When you're pregnant, a lot of your body nutritional needs changes. Have you ever wonder how a baby has well formed head, body, limbs and fingers in a short span of 40 weeks? It is a well known fact that calcium helps form strong bones and this process actually begins in utero right when those tiny fingers are forming.
For the baby, calcium also helps with the growing a healthy heart, nerves, and muscles as well as develop a normal heart rhythm and blood-clotting abilities. If you don't get enough calcium in your diet when you're pregnant, your baby will draw it from your bones, which may impair your own health later on causing issues like osteoporosis.
For the mother, calcium supplementation in pregnancy has been associated with a reduced risk of pregnancy-induced hypertension (1)
How much calcium do you need in pregnancy: (2)
Women ages 19 to 50: 1,000 milligrams (mg) a day before, during, and after pregnancy
Women age 18 and younger: 1,300 mg a day before, during, and after pregnancy
Food with high calcium
If you are taking Calcium supplements/ Calcium as part of your prenatal supplements
Calcium supplements come in two forms: carbonate and citrate
Calcium carbonate is less expensive and works best if you take it with food.
Calcium citrate works just as well with food or on an empty stomach.
Breastfeeding needs more calcium, too. It is important that you continue calcium supplements while you're breastfeeding. Research shows you may lose 3% to 5% of your bone mass when you nurse because you lose some of your calcium through breast milk. Luckily, if you are careful to eat foods with calcium and take supplements as advised, you should regain that bone mass within 6 months after you stop breastfeeding.
1. Beinder E. [Calcium-supplementation in pregnancy--is it a must?]. Ther Umsch. 2007 May;64(5):243-7. Review. German. PubMed PMID: 17685081.
What is Zinc
Zinc, which is a type of metal, is actually an important trace mineral that people need to stay healthy. Without zinc, there is no life. This element is second only to iron in its concentration in the body.
Essential to human growth, Zinc is key to proper T-lymphocytes or T cell (a type of white blood cell that fights off foreign invaders in your bloodstream) activity. Zinc also plays a major role in activating growth and development of bones and major organs, enabling brain functions, including memory, sensory messaging and cognition to function. (1) Other than that it is also responsible for maintaining normal immune system, wound healing, blood clotting, thyroid function, senses of taste and smell. (2) Zinc also helps the cells in your body communicate by functioning as a neurotransmitter. (3)
Zinc in Pregnancy
Do you know that what you eat while you’re pregnant and breastfeeding is very important? This is where your baby will get the nutrients that go on to make up absolutely everything about them – from their bones to their immune system and even their metabolism. (4)
Zinc is one of these building blocks – and getting the right amount of it while pregnant is essential for growing a healthy baby. A good prenatal vitamin will have zinc in it.
- Important for normal brain function, which contributes to all future learning and development of your baby.
- Building a robust immune system by maintaining a healthy amount of antibodies. (5)
- Extra immune support for mother and baby during this vulnerable period
- Lower the risk of premature birth. (5)
How much Zinc is enough in pregnancy?
Pregnant women age 18 and younger: 12 milligrams (mg) per day
Pregnant women age 19 and older: 11 mg per day
Breastfeeding age 18 and younger: 13 mg per day
Breastfeeding women age 19 and older: 12 mg per day
Nonpregnant women ages 19 and older: 8 mg per day (6)
Food sources of Zinc
Oysters are actually the richest food source of zinc – just two can provide more than the recommended amount for the whole day – but it is not advisable for pregnant woman to eat raw oysters for fear of food-borne diseases. Moreover depending on where the oyster is harvested, it can contain high amount of mercury.
Can you get too much zinc?
Yes. Too much zinc can cause nausea, vomiting, abdominal pain, and diarrhea. In fact, the National Academy of Sciences, the group that sets the recommended daily amounts for the government, suggests that adults should get no more than 40 mg of zinc a day from all sources. (Women 18 and younger should get no more than 34 mg). (6) Taking high dose of zinc for long period may disrupt the absorption of copper and iron.
