In addition to protein, fats, carbohydrates and fiber, the body needs small amounts of other nutrients, the vitamins and minerals. Vitamins are complex organic chemicals which are essential for normal functioning of our bodies’ cells. Some vitamins are involved in the cell-energy process, others in the production or breakdown of tissue. Some vitamins play a support role for other vitamins. The minerals used in the human body are many of the same inorganic elements which make up our planet (iron, zinc, copper, calcium, etc.). At least 13 minerals are used by the human body.
Almost all the vitamins and minerals a pregnant woman needs are supplied in a balanced diet consisting of fruits, vegetables, legumes, dairy products and meats. Below is a list of the recommended dietary allowances of the essential vitamins and minerals for both pregnant and non-pregnant women. Your doctor or midwife should make some attempt to analyze your nutritional intake. A 24-hour diet recall is a good starting point, but some practitioners prefer a 3-day diet recall. Although vitamin/mineral supplementation is common in pregnancy, it is not always necessary. If you or your clinician are uncertain if you should be on a supplement, a consultation with a dietician/nutritionist is a good idea.
| RDA, adult women | RDA, pregnant women | |||
| Water-soluble Vitamins | ||||
| B1 (thiamine) | 1 mg | 1.4 mg | ||
| B2 (riboflavin) | 1.2 mg | 1.5 mg | ||
| B6 (pyridoxine) | 1.6 mg | 2.2 mg | ||
| B12 (cyanocobalamin) | 2.0 mcg* | 2.2 mcg* | ||
| Biotin | 30-100 mg | no increase in pregnancy | ||
| C | 60 mg (100 mg for smokers) | 70 mg | ||
| Folic acid | 0.4 mg | no increase in pregnancy | ||
| Niacin | 11.3-13.3 NE** | 13.3-15.3 NE | ||
| Pantothenic acid | no RDA has been established | |||
| Fat-soluble Vitamins | ||||
| A | 800 RE *** | no increase for pregnant women | ||
| D | 0.005 mg (200 IU) | 0.01 mg (400 IU) | ||
| E | 8 mg | 10 mg | ||
| K | 1mcg/kg | no increase for pregnant women | ||
| Minerals | ||||
| Calcium | 1200mg (ages 11-24) | 1200 mg | ||
| 800 mg (ages 24+) | ||||
| Copper | 1.5-3 mg**** | |||
| Iron | 15 mg | no increase for pregnant women | ||
| Magnesium | 280 mg | 300 mg | ||
| Manganese | 2-5 mg | no increase for pregnant women | ||
| Molybdenum | 0.075-0.25 mg | no increase for pregnant women | ||
| Selenium | 0.055 mg | no increase for pregnant women | ||
| Zinc | 12 mg | no increase for pregnant women | ||
| *B12 is stored over long periods of time in the human body. Deficiencies are rare except in strict vegetarians. |
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| **NE = niacin equivalents (since tryptophan is converted into niacin in tbe body; 1 NE = 60mg of tryptophan = 1 mg niacin) |
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| ***RE = retinol equivalents (vitamin A is derived from both retinol and carotenoids, which have different levels of bioavailability; 1 mg retinol = 1,000 RE = 3,333 IU) |
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| ****There is no RDA for copper yet. However, the National Research Council has determined this level to be a “safe and adequate” range. |
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Calcium
Calcium is an integral component of the human skeleton. Human bones are continuously being broken down and re-built in the healthy adult. The bones of children and young adults are being built up as they grow. Older adults generally lose more bone than they create. During pregnancy there does not seem to be a net loss of bone except possibly for adolescent girls.
There is still disagreement on the calcium requirements for healthy females of childbearing age. A focus on the health of older women and their risk of osteoporosis (bone loss) has spurred interest in the calcium needs of women in the older age categories. The NRC advises an increase in the RDA for calcium for pregnant and lactating women (see below), but levels above 2500 mg may cause a constipation, increase the risk of kidney stones, and may block the absorption of iron and zinc (both of which are also essential minerals).
Most of the calcium requirements of the fetus are limited to the third trimester of pregnancy. The TOTAL calcium needs of a pregnant women can be met with about 4 glasses of whole milk per day. However, this is not a recommendation since it excludes the other dietary sources of calcium.
A fair percentage of women are lactose intolerant to some degree. “Lactose intolerance” describes a condition in which one of the sugars in milk, lactose, is not well absorbed. In these people the undigested lactose ferments as it passes through the intestines. This can cause cramping and diarrhea. For many women, lactose intolerance may improve during pregnancy. If you have been diagnosed with mild lactose intolerance, you may want to try to reintroduce some dairy products during your pregnancy.
Calcium and Vitamin D are both necessary for maintenance of good bone. Vitamin D can be produced in skin which is exposed to direct sunlight. However, because of variations in sunlight exposure due to climate and geography, milk is often fortified with Vitamin D. If you do not drink milk it is important to assess the level of sunlight you receive. Unfortunately, there are no standardized recommendations for amount of sunlight exposure to ensure adequate Vitamin D production.
