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Prenatal vitamins

Since calcium absorption is highest with a lower dose taken at once, there will be greater absorption of 500mg twice daily is the recommended dose for pregnant women, rather than 1000mg daily (Duerbeck, 2012; Hacker, 2012). Since Vitamin A is available in most green, yellow vegetables, there is a trend that the suggested dose of Vitamin A (2565 IU daily) is being supplemented in the form of beta-carotene (4800 μg) (Duerbeck, 2012) in common, over-the-counter prenatal vitamins, such as Vitamin Code® Prenatal Multivitamin (Garden of Life Prenatals ), Prenatal Vitamins with DHA Liquid Softgels (Nature Made® ), Perfect Prenatal™ Multivitamin (Next Chapter ).

Moving on to the B vitamins, the recommended dosage for Vitamin B1 (Thiamine) during pregnancy is 1.4 mg daily (NIMH, 2013), however B1 can be found in sources such as cereals, grains, and yeast so it is rare to see a deficiency (except alcoholism). B3, or niacin, is not recommended for pregnant women to take according to the last revision by NIH (NIH, 2018). The dosage of Vitamin B5 during pregnancy is 6mg daily and during breastfeeding 7mg daily (Duerbeck, 2015; NIMH, 2017). NIH recommends a daily dose of 1.9mg during pregnancy for B6, and 2mg daily is likely to be safe while breastfeeding (NIH, 2017). The dosage for B7 (biotin) is recommended at 30mcg during pregnancy and 35mcg when breast-feeding (NIH, 2017). According to the CDC, the recommended dosage for B9 (folic acid) is 0.4mg for pregnant women and is important to consume since it reduces the change of the fetus developing neural tube defects. Folic acid is common in foods such as spinach, oranges, peas, and is also made by the body (kidney and liver). Vitamin B12's recommended dosage is 2.6 mcg per day for pregnant women. Pregnant/breastfeeding women require greater amounts of B12 because it is necessary for RBC formation, which is in greater demand due to the developing fetus. .

Most of the other recommended amount of supplements can be found online in the Office of Dietary Supplements, created by NIH. The recommended dose for Vitamin C (ascorbic acid) is 85 mg daily for pregnant women and 80mg for pregnant teens. . Vitamin D is recommend is 15 mcg daily for pregnant and breastfeeding women. The recommended dose for Vitamin E for pregnant teens and women is 15mg, while breastfeeding teens and women should intake 19 mg. The recommended amount for iron is 27mg daily for pregnant women and teens, while breastfeeding women are recommended to take 10 mg versus 9 mg breastfeeding teens. A deficiency of iron in pregnant women could lead to anemia, since greater doses are needed because 200mg will go to the fetus, if supplemented with 300 mg of ferrous sulfate. Zinc's recommended dosage is 13mg for pregnant 14 to 18 year olds, 13 mg for lactating 14 to 18 year olds, 11mg for pregnant 19+, and 12 mg for lactating pregnant 19+ year olds. The omega-3 fatty acids (pantothenic acid) dosage is suggested at 1.4 g for pregnant teens and women, and 1.3 g for lactating teens and women.

References

Duerbeck, N; Prenatal Vitamins What Is in the Bottle? Journal of Obstetrical & gynecological survey, Volume 69, Issue 12, 1 December 2014, Pages 777-788, https://doi.org/10.1097/OGX.0000000000000138

Niacin and niacinamide (vitamin B3): MedlinePlus. .S. National Library of Medicine. NIH: National Institutes of Health Office of Dietary Supplements. http://www.nlm.nihgov/medlineplus/druginfo/natural/924.html. Accessed May 2018.

“Perfect Prenatal™ Multivitamin.” New Chapter, www.newchapter.com/products/vitamins/perfect-prenatal-multivitamin/.

“Prenatal Multi + DHA.” Prenatal Vitamins with DHA Liquid Softgels| Nature Made®, www.naturemade.com/multivitamins/prenatal-and-postnatal/prenatal-dha-liquid-softgel#xA4m6RmWKSe8uF7t.97.

