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Planning for a Healthy Baby : Charge Up the Calcium, Pump Up the Iron, The Scoop on Prenatal Vitamins

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1. Charge Up the Calcium

Calcium is a mineral that deserves special attention throughout a woman’s life, especially when it comes to pregnancy. Calcium is important to strong bones and teeth, a healthy heart, nerves, and muscles, and the development of normal heart rhythm and blood-clotting abilities. Not consuming enough calcium and/or not having good calcium stores will force the baby to use calcium from your own bones. Consuming plenty of calcium before, during, and after pregnancy can also help to reduce your risk for osteoporosis, or brittle bone disease, later in life.

Intake Requirements

Whether pregnant or not, calcium needs for teens (age fourteen to eighteen) is 1,300 milligrams (mg) and 1,000 mg for woman nineteen to fifty. Women older than fifty need 1,200 mg of calcium daily. The tolerable upper intake level for calcium is 2,500 mg daily.

The easiest way to get all the calcium you need is to eat at least two to three servings of low-fat or fat-free dairy foods each day. Other sources include green leafy vegetables, calcium-fortified orange juice, calcium-fortified soy milk, fish with edible bones, and tofu made with calcium sulfate. Reading the nutrition facts panel (included on all packaged foods) is a great way to spot calcium-rich foods. The amount on the panel is presented in terms of “% Daily Value,” which is an approximation of the percentage of your day’s calcium need supplied by one serving of that food.

Most prenatal supplements do not provide all of the calcium you need daily. You may need to take a calcium supplement, especially if you are not a milk drinker, are a strict vegetarian, or are lactose intolerant. There are all types of calcium supplements on the market today. Ideally, a calcium supplement should also contain vitamin D for maximum absorption to occur.

Elemental Calcium

In a discussion of the amount of calcium in supplements, it is important to understand the concept of elemental calcium. Calcium occurs in combination with other substances, forming compounds such as calcium carbonate, calcium phosphate, or calcium citrate. What is really important is the “elemental” calcium, or the actual amount of calcium in the compound. Some compounds contain more elemental calcium than others. For instance, a calcium supplement made from calcium carbonate might have 625 mg in each tablet, but the amount of elemental calcium in each tablet is about 250 mg. When looking for a calcium supplement, be sure to read the label carefully. Ideally, the label will list how much elemental calcium is in each tablet. If the label does not state elemental calcium, you can figure it out with the following chart. Elemental calcium accounts for these percentages of the following compounds:

• 40 percent of calcium carbonate

• 21 percent of calcium citrate

• 13 percent of calcium lactate

• 9 percent of calcium gluconate

How to Take Calcium Supplements

Supplements that contain calcium citrate can be taken with or without food, whereas calcium carbonate should be taken with food for optimal absorption. Many antacids, such as Tums, contain calcium carbonate, which may be a more convenient and less expensive way to take your calcium. If you prefer a chewable pill, products such as Viactiv can be a good choice. Avoid the natural-source calcium pills, such as those produced from oyster shell, dolomite, or bone meal. These supplements may contain lead or other toxic metals. When taking calcium supplements, it is best to take smaller amounts several times a day for the best absorption. If you are taking a calcium supplement and an iron supplement or a supplement with iron in it, take them at different times of the day. They will each be better absorbed alone.

Regular exercise can have many healthy benefits for pregnant women, including making the birthing process easier. It is a good idea to start an exercise program before you become pregnant. This will give you time to adjust and will help get your body ready for pregnancy. Women who are already exercising before pregnancy can continue to do so, but they may need to decrease the intensity. Women who are not exercising before pregnancy can start, but they must start very slowly and should consult their doctor first. Talk to your doctor about the amount of exercise that is safe for you.

2. Pump Up the Iron

Iron is another essential mineral that merits special attention as part of your diet before and during pregnancy. Iron is essential to the formation of healthy red blood cells, which are responsible for carrying oxygen through your blood to the cells of your body. Almost two-thirds of the iron in your body is found in hemoglobin, the protein in red blood cells that carries oxygen to your body’s tissues. The increase in blood volume that takes place during pregnancy greatly increases a woman’s need for iron. If you do not get enough iron and/or do not have adequate iron stores, the growing baby will take it at your expense. Iron deficiency during pregnancy can cause anemia, extreme fatigue, a low birth-weight baby, and other potential problems. The greater your iron stores before you become pregnant, the better iron will be absorbed during pregnancy.