The signs of a zinc deficiency
Zinc deficiencies in pregnant women have been linked to low birth weight, toxemia and miscarriage. (4)
Other common symptoms of zinc deficiency include loss of appetite, impaired senses of smell and taste, growth retardation, delayed wound healing, depression, impaired concentration, nervousness, night blindness, and slowed nail and hair growth. (7)
1. International Zinc Association http://www.zinc.org/health/
2. Zinc https://www.healthdirect.gov.au/zinc
3. The 10 Best Foods High in Zinc https://www.healthaliciousness.com/articles/zinc.php
4. The role of zinc in your pregnancy and how to get it http://www.kidspot.com.au/health/early-life-nutrition/pregnancy-nutrition/the-role-of-zinc-in-your-pregnancy-and-how-to-get-it
5. Zinc in pregnancy https://www.aptaclub.co.uk/article/pregnancy-vitamins-zinc
6. Zinc in your pregnancy diet https://www.babycenter.com/0_zinc-in-your-pregnancy-diet_673.bc
7. ZINC: THE IMMUNE SYSTEM NUTRIENT http://www.dummies.com/health/nutrition/zinc-the-immune-system-nutrient/
Are you taking enough iron
Iron is used by your body to make haemoglobin, a substance in red blood cells that transports oxygen throughout your body. During pregnancy, your body supplies blood and oxygen to your baby, so the demand for iron goes up with the increase in blood supply. (1) If your body lacks sufficient amount of red blood cells which are used to carry oxygen through the body, you will have anemia.
While you may experience mild anemia during pregnancy, severe anemia might put you and your baby at risk of premature delivery and low birth weight. If you're anemic when you give birth, you're more likely to need a transfusion and have other problems if you lose a lot of blood at delivery. Iron intake is most important in the final weeks of pregnancy. It is right at the time that your growing baby is most in the market for new red blood cells.
How much iron do you need
Pregnant women: 27 milligrams (mg) of iron per day
Nonpregnant women: 18 mg
Do you need to take an iron supplement? - YES or a prenatal vitamin that contains iron
Take iron rich food or supplement with Vitamin C source such as orange juice as it is iron's best buddy. It is well known to improve iron absorption.
Too much iron is not good
Aim to get no more than 45 milligrams of iron a day. If you take more than that (either from an extra iron supplement or from your prenatal vitamin), it can cause your blood levels of iron to rise too high, possibly causing problems for you and your baby.
Finally, iron is known to cause constipation so take more fibre and don't worry if your stools look darker when you start taking iron. That's a normal and harmless side effect.
2. T. H. Bothwell, “Iron requirements in pregnancy and strategies to meet them,” American Journal of Clinical Nutrition, vol. 72, pp. 257S–264S, 2000
Vitamin B6, also known as pyridoxine is a water soluble vitamin present in many foods. Vitamin B6 is extremely important and it is involved in a variety of functions in the human body. It is involved with more than 100 enzyme reactions, mostly related to protein metabolism. (1)
Below is a table which shows where you can find Vitamin B6 rich foods:
Vitamin B6 has many other health functions from improving cardiovascular health,
cancer, cognitive function to premenstrual syndrome.
Isolated vitamin B6 deficiency is uncommon however some groups of people are particularly at risk of Vitamin B6 deficiency, particularly those who have imparied renal function, alcohol dependence and autoimmune diseases.
Vitamin B6 and pregnancy
In a study published in American Journal of Epidemiology, researchers found that higher preconception plasma vitamin B6 concentrations were associated with reduced odds of early pregnancy losses and higher probabilities of achieving conception and clinical
Moreover, randomized trials have shown that a combination of vitamin B6 and doxylamine (an antihistamine) is associated with a 70% reduction in nausea and vomiting in pregnant women and lower hospitalization rates for this problem. (3)
The recommended daily allowance (RDA) for pregnant women is 1.9milligrams
Vitamin B6 Supplements
While taking B vitamins supplements can be helpful for some people, it’s always best to get your nutrients from real food sources. However, as this is sometimes not always possible with the busy lifestyle. Hence, it is extremely important that If you are going to be taking any supplements that contain vitamin B6, be sure to purchase a high-quality potency guaranteed safe product that doesn’t contain fillers or toxins. This is extremely important especially during pregnancy as the baby absorbs everything that the mother takes.
1. Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Cholineexternal link disclaimer. Washington, DC: National Academy Press; 1998.
2: Ronnenberg AG, Venners SA, Xu X, Chen C, Wang L, Guang W, Huang A, Wang X.
