Pregnancy, natural supplements that may help reduce complications
August 25 2017 by Ray Sahelian, M.D.

In order to have a healthy pregnancy, women should start taking measures to protect their babies before getting pregnant. That's the time to improve nutrition, be checked for medical problems, and shake poor lifestyle habits (smoking, taking drugs, or drinking alcohol in excess). Once you become pregnant you should see your doctor or certified nurse-midwife on a regular basis to help safeguard your health as well as the well-being of your baby. Prenatal check-ups also give you the chance to voice any questions or concerns. It's important for you to be completely honest and to tell your doctor about any physical or emotional problems you may have. Initially, your physician will take a medical history, do a thorough examination, estimate your due date, and take tests to check for diabetes, urinary tract problems, anemia, hepatitis C virus, and sexually transmitted diseases, including human immunodeficiency virus (HIV).
   Delaying clamping of the umbilical cord for at least a minute after birth significantly improves iron stores and hemoglobin levels in newborn babies.

Diet and food selection, what to eat
The diet a mother eats while she is pregnant can influence the health of her baby. For instance, maternal oily fish intake during pregnancy may protect offspring from asthma; however, eating fish sticks during pregnancy may increase asthma risk in children. Drinking lots of sugar-sweetened cola may increase women's likelihood of developing diabetes during pregnancy, a condition known as gestational diabetes.
   High cholesterol and inflammation during pregnancy increase a woman's odds of premature delivery. Pregnant women with elevated levels of cholesterol or C-reactive protein -- a marker of inflammation in the body -- are at increased risk of having their baby prematurely. Elevations in both measures raises the risk even further. Since diet influences cholesterol levels and inflammation, this indicates that diet has a role to play in premature delivery.
   It is best to limit caffeine use. Women who drink a lot of sweet sodas during pregnancy may be more likely to give birth prematurely.

Supplements helpful during Pregnancy, safe and effective
There is little risk in taking low dosages of supplements during the first two trimesters and the possibility that they could be beneficial. I suggest avoiding high dosages of supplements, it's better to err on the safe side.

Biotin is a B vitamin that can be of benefit.
Folic acid is a B vitamin that should be considered. Supplementation with this B vitamin can reduce the risk for depression during and after.
   The U.S. Preventive Services Task Force continues to recommend that all women planning or capable of pregnancy should take a daily supplement of 0.4-0.8 mg of folic acid to prevent neural tube defects in their offspring.
Choline at 200 to 500 mg capsule a few times a week should be sufficient.
Fish oils may reduce the risk for pregnancy related increases in blood pressure. DHA supplementation has been found to be of benefit.
Prenatal vitamins may reduce the risk of brain tumors in children but they are only necessary the first few months. British researchers found that a woman's risk of delivering prematurely tripled if she continued taking the prenatal pills into her third trimester. "These supplements are available over-the-counter in the United Kingdom and frequently promoted as being beneficial for mums-to-be," said Dr. Nigel Simpson of the University of Leeds in the U.K., and one of the authors of the study. April 2010.
Vitamin D - Women with insufficient vitamin D intake during pregnancy may be at increased risk for birth by cesarean section. Journal of Clinical Endocrinology and Metabolism, April 2009. High levels of vitamin D, obtained through the diet or through supplements, appear to reduce the risk of recurrent wheeze or wheeze symptoms in early childhood.
Vitamin E - Women who get enough vitamin E may help lower their child's future risk of asthma. Vitamin E may aid in lung and immune system development. However, excess intake may increase the risk for heart defects.
Taking iron supplements reduces women's risk of anemia and is linked with an increase in birth weight and a reduced risk of low birth weight.

