During pregnancy, the body of the mother undergoes multiple physiological changes. The role of vitamins has been studied in recent years, and according to research, it can be concluded that vitamins in the early stages of pregnancy are highly important for the mother and the child.  In this article, we will discuss some facts about vitamins and their role in pregnancy.¹

The vitamins are not only required during pregnancy but also play an important role before conception. Hence, the right time to start taking vitamins is when a woman is about to conceive. The important vitamins and minerals that we will discuss in this article are as follows.

• Vitamin D
• Folic acid 
• Vitamin c
• Vitamin B12 
• Calcium 
• Iron 

Each will be discussed in detail,  including dietary sources, the required doses, and the duration of vitamin consumption as recommended by guidelines.

Overview of prenatal vitamins 

During pregnancy, the nutritional requirement is increased manyfold, which is predominantly due to an increased need for vitamins for the healthy development of a baby. 

Importance of vitamins during pregnancy 

The levels of vitamins significantly decrease during pregnancy. Therefore, providing adequate replacement for the required minerals and vitamins is important for the mother and the baby.²

The commonly recommended vitamins include vitamin C for good collagen production, vitamin D for bone and muscle health of the baby, folic acid for prevention of spinal cord defects, and vitamin B12. The role of vitamin B12 will be discussed in detail later.²

What is vitamin B12 (cobalamin)?

Vitamin B12 is a water-soluble vitamin, produced by certain bacteria in the gut of animals. From there, it is absorbed into the blood of the host animal. It helps keep one's nerve cells healthy and helps to make DNA, the genetic material present in all cells of the body.⁴

Sources of vitamin B12 

It is important to understand that animals are the major source of vitamin B12.³ These foods include pulses, lamb, beef, chicken, eggs, and dairy products.

If we talk about the absorption of vitamin B12, it is absorbed from the gut by an enzyme called intrinsic factor.

Why is vitamin B12 important during pregnancy?

The role of vitamin B12 in pregnancy is of keen importance. Vitamin B12 is involved in the formation of blood cells, cellular metabolism, DNA and myelin synthesis. 

Role of vitamin B12 for the mother⁵

It is important for reducing the risk of:

•  Infertility
•  Anemia 
•  Miscarriage
•  Pregnancy-induced diabetes 
•  Preeclampsia
•  Preterm labor 

Role of vitamin B12 for the infant⁵

 Vitamin  B12 is associated with:

• Normal birth weight
• Normal spinal cord development 
• Normal haemoglobin  levels 
• Prevention of childhood diabetes

Prenatal vitamins and their composition

• Folic acid: Folic acid should be started when a woman is trying to conceive and during the first three months of pregnancy. Folic acid is found naturally in green leafy vegetables, bread, pulses,  and beans

The recommended dose of folic acid is 0.4mg for the first trimester.

• Vitamin D: Vitamin D is important for bone health and strengthening the body's muscles. The most available source of vitamin D is sunlight. If one is pregnant or breastfeeding, one should consider taking a daily vitamin D supplement containing 10 10mcg⁵
• Vitamin C: Vitamin C is an important antioxidant and water-soluble compound. During pregnancy, an adequate dose of vitamin C helps to produce collagen and helps in the development of bones, muscles, and teeth. The current recommended dose is 85 mg/day for pregnant women
• Vitamin B12: As discussed above, vitamin B12 has a significant role in pregnancy for the development of the baby. It is advised to take 25 mcg/day. Vitamin  B12 should be taken for at least a few months before trying to conceive to reduce the risk of spine and brain defects. For vegetarians, the required dose is around 50 mcg/day due to the very low B12 content of vegetarian diets²

Benefits of higher levels of B12 in prenatal vitamins

• Supporting overall maternal and fetal health 

The evidence suggests that higher levels of vitamin B12 in prenatal supplements ensure better maternal and fetal well-being by preventing anaemia, birth defects, fetal low birth weight, brain developmental defects, and gestational diabetes.⁶

• Preventing B12 deficiencies 

Prevention of a B12 deficiency can be ensured through supplementation of vitamin B12 during pregnancy to prevent the harmful outcomes associated with low levels of B12.

Risk factors for vitamin B12 deficiency

Now we will discuss the risk factors for vitamin B12 deficiency

• Vegetarians /vegans

The compound cobalamin exists in meat and dairy sources. Individuals who adopt a vegan diet are likely to be deficient in vitamin B12.

• Pernicious anemia 

Certain medical conditions that cause the lining of the stomach to be distorted, for example, removal of the ileum, celiac disease, irritable bowel disease, etc. This can cause hindrance in the absorption of vitamin B12 as the enzyme responsible for its absorption (intrinsic factor)is deficient. 

• Pregnancy 

During pregnancy, the body’s requirement for nutrition is increased several-fold to compensate for the baby’s needs. Hence, pregnant mothers are at increased risk of B12  deficiency.

Symptoms of vitamin B12 deficiency 

Signs and symptoms of B12 deficiency. 

• Numbness in the body 
• Lethargy 
• Anemia 
• Trouble walking 
• nausea 
• Mouth ulcers 
• Pins and needles sensation
• Vision disturbance  

Consequences of low vitamin B12 for mother and Baby 

Low levels of vitamin B12 are responsible for infertility, premature rupture of membranes, anaemia, growth restrictions in the baby, stillbirth, miscarriage and fetal abnormalities.  

Recommendations for expectant mothers

The expectant mothers are advised to ensure the following when considering an adequate vitamin B12  supply.

• Pick a prenatal vitamin that suits one's needs. It is important to check that the supplement has the necessary vitamins, including folate, vitamin B12, vitamin C, vitamin B, iron, and calcium
• Check the dose of vitamin B12 in the supplement
• Include foods rich in vitamin B12. That includes adding meat, dairy, eggs, chicken, and pulses to the  diet
• Consulting the doctor for appropriate advice regarding an individual’s needs for supplements

Summary

To conclude, prenatal vitamins before, during and after conception are essential. Vitamin B12  is essential for the growth of a baby's organs, including bone growth, muscle growth, the heart, and blood cells. In addition, it is important for the mothers. Hence, understanding the importance of vitamins and incorporating them into her diet is imperative for the mother's health. 

Frequently asked questions 

Can vitamins be taken with food?

Yes, the suggested method for taking vitamins is after a meal.

Can I take vitamins with milk?

It is generally not recommended to take vitamins with milk. There are no suggestions as to whether taking vitamins with milk has any benefit.

What is the best source of vitamins? 

 Different foods contain different levels of vitamins; hence, generally speaking, fruits and vegetables, dairy, and meat provide a variety of vitamins required for a balanced diet.

When to see a doctor for a vitamin deficiency?

If one feels numbness, lethargy, or dizziness, please consult a physician for appropriate advice.

Do multivitamins have any safety concerns?

Taking a normal amount of multivitamins will not cause harm to one's health. Usually, it contains recommended amounts of vitamins and can help ensure one gets the desired nutrition without any harmful effects. 

Is it common to need vitamin B12 injections?

Vitamin B12 is found naturally in animal foods, including meat, poultry, fish, pulses, eggs and milk. 

Most people usually get enough vitamins from the food they eat. However, some people still undergo a vitamin deficiency. This is mainly because some people, especially geriatric adults and those with certain health conditions such as pernicious anaemia, have trouble absorbing vitamin B12 from food.

Why should I take a multivitamin before I conceive?

Yes, these vitamins help to prevent brain and spinal cord defects. These are called neural tube defects. Usually, the woman is aware of her pregnancy after one to two weeks of conception. These defects arise in the first trimester. Hence, it is advised to take these supplements before conception to prevent these defects from occurring.