Here are some sources of calcium for comparison:
| whole milk, 8 oz. | 291 mg |
| Dannon yogurt, 8 oz. | 400 mg |
| cheeseburger | 102 mg |
| Kellogg’s Raisin Bran, 3/4 cup | 16 mg |
| Total cereal, 1 cup | 48 mg |
| 1 egg | 25 mg |
| 1 apple | 10 mg |
| 1 peach | 5 mg |
| 1 banana | 7 mg |
| 1 navel orange | 56 mg |
| orange juice from conc., 8 oz. | 21 mg |
| brown rice, 1 cup | 20 mg |
| whole wheat bread, 1 slice | 18 mg |
| baked potato, with the skin | 20 mg |
| tofu, 1/2 cup | 130 mg |
| zucchini, 1/2 cup | 10 mg |
| 1 carrot | 19 mg |
Vitamin Supplementation
Vitamin supplementation in pregnancy became big news during World War II when food rationing made nutritional priorities essential policy for both England and Holland. Because of the Nazi blockade and subsequent food shortages, both countries gave pregnant women top priority for food stuffs. Conditions deteriorated to the point of near-starvation in Holland. Records kept by Dutch physicians showed that pregnant women receiving vitamin supplements gave birth to normal-sized babies until they were literally starving. Vitamins supplementation during pregnancy has been the rule ever since.
Fortunately for your baby, your unborn baby has a parasitic relationship with your body. Unfortunately for you, your unborn baby has a parasitic relationship with your body (wait till s/he’s a teenager!). By and large, in almost all cases, your baby will draw whatever it needs from your bloodstream. Without good nutrition it will be at your expense. Human history is fraught with the miseries of mothers, anemic from years of childbearing, dying from what were probably otherwise relatively minor health afflictions. There is simply no substitute for good nutrition……but there may be supplements for optimal nutrition.
It is no small task to try to unravel the truth about the role of vitamins and minerals in our health. In some ways, we are caught in a historical time warp. For most of the last hundred years, traditional medicine has been trapped in crisis management mode attempting to stop disease. In part blinded by heroic efforts to solve the problems of smallpox, polio and cholera, the patriarchal approach of traditional medicine has alienated many people . While traditional medicine fought the good fight on the front lines of the war on illness, folk medicine periodically waxed and waned on remedies based on herbs, faith and lifestyle choices. With a focus on health maintenance, improvement and life enrichment, the newest version of folk medicine has captured the souls of many people searching for “natural” methods to enhance wellness. Recently the two extremes are moving toward middle ground. In the meantime, what’s a mother to do?
Simply stated, if you are following sound and sensible recommendations on nutrition, you probably don’t need a vitamin/mineral supplement. However, there is a case for vitamin/mineral supplementation if you are not eating a good, nutritious diet. But vitamins are not the solution to the entire problem. They just plug the holes. We know so little about the complete role of all the vitamins and minerals. We are not even certain what dosages are best. RDAs were established “levels of essential nutrients…judged….to be adequate to meet the known nutrient needs of practically all healthy persons”. The “DV”, or Daily Value, is a reference value for nutrients which still have not had RDAs established. Both RDAs and DVs change as new scientific information becomes available.
Also, it is possible for one to consume too much of some of the vitamins and minerals (megadoses of Vitamin A may cause birth defects!). And some minerals block the absorption of other nutrients (for example, excess iron may block zinc and copper absorption). Iron absorption is decreased by the presence of too much calcium or phosphorus. This can be a problem since most women have little to no iron stored (especially if they’ve been menstruating since age 12). Iron is poorly absorbed, and in large doses makes some people nauseated and constipated. If you are uncertain about supplementation of your diet with vitamins and minerals, talk to your clinician. Even better, talk to a dietician.
There’s no replacement for sensible, high quality nutrition. Replacement, no…..but, supplement……well, maybe. Vitamin supplementation has become an unofficial standard in prenatal care. There is some scientific evidence to support it, but it is certainly not conclusive. This is a topic to discuss with your doctor or midwife after an assessment of your nutritional status. Almost all of your nutritional needs can be easily met through a balanced, wholesome diet. The one exception may be iron. (see Nutrition Before Your Pregnancy)
The WIC Program
The Special Supplemental Nutrition Program for Women, Infants, Children (WIC) is a federal program administered through state and county health agencies. The WIC Program’s charge is to assure that the nation’s children and pregnant women (breastfeeding mothers, too!) receive nutritious foods and nutritional counseling.
The nutritional needs of pregnant and breastfeeding women are high priorities for the WIC Program. If you are unable to purchase all the nutritious food you need for yourself and your growing baby, call your local WIC office. In most communities, the WIC Program is administered through the county health department. You can find their phone number in the government section of your phonebook. If you qualify, the WIC program will provide you with nutrition assessment, education, and help you purchase wholesome foods with the help of WIC coupons. WIC coupons may be used to pay for certain foods at most grocery stores. These foods include cereals, eggs, juices, dairy products, peanut butter, and infant formula. You must fall below 185% of the federal poverty level to qualify for WIC coupons and services (that’s just less than $30,000 for a family of four…..and your unborn baby counts as a family member).