You’re pregnant – Congratulations!

You have been careful to do everything just right and your hard work and attention to detail has paid off. Now you need to be sure that you are just as careful during this pre-natal period as you were in your pre-pregnancy period so that you can have an uneventful pregnancy and a happy, healthy baby.

The old saying “you are eating now for two” has a lot of truth to it (though it’s not an excuse to go overboard!) and it holds true for all essential nutrients. If your diet is lacking in any nutrient, that can be reflected in the development and health of your baby-to-be.

Let’s look at some of the nutrients that are essential for baby’s healthy development in the womb.

The Big Three:

Folic Acid / Folate

Folic acid is one of the best known of the prenatal essentials, since it is needed for proper development of brain and spinal cord. Neural Tube Defects such as Spina Bifida can result from folic acid deficiency. Low folate status has also been linked to recurrent pregnancy loss, low birth weight and a variety of age-related high risk complications of pregnancy.

One of the B Vitamins, folic acid is a synthetic form of folate found in many nutritional supplements. Synthetic folic acid is metabolized in the body into the useable form, 5-methyltetrahydrofolate. Approximately 10% of the general population lack the enzymes needed to receive any benefit from folic acid and another 40% of the population may convert only a limited amount of folic acid into 5-methyltetrahydrofolate and cannot fully process supplemental folic acid at higher doses or even RDA levels The remaining 50% of the population do metabolize folic acid more efficiently, but obtaining folate in its 5-methyltetrahydrofolate form avoids any concerns about effective metabolization. Conventional medicine recommends a daily intake of 400 to 800 micrograms (mcg) daily.

Calcium and Vitamin D

Calcium and vitamin D are vital especially during the third trimester, when baby’s bones are growing and strengthening. Conventional medicine recommends 250 milligrams (mg) of calcium and 400 International Units (IU) of vitamin D daily.

The usual recommendation is to obtain calcium through diet – from “fortified foods” and milk and dairy products. Unfortunately, milk and many dairy products contain casein which can be very problematic for many people. Further, calcium taken without an appropriate amount of magnesium to balance it will have only very minor bone-building effects. Magnesium must be a part of any formula that contains calcium.

Calcium also tends to contain an unwanted substance, lead. This includes natural sources of calcium, like milk and dairy, leafy green vegetables as well as almost all calcium supplements.

While the lead that may be present in supplements is undesirable, this must be balanced with the need for calcium for fetal development. Some forms of calcium supplements such as calcium citrate and calcium malate are better absorbed and tend to have lower levels of lead. And, according to The LEAD (Lead Education and Abatement Design) Group of Australia, “Lead is released from the bone through resorption (the recycling of calcium and other minerals including lead from the bone to the bloodstream) during pregnancy, and there is strong evidence that calcium supplements reduce blood lead during this crucial period, in turn reducing lead levels in the newborn child.”

Vitamin D and calcium work hand-in-hand for bone creation and health, and vitamin D is perhaps best obtained in the form that Mother Nature intended – that is, from sunlight on skin. Our skin can produce approximately 10,000 IU of Vitamin D in response to as little as 30 minutes of unprotected summer sun exposure – but obviously this is neither practical nor even possible for many people and so vitamin D deficiency is very common. Supplementation becomes essential, but should be done carefully at higher doses. Vitamin D testing is available inexpensively and can remove the element of guesswork.

Recent research is suggesting that very high doses of vitamin D, once thought to possibly cause birth defects, are not only safe, but even beneficial. Neonatologist Carol L. Wagner, of the Medical University of South Carolina reports that in her study women who took 4,000 IU of vitamin D daily in their second and third trimesters not only showed no evidence of harm, they had half the rate of pregnancy-related complications like gestational diabetes, pregnancy-related high blood pressure, or preeclampsia, as women who took 400 IU of vitamin D every day and they were also less likely to give birth prematurely.

Learn more about Vitamin D here.

