The need for several micronutrients increases significantly during pregnancy and breastfeeding period, but the additional requirements of most vitamins and minerals can be met by a balanced selection of foods with a high nutrient density and the diet doesn't need to be highly caloric in this regard.
Fruits and vegetables (including salads) as well as whole grains, legumes, sprouts and seeds are even more recommended than usual.
For some nutrients, it can be more difficult to cover the need well, so to be on the safe side, supplementation with standardized supplements is recommended.
German Nutrition Society (DGE) Recommendations for daily requirements - (for supplementary doses see below)
| Nutrient / Trace element - Dose per day | Pregnant woman | Breastfeeding women |
| Folic Acid |
when planning pregnancy * - 400 µg / day during pregnancy - 550 µg / day at the beginning only in present pregnancy (if not previously supplemented) * - 800 µg / day for the first trimester |
450µg/day |
| Iodine | 230µg/day (WHO 200µg/day) | 260µg/day (WHO 200µg/day) |
| Iron | 30mg/day | 20mg/day |
There may be a different need for certain metabolic disorders and certain diseases. In such cases, this should be discussed with the doctor and adjusted if necessary, according to the routine supplement doses.
Before and during pregnancy as well as during breastfeeding, in addition to a balanced diet with good sources of folic acid, a large part of the required folic acid dose should be completed for safety reasons with a nutritional supplement (folic acid is sensitive to heat and light).
The supplementation of iodine is recommended for healthy pregnant women between 100-150 µg/day in addition to the diet since the remaining dose should be given by the food (especially with fish consumption and through foods with iodized salt)*.
* If there are enough sources of iodine from the diet, additional supplementation is not necessary.
In the case of thyroid disorders, it is essential to consult the doctor treating you before taking the supplement.
Iodine deficiency increases the risk of miscarriages, malformations and impairs mental development.
Food sources: use iodized table salt, eat sea fish such as saithe or herring twice a week, and regular milk and milk products.
At least 200mg / day is recommended for omega 3 fatty acids (bioactive forms DHA and EPA) during pregnancy. The supplementation of 1-2g per day has advantages in various factors, so such a dose can be recommended even if the diet (e.g. twice a week cold sea fish) already provides these important fatty acids. Over 4g per day should not be supplemented - 2g DHA / EPA is a good daily dose.
The following health-related statements from EFSA are permitted as health claims based on the scientific data: http://onlinelibrary.wiley.com/doi/10.2903/j.efsa.2011.2078/full
Effects of Docosahexaenoic acid (DHA), Eicosapentaenoic acid (EPA)
Note
It should always be pointed out that the effects cannot be viewed in isolation. Numerous other factors always play a role in healthy eating. Therefore, one often observes the sensibility of supplementing omega-3 fatty acids, but the effects cannot be explained with such a supplement alone.
In addition to the indication of the need for a balanced healthy diet, it must always be pointed out that an overdose of fatty acid supplementation should be avoided, as this could cause undesirable effects.
The dosage information of such nutritional supplement products should, therefore, be adhered to. The possible, sometimes higher dosage as part of therapy is reserved for doctors or other therapists with a state of science education. Even with normal dosages, as with all foods, there may be undesirable effects or even contraindications to individual peculiarities. This should also be discussed with the attending doctors. Usually, supplements with omega-3 fatty acids are uncomplicated and well-tolerated.
The vitamin D requirement is covered on average only by 10% through food, the rest needs to be produced through skin contact with the sun usually. Supplementation is advisable at certain times of the year or due to other factors that do not lead to sufficient sun contact and production of vitamin D in the skin - this does not only affect pregnancy and lactation. Since vitamin D is a fat-soluble vitamin and it also stores in the adipose tissue for some time, there are reserves, which vary from person to person. The safest way to evaluate whether and which doses of supplementation are recommended is to use laboratory analyzes from blood values.
A vitamin D blood serum value of approx. 70 ng/ml is defined by some doctors as a target value. But if you look closely at the newer study situation, you can say that a lower threshold of 20ng / ml may be sufficient and 30ng/ml for the absolute majority of the targeted study participants was seen as sufficient (including people who are considered to be a high-risk group for secondary diseases in the context of deficiency).