Preconception B-vitamin and homocysteine status, conception, and early pregnancy
loss. Am J Epidemiol. 2007 Aug 1;166(3):304-12. Epub 2007 May 2. PubMed PMID:
3. Niebyl JR. Clinical practice. Nausea and vomiting in pregnancy. N Engl J Med 2010;363:1544-50.
Everyone needs a certain amount of niacin -- from food or supplements -- for the body to function normally. This amount is called the dietary reference intake (DRI), a term that is replacing the older and more familiar RDA (recommended daily allowance). For niacin, the DRIs vary with age and other factors:
Women: 14 milligrams daily
Women (pregnant): 18 milligrams daily
Women (breastfeeding): 17 milligrams daily
Maximum daily intake for adults of all ages: 35 milligrams daily
Most people can get the amount of niacin they need by eating a healthy diet. 
According to the U.S. Food and Drug Administration (FDA) classifies oral niacin under Pregnancy Category C which means that it has not been fully studied on pregnant humans and animals. Since there are no adequate studies to determine the possible effects of niacin (at high doses) on pregnancy and the unborn child; caution is advised when using this drug. On the other hand, doses not exceeding the recommended dietary allowance for pregnant women are considered safe.
It is generally advised that women taking high doses of niacin for treatment of high “bad cholesterol” level should stop taking the high levels of this vitamin throughout pregnancy. Meanwhile, women taking niacin for high triglycerides may need to continue taking the vitamin since pregnancy increases the risk of complications due to high triglycerides(such as pancreatitis). Discuss with your healthcare provider whether it is safe for you to continue taking the drug during pregnancy. 
Niacin During Pregnancy
Niacin deficiency is also a concern during pregnancy, and it is relatively common according to a study published in 2002 in the "Journal of the American College of Nutrition." The study found that deficiencies in niacin, thiamine, vitamin B-12, vitamin B-6 and vitamin A were common in all three trimesters of pregnancy even with vitamin supplementation. 
Can Breastfeeding Women Take Niacin?
In general, breastfeeding women can safely take low doses of niacin. However, breastfeeding women are advised to discuss with their healthcare provider the safety of this vitamin before initiating treatment as more studies are needed to determine the safety of high dose-niacin for breastfeeding women and the infant.
Basically, niacin dosage not exceeding the recommended dietary allowance (RDA) for breastfeeding women of 35 mg/day is considered safe. 
1. Niacin (Vitamin B3) http://www.webmd.com/diet/supplement-guide-niacin#1
2. How Much Niacin Is Okay During Pregnancy? http://www.livestrong.com/article/441111-how-much-niacin-is-okay-during-pregnancy/
3. Niacin During Pregnancy & Breastfeeding http://www.drugsdb.com/sup/niacin/niacin-during-pregnancy-breastfeeding/
Vitamin B3 (also known as niacin) is one of 8 types of vitamin B. It is an important water-soluble vitamin, meaning that it can't be stored in the body unlike fat soluble vitamins.
It comes in 3 forms: Nicotinic acid, Niacinamide and Inositol Hexaniacinate. Niacin has been studied extensively and shows positive results treating a wide range of many commonly occurring health problems. 
Health Benefits of Vitamin B3 / Niacin
Niacin is an important vitamin for maintaining a healthy cardiovascular system and metabolism- especially balancing blood cholesterol levels. In addition, niacin helps with brain function, healthy skin formation and maintenance and even preventing or treating diabetes. 
Niacin also helps the body make various sex and stress-related hormones in the adrenal glands and other parts of the body. Niacin helps improve circulation, and it has been shown to suppress inflammation. 
Top Vitamin B3 / Niacin Foods
These percentages are based on the adult RDA of 16 mg/daily for adult males, adult females should consume roughly 14 mg/ daily:
1.Vitamin B3 / Niacin Side Effects, Benefits & Foods https://draxe.com/niacin-side-effects/
2.Vitamin B3 (Niacin) http://www.umm.edu/health/medical/altmed/supplement/vitamin-b3-niacin
A lot of people knows folic acid as the pregnancy vitamin. But what exactly is folic acid?
Folic acid, also known as folate is part of the vitamin B group. Your body needs it to produce red blood cells to prevent anaemia and it is an important chemical component of the nervous systems. It is also essential for the production, repair and functioning of DNA. However, folic acid's role in pregnancy has been proven to be particularly important for the development of the nervous system and to prevent neural tube birth defects, such as spina bifida.
In Australia, about 70 babies per year are born with a neural tube defect, which is around 2.5 in every 10,000 babies born! It occurs in the first weeks of pregnancy, when the brain and spinal cord are forming. Women who don't get enough folate may likely increase the chance of miscarriage! (1)
When should I start taking folic acid?
Women of child-bearing age should take extra folate daily to prevent neural tube defects. Even if you are not planning to have a baby, you should increase your folate intake because half of all pregnancies in Australia are unplanned.
