There is no universal agreement about the use of vitamin and mineral supplements during pregnancy . Ideally, the diet should supply all the nutriens needed so supplements are not necessary. Some physiciams prescribe a multivitamin and mineral supplement as a precaution against deficiencies. The Subcommitee on Dietary Intake and Nutrient Supplements During Pregnancy of the Food and Nutrition Board (Institute of Medicine, 1990) considers supplements During pregnancy an intervention to be used oly when specifically indicated. They point out that supplementation can create imbalances.
Because increasing one nutrient often hanges the requirement for other nutrients. There also may be unidentified essential nutrients. There also may be unidentified essential nutrients that supplementation could affect adversely.
Iron and folacin the most frequently recommended supplement, because they are difficult to obtain by diet alone. The subcommittee for an Implementation Guide (Institute of Medicine, 1992) recommends a low-dose supplement of 30 mg /d of elemental iron for the woman who is not anemic. For the anemic woman, a supplement of 60 to 120 mg/d is recommended. Iron tablets taken between meals are absorbed more completely than those taken with food. Because large doses of iron appear to depress plasma zinc in preganant women, zinc supplementation may be needed when a supplement of more than 30 mg/d of elemental iron is taken. If zinc is given, the Subcomitee recommends the addition of a 2-mg copper supplement
to offset zinc’s depressive effect on copper absorption (Institute of Medicine, 1992).
Folic acid is recommended for 4 weeks prior to conception and during the first 3 months of pregnancy (Institute of Medicine, 1992). Suplementation prior to in early pregnancy has been found to protect against neural tube defects in women who had a previously affected pregnancy (MRC Vitamin Study Research Highlight). If there is any evidence of an inadequate dietary intake, folic acid may be given throughout the pregnancy.Certain conditions or habits of the pregnant woman may increase requirements fo certain nutrients. For example, women who are carryng more than one fetus or who smoke cigarettes, drink alcohol, or use illicit drugs may require additional supplementation. Special attention also needs to be given to the adequacy of calcium and vitamin D intake for pregnant women younger than 25 years, because their bon mineral density is still increasing (Institute of medicine 1990). Calcium Supplements might be advised for women who drink little or no milk, and Vitamin B12 might be needed by the vegan who eats no animal protein (Williams, 1993). If any vitamin or mineral supplements are used, it is important for the woman to understand that these are in addition to, not stead of, her recommended dietary intake
(taken From Assesment and Management in the Antepartum Period Book)
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