Iron

Iron is almost universally recommended for prenatal vitamins by conventional medicine in doses of around 30 to 60 mg daily

During pregnancy, more iron is needed to supply the growing baby and placenta, and iron supports normal brain development in the fetus. In the third trimester baby builds up iron stores for the first six months of life. Iron deficiency can lead to maternal anemia, premature delivery, low birth weight, and an increased risk of perinatal infant mortality.

However necessary iron is, it is neither benign nor free of problems and side effects. The most common form of supplemental iron, iron sulfate or ferrous fumarate, is about as absorbable as swallowing nails, and frequently causes either diarrhea or (more often) constipation and nausea – not something that is desirable for a mom in the first trimester especially! Iron-containing supplements can also be highly toxic to children.

A more bioavailable form of iron called heme iron is not only better absorbed but also causes far less side effects. One clinical study demonstrated that heme iron increased serum iron levels 23 times better than ferrous fumarate on a milligram-per-milligram basis.

Excessive iron levels, while not common during pregnancy, can be problematic and iron supplementation should be guided by the information obtained with regular, routine lab studies – especially serum ferritin. Thus, it may be wise to use a separate iron supplement instead of a prenatal containing iron as this allows fine-tuning instead of relying on a one-size-fits-all dose of this important nutrient.

Important Supplement Interaction Note: Calcium, taken at the same time or within an hour or two of taking iron can interfere with the absorption of iron – another very good reason to not include iron in a multiple vitamin that contains calcium!

Those are the “Big Three” of supplements almost universally recommended by conventional medicine.

Many conventional doctors are now recognizing the value of Omega 3 fatty acids to both mother and baby-to-be.

Omega 3 fatty acids, in the form of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) each have unique benefits. EPA is important to the heart, immune system, and inflammatory response and DHA supports development of the brain, eyes, and central nervous system.

While many people think that flaxseed and flaxseed oil contain omega-3s. That is true, but flaxseed contains a short chain omega-3, ALA (alpha-linolenic acid), which is different from the longer-chain EPA and DHA. It was once thought that we could convert ALA to EPA and DHA, but current research shows that this conversion rarely occurs and only very inefficiently when it does happen.

Fish oil is the most reliable source of EPA and DHA but because of concerns with contamination of fish by mercury and other pollutants it is important to choose a fish oil supplement that is highly purified and certified free of contaminants. Further, these oils are easily damaged by heat, so low-temperature processing such as molecular distillation is essential to prevent oxidation.

Liquid oils may be preferred by those who dislike swallowing capsules, but can be hard to tolerate due to their taste and many are artificially flavored and colored in an attempt to make them more palatable. Capsules can likewise cause “fishy burps” for some, especially if their digestion is poor. Some premium quality fish oil supplements are supplied in enteric coated capsules which avoid the “fishy burps” problem by passing through the stomach intact before dissolving in the small intestine for absorption.

Other conventional recommendations for inclusion in a prenatal vitamin usually include:

Vitamin A. Most sources recommend between 4000 and 5000 IU per day, and warn about the potential for “large doses” to be teratogenic (causing birth defects). The World Health says that “During pregnancy, a daily supplement should not exceed 10,000 IU.”

All vitamin A is not the same however. Retinyl palmitate which preformed vitamin A is the most common form and comes from animal sources. Beta carotene, a provitamin, is derived from vegetable sources – carrots being a good example. Retinyl palmitate is the form that is acknowledged to be a possible teratogen in very high doses. Beta carotene has never been associated with any teratogenic risk.

Vitamin C is usually included in prenatal vitamins since it is necessary for collagen synthesis which is important to your baby’s normal development of connective tissues. The RDA for pregnant women as stated by the USDA is a comically low 85 mg per day – just about enough to prevent scurvy. Having a low intake of vitamin C may be associated with complications in pregnancy such as pre-eclampsia, anemia and having a small baby.

Unlike most other animals, humans do not make vitamin C – we have lost that ability and must obtain it from diet or supplements. It is very important to remember this when reading research that details ill effects caused by high doses of vitamin C given to lab rats. Vitamin C is water soluble and is not retained to any degree in the body – any excess is quickly flushed out in the urine.

