Health Tips

Supplements & Vitamins for Pregnancy

Supplements, vitamins and healthy dietary behaviour is essential prior, during and after pregnancy. Getting the right prenatal nutritions ensures maternal health and provides optimal growth and development of the fetus.

So what should you take before, during, and after pregnancy? 

1. Folic acid

Recommended dose of folic acid: 

• Pre-pregnant: Take at least 400 microgram (mcg) of folic acid daily before pregnant until you are 12 weeks pregnant*
• Pregnant: Take at least 600 mcg of folic acid daily. Continue throughout pregnancy until 3 months postpartum. *
• Lactating: Take 500 mcg of folic acid daily during breastfeeding*

Higher dose of 5mg folic acid starting 4 weeks before pregnancy and continued through 1st trimester may be required if you have a higher chance of being affected by neural tube defects. Do consult your doctor for further information if: 

• You have a family history of neural tube defect 
• Pregnant mothers having baby with neural tube defects in last pregnancies 
• Pregnant mothers taking antiretroviral drug for HIV or anti-epilepsy medicine  
• Pregnant mothers having diabetes 

Sources of folic acid: Folic acid can also be obtained from green leafy vegetables, cabbage, tomatoes, nuts, beans, legumes, whole grain products, fruits such as orange 

Reason: Folate is a vitamin B that helps in DNA synthesis, red blood cell production, and fetal growth and development. Taking folic acid thus reduces risk of defect of the spine (neural tube defects or spina bifida) and congenital abnormalities such as cleft palate and heart defects. For pregnant women with MTHFR genetic mutation, should choose a supplement that contains L-methylfolate for maximum uptake.

*Above values are just a guide. Seek medical advice 

2. Iron

Pregnant mothers will have to undergo blood tests to determine the iron levels in their bodies. If your iron levels are low, you should take an iron supplement. This is because iron requirements increase significantly during pregnancy due to an increase of maternal blood volume by ~45%. 

Recommended dose of iron: 

• Pre-pregnant: Take 29-39 mg iron daily. Do not take more than recommended iron intake to prevent side effects such as constipation, vomiting, abnormally high haemoglobin levels.*
• Pregnant: 30-60mg Iron tablet supplements are recommended for all pregnant women. Daily 100 mg iron supplements given during the 2nd half of pregnancy are adequate in the non-anemic pregnant woman. If the woman is anemic, higher doses will be provided as recommended by the doctor.*
• Lactating: Take 15-20 mg iron daily*     

Sources of iron: Iron can be obtained from lean meat, green leafy vegetables, dried fruits, raisins, dates, and nuts. 

Reason: Iron is required for transport of oxygen, infant growth and development, and placenta. Iron can help prevent fatigue, anaemia, and reduce risk of premature birth. Low iron levels can cause anaemia during pregnancy, resulting in preterm delivery, maternal depression, and infant anaemia. 

*Above values are just a guide. Seek medical advice 

3. Vitamin A 

Only recommended if vitamin A deficiency is considered a severe public health issue. This is because excessive vitamin A intake can cause liver dysfunction and birth defects, ie abnormal development of the heart, lungs, eyes and skull

Recommended dose of vitamin A: 

• Pre-pregnant: 1.1mg vitamin A* 
• Pregnant: 800 mcg vitamin A* 
• Lactating: 850 mcg vitamin A*

Sources of vitamin A: Vitamin A is obtained from darkly colored fruits and vegetables, oily fruits, red palm oil

Reason: For vision, immune function, and growth 

*Above values are just a guide. Seek medical advice 

4. Vitamin C 

Recommended dose of vitamin C: 

• Pre-pregnant: 70 mg vitamin C *
• Pregnant: 80 mg vitamin C *
• Lactating: 95 mg vitamin C *

Sources of vitamin C: orange, red and green peppers, strawberries, blackcurrants, broccoli, brussel sprouts, potatoes, tomatoes 

Reason: Protects cells and keeps cells healthy. Vitamin C can also helps absorption of iron from food in the body 

*Above values are just a guide. Seek medical advice 

5. Vitamin D

Recommended dose of vitamin D: 

• Pre-pregnant: Take 5- 10 mcg (200- 400 IU) of vitamin D supplement daily. Do not take more than 100 microgram (4000 IU) vitamin D per day as it can be harmful *
• Pregnant: Take 5mcg vitamin D supplement daily*
• Lactating: Take 5mcg vitamin D supplement daily*

Sources of vitamin D: Vitamin D can be obtained from food including fatty or oily fish (i.e. salmon, mackerel, herring, sardines), eggs, red meat etc. Vitamin D can be obtained when exposed to sunlight for 5-15 minutes 2 to 3 times per week during summer. Longer sun exposure may be needed during winter, for dark-skinned individuals, for those whose skin is covered extensively with clothing, or with sunscreen use

Reason: Vitamin D is a fat soluble vitamin and is important for immune function, bone health and cell division. Vitamin D keeps bones and muscles healthy, and aids in calcium and phosphate absorption. Vitamin D deficiency during pregnancy can increase the risk of cesarean section, preeclampsia, preterm birth, and gestational diabetes.