Med Monatsschr Pharm. 2013 . Nutrient supplements --possibilities and limitations. Pregnant women are at greater risk of an insufficient vitamin and mineral supply. Based on hemodynamic, endocrine and metabolic changes due to pregnancy, the body weight and blood volume increase. These changes result in an increased requirement of most vitamins and minerals while the energy requirement increases by about 10%. Besides iodine (recommended intake as supplement 150 microg/d), iron (recommended intake 30-40 mg/d), vitamin D (recommended intake as supplement 20-50 microg/d), and docosahexaenoic acid (recommended intake 200 mg/d), folic acid is one of the critical micronutrients during pregnancy. Food folate and synthetic folic acid differ in their bioavailability. About 50% of the food folate is absorbed whereas almost 100% of folic acid from supplements is bioavailable.

Q. I have been taking acetyl l carnitine and DMAE in the past as they helped me increase my mental energy, focus and alertness. Since I got pregnant five months ago, I stopped taking them as I wasn't sure about their safety. I would like to start taking them again but I worry they may harm my baby. Any suggestion please?
   A. The use of these supplements for pregnant women has not been tested so it is difficult to say how safe they are to resume.

Alcohol influence
Women who have one or two alcoholic drinks a week during pregnancy do not harm their children's behavioral or intellectual development. Journal of Epidemiology and Community Health, 2010.
   Alcohol is one of the most dangerous drugs for pregnant women, especially in the early weeks. In the mother’s body, alcohol breaks down chemically to a cell-damaging compound that is readily absorbed by the fetus. Heavy drinking during early pregnancy greatly increases the risk of a cluster of birth defects known as fetal alcohol syndrome. Women who binge-drink early in pregnancy may raise their risk of having a baby with an oral cleft.

Smoking and influence of inhaled smoke from cigarettes
Smoking during pregnancy reduces blood flow to the developing fetus and, in turn, retards growth. If all pregnant women stopped tobacco use smoking, there would be an estimated 10 percent reduction in infant deaths. Cigarette smoke contains more than 2,500 chemicals, with nicotine, tar, and carbon monoxide thought to be the most dangerous to the fetus.
   Smoking during pregnancy can affect the baby's immune system which may explain why asthma and respiratory problems are more common in children whose mothers smoke. Babies of smokers are more likely to suffer from respiratory infections than children of non-smokers due to changes to biological receptors in the baby's immune system that are responsible for recognizing and fighting infections and bacteria.
   Mothers who smoke during pregnancy put their children at greater risk of developing psychotic symptoms as teenagers. Stanley Zammit, a psychiatrist at Cardiff University's School of Medicine says the more mothers smoke, the more likely their children will have psychotic symptoms. October 2009.

Depression
Women who are depressed during pregnancy are at a higher risk for preterm delivery, preeclampsia, birth difficulties, and postpartum depression. The treatment of depression in conventional medicine has focused on physiological factors that lead to impaired neurotransmitter function and treatments to improve neurotransmitter function. Pharmaceutical substances pose risks for pregnant and lactating women, and lower risk options are preferred. Micronutrients, including certain B vitamins, folate, EPA and docosahexaenoic acid (DHA), play a role in the synthesis and absorption of neurotransmitters. Experimental studies suggest that supplementation with specific micronutrients may alleviate depressive symptoms and improve birth outcomes in patients with perinatal depression.

Up to half of women with postpartum depression -- a mood disorder that can occur after childbirth -- develop long-term depression, according to Harvard Review of Psychiatry, news release, Jan. 13, 2014.

Diabetes, high blood sugar
Many pregnant women gain more weight than recommended during pregnancy. This is a concern because gaining too much weight has health consequences for both mothers and infants.

Engaging in regular physical activity before and during pregnancy reduces a woman's risk developing pregnancy -induced diabetes (also known as gestational diabetes). A lack of exercise may be one of the few modifiable risk factors for gestational diabetes, which affects upwards of 7 percent of pregnancies and is associated with harmful effects on the fetus and mother-to-be. Babies born to mothers with gestational diabetes may be abnormally large, may suffer from jaundice, low blood sugar and low calcium, and may experience traumatic births, while women with gestational diabetes are more likely to become diabetic after pregnancy.