Thiamine (vitamin B1). MedlinePlus. U.S. National Library of Medicine. NIH: National Institutes of Health Office of Dietary Supplements. http://www.nlm.nih.gov/medlineplus/druginfo/natural/965.html. 2013. Accessed May 2018.

"Vitamin Code® Prenatal Multivitamin.” Garden of Life, www.gardenoflife.com/content/product/vitamin-code-raw-prenatal-multivitamin/.

Talk page : Prenatal vitamins

"Category leaders utilize this as the dosage form of choice.[citation needed]."

Most of these "category leaders" for recommended dosage amounts can be found on factsheets developed by the NIH, Office of Dietary Supplements, the CDC (on Folic Acid), and The Journal of Obstetrical and Gynecological Survey.

https://ods.od.nih.gov/factsheets/list-VitaminsMinerals/

https://journals.lww.com/obgynsurvey/Pages/default.aspx

https://www.cdc.gov/ncbddd/folicacid/index.html

~amn73


 * "Category leaders utilize this as the dosage form of choice.[citation needed]."
 * Most of these "category leaders" for recommended dosage amounts can be found on factsheets developed by the NIH, Office of Dietary Supplements, the CDC, and The Journal of Obstetrical and Gynecological Survey.
 * "For example, many[citation needed] prescription prenatal vitamins will contain a more bioavailable form of folate; 5-methyltetrahydrofolate (5-MTHF)"
 * Look into further studies to explain difference between folate, 5-MTHF, and folic acid.
 * Mineral/vitamins put into prenatal vitamins
 * Journal article: "Metafolin--alternative for folate deficiency supplementation in pregnant women"
 * "Taking the appropriate amount of folic acid before conception can reduce or prevent the incidence of neural tube defects by as much as 70%."
 * Add citations to support this claim:
 * Evidence from multiple studies conclude that folate acid intake by pregnant women can significantly reduce the likelihood of the fetus developing neural tube defects.

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~Past Research~

I chose this topic because we just learned about the B vitamins and how pregnancy requires more intake of B6. That would expand my knowledge on how the B vitamins work. It may require a complex knowledge of biochemistry...

- Possible improvements: Include more discussion about the controversies surrounding certain vitamins/minerals recommended for pregnant women, however may be beyond the scope of my knowledge of biochemical mechanisms of vitamins.

Further references

(1) Prenatal micronutrient supplementation and postpartum depressive symptoms in a pregnancy cohort https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3585741/


 * the finding(s) in that study that relates to your nutritional controversy
 * The findings showed the relationship between the likelihood of women taking nutrients during with the social and environment circumstances, which in turn facilitate the development of postpartum depression or not. Despite their interpretations of their findings, taking nutritional supplements during pregnancy had no statistically significant results on inhibiting/being a protective factor for the risk of PPD.


 * the strengths of the article that support the finding
 * The mean intakes for B6, B9, B12, and E were more likely to be higher in women with lower levels of PPD
 * Selenium and omega-3: lower EPDS (Edinburgh Postnatal Depression Scale) vs higher EPDS different a lot according to p scores (p for selenium was very low, p for omega-3 very high)** ask Professor Levitsky for more clarification


 * the weaknesses of the article that refute the finding
 * findings of how prenatal vitamins affect PPD were ultimately inconclusive


 * which side of the controversy is best supported by this study
 * there is a lot of further research that must be done on prenatal vitamins, course of pregnancy, and onset of PPD - especially with the B vitamins

(2) Nutritional knowledge as a determinant of vitamin and mineral supplementation during pregnancy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3933411/


 * the finding(s) in that study that relates to your nutritional controversy
 * The researchers measured which factors determined the likelihood of pregnant women to take folic acid, along with iron and a multivitamin
 * Which population is more likely to even take these vitamins? Why should we consider this/acknowledge that it's important? (Maybe to introduce the B vitamins to a population that has not ingested them before and look at the results)


