Vitamin D

Many pregnant women have reduced vitamin D levels.  You are at increased risk of deficiency if you have dark skin or are veiled, but also if you use sunscreen regularly or spend little time outdoors.  It is important to ensure your vitamin D level is adequate, as vitamin D is important in the absorption of calcium, so can affect your (and your baby’s) bone strength and formation.  Your GP or Dr Sen can send you for a simple blood test to see if a supplement is required.  You may also be prescribed some ‘sun time’!  Once you start taking a vitamin D supplement you should have a follow up test in 4-6 months to check your level has risen sufficiently.  It is not uncommon for some women to need a supplement for the long term.

Vitamin B12

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) recommend that vegetarian and vegan women take a B12 supplement.  However, in practice, often supplementation is only recommended if you are showing a deficiency on blood testing.  If you are vegetarian/vegan or if you have any concerns about your B12 level you can request for Dr Sen to check your level.  It is certainly possible to obtain adequate B12 through your diet, even if you are vegetarian/vegan, although it does require more careful planning.  Low vitamin B12 levels have been associated with early pregnancy loss and increased rates of NTD and spina bifida.

Iron

In Australia, it is not recommended that all women take an iron supplement as not all women will become deficient, and excess iron can be harmful.  Women are screened several times through their pregnancy to check for iron deficiency (anaemia).  Anaemia in pregnancy can result in pre-term delivery and small for gestational age babies and will result in you feeling very fatigued.  Dr Sen will test your iron levels routinely at 26-28 weeks of pregnancy. If you are found to be deficient, one of our midwives or our dietitian will call and advise you regarding your supplementation requirements. Your levels will then be tested again later in your pregnancy, to check that they have risen to a healthy level. The amount of iron contained in a multivitamin is usually small and not sufficient if you are found to have iron deficiency.  The amount of iron required in late pregnancy is more than is possible to obtain from your diet alone.

Calcium

Ideally you will be able to obtain adequate calcium (3 serves per day or 1000mg) through your diet.  If you are unable to consume this amount of dairy or dairy equivalent, you should be taking a calcium supplement.  As is the case with iron, multivitamin preparations do not contain significant amounts of calcium, usually meaning a separate supplement is needed.

Omega 3 fatty acids

While there is growing evidence as to the important role these nutrients may play, there is currently not enough evidence to recommend they be routinely prescribed in pregnancy.

For more information about pregnancy nutrition, visit our website.

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What is iron and why do I need it?

Iron is a mineral that is involved in making red blood cells, carrying oxygen and producing energy.  It is therefore important to ensure you’re eating enough of it!

What is different in pregnancy nutrition?

In pregnancy, your iron requirements rise greatly so you can provide for your baby’s blood supply and build up their stores.   If you eat meat, you should aim to include red meat at least three times per week as well as choosing white meats, eggs, wholegrain bread and fortified cereals, legumes and vegetables regularly.  Vegetarian women will need to rely more heavily on plant sources of iron, which aren’t as well absorbed by the body.

Why does my iron level matter?

Iron deficiency can lead to complications for you and your baby.  Women who are low in iron have a higher risk of small for gestational age babies as well as premature delivery.  Women themselves usually feel quite fatigued and may become short of breath.

How do I know if I’m getting enough iron in my pregnancy diet?

Even if you do eat red meat, it is often difficult to consume the amount of iron that is needed in the last trimester of pregnancy.  However, not all women will become iron deficient (anaemic), even those that follow vegetarian diets.  It will depend in part on how well you absorb iron and on your body’s initial store.

Dr Sen will check your ferritin (body store) level, usually when you are around 26-28 weeks.  Your haemoglobin level (amount of iron in your blood) is also checked, but as your blood supply doubles during your pregnancy, this level drops due to a ‘dilution’ effect and therefore isn’t reliable as a measure of iron deficiency.

Supplements

If your ferritin level is low increasing your intake of red meat will not be enough to increase your stores.  You will need to begin taking a high dose iron supplement formula (usually FerroGrad + C or Maltofer or Ferrotabs) 1-2/day depending on your result.  Iron supplements may cause tummy upset including constipation or diarrhoea, especially in higher doses.  If you suffer any discomfort, try taking it every 2^nd day rather than stopping it all together.  Low dose iron or the iron in your multivitamin (if you’re taking) is not sufficient. It is normal that your stool colour can change to very dark/black.  This is not dangerous.  Dr Sen may also discuss the possibility of an iron infusion with you.

Iron supplements should be continued until 6 weeks after delivery, though if you’ve been taking more than 1/day you can decrease to just 1/day from when you have your baby.  Iron supplements are best consumed away from dairy products or calcium supplements.

It is not advised that women take a high dose iron supplement unless they have been shown to have iron deficiency.

If you have any more questions regarding your pregnancy nutrition, visit our website.

The post Pregnancy nutrition – Iron in Pregnancy appeared first on Dr Rahul Sen.