What needs to be supplemented

According to latest recommendations, expectant mothers should supplement their diet with folic acid and iodine as well as docosahexaenoic acid (DHA) and iron, if necessary. According to the 2005/6 National Survey on Consumption, the average folate intake by men amounts to 207 micrograms per day. Women ingest an average of only 184 micrograms daily. Reasons for the suboptimal supply are that not enough vegetables and fruits are eaten, plus the fact that storage and preparation of the respective foods entail the loss of folates. The recommended intake quantity for pregnant women, namely 550 micrograms per day, can rarely be achieved even if the choice of food is very specific. This is a problem: If there is an undersupply of folate during the early stages of pregnancy, the child may be in danger of suffering a malformation of the brain and/or spinal cord. The most common form is the so-called spina bifida, better known as »open spine«.

The so-called neural tube, which is the preform of the later spinal canal, is formed in the embryo already between the 22nd and 27th day. At that point many women often don’t know yet that they are pregnant. If the amount of folate is not sufficient in this critical phase the risk increases that the neural tube will not or not completely close. Neural tube defects can, however, also have other causes, but numerous studies have proven that their frequency can be reduced by taking folic acid preparations. Moreover, the incidence of congenital heart disease, malformation of the efferent urinary tracts as well as cleft lips and palate will decline.

Women who want to become pregnant should supplement their food with 400 micrograms of folic acid per day. They should already start taking the supplement when they want to become pregnant and are no longer taking contraceptives. The early start is important as it takes about six weeks until a sufficiently high folate level is achieved. It is recommended to continue supplementing during the entire first third of the pregnancy.

During pregnancy, the iodine requirement increases as more thyroid hormones are synthesized and also the child’s thyroid gland produces hormones from about the twelfth pregnancy week on. The requirement does, however, only rise by 15 percent. As most women have not been optimally supplied even before that time, a relevant deficit exists during pregnancy which saltwater fish and iodized salt alone cannot remedy. If the mother has an iodine deficiency, the danger of a premature birth or a stillbirth will increase as well as the risk of the child having irreversible mental and motoric developmental disabilities. Some children are born with a goitre due to an iodine deficiency.

Even a slight enlargement of the thyroid gland can lead to the new-born baby having dyspnoea and dysphagia (swallowing difficulties) straight after birth. Pregnant and nursing women have been recommended by expert associations to supplement their diet with 100 to 150 micrograms of iodine per day. However, for safety reasons it needs to be clarified first if the pregnant woman is already taking other supplements containing iodine or has a diet particularly rich in iodine. Pregnant women suffering from a thyroid disease should consult their doctor first before supplementing.

During pregnancy the iron requirements increase considerably. Almost half of the expectant mothers ingest considerably less iron via their food than is recommended by the DGE (German Nutrition Society). If the result is a considerably reduced haemoglobin value, the child may not receive enough oxygen. This deficiency can delay its development and lead to birth complications and a low weight at birth. As part of the prenatal care, gynaecologists therefore regularly measure the haemoglobin level in the blood. Should it be below a certain limit value, they prescribe as a rule an iron supplement. But categorical supplementing with iron is not recommended to every pregnant woman by the expert associations. Because an excess can also be harmful.

Omega-3 fatty acids are vital during pregnancy especially for the development of the child’s brain and sight. Particularly eicosapentaenoic acid and docosahexaenoic acid (DHA) are playing an important role here. The DGE recommends that pregnant women daily take at least 200 milligrams of DHA on average – preferably from two portions of fatty saltwater fish per week. Who does not like this, can fall back on supplements which provide 200 milligrams of DHA per day.