While folic acid has been in the spotlight as an essential vitamin for expectant mothers and women of childbearing age, there are other essential vitamins, minerals and herbs that also warrant attention. According to the Centers for Disease Control (CDC), over 75% of certain birth defects could be prevented if a woman took the proper supplements before and during her pregnancy. Most pregnant women in developed countries do take a prenatal supplement and most healthcare providers agree that supplements are necessary because ob­taining optimal levels of nutrients from food sources alone is unlikely, especially during pregnancy.

Yet beyond basic multivitamin and mineral supplementation, not much additional information is available and not much research is being done due to the obvious ethical considerations of testing unapproved nutrients on pregnant subjects. What follows is a brief overview of the state of this industry segment today.

Nutrients that are needed above and beyond their normal requirements during pregnancy include iron, folic acid, calcium, vitamin D and C and zinc. Women need an extra dose of iron during pregnancy because their body is making so much extra blood. For increased iron absorption, vitamin C is essential. Calcium supplementation is said to reduce the risk of developing preeclampsia, which consists of severe swelling, high blood pressure and protein in the urine during pregnancy. With calcium, vitamin D is needed for calcium absorption as well as homeostasis. Lastly, zinc is an essential nutrient that helps form the organs, skeleton, nerves and circulatory system. In theory a good prenatal vitamin supplement should contain vitamins A, C, D, and E, B vitamins, calcium, copper, zinc, and pantothenic acid in significant doses. This is not always the case, however, as our industry struggles with the regulatory hurdles involved in getting new nutrients added to prenatal vitamin formulas.

Nutrients For Support During Pregnancy

While many women may be hesitant to take anything beyond their doctor-recommended prenatal supplement, there are other herbs and nutrients that can help during pregnancy.

Morning sickness affects many women during early pregnancy and can often be an uncomfortable situation for expectant mothers. At its worst, morning sickness is referred to as hyperemesis gravidarum, which is the most severe form of nausea associated with pregnancy. It has been estimated that 50-90% of pregnant women ex­perience morning sickness, which may be attributable to elevated hormone levels and can in fact occur all day long and into the evening.

Probably the most studied herb for nausea is ginger root (Zingiber officinale), which in addition to being a popular spice used in cooking, is also said to have calming effects on an upset stomach. A re­cent article in Prevention magazine stated, "In one study, 940 mg of ginger worked as well as the standard dose of Dramamine." Ginger has no adverse side effects and is most effective in the form of ginger powder. Ginger is also noted for its effect on improving digestion and has also been used extensively in the study of hyperemesis gravidarum.

Red raspberry (Rubus idaeus) leaf is most well known for general support during pregnancy and breast feeding, according to the Women's Encyclopedia of Natural Medicine. In that respect it is a good herb to be used throughout pregnancy because it is high in iron, vitamins and minerals. It also helps to tone the uterus, increase the flow of milk and restore the reproductive system after childbirth. It can be taken in capsule form, liquid extract or tea.

Another herb used in taming morning sickness is dandelion leaf and root (Taraxacum officinale), which alleviates nausea, upset stomach and indigestion. It is also high in vitamin A, calcium, iron and potassium. Dandelion can be taken as a tea, in capsule form or as a liquid tincture and is regarded as safe to be taken throughout pregnancy without any adverse effects, according to Women's Encyclopedia of Natural Medicine.

Nettle (Urtica dioica) is an herb high in calcium and iron and is used as a mild diuretic. According to Women's Health Interactive, it can increase breast milk and energy after childbirth.

Used mainly after birth, la­vender (Lavandula officinalis) may reduce perineal pain three to five days after birth, according to Women's Health Interactive.

Tyler's Honest Herbal said of sage (Salvia officinalis), "Sage is taken extensively as a household remedy in Europe for drying up the flow of mother's milk at the end of the nursing period."

In the vitamin area, B vitamins are common recommendations during pregnancy for numerous reasons. One popularly recommended vitamin for morning sickness is vitamin B6 (pyridoxine). It is good for nausea and is said to be safe, with no risk of side effects or birth defects at 25 mg two to three times a day during the first trimester. In one study, however, eight out of 31 patients reported vomiting after treatment with vitamin B6 (Obstet Gynecol July 1991: 78; 33-36).

Additionally, vitamin B1 (thiamin) is also an important nutrient. Tori Hudson, author of the Women's Encyclopedia of Natural Medicine, notes that thiamin depletion is common during pregnancy, therefore supplementation is suggested. And B1 supplementation has shown higher infant birth weight and size. Vitamin B3 (niacin) taken during pregnancy has also been associated with higher birth weight, longer length and appropriate newborn head circumference. Vitamin B2 (riboflavin) depletion is also a common situation during pregnancy and supplementation is suggested to prevent metabolic disturbances.

Vitamin C and vitamin K displayed remarkable results in a study of women who took five mg of vitamin K and 25 mg of vitamin C per day and reported the complete disappearance of morning sickness within three days (Am J Obstet Gynecol 1952: 64; 416-418).

Latest Research

Although extensive research into nutrients for use during pregnancy is not really being done, here is an overview of some of the research in the last year on pregnancy and vitamins, minerals and other nutrients.