Recommended daily dose of folic acid should be taken at least one month before conception and during the first trimester of pregnancy.(3) By doing so, 7 out of 10 cases of neural tube defects can be prevented. Neural tube defects occur at a very early stage of development, before many women even know they are pregnant - which is why it is important to take folic acid before starting to try to conceive.
What dietary source contains Folic Acid?
Most women don't get enough folate from their diet. Many foods are naturally rich in folate. However folate is water-soluble and easily destroyed by cooking. It is best for vegetables to be lightly cooked or eaten raw. Cooking by microwave or steaming is best.
Should I take a supplement?
The recommended daily intake of folic for women is 400mcg daily. Once you are pregnant, the need for folic acid supplements increase exponentially. Women should take 600mcg of folic acid from their normal diet. If you are planning a pregnancy or in the first trimester of pregnancy, you should take a daily supplement containing 500mcg of folic acid (4)
It is BEST to take a prenatal supplement to ensure daily nutrient intake is sufficient. Getting enough folic acid is particularly important for the rapid cell growth of the placenta and your developing baby.
2. Scholl TO, Johnson WG. Folic acid: influence on the outcome of pregnancy. Am J Clin Nutr. 2000; 71(Suppl):1295S–1303S.
Thiamin (also known as thiamine or vitamin B1) is a water soluble substance. Thiamin is essential for carbohydrate metabolism and is involved in nervous system and muscle function. It enables conversion of carbohydrate into energy in you and your baby.
On top of making sure your nervous system, muscles, and heart function normally. It is also essential for your baby's brain development. Studies in experimental animals have shown that thiamine deficiency leads to delayed maturation profiles for enzymes involved in brain energy metabolism (1)
Deficiency is common in Asia, where diets are often high in thiamine-depleted polished rice and can be low in other food sources. On top of that pregnancy imposes an increasing requirement for thiamine over the course of gestation. This deficiency can lead to widespread metabolic disturbances affecting the placenta and fetus.
Nutritional deficiency for thiamine is rare in people who consume a moderately varied diet that contains whole grains. However, excessive vomiting in pregnancy can cause thiamine depletion, in which case antenatal vitamins containing thiamine and other B vitamins may be beneficial. (1)
Food sources of Thiamin:
Fortified breads, cereals, whole grain products, lean pork, dried beans, nuts and peas all contain good amounts of thiamin. Fruits, vegetables, and dairy products have small amounts too.
How much Thiamin you need:
Pregnant and breastfeeding women: 1.4 milligrams (mg) per day
Nonpregnant women: 1.1 mg per day
1. Fournier H, Butterworth RF. Effects of maternal thiamine deficiency on the development of thiamine-dependent enzymes in regions of the rat brain. Neurochem Int 1989;15:439–44.
2. Sir Peter Gluckman, Mark Hanson, Chong Yap Seng, and Anne Bardsley. Vitamin B1 (thiamine) in pregnancy and breastfeeding. Oxford University Press. Dec 2014
Vitamin C, also known as ascorbic acid, is a water-soluble vitamin. Unlike most mammals and other animals, humans do not have the ability to make ascorbic acid and must obtain vitamin C from the diet.
Food Sources of vitamin C
Vitamin C can be found in vegetables and fruits. Citrus fruits are especially high in vitamin C, but leafy greens and many other fruits and vegetables are also excellent sources. Choose fresh foods as your source of vitamin C as heat can destroy this vitamin.
Foods that provide vitamin C include: orange juice, grapefruit juice, kiwi, strawberries, broccoli, grapefruit, baked potato, tomato, spinach
Do you know that one medium orange gives you about 70mg of Vitamin C?
Why you need vitamin C during pregnancy
Both you and your baby need vitamin C daily because it's necessary for the body to make collagen, a structural protein that's also a component of cartilage, tendons, bones, and skin. Based on animal studies, some researchers believe that vitamin C deficiencies in newborn babies can impair mental development. (1)
Other than that, Vitamin C is also essential for healthy skin, tissue repair, wound healing, bone growth and repair. Vitamin C helps your body fight infections, improves your immune system and acts as an antioxidant, protecting cells from damage.
Vitamin C also helps your body absorb iron, especially from vegetarian sources. One tip will be to take Vitamin C together with iron supplements during pregnancy.
How much vitamin C do you need?