It should be emphasized that - in the context of prevention - I do not define the target values that some colleagues seek with high doses of daily supplementation. Even if some therapies may be positively supported, sometimes with high doses, there is too little evidence for the doses regarding the majority in the risk groups and it cannot be ruled out that long-term high doses will have undesirable interactions (too high doses could trigger something that is not immediately considered or measured as an undesirable side effect).
My recommendation is based on the guidelines of the specialist institutions: It states that between 1000 and 2000 IU of vitamin D3 supplemented daily is sufficient for most people. These doses have also been shown to be safe from overdoses. I, therefore, recommend supplementing in this dose range as long as you do not have enough sun contact on the skin. Have your serum value checked in wintertime and even e.g. in June when there is more sun contact.
A value of 30ng/ml should already be safe in preventive medicine; however, if there are various complaints, it can be clarified whether values between 50-70 ng / ml improve. It should also be clarified whether you may not need the higher serum values because you have lower values for the vitamin D-binding protein and thus already with lower serum values more free vitamin D results. Determination of the free vitamin D (bioactive form) and the vitamin D binding protein (VDBP).
Note and recommendation: since there is 95-99% of the vitamin D in the serum inbound (inactive) form (through the vitamin D binding protein VDBP), it is crucial how much VDBP is genetically produced. With low VDBP values, a significantly lower vitamin D dose may be sufficient - the high target values of 70ng/ml are then not required. The additional analysis of bioactive Vit. D (free Vit. D) gives even more clarity.
Since the vitamin D formation in the body is mainly stimulated by sun contact on the skin and this is lower in our culture groups in infants, vitamin D in infants is regularly supplemented according to the guidelines of the specialist societies.
Among other things, vitamin D is used for tooth and bone development. The same conditions apply to vitamin D supplementation for the mother during breastfeeding during pregnancy.
If the mother has a high vitamin D level (e.g. when the sun is high in the summer there is sufficient sun) and breastfeeds the infant, the higher vitamin D dose in breast milk can be guaranteed. In our cultures, however, this is often not the case, which is why general supplementation in infants is recommended as a precaution. Breast milk has sufficient doses of vitamin D for the child if the mother takes 5000 to 6000 IU of vitamin D daily. However, this is not the primary recommended route, as it already means doses for the mother that can exceed the safe dose limit (possible undesirable side effects).
Usually, the amount of vitamin D in breast milk is relatively low. To prevent rachitis and lower caries incidence, 400 - 500 IU vitamin D is given orally from the second week of life (see above).
Depending on the region were you live, 0.25 mg of fluoride is also given (fluorine is not recommended consistently) - If it is given, this is usually done together with the vitamin D (as D-fluorite). See notes on fluoride.
In regions where the drinking water has too high fluorine values, fluoride should not be supplemented. With a drinking water fluoride of 0.3 mg / l, it is not necessary to supplement it. With values above 0.7 mg / l, no extra fluorine should be given (attention should also be paid to any table salt with fluoride used).
But note fluorine supplementation is not necessarily recommended or viewed more critically by some institutions.
For example, the Institute of Medicine USA recommends only 10% of the recommended supplement dose, but drinking water is fluoridated in many places in the USA. Drinking water is not fluoridated in Germany.
While low-dose fluoridation in the first few years of life helps reduce dental caries development in children (not significant in adults), too long or too high fluorine doses lead to tooth enamel damage with brownish-yellow spots on the teeth (with lower overdosage, white streaks or white spots) and more bone damage in adulthood are observed.
Note: In the case of older children and adults, it is generally agreed that fluorine supplementation via food or water is not the successful dental protection route; only toothpast containing fluoride and regular tooth brushing should be carried out there (toothpaste with lower fluorine doses should be used for children, as they do are offered for different age groups).
Pregnant women need twice as much iron as before, but the higher iron intake in our cultures should preferably come from food, which provides better protection against overdose.