Calcium. Two studies were conducted with calcium and related issues of pregnancy. The first examined fetal bone mineralization and calcium supplementation. In the study healthy mothers with early ultrasound confirmation of dates and singleton pregnancies were enrolled in a double-masked study and randomized before 22 weeks' gestation to 2 g/day of elemental calcium or placebo until delivery. Maternal dietary intake at randomization and at 32-33 weeks' gestation was recorded with 24-hour dietary recalls. The results of the study suggested that there were no significant differences between treatment groups in gestational age, birth weight or length of infants, or in the total-body or lumbar spine bone mineral content. In conclusion, the study noted that maternal calcium supplementation of up to 2 g/day during the second and third trimesters can increase fetal bone mineralization in women with low dietary calcium intake. However, calcium supplementation in pregnant women with adequate dietary calcium intake is unlikely to result in major improvement in fetal bone mineralization (Obstet Gynecol 1999: 94: 577-582).

In the second study the relationship between calcium and gestational hypertension was investigated. Calcium intake during the third trimester of pregnancy was determined in 82 pregnant women by recording the consumption of foods over a five day period and by calculation of the quantity of this element provided by dietary supplements. For each subject, blood pressures were measured once per week to detect and analyze differences in calcium intake between those with normal blood pressure and those suffering from gestational hypertension. It was concluded that calcium intake was significantly lower among subjects with high blood pressure (Ann Nutr Metab 1999: 43: 37-46).

Zinc. The following are three studies that have been conducted with zinc in the area of pregnancy. The first study examined maternal and neonatal zinc status in a Peruvian population. Beginning at gestation week 10-24, 1295 mothers were randomly assigned to receive prenatal supplements containing 60 mg iron and 250 mcg folate, with or without 15 mg zinc. Venous blood and urine samples were collected at enrollment, at gestation week 28-30 and at gestation week 37-38. At birth, a sample of cord vein blood was collected. Serum zinc concentrations were measured in 538 women, urinary zinc concentrations in 521 women and cord zinc concentrations in 252 neonates. Despite supplementation, maternal and neonatal zinc concentrations remained lower than values reported for well-nourished populations. Adding zinc to prenatal iron and folate tablets improved maternal and neonatal zinc status, but higher doses of zinc are likely needed to further improve maternal and neonatal zinc status in this population (Am J Clin Nutr 1999: 69: 1257-1263).

A separate study of the same group examined zinc supplementation. The objective was to estimate the effect of maternal zinc deficiency on pregnancy outcomes. Women were followed up monthly during pregnancy. At birth, newborn weight was recorded and crownheel length, head circumference and other circumferences and skinfold thicknesses were assessed on day 1. At delivery, with 1016 still in the study, duration of pregnancy was known for all women and birth weight information was available for 957 newborns. Results suggested that adding zinc to prenatal iron and folate tablets did not affect duration of pregnancy or size at birth in this population (Am J Obstet Gynecol 1999: 180:483-490).

In a third study, adding zinc to iron and folate tablets in order to improve fetal neurobehavioral development was studied. Fifty-five fetuses of randomly as­signed mothers received a daily supplement containing 60 mg iron and 250 mcg folate, with or without 15 mg zinc. Fetuses were monitored at 32 and 36 weeks gestation and fetal heart rate and movement patterns were quantified in 55 and 34 fetuses, respectively, as indexes of neurobehavioral development. Fetuses of mothers who received zinc supplementation showed fewer episodes of minimal fetal heart rate variability, increased fetal heart rate range, an increased number of accelerations, an increased number of bouts, an increased amount of time spent moving and an increased number of large movements. Differences by supplementation type increased with gestational age and were statistically significant at 36 weeks gestation. The conclusion of the study noted that improving maternal zinc status through prenatal supplementation may improve fetal neurobehavioral development (Am J Obstet Gynecol 1999: 180: 483-490).

Vitamin C and E. One study examined the relationship be­tween preeclamp­sia and vitamins C and E. A total of 160 pregnant subjects completed the trial, during which they received a combination of 400 IU of natural vitamin E and 1000 mg of vitamin C or placebo during the second term of their pregnancies. Natural vitamin E and C supplements reduced the risk of preeclampsia by 76% (Lancet 1999: 354: 810-816).

Beta-carotene. Beta-carotene and death during pregnancy was examined in a study in which researchers gave beta-carotene supplements, vitamin A supplements or placebos to more than 20,000 pregnant women in 270 rural villages in Nepal for at least three and a half years. As a result pregnant women taking 42 mg of beta-carotene supplements daily had a 49% reduction in the risk of death compared to those taking a placebo. The vitamin A supplements reduced the risk of death by 40%. The protective effect of both supplements occurred after one and a half years of use. Fewer obstetrical problems accounted for 27% of the decrease in deaths among women in the study (BMJ 1999;318:570-575).

Vitamin B6. Vitamin B6 and the prevalence and severity of nausea and vomiting was examined in one study. The prospective study analyzed three different cohorts of women, one population-based group of 193 women (Cohort A), one group of 555 women who sought advice for nausea with or without vomiting (Cohort B) and one group of 301 women who reported vomiting (Cohort C). Results showed that in Cohort C, vomiting was significantly associated with the lack of supplementation with multivitamins before six weeks gestation (Clin Invest Med 1999: 22: 106-110).

Vitamin E. This study measured levels of vitamin E and malondialdehyde (a marker for lipid peroxidation) in 18 preeclamptic, 15 eclamptic and 25 healthy pregnant women. Women with preeclampsia and eclampsia had higher levels of malondialdehyde and lower levels of vitamin E (International J Gyne and Obstet 1999: 64:27-33).

DHA: There is an ongoing clinical study, sponsored by Omega Tech, on infant and maternal nutrition and DHA. A short term study has already been completed that evaluated Omega Tech's DHA-enriched eggs compared to regular eggs; there was a dramatic reduction in preterm birthrates, preeclampsia and diabetes among the women who ate the DHA-enriched eggs. A long term study to confirm the results is now underway.

NW