Pregnant women age 18 and younger: 80 milligrams (mg) per day
Pregnant women age 19 and older: 85 mg per day
Breastfeeding women age 18 and younger: 115 mg per day
Breastfeeding women age 19 and older: 120 mg per day
Nonpregnant women age 18 and younger: 65 mg per day
Nonpregnant women age 19 and older: 75 mg per day (2)
What are the signs of a vitamin C deficiency?
Signs include fatigue, muscle weakness, joint and muscle aches, bleeding gums, and leg rashes. Prolonged deficiency can cause scurvy, a rare but potentially severe illness.
Are there any risks associated with too much vitamin C?
Vitamin C is generally regarded as safe. Side effects are rarely reported, but may include diarrhea, nausea, abdominal cramps, and other gastrointestinal symptoms.
For most healthy individuals, the body can only hold and use about 200-250 mg of vitamin C a day, and any excess is lost though urine. At times of illness, during recovery from injury, or under conditions of increased oxidative stress (including smoking), the body can use greater amounts. High doses of vitamin C (greater than 2,000 mg/day) may contribute to the formation of kidney stones, as well as cause severe diarrhea, nausea, and gastritis. (3)
1. Tveden-Nyborg P, Lykkesfeldt J. Does vitamin C deficiency result in impaired
brain development in infants? Redox Rep. 2009;14(1):2-6.
During prenatal care, you will be reminded to take folic acid and calcium, but what about vitamin B2?
Vitamins in the B complex play an important role in supporting a healthy pregnancy and to the health of breastfeeding mothers.
Vitamin B2, part of the vitamin B complex is also known as Riboflavin. it is water soluble, which means that your body doesn't store it. You must replace them through your diet or prenatal vitamins.
Why vitamin B2 during pregnancy?
In general, there are many health benefits of vitamin B2:
• Headaches - Vitamin B2 can prevent headaches and treat migraine headaches. It reduces the pain you feel during a migraine attack and stops them from lasting too long.
• Energy - Vitamin B2 is an important part of the metabolic process. The body uses it to properly digest food to give us the energy we want. So without it, we don't process food properly and end up gaining weight and not having the energy to get through the day. Vitamin B2 breaks proteins down into their amino acid bases, fats and carbs by converting them into glucose; the main fuel of the body.
• Cancer - Vitamin B2 is responsible for the production of glutathione which removes these free radicals from breaking down our bodies and keeps the liver clean. Free radicals do a lot of damage to the body and are the main reason you get sick. (1)
During pregnancy, consumption of vitamin B2 lowers the risk of developing preeclampsia, a pregnancy complication. It also promotes the healthy development and growth of baby's bones, muscles and nerves. For moms, vitamin B2 helps your skin look glowing and refreshed! Don't you want to look radiant even when you are pregnant? This is also because vitamin B2 increases blood circulation for mother and foetus and helps prevent pregnancy-related anaemia.
Not only that! Breastfeeding mothers need even more vitamin B2 than pregnant mothers. Some women need up to 50% more daily intake of riboflavin than they did before pregnancy. To provide for the hungry baby, breast milk absorbs much of the vitamin B2 than the mother ingests.
How do you know if you are riboflavin deficient?
Anemia, magenta (dry and red tongue), skin rash, dermatitis, dryness and cracking around mouth, nose and lips are all signs of riboflavin deficiency (2). If you are on a special diet due to lactose intolerant, vegetarian or anorexia, then you are at higher risk of riboflavin deficiency. (3)
What dietary sources contains vitamin B2?
The best sources of riboflavin are almond, mushrooms, wild rice, milk, yogurt, eggs, broccoli, brussels sprouts, spinach and whole grains. Flours and cereals are often fortified with riboflavin.
However, riboflavin can be destroyed by light. So food should be kept away from light to protect its riboflavin content. Although riboflavin is not destroyed by heat, it can be lost in water when foods are boiled or soak. The best way is to roast or steam the foods to preserve more riboflavin rather than frying or scalding your food.
Should you take a supplement?
YES - Although you can get enough riboflavin from a diet that includes grains, fairy products, meats, green vegetables and eggs, your doctor will advise you to take a prenatal supplements which provide the dietary reference intake (DRI) for riboflavin.
The recommended daily dietary intake for riboflavin (4)
• Women, 19 years and older: 1.1 mg (RDA)
• Pregnant women: 1.4 mg (RDA)
• Breastfeeding women: 1.6 mg (RDA)
Dr Nicole Ng (MBBS) is a medical doctor with a passion in women's health and medical research