Multivitamins and pregnancy – before, during and after part 2.

Last week we looked at the nutritional deficiencies possible in pregnancy. This week we are now walking through the most common products available in the Australian market and a short FAQ.

Elevit Preconception & Pregnancy Multivitamin: Elevit is a market leader favoured by health professionals.
Benefits – this is a complete pregnancy multivitamin. Women only need to take 1 tablet a day, and it contains a whopping 60mg of iron (making it ideal for women with iron problems).
Downside -it is lightly low in Vitamin D (only 200 IU), and it does not contain fish oil. Women taking Elevit Preconception & Pregnancy Multivitamin are encouraged to also take Elevit DHA fish oil supplements.
Elevit Preconception & Pregnancy Multivitamin is gluten-free, lactose-free, halal certified, and vegetarian friendly (although it does contain derivatives of sheep’s wool, which may be of concern to vegans).

Swisse Ultinatal Preconception & Pregnancy Multivitamin: Swisse is a respected brand amongst health professionals for many vitamins and supplements.
Benefits – this is a complete pregnancy multivitamin, it contains fish oil, and it has a high dose of Vitamin D (1000 IU daily).
Downside – you will need to take 2 capsules per day. It is gluten-free and lactose-free, but it does contain fish oil and beef gelatine which may be problematic for vegetarians and vegans.

Blackmores Pregnancy and Breastfeeding Gold: Blackmores is another established and trusted brand for vitamin supplements. It is essentially the same as the Swisse product above, in that it is a complete pregnancy multivitamin that also contains fish oil and a high dose of Vitamin D (1000 IU daily). You will need to take 2 capsules daily.

Megafol Folic Acid 5mg: This tablet is one of the few supplements in the Australian market that contains 5mg of folate. Standard pregnancy multivitamins meet folate requirements for the general population, but they do not meet the folate requirements of women who are in a high-risk category for neural tube defects as discussed above. For that reason, women in a high-risk category should take this supplement in addition to their usual pregnancy multivitamin.

Frequently asked questions:

1. Do I really need to take a multivitamin? My diet is usually good.
During pregnancy, your body’s requirements for certain nutrients increase dramatically, in some cases by up to 50%. Despite your best intentions, this can make it difficult to ensure that you are receiving adequate nutrition for both you and your baby. It is also a time when many women change their diet (due to food safety considerations specific to pregnancy) or reduce their usual food intake (due to pregnancy-related nausea). For these reasons, it is both reassuring and prudent to take a pregnancy multivitamin throughout your pregnancy.

2. How long do I need to take my pregnancy multivitamin?
There is a common misconception that pregnancy multivitamins should only be taken in the first 3 months of pregnancy. In fact, we have strong evidence that it is best to start taking a multivitamin when you begin actively trying to conceive, and certainly from at least one month before you fall pregnant. Folate supplementation is critical throughout the first trimester while the baby’s brain and spine are in rapid development. There are nutritional supplements besides folate that continue to be important in your second trimester, third trimester, and also in breastfeeding.

3. My multivitamin is making me nauseous. What should I do?
Iron may be the culprit. If your multivitamin has a high iron content (such as Elevit), switch to a brand with lower iron. If nausea persists, some women are tempted to stop their multivitamins altogether, or switch to a more targeted supplement (e.g., a folate and iodine tablet such as Blackmores I-Folic). The risk here is that the women who stop taking multivitamins are also more likely to be experiencing significant morning sickness. These women may have very limited food intake and are at higher risk of nutritional deficiencies.
In general, if your pregnancy nausea is affecting your ability to eat and take your daily multivitamin, it would be a good idea to chat to your GP about different strategies to address morning sickness.

References:

Vitamin and Mineral Supplementation and Pregnancy, The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, 2015.

Clinical Practice Guidelines: Pregnancy Care, The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, 2018.