In the experience of Dr. Frederick R. Klenner who published his findings in the Journal of Applied Nutrition in 1971, doses of from 4 grams to 15 grams per day of vitamin C given to pregnant women conferred significant benefits to both baby and mother.

In Dr. Kenners words: “Observations made on over 300 consecutive obstetrical cases using supplemental ascorbic acid, by mouth, convinced me that failure to use this agent in sufficient amounts in pregnancy borders on malpractice.”

There are anecdotal reports on the internet and other places of vitamin C being used as an abortificant. This may be related to the lab rat studies mentioned above. The dosages usually quoted for this purpose are in the region of from 6 to 12 grams per day for 5 to 10 days, and most sources are very specific that only pure ascorbic acid may be used because any bioflavonoids will “work to prevent miscarriage.”

Finally, for vitamin C, there is a recent study showing that vitamin C has a protective effect on the lungs of all babies, and especially those born to mothers who smoke:

“Vitamin C is a simple, safe and inexpensive treatment that may decrease the impact of smoking during pregnancy on childhood respiratory health,” said lead author Cynthia McEvoy, associate professor of pediatrics at Oregon Health & Science University Doernbecher Children’s Hospital. “Though the lung function of all babies born to smokers in our study was improved by supplemental vitamin C,” she said, “our preliminary data suggest that vitamin C appeared to help those babies at the greatest risk of harm during their development from their mother’s smoking in pregnancy.”

The B vitamins group includes folate – which is widely recognized as necessary to prevent Neural Tube Defects in baby. This group also includes a number of other related vitamins with a wide variety of positive effects on both mother and baby.

Vitamin B-6 is well-known to be useful in combatting nausea during pregnancy (though the reason for this is not yet known), and vitamin B-12 is strongly linked to neural (brain and nervous system) development in baby. Inadequate B-12 levels may also contribute to pre-term delivery.

Vitamin E is best known for its importance to fertility, but it is also important during pregnancy. According to research published in the American Journal of Clinical Nutrition in 2006: “In summary, our results suggest that α-tocopherol is positively associated with fetal growth. It is plausible that circulating concentrations of α-tocopherol could be associated with some increase in fetal growth by greater blood flow and nutrient supply to the fetus.”

Maternal vitamin E deficiency may be associated with pre-eclampsia and pregnancy induced hypertension.

Vitamin K – most commonly known as “clotting factor” – is not normally considered to be essential for baby’s development by conventional medicine. However, developing teeth and bones contain two proteins that need vitamin K to function: matrix gla protein is necessary to keep growing cartilage from calcifying prematurely and bone gla protein is important for tooth mineralisation.

Vitamin K deficiencies can cause severe developmental defects as was demonstrated by an unfortunate baby born to a mother who had been on warfarin therapy during pregnancy. The warfarin drug essentially creates a vitamin K deficient state and the child was born with facial and spinal deformity and calcifications and was quadriplegic by 20 months. Clearly, adequate to generous vitamin K status during pregnancy is critical for normal fetal development. There are 2 natural forms of vitamin K: K1- phytonadione and K2 menaquinone. K1 is converted in the body to K2 and for this reason Dr. Myatt prefers the K2 form for supplementation.

Biotin deficiencies have been linked in rat studies to limb and palate defects – but there has been little research in humans except for studies that show biotin deficiencies are common during pregnancy.

The minerals: Iodine, magnesium, selenium, zinc, copper and others.

Conventional medicine thinks little about minerals other than iron in pregnancy, however these trace minerals are all highly important to your growing baby as they participate in many enzyme and transcription factors that are critical to the correct functioning of developing DNA and RNA. With actions closely inter-related, deficiencies in one mineral can also affect the function and availability of other minerals.

Copper deficiencies can result in skin, neuronal and hair abnormalities and possibly to breathing problems such as persistent respiratory distress syndrome and to an increased risk of aortic aneurysm in early life because of reduced elasticity of these structures.

