Supplements and pregnancy: what to ask your doctor first

Ask your doctor, midwife or pharmacist about every supplement before you take it, and do it before you buy. Government health sources say the same thing for different reasons: many supplements have never been tested in pregnant women, some ingredients carry specific pregnancy warnings, and even a vitamin can be harmful in a high amount. This article collects what those sources say and turns it into questions you can bring to your appointment. It is general information, not medical advice.

Why is pregnancy treated differently for supplements?

Three facts from official sources explain most of the caution.

First, NCCIH says that many dietary supplements have not been tested in pregnant women, nursing mothers or children. A missing safety study is not the same as a proven danger, but it does mean nobody can tell you the product is safe for you from the research.

Second, the FDA does not approve dietary supplements for safety and effectiveness before they are sold. Companies are responsible for making sure their products meet the safety standards, and the agency mostly acts after a product is already on the market. So there is no regulator review you can lean on in place of a professional's opinion.

Third, the FDA's own advice on medicines applies here too: if you are pregnant or breastfeeding, talk to your doctor before you take any medicine, and know what ingredients are in the medicines you take so you can avoid possible allergic reactions.

Which supplements are recommended in pregnancy?

Pregnancy is not a time to avoid every supplement. MedlinePlus, from the National Library of Medicine, says you need more of several nutrients than before pregnancy, and gives these figures:

• Folic acid: 400 mcg a day before pregnancy and 600 mcg a day during pregnancy and breastfeeding, from food and/or vitamins. MedlinePlus says it is hard to get that amount from food alone, so most people will likely need a supplement that contains folic acid.
• Iron: 27 mg a day.
• Calcium: 1,000 mg a day for pregnant adults, and 1,300 mg for pregnant teenagers aged 14 to 18.
• Vitamin D: 600 IU a day.

The same page then adds two cautions that matter for anyone shopping online. Taking too much of a supplement can be harmful, and very high levels of vitamin A can cause birth defects. It concludes that you should only take vitamin and mineral supplements that your health care provider recommends.

That is the useful distinction. A prenatal vitamin with printed amounts that your provider has looked at is a different thing from a multi-ingredient blend whose amounts are hidden. Our how we review page explains how we read a label and score whether it shows its amounts.

Which ingredients carry specific pregnancy warnings?

Some plant ingredients come with named cautions. NCCIH says that St. John's wort may be unsafe during pregnancy because it may increase the risk of birth defects. The MedlinePlus pregnancy page adds a caution on caffeine: drinking high amounts may be harmful for your baby, and for most people it is best to limit caffeine to less than 200 mg a day during pregnancy, after checking with your provider about whether to have it at all.

Those two examples matter because both ingredients turn up in products that are not sold as pregnancy or medical products at all. Herbal formulas for focus, sleep or blood sugar can include them without saying so up front. Here is how that looks in our reviews, repeated as the reviews describe them:

• Our SonoVive review notes that the label carries St. John's wort and cautions that anyone on blood thinners, MAO inhibitors or hormonal medication, or who is pregnant, nursing or has a bleeding disorder, should talk to a doctor first.
• Our Gluco6 review notes the label says the capsule is not for anyone under 18, pregnant or nursing, and advises consulting a doctor if you take medication or have a medical condition.
• Our LeanBiome review notes that its label advises pregnant or nursing women, people under 18 and anyone with a medical condition to consult a physician first.

Those are reasonable warnings, and they are worth reading. The problem is when a sales page never mentions them and you only see them on the bottle after it arrives.

What should you ask your doctor?

You do not need to be an expert to have a useful conversation. Bring the supplement facts panel, or a photo of it, and ask:

1. Is any ingredient in this product a concern during pregnancy or breastfeeding?
2. Does this product, added to my prenatal vitamin, push any nutrient above what I need?
3. Does it duplicate something I already take, such as vitamin A in two products?
4. Is there a food or a prenatal vitamin that covers the same need?
5. Should I wait until after pregnancy or breastfeeding to consider it?

The FDA also suggests asking whether a product can be taken with other drugs, whether certain foods or products should be avoided, and what signs of a problem to watch for. If you are planning a pregnancy, ask before you conceive, since folic acid is recommended before pregnancy as well.

What should you watch for on a supplement sales page?

Pregnancy is exactly the time when a page's promises can pull hardest and the risk of an unknown ingredient is highest. Some patterns to treat with caution:

• Hidden amounts. A proprietary blend with no per-ingredient amounts makes it impossible for a clinician to check the dose.
• Promises about pregnancy itself. A page that promises a pregnancy outcome is making a medical claim. Fertility, morning sickness and labor are medical topics.
• "Natural" as a safety claim. The St. John's wort example above is a plant, and NCCIH still says it may be unsafe in pregnancy.
• Missing or buried warnings. If the page never says to talk to a doctor, look for the label.
• No refund path. If you decide not to use a product after your appointment, you want to be able to ask for your money back. See our ClickBank refund guide.

Our women's health reviews apply the same checks to each offer: what the label lists, what the page claims and what the research supports.

What if you already take something and then find out you are pregnant?

Do not guess and do not panic. Write down the product name, the amount per serving and how long you have taken it, then call your provider or pharmacist and ask what to do. Keep the bottle. The FDA's general advice on supplements applies: if you have a bad reaction or side effect, stop using the supplement right away, seek medical care or advice and report the problem to the FDA. Stopping a prescribed medicine on your own is a different matter, and that decision belongs with your doctor.

The same steps help if you are breastfeeding. Since NCCIH says many supplements have not been tested in nursing mothers, showing the label to a professional is the practical way to find out whether a given ingredient is a concern for you and your baby.

FAQ

Is it safe to take supplements while pregnant?

It depends on the supplement, the amount and your health. NCCIH says many have not been tested in pregnant women, and MedlinePlus says to take only the vitamin and mineral supplements your health care provider recommends. Ask before you start.

Do I need a prenatal vitamin?

MedlinePlus says pregnant people need more folic acid, iron, calcium and vitamin D than before pregnancy, and that it is hard to get enough folic acid from food alone. Whether you need a prenatal vitamin and which one is a question for your provider.

Can I take herbal supplements while breastfeeding?

NCCIH says many dietary supplements have not been tested in nursing mothers. Check the specific herb with your provider or pharmacist before use, and show them the full label.

Can too many vitamins hurt a pregnancy?

MedlinePlus says taking too much of a supplement can be harmful and that very high levels of vitamin A can cause birth defects. This is one reason to count the amounts across everything you take, not just one bottle.