. Accessed April 18, 2016.
• Ural SH, Chelmow D. Prenatal nutrition. Medscape website. http://emedicine.medscape.com/article/259059-overview#a6. Accessed April 18, 2016.
• Vitamins and other nutrients during pregnancy. March of Dimes website. http://www.marchofdimes.org/pregnancy/vitamins-and-other-nutrients-during-pregnancy.aspx. Accessed April 18, 2016.
• Nutrition during pregnancy. The American College of Obstetricians and Gynecologists website. http://www.acog.org/-/media/For-Patients/faq001.pdf?dmc=1&ts=20150402T1126130956. Accessed April 18, 2016.
• Plan ahead: folic acid can help prevent certain birth defects. CDC website. http://www.cdc.gov/features/folicacidbenefits. Accessed April 18, 2016.