Pregnant women with a history of pregnancy-related diabetes, also called gestational diabetes, have a good chance of developing the condition again. The risk of having gestational diabetes during a future pregnancy increases with each previously affected one. American Journal of Obstetrics and Gynecology, online July 14, 2010.

Boys born to mothers who have relatively minor elevations in glucose during pregnancy are at significantly increased risk of having abnormal testicular descent. In the condition, also known as congenital cryptorchidism, the testes remain in the pelvis rather than moving into the scrotum.

Heart attack, myocardial infarction
The risk of heart attack in women of reproductive age is low, and the risk increases three to four times in pregnant women compared with women who are not pregnant. Overall, 6 of every 100,000 pregnant women will have a heart attack. the heart attack risk increases with age, with pregnant women over 40 years old 30-times more likely to have a heart attack than pregnant women under the age of 20.

Yoga benefit
The practice of yoga during pregnancy seems to improve birth weight and reduce prematurity and overall complications. Dr. Shamanthakamani Narendran, from the Vivekananda Yoga Research Foundation in Bangalore, and colleagues studied 169 pregnant women trained in the integrated approach to yoga and in 166 "controls" who received routine prenatal care. The yoga training included various loosening exercises, postures ("asanas"), relaxation, deep breathing exercises ("pranayamas"), and meditation, which was practiced for 1 hour daily. Fourteen percent of deliveries were premature in the yoga group compared with 29 percent in the controls. Rates of pregnancy-related high blood pressure were also lower in the yoga group. Possible mechanisms whereby yoga improves pregnancy outcomes include increased blood flow to the placenta, decreased transfer of maternal stress hormones, and decreased premature release of hormones that trigger the onset of labor. Journal of Alternative and Complimentary Medicine, 2005.

Exercise, good diet
Eating a healthy diet and exercising during pregnancy lowers a mom-to-be's chances of having a Cesarean-section delivery or developing diabetes while pregnant; July 13, 2017, BMJ.

SSRI drug use, prescription antidepressant
It may not be a good idea for pregnant women to take SSRIs during pregnancy unless absolutely necessary. Dr. Ema Ferreira and colleagues from the University of Montreal, Quebec, Canada, examined the outcomes in a group of infants born to mothers taking SSRIs or venlafaxine during their third trimester and mothers who were not taking any antidepressants, psychotropic medications, or benzodiazepines at the time of delivery. Included in the study were 76 mothers taking an SSRI or Effexor at the time of delivery and their 79 infants, and 90 unexposed mothers and their 91 infants. Among the exposed infants, "the signs most often observed involved the central nervous system: tremors, shaking, agitation, spasms, hyper- or hypotonia (muscle spasticity and loss of muscle tone, retrospectively), irritability and sleep disturbances," Dr. Ema Ferreira's team reports. There were symptoms involving the respiratory system as well as infants with rapid or slow heart beats. All of these signs appeared during the first day of life, and the average duration was 3 days for exposed infants. All premature infants who were exposed to the SSRI antidepressant agents exhibited behavioral manifestations, compared with about two thirds of exposed term infants. The average hospital stay was nearly four times longer for exposed preterm newborns than for unexposed preterm infants. Pediatrics, 2007.

Dr. Ronit Calderon-Margalit, of the Hebrew University-Hadassah School of Public Health in Jerusalem, says pregnant women who take certain drugs for depression or anxiety may have heightened risks of preterm delivery or other birth complications. Dr. Ronit Calderon-Margalit found that those who started taking antidepressants known as selective serotonin reuptake inhibitors in the second or third trimester had a higher risk of preterm birth. The same risk was not seen, however, among women who started on a SSRI before pregnancy or during the first trimester. SSRIs include drugs like sertraline (Zoloft), paroxetine (Paxil) and fluoxetine (Prozac). Investigators also found a higher risk of preterm delivery among women who took anti-anxiety drugs known as benzodiazepines, regardless of when they began treatment. Those drugs, which include medications like lorazepam (Ativan) and alprazolam (Xanax), were linked to higher risks of other complications as well - including low birth weight, newborn respiratory distress and a low Apgar score. American Journal of Obstetrics and Gynecology, 2009.

Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) may delay a woman's breast milk production soon after giving birth. Journal of Clinical Endocrinology and Metabolism 2010.

Infants who are exposed to SSRIs, such as Prozac and Zoloft, in the womb are at risk for developing neonatal abstinence syndrome (NAS), a withdrawal disorder characterized by high-pitched crying, tremors, and disturbed sleep. Fetal exposure to SSRIs has been linked to major congenital malformations, but there is growing evidence that it may also be tied to NAS.

A 2015 study shows that women who take antidepressants in the later stages of pregnancy are more likely to have a child with autism. The study specifies one particular group of antidepressants in particular — the SSRIs, or selective serotonin reuptake inhibitors, such as Prozac, Zoloft or Paxil.

Birth defects
Women who conceive in the spring or summer may run a higher risk of having a baby with a birth defect -- and pesticide exposure might help explain why. Using government data on U.S. births between 1996 and 2002, researchers found that birth defect rates were highest among women who had conceived between April and July. During those same months, surface-water concentrations of pesticides and other agricultural chemicals generally increased based on government water-quality assessments. Birth defects, such as cleft lip, spina bifida and Down syndrome, affect about 3 percent of U.S. newborns. Certain risk factors, including older age, smoking or drinking in mothers, have been established, but researchers are still trying to piece together the other environmental factors that might be at work. Acta Pediatrica, 2009.

Morning sickness
Women whose mothers suffered from a serious type of morning sickness are at triple the risk of the condition themselves. The cause of severe morning sickness is unknown, although investigators have suspected there might be a genetic component. It occurs in up to 2 percent of pregnancies, and causes near-constant nausea and vomiting, putting both mom and baby at risk of serious complications. BMJ, online April 30, 2010. Some women benefit from ginger intake.

EPT test - Home test
Pregnancy is the period of time when a fetus develops inside a woman’s uterus and ends with the birth of the infant. There are a variety of clinical laboratory tests related to pregnancy, from the time pregnancy is first considered through the initial days of the newborn’s life to pregnancy due date. Some of these tests are performed on most women at specified times throughout the pregnancy, others are ordered as needed to detect and address conditions or problems that arise during pregnancy. Some are offered to women who have increased risks because of their age or lifestyle, while others are selectively chosen based on the woman’s and her partner’s personal and family history. The purpose of these tests is to diagnose existing problems that may affect the mother’s or baby’s health, identify and address problems as they arise, and to assess the risk of a baby having a chromosomal or genetic abnormality. Most of the routine tests are associated with infections or conditions that should be resolved prior to a woman getting pregnant or, if she is already pregnant, should be resolved and/or monitored during her pregnancy. Many pregnancy tests can be ordered online.
   There are two basic types of pregnancy tests. Blood and urine. They are both used to test for the presence of Human Chorionic Gonadotropic (hCG). hCG is secreted in your urine and detected in your blood beginning at different times during pregnancy. Blood test are the more accurate of the two types of testing. They can not only tell you if hCG is present, but a quantitative hCG can tell you how much hCG is present. This can be helpful in dating a pregnancy, or watching the levels to observe the well-being of the pregnancy. (hCG usually doubles about every two days during the first few weeks of pregnancy.). Urine tests are accurate for what they detect the presence of hCG. However, the amounts of hCG detectable by home pregnancy tests and lab urine pregnancy test varies. If you choose to use a home urine pregnancy test, make sure that your urine has been in your bladder for four hours. Do not drink excessive amounts of fluid in an attempt to increase the volume of urine, this can dilute the urine, making hCG not as detectable. If you are taking any medications, including fertility drugs, read the package inserts before testing to see if your medications will affect the results. If your pregnancy test is positive make sure that you seek prenatal care from a qualified doctor or midwife.