 * the strengths of the article that support the finding
 * The greater the nutritional knowledge the pregnant women had about prenatal care, the more likely they consumed B vitamins


 * the weaknesses of the article that refute the finding
 * No clear association which factor - (1) socio-demographic factors or (2) higher level of nutritional knowledge predicts the use of iron, folic acid, and multivitamins


 * which side of the controversy is best supported by this study
 * A lot of SES implications and socio-economical implications we have to consider in the first place

(3) Doretta Caramaschi, Gemma C. Sharp, Ellen A. Nohr, Katie Berryman, Sarah J. Lewis, George Davey Smith, Caroline L. Relton; Exploring a causal role of DNA methylation in the relationship between maternal vitamin B12 during pregnancy and child’s IQ at age 8, cognitive performance and educational attainment: a two-step Mendelian randomization study, Human Molecular Genetics, Volume 26, Issue 15, 1 August 2017, Pages 3001–3013, https://doi-org.proxy.library.cornell.edu/10.1093/hmg/ddx164


 * the finding(s) in that study that relates to your nutritional controversy
 * Explores the amount of intake of B12 during pregnancy and that showed there was a causal effect of the amount of the mother's B12 umbilical cord and the babies' cognition/IQ


 * the strengths of the article that support the finding
 * Uses a two-step Mendelian randomized approach
 * empirical research experiment


 * the weaknesses of the article that refute the finding
 * [a lot of genotype terminology that I don't understand...]
 * [understanding the causal effect of maternal B12 to DNA methylation]


 * which side of the controversy is best supported by this study
 * The intake of B12 vitamins is associated with sociodemographic factors.. again, similar pattern is showing in these studies

(4) Verkleij-Hagoort, A., et al. "Validation of the Assessment of Folate and Vitamin B12 Intake in Women of Reproductive Age: The Method of Triads." European journal of clinical nutrition 61.5 (2007): 610-5. ProQuest. Web. 15 Mar. 2018.


 * the finding(s) in that study that relates to your nutritional controversy
 * Maternal consumption of B12 and association with the likelihood of a bearing a child congenital with a congenital heart defect
 * Can B12 prevent/decrease likelihood of consequences to the child? (or maybe revert (?) maladaptive maternal behavior - smoking, drinking, etc - just a tangent)


 * the strengths of the article that support the finding
 * "Mean of the 24HR revealed deattenuated correlation coefficients of .98 for folate and 0.66 for vitamin B12."


 * the weaknesses of the article that refute the finding
 * Used a food-frequency questionnaire - self-report biases


 * which side of the controversy is best supported by this study
 * Agenda - this paper was published by the Netherlands Heart Foundation.... (conflict of interest?)

Ortiz-Andrellucchi, Adriana, et al. "Dietary Assessment Methods for Micronutrient Intake in Pregnant Women: A Systematic Review." The British journal of nutrition 102 (2009): S64-86. ProQuest. Web. 15 Mar. 2018.

Roth, Daniel E., et al. "Vitamin D Supplementation during Pregnancy: State of the Evidence from a Systematic Review of Randomised Trials." BMJ : British Medical Journal (Online) 359 (2017)ProQuest. Web. 15 Mar. 2018.

Antonysunil Adaikalakoteswari, Manu Vatish, Mohammad Tauqeer Alam, Sascha Ott, Sudhesh Kumar, Ponnusamy Saravanan; Low Vitamin B12 in Pregnancy Is Associated With Adipose-Derived Circulating miRs Targeting PPARγ and Insulin Resistance, The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 11, 1 November 2017, Pages 4200–4209

Hofmeyr GJ, Manyame S''. Calcium supplementation commencing before or early in pregnancy, or food fortification with calcium, for preventing hypertensive disorders of pregnancy.'' Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD011192. DOI: 10.1002/14651858.CD011192.pub2.