*Above values are just a guide. Seek medical advice 

6. Calcium 

Calcium supplement is usually prescribed for pregnant mother who are allergic to milk, as they cannot absorb enough calcium from diet. 

Recommended dose of calcium: 

• Pre-pregnant: Take 700-1000mg of calcium*
• Pregnant: Take 1000 mg of calcium*
• Lactating: Take 1000 mg of calcium*
• For mothers aged 14-18 years old: 1300mg of calcium 
• For mothers aged 19-50 years old: 1000mg of calcium 

Various calcium compounds in calcium supplements have varied amounts of calcium elements. 

• 1 g of elemental calcium= 4 g of calcium acetate
• 1 g of elemental calcium= 2.5 g of calcium carbonate
• 1 g of elemental calcium= 5 g of calcium citrate
• 1 g of elemental calcium= 11 g of calcium gluconate 
• 1 g of elemental calcium= 8 g of calcium lactate

Sources of calcium: milk, cheese, yoghurt, tofu, bread and food made with fortified flour, fish (i.e. sardines, pilchards) 

Reason: For healthy bones and teeth of babies especially in third trimester. Calcium prevents pregnant mothers from having leg cramping and tooth decay. Inadequate calcium intake may increase risk of gestational hypertension and preterm labour. Severe calcium deficiency can increase risk of preeclampsia, which might cause death to mother and unborn baby. 

*Above values are just a guide. Seek medical advice 

7. Iodine 

Recommended dose of iodine: 

• Pre-pregnant: Take 150 mcg of iodine*
• Pregnant: Take 200 mcg of iodine* 
• Lactating: Take 200 mcg of iodine*

 Sources of iodine: Fish, seafood, mussels, oyster, prawns, seaweeds, egg yolk, milk, milk products. Iodised salt can be used for cooking, but try to limit salt use 

Reason: Fetal brain development and growth. Iodine deficiency can result in maternal and fetal hypothyroidism, but excessive iodine intake can cause fetal goitre 

*Above values are just a guide. Seek medical advice 

Summary 

Table: Daily Recommended Dietary Allowances of Micronutrients for Pre-pregnant, Pregnant and Lactating Women (MIMS) 

**Above values are just a guide. Seek medical advice 

*Some supplements are NOT a necessity for all pregnant women. Remember to visit your doctor or specialist for advice. If there is a clear indication as indicated by the doctor or specialist, you will be required to start on these additional supplements.

What to AVOID during pregnancy? 

1. Cigarette Smoking or second hand smoke 
2. Alcohol (wine, beer, liquor) 
3. Caffeine in tea, coffee, chocolates, sodas, medication (recommended in moderate amount) 
4. Certain food (ex: raw meat, smoked seafood, unpasteurised dairy etc) 
5. Certain medications 
6. Wet paint 
7. Stick to heels with 3 inch heel or less 
8. Avoid hot tubs and sauna 
9. Avoid sitting or standing too long
10. If you must change kitty, wear gloves and wash your hands well afterward. Cat feces can carry toxoplasmosis, a rare parasitic disease.

A WORD FROM DOC2US

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Reference: 

1. NHS. Vitamins, supplements, and nutrition in pregnancy. Available from https://www.nhs.uk/pregnancy/keeping-well/vitamins-supplements-and-nutrition/ 
2. Healthline. Supplements During Pregnancy: What’s Safe and What’s Not. Available from https://www.healthline.com/nutrition/supplements-during-pregnancy#safe-supplements 
3. MyHealth Kementerian Kesihatan Malaysia. Vitamins and Health Supplements for Pregnant Mothers. Available from http://www.myhealth.gov.my/en/vitamins-health-supplements-pregnant-mothers/ 
4. Healthline. 11 Things to Avoid During Pregnancy - What Not to Do. Available from https://www.healthline.com/health/pregnancy/things-not-to-do-while-pregnant#dont-wear-stilettos 
5. MIMS. Obstetrics & Gynaecology. Available from https://specialty.mims.com/nutrition%20in%20pregnancy/treatment 

Written By

Ms. Rosamund Koo Wei Xin

Reviewed By

Doc2us Medical Board