Viral Infection
Treatment with the anti virus drug valacyclovir, sold as Valtrex, reduces recurrent bouts of genital herpes in pregnant women. Thus far, treatment with this drug appears to be safe in mothers, fetuses, or neonates. Genital herpes is usually caused by herpes simplex virus type-2 (HSV-2). It's estimated that up to 25 percent of pregnant women have been exposed to the virus and about 20 percent of them have a recurrence during pregnancy. This often occurs late in pregnancy, raising the risk that mom will transmit the virus to her baby, which is a big concern given that HSV-2 can be deadly to the fetus or newborn infant. To curb the odds that mom will pass the virus on to her infant, it's recommended that women with active genital herpes sores, or early symptoms suggestive of an outbreak, deliver by cesarean section. It's previously been reported that the antiviral drug acyclovir, started late in pregnancy can reduce recurrent genital herpes bouts and may reduce the need for cesarean delivery resulting from active HSV-2 lesions. American Journal of Obstetrics and Gynecology 2006.

Sex and Pregnancy
For women who've previously had a preterm delivery, having sex during early pregnancy does not affect the likelihood of having another preterm birth.

With a normal pregnancy, a woman can make love right up until the water breaks. However a pregnant woman should check with her doctor or midwife to see if she has a risk for premature labor or conditions such as a shortened or dilated cervix, leaking amniotic fluid, placenta previa, or bleeding. But as long as the pregnancy is normal, there should not be a problem having sex, even with the partner on top. The thick mucus plug that seals the cervix helps guard against infection.

Urinary Incontinence
The risk of having stress urinary incontinence many years following first childbirth is significantly increased in those women with an onset of stress urinary incontinence symptoms following first delivery or during first pregnancy compared with those women who do not experience initial symptoms.

Pregnancy Stage and Drugs
Virtually all illegal drugs, such as heroin and cocaine, pose dangers to a pregnant woman. Legal substances, such as alcohol and tobacco, are also dangerous, and even medical drugs, both prescription and over-the-counter, can be harmful. If you are pregnant, avoid all drugs and medicines as much as possible. Some drugs can be harmful when used at any time during pregnancy; others, however, are particularly damaging at a specific stage of pregnancy. Most of the body organs and systems of the baby-to-be are formed within the first ten weeks or so of pregnancy. During this stage, some drugs—and alcohol in particular—can cause malformations of such parts of the developing fetus as the heart, the limbs, and the facial features. After about the tenth week, certain drugs may damage organs that are still developing, such as the eyes, as well as the nervous system. Continuing drug use also increases the risk of miscarriage and premature delivery.

Drug Abuse
Pregnant mothers caught using illegal drugs could go to prison for endangering their unborn children under a drug abuse bill passed by the Idaho State Senate in March, 2006.

Medicines, prescription medications - which to avoid
Isotretinoin (Accutane) and etretinate (Tegison) are used to treat chronic acne and psoriasis. They may cause chronic malformations during the stage of organ development. Anticonvulsants, such as phenytoin (Dilantin) and carbamezapine (Tegretol), are used to prevent epileptic seizures. They are associated with defects of the heart and face, as well as mental retardation. Anti-migraine drugs, such as ergotamine and methysergide, are used to head off migraine attacks but raise the risk of premature labor.
     Aspirin, ibuprofen, and other non-steroidal anti-inflammatory drugs (NSAIDs) interfere with blood clotting and increase the risk of uncontrolled bleeding for both mother and baby. Toward the end of pregnancy, they hinder production of the hormones that stimulate labor, so that labor may be dangerously delayed or extended.
Anticoagulant drugs based on coumarin are used in the treatment of heart disease and stroke, to slow blood clotting. Taken during early pregnancy, they are associated with facial malformations and mental retardation. Later on they raise the risk of uncontrolled bleeding.

Complications
Preeclampsia is a common pregnancy complication. Could fish oils be helpful?
Stretch marks are quite common.

Questions
Q.  Is it okay to take CoQ10, lipoic acid, or curcumin during pregnancy?
     A. I am not sure, but I suspect a low dose of CoQ10, such as 10 to 30 mg, a few times a week would be safe, and a low dose of curcumin, let's say 500 mg a few times a week would also be okay, but we don't studies to confirm this. As to lipoic acid, 10 to 20 mg a few times a week should also be okay.

