My Daily Supplement Routine (Prenatal Edition)

Don’t get me wrong, I love me some Walmart gummy vitamins. I may or may not have purchased them before purely for snacking purposes (I know this is ill-advisable) but despite their fantastic texture and brilliant flavor, they really don’t do much for a person by way of nutrition.

Here’s the main problem: even if the gummy vitamins are made with the highest quality vitamins available, those high-quality vitamins are extremely sensitive to environmental factors, namely light and moisture. Then, we have the gumminess that makes these vitamins so delightful. The main ingredient (gelatin) has a very high percentage of water in it, which is necessary otherwise the gummy vitamins wouldn’t be gummy at all—they’d be dense, hard rocks. So, when you mix sensitive vitamins with a very moist environment you get…oxidation. For folks who don’t love chemistry, basically that means that the vitamins go rancid even when they’re brand-new, sitting on the grocery shelf.

So, while gummy vitamins make a fantastic snack, they don’t do much by way of providing nutrition to a rapidly growing and very hungry baby.

What I take instead…

Really quickly before I jump into my own current supplement routine, I’d like to give the reminder that although I am a doctor, nothing you find on this site should be construed as medical advice.

I’m sharing my own health routine not to set the expectation that you also should follow this routine, but rather to inspire you if you are wondering what else you might be able to do to support your growing baby if your healthcare provider hasn’t broached the subject with you. If you’re interested in starting anything new, talk it over with your healthcare provider.

But alas, without further ado…here’s what I’m taking!

While the majority of my daily supplement routine is nearly identical to what I took before becoming pregnant, there were a few pregnancy-specific swaps I made once my husband and I started trying to conceive. I also discontinued a few supplements that I had previously been taking because I knew they weren’t pregnancy-safe, and also stopped my allergy medication because it can cause problems with fertility (not long-term, just while taking it.) I am a big advocate for discussing medications and supplements with your healthcare provider, but I also know that most healthcare providers aren’t trained in herbs and supplements and consequently aren’t qualified to give appropriate recommendations. (Many of them also aren’t fully aware of the effect son fertility becasue, well, the research just hasn’t been done!) If your provider isn’t willing to discuss the topic with you, I highly encourage you to find one who will. Your health matters, and if you don’t advocate for yourself, who will?

If your healthcare provider isn’t willing to discuss nutrition with you, it’s okay to find a new healthcare provider…

My daily supplement routine (pre-natal edition)

Note: Just like gummy vitamins aren’t a great source of nutrition, not all pills or powders are created equal, either. Because supplements aren’t regulated by the FDA, it’s hard to know if the label is providing exactly what it says it is. Furthermore, without a medical degree and training in functional medicine, it’s hard to know whether the form of the vitamin or supplement is even able to be absorbed by the body and used for the intended purpose. As a functional medicine doctor, I rely on third-party certifications that ensure quality and safety, including protection from contamination from allergens, heavy metals, and more.

Another note: I highly recommend against purchasing supplements from Amazon. They have notoriously bad storage conditions in their warehouses and that whole vitamins + light + moisture + heat = rancidity situation is the norm rather than the exception. You’re generally better off buying from a local health food store or online dispensaries if your doctor uses one.

Cod Liver Oil

I took this supplement before pregnancy to boost my Omega 3 intake (I don’t eat enough fish…does anyone?) mainly for the cardiovascular benefits but also to reduce inflammation, support mood, and balance the many omega-6 oils I get from my daily diet. Cod liver oil is a great source of omega-3’s and is relatively inexpensive. Be careful with your source of oils, though, because fish are notorious for heavy metal contamination (hence the restriction on consumption in pregnancy) and depending on the storage conditions, can be subject to oxidation AKA rancidity. It’s also important to make sure that the fish is wild caught rather than farm-raised, and that the bottle lists out the EPA/DHA content.

With pregnancy, be careful about vitamin A content in fish oil. High doses of vitamin A are toxic to the baby, especially in the first trimester. The particular form of cod liver oil that I’m taking has vitamin A added, but the total amount for two gels (the amount I take) has less than 10% of the RDA. Vitamin A “dose” is written in many different forms, such as IU, RAE, mcg, etc. Here’s a link from the NIH that explains how to interpret these different measurement forms.

Calcium Citrate

I take 1,000 mg (1 g) of calcium citrate daily to prevent pre-eclampsia, which is the daily dosage recommended by the WHO. It’s also helpful in preventing leg cramps which, if you’ve experienced them, are downright awful.

Pre-eclampsia is largely preventable with good nutrition (such as by following The Brewer Diet, which I recommend as a loose framework for all my pregnant patients) but it can happen to anyone — even young, healthy, spry mamas with no underlying conditions. Pre-eclampsia is not treatable except by delivery, and is one of the common reasons for induction and cesarean, two interventions I’m hoping to avoid in my pregnancy.

Prenatal Vitamin with Choline

There are about a million and one different prenatal vitamins on the market, and most of them are just fine, as long as they have a) nutrients that aren’t rancid, b) nutrients in a form that is easily absorbed and c) a wide enough range of nutrients to make it worth it.

Key questions to ask yourself about your pre-natal vitamin include:

a) Is my B12 in the active form? (methylcobalamin)

b) How much folate does this contain, and am I getting enough sources of folate otherwise? (there should be at least 400 mg of folate, most often in the form of folic acid though methylfolate is better.)

c) Does this contain choline? If not, am I including food sources of choline in my diet? (choline is responsible for neural tube, brain and nervous system development. Most pre-natal vitamins don’t have any at all, but 2 free-range, organic eggs + a serving or two of cruciferous veggies per day should provide plenty.)

