Folic acid, vitamin B12 and iron during pregnancy, breastfeeding and desire to have children

As you learn when you mention to the gynecologist that you are planning to have children, the need for minerals and vitamins increases during pregnancy and breastfeeding. Iron, folic acid and vitamin B12, among others, are needed to ensure the healthy development of the fetus or infant. Learn here why a deficiency should be prevented when you are already planning to have children and how high the need for these biofactors is during pregnancy and breastfeeding.

TOPIC OVERVIEW

Why are iron, vitamin B12 and folic acid important during pregnancy?

The vitamins and minerals folic acid, vitamin B12 and iron are indispensable for the healthy growth of the embryo. In this process, each one of these biofactors has specific tasks in the organism of mother and child. Since all three nutrients are essential for the formation of blood, all three nutrients are essential.

This is why you need iron during pregnancy

Adequate supply of the mineral iron is needed for the formation of blood, among other things – iron is an important component of red blood cells (hemoglobin), which transport oxygen in the blood. In order to supply the growing uterus with blood and fhe embryo with enough oxygen, a lot of it is needed during pregnancy. An expectant mother carries between six and six and a half liters of blood in her body – up to one and a half liters more than usual. Therefore, the need for iron during pregnancy doubles from 15 to 30 mg a day, as the German Society for Nutrition notes. During the course of pregnancy, the hemoglobin level of the expectant mother is monitored at regular intervals as part of prenatal care. If the hemoglobin level drops under a certain threshold, tests are carried out to see whether an iron deficiency is present. Since there are quite a few women in Germany who do not get enough iron or even struggle with an iron deficiency and therefore start their pregnancy with already low iron levels, this prevention is indispensable most of the time.

The consequences of iron deficiency during pregnancy

Many women – whether pregnant or not – notice an iron deficiency through tiredness and fatigue. If the iron deficiency is severe and significant anemia results from it and there can be complications during pregnancy. The mother’s immune system is weakened, thereby raising not only the infection risk but also the risk of having a baby with very low weight at birth. However, if the mother’s health is generally good and she has a healthy, balanced diet that includes foods with iron such as fresh spinach, legumes or red meat, severe anemia occurs only rarely.

Should you pay attention to your iron balance when you are already planning to have children?

If you know that you have an iron deficiency, it is advisable to compensate for it even before pregnancy starts. Women who have especially severe or long menstrual bleeding and are planning to have children should check their iron levels to be on the safe side. This also applies to women who eat mostly vegetarian food or engage in a lot of endurance sports. If poor iron supply is known early enough, it is possible to prevent iron deficiency when there is a plan to have children.   

This is why folic acid is indispensable during pregnancy

The vitamin folic acid, also known as folate or vitamin B9, is crucially involved in DNA synthesis, cell formation and cell protection. During pregnancy, an enormous amount of new cells must be formed, and the need for folic acid during pregnancy increases accordingly: The German Society for Nutrition recommends pregnant women a daily intake of 550 µg – almost twice as much as needed when not pregnant. An adequate supply of folic acid is above all crucial in the first trimester of pregnancy, when the embryo’s organs and nervous system start to develop.

The consequences of folic acid deficiency during pregnancy

If during this critical period the mother has folic acid deficiency, the risk of malformations in the unborn child increases considerably. One of the known symptoms of folic acid deficiency in the first trimester of pregnancy is the so-called neural tube defect. This malformation, also known as open back, occurs when the unborn child’s spinal cord and brain cannot develop correctly. An adequate supply of folic acid lowers the risk for this and other malformations of the nervous system by up to 70%. However, most of the time this adequate supply must be established first. According to the national consumption study II more than 80% of non-pregnant women do not reach the lower target values that apply to them.

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This is why you should prevent folic acid deficiency even when you are planning to have children

According to surveys, only one of ten pregnant women takes in a high enough quantity of folic acid and in due time – because in the crucial first weeks, an existing pregnancy is often not even known. The certain diagnosis of pregnancy through ultrasound in the gynecologist’s office, for example, is possible starting on the fifth week of pregnancy at the earliest. For this reason, many gynecologists advise women who are planning to have children to increase their folic acid intake to prevent a deficiency. Although some foods like kale or legumes contain folic acid, the German Society for Nutrition expressly recommends folic acid supplementation to lower the preventable risks of malformations as much as possible. The supplementation should be maintained at least four weeks before the start and during the first three months of pregnancy. In this way, the embryo is also adequately supplied with folic acid even if the pregnancy has not been detected in the crucial first weeks. Here you can obtain more information about folic acid if you are planning to have children or during pregnancy.

