Using Supplements For Women Of Childbearing Age: What is Advisable And What Is Not

Women of childbearing age have special nutrient needs. These should be met via a good, healthy, wholesome diet, but this doesn't happen.  

We also see that most women of childbearing age in India weigh less than 45 kilograms and are severely malnourished, passing their malnutrition on to their infants.

Things are not too good amongst the urban, educated womenfolk too.

Why? Just put yourself in the shoes of a young woman, who is working, is married and preparing for motherhood. Would she have the time to think about right nutrition for herself? More often than not, she would have no idea of what micronutrients to include in her diet to keep healthy and strong for the next big step in her life- giving birth.

If you are in the age group of 18-40, you might want to pay particular attention to getting enough of certain key nutrients daily as meeting your recommended intake of these will help keep your bones strong as you get older, lessen your risk of chronic disease and protect your baby, if you decide to get pregnant.

Here is a list of top 5 nutrients, their recommended daily dosage or RDAs, and the supplements that you can take to plug nutritional deficiencies:

1.    Folic acid and Folate

Folate and folic acid are forms of the water-soluble B vitamin, also known as B9.

The difference between the two is that folate occurs naturally in food and folic acid is the synthetic form of this vitamin and is usually added to cereals, flour, bread, pasta, and other bakery items.

How does folic acid help?

• Folic acid is used for preventing and treating folate deficiency and its complications, including anaemia and the inability of the bowel to absorb important nutrients.
   
• Pregnant women or those planning to get pregnant need to take folic acid to prevent miscarriages and birth defects of the brain and spinal cord called “neural tube defects” like “spina bifida” in which the foetus’s vertebrae do not fuse together properly, exposing the spine.
  This can lead to varying degrees of paralysis, incontinence, and mental disability
  Folic acid is most needed during the first 28 days after conception when most neural tube defects occur. Unfortunately, most women do not realize they are pregnant for 28 days.
  This is the reason why it's important to start folic acid supplementation before conception and continue it through your pregnancy.
   
• Folic acid also prevents colon and cervical cancers. It is also used to reduce blood levels of a chemical called homocysteine, which is linked to heart disease.

Sources

Foods that are naturally high in folate include leafy vegetables like spinach, broccoli, and lettuce, and fruits like bananas, melons, and lemons.

It’s also found in beans, mushrooms, meat such as beef liver and kidney, orange and tomato juice.

Folic acid, on the other hand, is found in some green leafy vegetables, nuts, beans, citrus fruits, fortified breakfast cereals, and vitamin supplements.

RDA

All women of childbearing age need 400-600 micrograms (0.4-0.6 mg) of folic acid/folate each day. This is the minimum amount to prevent birth defects.

Supplementation

Folate is a superior form of this critical vitamin B because it’s the natural form and is also more easily absorbed. Folic acid is linked to a number of health risks to moms.

You can take 800-1200 mcg of folic acid/folate pre-pregnancy but not more than that. You can reduce this number to 500 micrograms when you are breastfeeding.

As always, check with a doctor before taking a folic acid supplement!

2.    Iron

Iron is a nutrient that’s absolutely critical to having a healthy pregnancy and baby. But, many women have low iron stores as a result of monthly periods and because of eating foods low in iron.

How does Iron help?

Iron deficiency anaemia is the most common type of anaemia in women of childbearing age, and it occurs when your body doesn’t have enough of the mineral iron and is usually caused due to the loss of iron in the blood due to heavy menstruation or pregnancy.

Getting enough iron can prevent this condition in which there are simply too few haemoglobin containing red blood cells that can cause dragging fatigue. 

Having this type of anaemia can also cause your baby to be born too small or too early.

Anaemia during pregnancy has also been associated with preterm delivery, maternal depression and infant anaemia.

How much Iron should you take?

You need about twice the amount of iron as you did before getting pregnant because your body uses it to make extra blood for your baby.

The recommended dose of iron is 27 milligrams of iron every day during your pregnancy and this can be easily met with most prenatal vitamins. However, if you are anaemic you will need higher doses of iron.

While you're breastfeeding, you need at least 9 mg of iron every day.  

According to the CDC, you should start taking about 30 mg of iron a day when you have your first prenatal appointment.

Never take more than 45 mg iron each day during your pregnancy or while breastfeeding as this can have serious side effects and always take iron supplements exactly as your doctor recommends.

Sources

You can source iron from meat, poultry, and plant-based foods as well as through supplements.

There are two types of iron in foods- heme and nonheme.

Heme iron is the type your body absorbs best. You get it in beef, chicken, turkey, and pork. Nonheme iron is found in beans, spinach, tofu, and ready-to-eat-cereals that have added iron.

3.    Calcium

Preparing for pregnancy includes working to build healthy bones. If there is not enough calcium in your pregnancy diet, the foetus may draw calcium from your bones, which can put you at risk for osteoporosis later in life.

How much calcium do you need?

The recommended calcium intake for women in the age-group of 19-50 is 1,000 milligrams per day according to the Institutes of Medicine. We would suggest that you don’t go overboard with calcium as it can seriously affect your body.

Sources

You can get the calcium you need by eating a well-rounded diet with calcium-rich foods like dairy, tofu, sardines, broccoli, almonds, and spinach.

Supplementation

You may require a calcium supplement containing vitamin D if you are vegan or/and lactose intolerant.

However, do take calcium pills only after a test to check your calcium levels.  

You can take one 500 mg pill with vitamin D daily if your calcium level is normal that is 8.5-9 mg/ dl. But you may have to take three 500 mg calcium pills per day if you are deficient.

4. Vitamin D

This vitamin is absolutely critical, especially for women of childbearing age as it is important for immune function, cell division and bone health as it helps your body use calcium.

A deficiency during pregnancy has been linked to an increased risk of cesarean section, preeclampsia a condition where the blood pressure of a pregnant woman rises dangerously, preterm births and gestational diabetes.

It can also cause repeated pregnancy loss and postpartum depression.

Evidence has also been accumulating regarding the impact of maternal low vitamin D levels on the long-term health of your baby.

Studies have shown a high risk of type 1 diabetes in children of women with low levels of vitamin D during pregnancy and there is an association of maternal vitamin D deficiency with asthma and impaired lung function in children.

Sources

Sun is the best source of vitamin D. Oily fish like salmon and milk are other good sources.

How much Vitamin D?

4000 IU vitamin D, administered daily over 6 months of pregnancy is recommended for pregnant women.

This dose has demonstrated a significant decrease in complications of pregnancy including cesarian section and hypertension.

Supplementation

Experts recommend a vitamin D3 supplement as this is the type of vitamin D closest to what you would get from the sun but before you start on a D supplement, do speak to your doctor regarding screening for vitamin D deficiency and a proper supplement.

5. Magnesium

Magnesium is a mineral involved in hundreds of chemical reactions in your body related to immunity as well as muscle and nerve function.

Deficiency in this mineral during pregnancy can increase the risk of preeclampsia, chronic hypertension, placental dysfunction, and premature labour as well as foetal growth restriction and preterm birth.

Sources

It’s present in grains, green vegetables, and seeds but the irony is that insufficient Mg intake is common, especially in low-income regions. Adolescents and women are also more prone to Mg deficiency.

How much Magnesium?

It is recommended that women consume 280 mg of Mg per day, increasing in pregnancy, after consultation with their doctor.

The upper limit for magnesium applies to supplements only and is 350 milligrams per day, no matter what your age.

You also need more calories during pregnancy and your protein needs also increase to about 1.1 gm per day per kilogram body weight when you are pregnant.

But, do check with your healthcare provider before taking any supplementation especially during a pregnancy.