What supplements should every pregnant woman take during pregnancy?

Essential Supplements for Every Pregnant Woman

Every pregnant woman should take a daily prenatal multivitamin containing folic acid (0.4-0.8 mg), iron (30-60 mg), calcium (1200-1500 mg), and vitamin D (>40 mcg/1000 IU) throughout pregnancy to reduce risks of maternal mortality and improve fetal outcomes. 1

Core Supplements and Dosages

Folic Acid

• Standard risk women: 0.4 mg daily, starting at least 2-3 months before conception through pregnancy 1, 2
• Higher risk women (previous NTD pregnancy, family history of NTD, diabetes, BMI >30): 4-5 mg daily from 3 months before conception through first trimester 1, 2
• Benefits: Prevents neural tube defects and possibly other congenital anomalies
• Timing: Ideally begin before conception and continue throughout pregnancy

Iron

• Recommended dose: 30-60 mg elemental iron daily 3
• Benefits: Prevents maternal anemia, which is associated with poor maternal and fetal outcomes
• Note: Lower doses may be sufficient for women without anemia

Calcium

• Recommended dose: 1200-1500 mg daily (including dietary intake) 1
• Benefits: Prevents preeclampsia, a leading cause of maternal mortality
• Administration: Best taken in divided doses of no more than 500 mg elemental calcium per dose 1

Vitamin D

• Recommended dose: >40 mcg (1000 IU) daily 1
• Benefits: Maintains bone health and may reduce risk of preeclampsia
• Note: Should be monitored during pregnancy to maintain levels above 50 nmol/L

Additional Important Nutrients

• Vitamin B12: 2.6 mcg daily 4, 2

  • Especially important for vegetarians/vegans
  • Required during pregnancy (4 mcg daily recommended)
  • Prevents neurological complications

• Iodine: Adequate intake needed for fetal brain development

  • Usually included in prenatal vitamins

• DHA (omega-3 fatty acid): Supports fetal brain and eye development 5

  • Often included in prenatal vitamins or as separate supplement

Special Considerations

Women with Bariatric Surgery History

These women require more intensive supplementation and monitoring 1:

• Higher doses of most nutrients
• Regular blood monitoring during each trimester
• Vitamin A in beta-carotene form only during pregnancy
• Additional B12 supplementation (1 mg daily oral or quarterly injections)

High-Risk Populations

• Women with previous neural tube defect pregnancies: 4 mg folic acid daily 1, 2
• Women with obesity (BMI >30): 4-5 mg folic acid daily 1
• Women with diabetes: 4-5 mg folic acid daily 1

Common Pitfalls to Avoid

1. Delayed supplementation: Folic acid should ideally begin before conception, not after pregnancy is confirmed
2. Vitamin A toxicity: Avoid supplements with high retinol content; beta-carotene form is safer during pregnancy 1
3. Calcium-iron interaction: While calcium can inhibit iron absorption, clinical studies show minimal effects; for simplicity, they can be taken together 1
4. Inadequate vitamin D: Many women are deficient; supplementation is crucial
5. Assuming diet alone is sufficient: Most pregnant women cannot meet all nutrient requirements through diet alone 6

Monitoring Recommendations

• Hemoglobin/ferritin levels to assess iron status
• Vitamin D levels, particularly in high-risk women
• Calcium levels if at risk for preeclampsia
• Folate and B12 levels in high-risk women

By following these supplement recommendations, pregnant women can significantly reduce risks of maternal mortality from conditions like preeclampsia while supporting optimal fetal development and preventing birth defects.