Zinc is essential to hundreds of enzymes and proteins and deficiencies can cause birth defects and post-natal problems for baby. Zinc is vital to immunity and deficiency can result in permanently compromised immunity for baby. Deficiency can also cause complications of labor including premature rupture of membranes and an increased risk of pre-term delivery.

Maternal iodine requirements increase during pregnancy, mostly due to increased thyroid activity. Iodine deficiency can lead to cretinism.

Selenium is essential to the enzyme glutathione peroxidase and to the function of glutathione – a vital antioxidant in our bodies and also important for metabolic and biochemical processes such as DNA synthesis and repair, protein synthesis, prostaglandin synthesis, amino acid transport, and enzyme activation. It is also thought that selenium and iodine work together to prevent cretinism.

What’s important in a prenatal multivitamin?

Cost?
Price can be an important factor in the decision to purchase and take a multivitamin. Bargain prices are attractive, but these may come with suboptimal potency, substandard quality, inappropriate forms of ingredients, poor bio-availability or unwanted contaminants. A half-price vitamin is no bargain if one has to take twice as much of it to achieve the same effect!

Quality?
The world of vitamins, minerals, and supplements is still “the wild west” – largely unregulated, with few consequences for those sellers who put more effort into their sales copy than their quality control. Wild claims and glowing “patient testimonials” are often a tip-off to this sort of seller. A conscientious formulator or seller will also be able to provide a very important document, the Certificate of Analysis or CofA for a product to attest to its purity and potency.

Number of pills per day?
There is no such thing as an optimal dose “one-a-day” vitamin. It is simply not possible to put meaningful doses of vitamins, minerals and nutrients into a single pill or capsule of any reasonable size. Those multivitamins that claim to do so end up having “pixie dust” doses of ingredients in them. Read the product label, and be sure that you are receiving meaningful, optimal doses of nutrients. Experience has shown us that optimal doses cannot be achieved in less than 6 to 9 capsules of a reasonable size. These should be taken divided into three times per day since many vitamins are water-soluble and do not remain in the body for long.

Chewable? Liquid? Tablet? Capsule?
Let’s face it – taking pills is no fun. Even less if they are large. Candy-like chewable or “gummy” formulations have become popular, as have liquid preparations since they are easier to swallow. Unfortunately, many vitamins and most minerals taste terrible, and so it takes a lot of flavoring, sweetening, and coloring to make them palatable. Do you really want to be eating artificial flavors, artificial sweeteners, artificial food colorings, and preservatives when you are carrying your new baby-to-? Tablets have a different problem, in that they often don’t dissolve well especially if digestion is weak and almost any nurse can tell stories of seeing vitamin tablets passed out into a bedpan looking virtually unchanged. Capsules tend to dissolve more easily.

One pill with everything in it?
As we have seen, there are good reasons to keep some nutrients separate from others. For example, calcium interferes with the absorption of iron and prenatal formulations that contain both these minerals make little sense. On the other hand, some nutrients are synergistic – calcium should always be accompanied by magnesium and copper should always accompany zinc to avoid deficiencies. A well-designed multiple accounts for these factors, providing maximum benefit with a minimum of separate products.

A good formulation would include plant enzymes to ensure absorption of nutrients since many people have deficient digestion. Also, a formula must be hypoallergenic, ultra-pure and suitable for even highly sensitive individuals. Some potential problems to look for are artificial flavors, artificial colors, artificial sweeteners, corn, gluten, casein, soy, yeast, lactose, sugar or high fructose corn syrup, preservatives, and fillers. Some fillers and flow agents may be needed to allow a product to be packed into capsules, but these should be natural, functional, and the minimum possible consistent with good manufacturing practice.

What should a good formulation look like?

Opinions vary wildly. Much of conventional medicine is vitamin-phobic and will recommend that vitamins are best obtained “from a healthy diet.” Others are fond of mega-doses of vitamins or minerals for a variety of usually unproven reasons. The internet is full of theories, advice, conjecture and fantasy from scientists, laypeople and salespeople. Who to believe?

