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If you’re pregnant, you should be taking a prenatal vitamin. In fact, even if you’re just thinking about becoming pregnant you should be taking one. But what is it about these specialized pills that makes them so pertinent?
The F word
A key component of any prenatal is folic acid, the synthetic form of the naturally occurring B vitamin folate. It’s vital in early gestation to prevent neural tube defects (NTDs) like spina bifida (when the spinal cord doesn’t close completely) and anencephaly (when most of the brain and skull do not develop).
These severe abnormalities occur in the first three to four weeks after conception—often even before a woman finds out she’s expecting—so the U.S. Public Health Service and Centers for Disease Control and Prevention (CDC) recommend that all women of childbearing age consume 400 micrograms of folic acid daily as a precautionary measure in case of an unplanned pregnancy. Once you become pregnant or if you’re actively trying to conceive, the recommended daily allowance (RDA) increases to 600 micrograms. In addition to preventing NTDs, folic acid is also thought to help reduce the likelihood of congenital heart disease, oral cleft and preterm birth.

It’s what’s inside that counts
Beyond folic acid, prenatal vitamins typically contain beneficial dosages of iron, which is used to generate extra blood for you and baby, and calcium, which helps build and strengthen baby’s bones and teeth. Thiamin, riboflavin, niacin, iodine, zinc and vitamins B12, C, D and E may also be included.
However, not all prenatal vitamins boast the same types or amounts of nutrients. It’s wise to discuss with your care provider which components are most critical based on your diet, health and risk factors, so you can select the best formula for your particular pregnancy.

Less is more
Unless your practitioner recommends otherwise, do not exceed the RDAs of vitamins and minerals. “If one prenatal vitamin is good, five are not better,” warns Beth Conover, APRN, CGC, genetic counselor, pediatric nurse practitioner and founder of MotherToBaby Nebraska. Too much vitamin A, for example, can be toxic to the mother and increase the risk of adverse outcomes on baby. Studies suggest excess vitamin C, vitamin E and iodine could have detrimental effects as well.
Of course, there are exceptions to the rule. Conover says, “If a woman has had a baby with a neural tube defect, or if she has a condition such as diabetes or inflammatory bowel disease, or is on certain medications such as anti-convulsants, a provider may suggest that she take extra folic acid in addition to her single prenatal vitamin.”

The bottom line: Talk to your midwife or OB to find out what vitamins and minerals you need to focus on most during your pregnancy based on your health and lifestyle. And remember that a prenatal vitamin is intended to complement a healthy, well-balanced diet, not replace it.
But how does that make you feel?
In addition to the composition of your prenatal, you’ll also need to factor in how your body responds to it. “I find that each woman … is very different in terms of her tolerance of a prenatal vitamin,” says Sarah Obican, MD, maternal-fetal medicine specialist at the University of South Florida and member of MotherToBaby’s expert network.
If swallowing a pill triggers your gag reflex or the iron content backs up your digestive system, your dread of taking your nutrient-packed nemesis might leave you inclined to skip it, which is hardly a suitable solution. Fortunately, there are plenty of preferable
alternatives to accommodate a variety of issues.
Size matters. Good things come in small packages, right? If you can’t quite handle the horse pills you picked up on your first go-round at the drugstore, try shopping for a minipill instead. These scaled-down capsules pack the same nutrient punch but are simpler to swallow.
Perfect form. Skip the pills altogether, and select a drinkable or chewable substitute. There are powdery mixes you can add to your water bottle, innocuous biscuits you won’t mind gnawing and even gummy candies that taste like, well, candy. Many moms find these appetizing morsels go down a bit easier.

Iron stomach. Iron is critical to prevent iron-deficient anemia, a common pregnancy concern, but it can often cause constipation. To keep things moving, Conover recommends adding ample fluids and fiber to your diet. (Think beans, berries, bran cereal and broccoli.) You can also ask your doctor about using a stool softener.
Quease ease. Although it’s generally advised that prenatal vitamins be taken on an empty stomach with a full glass of water, women who experience nausea can take them with a light snack, says Mark De Fazio, MD, attending physician at the New York Methodist Hospital in Brooklyn, New York. (Crackers and toast are inoffensive options.) Another trick? Try taking it right before bed, suggests Obican, so you’re likely to sleep through any queasiness that may result.
It’s not uncommon to cycle through two or three kinds of prenatal vitamins before discovering which type meets your needs and is well-tolerated by your body. So be patient and perseverant, and don’t settle for something that makes you miserable. Popping a prenatal doesn’t have to be a pill.