Iron Bisglycinate

When my RBCs, hemoglobin, MCH, MCHC and hematocrit all came back slightly below range at my first trimester screen, I was shocked when my midwife said “You’re blood work looks pretty good. I’ve seen way worse anemia. I think you’re in good shape.”

Um…excuse me?

Yes, iron-deficiency anemia is common during pregnancy. But that doesn’t mean it’s normal. Blood volume increases around 50%, which means that there is an enormous increase in need for nutrition at all stages of pregnancy (which is yet another reason I want to burn the current pregnancy nutrition/weight recommendations at the stake.) A little bit anemic is still anemic and if it isn’t addressed, it’s only going to get worse. It’s way better to correct and prevent anemia than to try to play catch-up when blood levels plummet in the third trimester, when you bleed for weeks postpartum, and when babies literally steal all the nutrition from breastfeeding mamas. Pregnancy fatigue is bad enough without iron deficiency on top of it…

It was comments like that one (among others) that prompted me to switch care providers about halfway through my pregnancy. Although I’m prepared to advocate for myself during the prenatal period, childbirth and postpartum, I’d really like to minimize the amount of work I have to do in that regard when I’m birthing my child. But, I digress…

There is no need to put up with anemia, in any degree of severity, while pregnant or otherwise. Iron sulfate and citrate are poorly absorbed forms of iron and are very likely to cause constipation, which is the last thing any pregnant mama would want. Ferrous gluconate and iron bisglycinate are much less likely to cause constipation, which is why I take the latter. Floradix is the best brand of ferrous gluconate that I know of, however it’s pretty pricey and is a liquid. (I try to avoid all supplements that have a flavor because I’m very picky.)

Magnesium Glycinate

Like iron, magnesium comes in many forms…some of which are useless. Magnesium citrate and magnesium oxide tend to have a stool softening effect more than anything else, whereas magnesium L-threonate tends to be most beneficial for sleep and anxiety. Magnesium glycinate is a highly absorbable form that is rapidly incorporated into red blood cells, which supports blood sugar control and metabolism, modulates the nervous system (helpful for feeling calm and alleviating anxiety-induced constipation.) Magnesium also helps support bone density when calcium supplements are taken, and balances the potential tipping of the electrolyte scales that can occur when supplementing with magnesium, as I am. I take 3x 180mg capsules before bed with water and have been doing so for nearly 10 years.

D-Mannose

Two words: recurrent UTIs.

Maybe TMI, but I’ve had three since becoming pregnant. The first two were before 8 weeks, the third one was only recently and quite frankly I know exactly how it happened. I took the necessary antibiotics all three times but I’d rather not take any more. So, here we are with D-mannose, 1000 mg daily.

The most common cause of UTIs is E coli contamination from nearby structures (eyeroll) and E coli likes to feast on the naturally-occurring glucose in urine. (No, eating sugar does not cause UTIs.) D-Mannose is the chiral form of glucose (mirror image) which means that E coli binds onto it but the key doesn’t quite fit in the lock. Consequently, the D-mannose blocks the receptor for true glucose and that poor little E coli cell meets an unfortunate early end before it has the chance to stick to the lining of the urinary tract and cause infection.

D-mannose is naturally found in cranberries, which is why some folks drink cranberry juice for this reason. However, it is not curative, only preventative.

Pregnancy changes the structure of the urethra (and surrounding areas) making cross-contamination more likely. The changes in blood flow and hormones in the pelvic area also tend to increase risk of UTIs in pregnant women.

Prenatal Probiotic

This post isn’t about the benefits of probiotics in pregnancy (and daily life) but there are many. To keep this section short, I chose the probiotic that I did based on the bacterial strains included which have been shown in research to prevent the following:

  1. Urinary tract infections
  2. Group B strep
  3. Vaginal yeast infections

All of those are of increased concern in pregnancy and, like I’d mention, I’d prefer to avoid the need for even more antibiotics than I’ve already had to take.

Vitamin D3

As I tell my patients, if I got to rule the world, I would’ve named Vitamin D a hormone rather than a vitamin because that’s really what it is (and how it functions in the body.) But alas, nobody asked me…

There are a million and one reasons to make sure that your own blood levels of vitamin D are between 60 and 80 ng/ml. I’ve been on a Vitamin D journey for years, raising my levels from clinical deficiency in 2013 with 10,000 IU daily pills for a few years, to finally stabilizing in pregnancy at 4,000 IU daily.

The best type of vitamin D to take is Vitamin D3 with K2. The amount? Well, that varies. It depends on what your current blood levels are and how your own body absorbs vitamin D when you take a supplement. Like I mentioned, I had to take 10,000 IU daily for years to get my blood level up to an optimal 63 ng/ml, but I’ve had patients who took 10,000 IU daily for just a few weeks and their levels jumped a little too high. Other patients have been taking 10,000 IU daily for months and their levels only slowly inched upwards. Talk to your healthcare provider about testing your levels and put together a plan for supplementation and monitoring. (As always, if your doctor isn’t willing to discuss it with you, find a new doctor.)

Once again, these are the supplements that I am taking. This is not a post about what you should be taking. Supplement needs are highly individualized, and you may need something more in order to maintain the health of you and your baby, or you may not need half the things that I am personally taking. To best care for your own health, find a doctor who is trained in functional medicine and talk with them about it!

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