Q. Is Mangosteen safe for a pregnant woman in her third trimester?
     A. There have not been such studies with mangosteen and pregnancy, so we don't know.

Q. Can glucosamine and chondroitin be taken during pregnancy?
     A. Studies have been done testing these nutrients in women who are pregnant. The decision on supplementation will rest on a combined agreement between the patient and the doctor considering the risks and benefits of other therapeutic options. If a patient would otherwise require the use of NSAIDs, most likely glucosamine would be a safer alternative.

Q. Is serrapeptase safe to take during pregnancy?
     A. Since we don't have human studies with serrapeptase in pregnancy, we suggest not using this product while pregnant.

Q. I am curious to know if i can take Passion Rx with Yohimbe while im pregnant, i have had no sex drive at all not due to my pregnancy, its just not there, please let me know.
     A. We don't recommend taking any sex herbs during pregnancy since studies are not available to tell us how they influence the hormonal system during pregnancy.

Q. Q. I am interested in knowing whether it is okay for a woman to continue to take Sam- e while pregnant. Are there any studies?
     A. We are not aware of studies with SAM-e and pregnancy but SAM-e is powerful and influences body chemistry to a great extent and we suggest you discuss with your doctor. We are not in a position to make individual recommendations.

Q. Hello, my name is Jennifer. I use Passion Rx and absolutely love it!!! I have recently found out that I am pregnant and was wondering if you kknow if it is safe to take Passion Rx while pregnant?
     A. We don't recommend using Passion Rx during pregnancy since the herbs could influence hormonal levels.

Q. I'm thinking of taking DHEA or pregnenolone as a mood lifter and libido enhancement. I'm 7 months into my pregnancy. Would these be safe in low doses?
     A. We would definitely not recommend taking DHEA or pregnenolone, even in low amounts during any period of pregnancy.

Q. I just recently ordered passion RX and I am a little bit concern. I would like to no if passion RX is safe during pregnancy. or thinking about becoming pregnant when using this product. would there be any complication.
     A. We have not tested passion rx for pregnancy, so we really don't know if it is safe during pregnancy, but to be on the safe side we suggest not using it during this time. As to before becoming pregnant, again we have not tested it during this period, but it would be a good idea not to use herbal supplements at least a month before becoming pregnant. good luck!

Q. I really need your help. I am in the early stages of pregnancy and take a range of supplements for a joint condition I have in my knees. I am desperate to find out whether the supplements are safe to take during pregnancy and cannot seem to find anyone to give me any information - my doctor says ask the manufacturer of the supplements and the manufacturers say ask my doctor. It appears no-one seems to know. The supplements and dosage I take are as follows: Glucosamine Sulphate (1000mg per day), Calcium (400mg per day), Magnesium (200mg per day), MSM (Methyl-sulfonyl-methane) (1000mg per day), Hydrolysed Collagen (1500mg per day), derived from a fish source. I notice lots of information on your website regarding collagen and it has been suggested to be that the high content of mercury from the fish source may be a problem during pregnancy. I would value your opinion on this and wonder whether I could try changing the collagen to a chicken or bovine based collagen. What do you think? I really hope that you can help give me an indication as to whether there is any information to suggest whether I should carry on taking these supplements during pregnancy which I rely heavily upon.
   A. The reason why your doctor and supplement manufacturers cannot give assurances that these supplements are safe during pregnancy is that hardly any human studies have been done which each, let alone the combination. Therefore, how can anyone say they safe or not safe to use? If the manufacturers, or your doctor said they were safe to use during pregnancy, and something happened to the fetus (because of the supplements or just by coincidence), there would be a risk for lawsuit (not as likely in other countries as in the USA, we live in a litigious society). Unfortunately, that is the real dilemma everyone faces. Lack of adequate studies and fear of legal action if something does not go right.