Preventing folic acid deficiency even before you stop taking oral contraception

Women using hormonal contraception, in particular, should pay attention to their nutrient intake – because there is something that many don’t know: The contraceptive pill’s sexual hormones intervene in the nutrient balance and affect folic acid metabolism, among other things. Consequently, many women who take the pill for contraception purposes have a very low folic acid level. At the same time, over 20% of women become pregnant already one month after discontinuing the pill. Therefore, to rule out the risks of folic acid deficiency, women who want to have children are advised to start folic acid supplementation before discontinuing the contraceptive pill.

The tasks of vitamin B12 during pregnancy

Vitamin B12 works closely with folic acid. In addition, it plays a significant role in the normal functioning of the nervous system and the formation of red blood cells. And yet, in its own right, it completes important tasks in DNA synthesis, thereby suppoorting blood formation and the healthy growth of the unborn child. Vitamin B12 is also active in the production of important messenger substances, namely hormones and neurotransmitters, and  “healthy nerves” for mother and child. Therefore, attention should be paid to an adequate supply of this B vitamin outside of pregnancy too. If pregnancy exists, the daily requirement grows: Pregnant women should take 3.5 µg of vitamin B12 every day with their diet to ensure an adequate supply.

How does vitamin B12 deficiency manifest itself during pregnancy?

If there is vitamin B12 deficiency during pregnancy, there can be serious – initially non-specific – consequences due to the vitamin’s many interactions. This means that the symptoms are often not directly connected to vitamin B12 deficiency, which then remains unrecognized – and untreated. Vitamin B12 deficiency frequently becomes noticeable during pregnancy when the unborn child develops slowly. In serious cases, neuronal maldevelopments all the way to a miscarriage can be the consequences of vitamin B12 deficiency.

Should you pay attention to your vitamin B12 supply when you are already planning to have children?

Since vitamin B12 is absorbed above all from animal foods like meat and dairy products, women with a vegetarian or vegan diet are especially at risk of having vitamin B12 deficiency. The vitamin can be stored in the liver for a long time and for this reason a low dietary supply thereof becomes noticeable only once this long-term storage is exhausted. Then the consequences become apparent very quickly. If you take less vitamin B12 than the recommended dose or belong to a B12 risk group, you should check your vitamin supply if you are planning to have children. In this case, if necessary, a balanced vitamin B12 level can be ensured when pregnancy starts. In particular, and because vitamin B12 is closely connected with folic acid, among other things, an adequate supply is important already when children are being planned so there will be no lack of it during pregnancy.

How does the need for iron, folic acid and vitamin B12 change during breastfeeding?

If you breastfeed your baby after delivery, your need for iron, folic acid and vitamin B12 changes once again. Whereas the need for folic acid and iron decreases compared to pregnancy, the recommended daily intake of vitamin B12 even increases and is now 4 µg because the infant needs a lot of vitamin B12 to grow quickly. Breast milk is now the vital source to satisfy the child’s nutritional needs. Only adequate vitamin B12 absorption by the infant will guarantee the healthy development of nerves and age-appropriate growth. Vitamin B12 deficiency during breastfeeding can lead to serious developmental disorders in the toddler.

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The need for iron following childbirth and during breastfeeding

Nursing mothers, but also those who cannot or do not want to breastfeed should pay attention to an adequate iron supply after childbirth. Only if they do so will they be able to quickly compensate for the unavoidable loss of blood while securing an adequate supply for their child, in need of iron for healthy development. Iron deficiency after delivery is also associated with post-partum depression. For this reason, new mothers are advised to take 20 mg of iron every day, regardless of whether they are breastfeeding or not.

Folic acid during breastfeeding – how high is the need?

To satisfy the needs of mother and infant, the daily recommended folic acid intake for the nursing mother is 450 µg. The daily need is a little lower than during pregnancy when a lot of folic acid is needed for the development of the child’s nervous system. Mothers are also recommended now to pay attention to their nutritional needs and have a healthy and balanced diet – because only if they do this will they be able to supply their child with all the important vitamins and minerals while they are still breastfeeding.

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