Iron deficiency increases the risk of premature birth and low birth weight, but excessive iron intake with already sufficient blood levels increases complications. Since the study data shows different results, no general iron supplementation during pregnancy is recommended in Germany. I recommend to make the doctor's check of the blood values (iron and iron storage - ferritin, as well as transferrin the iron transport protein) and if necessary to have the therapy controlled by the doctor.
The WHO's international recommendation to generally supplement iron in pregnant women is based on the fact that in many developing countries many pregnant women have iron deficiency anemia. In Europe, studies show that 20% of women of childbearing age potential iron deficiency (2-4 times higher than the overall average)*.
* Stahl A, Heseker H. Physiology, functions, occurrence, reference values and care in Germany. Nutrition Review 2012; 6: 346-353
The best sources of iron are meat and fish. Although whole grains, legumes, nuts, and seeds also have good doses, only a significantly smaller proportion is absorbed from plant foods. This can be improved by combining it with foods rich in vitamin C (acerola juice, parsley, kiwi, red peppers, papaya, tomato juice, etc.). If there is an increased need, attention should also be paid to how certain foods are combined. The combination with inhibitors of iron absorption such as calcium and certain antinutrients can reduce the iron absorption.
Only a small fraction of the plant binding form (non-heme iron) is absorbed (on average only 3-5%; in the case of deficiency up to 10%). Much more iron is absorbed from meat and fish (approx. 23% on average; if there is a deficiency of up to 30%).
The need for iron increases during pregnancy because the placenta and uterus must be supplied additionally with iron. The fetus also creates its own iron stores.
The effective regulation of iron absorption in the body normally prevents the tissue from being overloaded with iron from food. Alcoholics and people who are genetically burdened with an iron storage disease (hemochromatosis) are excluded; they get iron overdoses faster.
However, it has been discussed for some years that high iron intakes - especially in the form of red meat heme iron –generally may increase the risk of chronic diseases such as coronary artery disease and cancer. Even if the last scientific evidence for this is still not given, excessive iron absorption should be avoided. In particular, it should be noted that foods that are fortified with iron or some food supplements are additional sources of iron, which means that in some population groups significantly more iron is consumed than necessary.
Supplement: in extreme cases - e.g. in children - there may be acute symptoms of intoxication such as vomiting, diarrhea, fever, blood coagulation disorders, but also kidney and liver damage. According to the current state of knowledge, it cannot be excluded that a high iron supply or high iron stores due to uncontrolled and long-term intake of dietary supplements with iron increases the risk of heart or cancer.
The intake of iron in the form of food supplements should therefore only take place after diagnosed insufficient supply and consultation of a doctor.
Source: Federal Institute for Risk Assessment Germany
The insufficient iron content in breast milk is reduced after the 4th-5th month of life relevant when the baby's iron store, which is well filled up in the uterus until birth, is increasingly exhausted and more iron is needed.
Nutritionists do not recommend a purely vegan diet for infants and young children. Adequate supply is possible with the appropriate nutritional supplements* that adult vegans also need, but the risk of undersupply is higher in these important growth phases since children often do not consume the food variety of adults anyway.
* Children can also overdose more quickly due to inadequate supplementary doses.
With good advice and a good nutritional composition and accompanying laboratory controls regarding various nutrients, as well as supplementation with certain nutrients, vegan nutrition is theoretically possible, but if one of the important points is not adequately implemented, the risk of undersupply with negative results; there are also sustainable deficits possible in somatic and intellectual development.
Vitamin K is low in breast milk. It has important functions in the blood coagulation system. For safety reasons, 3 mg of vitamin K is given orally three times in the first few days after birth (for the U1 - 1st day; for the U2 - 3-10th day; for the U3 in the 4th-6th week of life) - with Absorption disorder it will be given intravenous (0.1-0.2 mg i.V.).
Prof. Dr. Werner Seebauer is Dean of Studies – Association of German Preventologists, Head of Preventive Medicine Department of Institute of Transcultural Health Sciences (European University Viadrina) and Head of Preventive Medicine – NESA (The New European Surgical Academy). Since 2000, prof. dr. Werner Seebauer worked only in preventive medicine, after ten years spent at the Frankfurt University Hospital. He is also involved in the medical professionals training for nutrition and prevention.