Intake Requirements

It is very difficult to get enough iron from foods alone. Most multi-vitamin/ mineral supplements and/or prenatal vitamin supplements will provide you with your pre-pregnancy needs of 18 mg per day. If you have anemia before becoming pregnant, your doctor may prescribe a much larger dose. During pregnancy, your iron requirement climbs to 27 mg per day.

Again, as with many other vitamin and minerals, too much iron is not always best. Iron has a tolerable upper intake level of 45 mg. Foods that supply iron include meat, poultry, fish, legumes, and whole-grain and enriched grain products. Iron from plant sources (or “nonheme iron”) is not as easily absorbed as that from animal sources (or “heme iron”). Supplementing your meals with a food or beverage rich in vitamin C, such as citrus fruits or juices, broccoli, tomatoes, or kiwi, will help your body better absorb the iron in the foods you consume. The absorption of iron from supplements is best absorbed on an empty stomach or when swallowed with juice containing vitamin C.

3. The Scoop on Prenatal Vitamins

Prenatal supplements (PNVs) are specialized vitamin and mineral supplements that women can take even before pregnancy to get all of the essential nutrients they need during pregnancy. Studies have shown that the use of prenatal supplements before and throughout pregnancy can benefit a healthy baby.

Vitamins and minerals should never replace a healthy diet. They are only meant to supplement a healthy diet, not take the place of any one food or any food group. Foods contain hundreds of vitamins, minerals, and phytonutrients. Only food supplies the ideal mixture of these substances that are essential for optimal health. Supplements can provide you with insurance that you will receive everything you need, but they cannot do the entire job.

Prenatal vitamins come in many formulations. Most PNV are distributed as samples to physician’s offices, and it is a good idea to try multiple samples because some have stool softeners and other binders, which you may or may not tolerate. Finding one that you can tolerate will make it easier to take and therefore easier to remember to take it daily.

The Ideal Prenatal Vitamin

The components all PNV supplements should have in common are folic acid, iron, and calcium. Most PNVs have only 100 to 250 mg of calcium— women need 1,000 to 1,200 mg daily, so you should also take a separate calcium supplement. Except for calcium, you should never take any additional supplements with your prenatal supplement unless they are prescribed by your doctor. Since some over-the-counter supplements contain too-high levels of vitamins and minerals, it may be smarter to use a supplement such as a PNV that has been specifically formulated for pregnant women and/or women trying to conceive. PNVs are not recommended postpartum unless the mother is considered to be at “nutritional risk.” Some women can benefit from taking prenatal vitamins postpartum if they plan to become pregnant in less than one year, but most experts recommend spacing pregnancy by at least one year.

Who Should Take Supplements?

If you are a healthy woman who eats a well-balanced diet and has no risk factors, your doctor may not feel that you need to take a prenatal supplement. This is something that you need to discuss with your doctor so together you can determine what is right for you. No matter how healthily you eat, it is generally difficult to get what you need each and every day, especially while pregnant or trying to conceive, so a prenatal supplement can act as insurance. All doctors do agree that a folic acid supplement is necessary.

Women who have a history of poor eating habits, who are on a restricted diet such as a vegan diet, or who require a specific nutrient due to an existing medical condition will definitely need to take some type of supplement.

Women who are expecting more than one baby or have closely spaced pregnancies will need extra iron and may require additional vitamin and mineral supplementation. Nourishing two babies demands more from your body and therefore requires more nutrients. After pregnancy, your body may be depleted of some nutrients. If you are planning to become pregnant again soon, you may need special supplements to restore those nutrients. Speak to your doctor before starting any supplement program.

Are Your Prenatals Making You Sick?

Many women have trouble taking prenatal vitamins once they become pregnant because the iron content can exacerbate morning sickness. They are also known to cause constipation and gas. If you are having problems, try taking your prenatal vitamins with food or taking them right before bedtime. Also drink plenty of water and include plenty of fiber in your diet. If that doesn’t work, talk to your doctor about trying a different brand or switching to a prenatal supplement without iron for the first trimester. Many times these problems only last for the first trimester. In the meantime, make certain your prenatal contains vitamin B6. This vitamin has been found to help relieve nausea in some women during pregnancy, a common discomfort during the first trimester.

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