Dr. Myatt has applied over 23 years of clinical experience and a lot of scientific research to the formulation of her Maxi Multi. She believes that it is a perfect multivitamin for pre-conception, pre-natal, and post-natal use. Is it a complete, one product solution? Of course not! As we have seen, there are some nutrients that must be taken separately from a multiple vitamin, like iron and Omega-3 fish oil. These and other nutrients will be needed in different doses at different stages and so should be taken as needed.

With this consideration, her Maxi Multi is the most complete optimal dose multiple vitamin, mineral, and trace nutrient formula available and we always suggest that comparison shoppers use the Maxi Multi ingredient list as a standard that they can compare other formulations to.

Here is the Maxi Multi ingredient list:

Nine (9) Capsules (the recommended daily dose) contain:

Vitamin A (as natural beta-carotene) from D. salina

15,000 IU

Vitamin A (from palmitate)

2500 IU

Vitamin C (as ascorbic acid, magnesium ascorbate and calcium ascorbate)

1200 mg

Vitamin D3 (as cholecalciferol)

800 IU

Vitamin E (as mixed tocopherols)

400 IU

Vitamin K2 (as menaquinone)

150 mcg

Vitamin B-1 (as thiamin hydrochloride)

100 mg

Vitamin B-2 as Riboflavin

60 mg

Niacin (as niacinamide and inositol hexanicotinate)

200 mg

Vitamin B6 (as pyridoxine hydrochloride and pyridoxal-5-phosphate)

100 mg

Folate – 5-methyltetrahydrofolate

800 mcg

Vitamin B12 (as methylcobalamin)

400 mcg

Biotin

300 mcg

Pantothenic acid (as d-calcium pantothenate)

400 mg

Calcium (as carbonate, citrate, malate)

1000 mg

Iodine (from kelp)

150 mcg

Magnesium (as mg oxide, aspartate, citrate)

500 mg

Zinc (as zinc monomethionine)

20 mg

Selenium (as l-selenomethionine)

200 mcg

Copper (as copper amino acid chelate)

2 mg

Manganese (as amino acid chelate, gluconate, aspartate)

5 mg

Chromium (as picolinate and polynicotinate )

200 mcg

Molybdenum (as molybdenum amino acid chelate)

150 mcg

Potassium (as aspartate, chloride and succinate)

99 mg

Choline (as choline citrate and bitartrate)

350 mg

Inositol (Inositol, Inositol hexanicotinate)

200 mg

Vanadium (as vanadyl sulfate)

20 mcg

Boron (amino acid chelate)

2 mg

para-aminobenzoic acid

50 mg

Citrus bioflavonoids

100 mg

Lipase (8,000 USP u /g)

27.5 mg

Amylase (1,000,000 FCC u /g)

19 mg

Protease (5,000,000 FCC u /g)

5 mg

Other ingredients:  Gelatin, water (capsule), Arabinogalactan from Western Larch leaf, magnesium stearate and silica.

Dr. Myatt encourages her patients and customers to “comparison shop” to be sure that they are getting exactly what they need, and nothing that they don’t need – and to make sure they are getting the best quality and value for their money. The best way to do that is to compare actualingredients lists – not just advertising claims. The claim “Everything you need in one easy-to-swallow pill” sounds great, but a look at the label shows that claim to be misleading – such a formula is almost certain to be lacking in meaningful doses.

We have compared a few popular pre-natal formulas with Dr. Myatt’s Maxi Multi for you:

Daily intake of nutrients from recommended daily serving:

Nature’s Way Completia Prenatal:
2 tabs twice daily

Rainbow Light Prenatal:
One tab once daily

Thorne Research Basic Prenatal:
one cap 3 times daily

Vital Nutrients Prenatal: 6 caps daily

Dr. Myatt’s
Maxi Multi Optimal Dose:
3 caps three times daily

Vitamin A (as natural beta-carotene) from D. salina

8000 IU

4000IU

3000 IU

7500 IU
beta carotene, mixed carotenoids, vit. A acetate

15,000 IU

Vitamin A (from palmitate)

2000 IU

2500 IU

Vitamin C

120 mg
calcium ascorbate

100 mg
ascorbic acid

150 mg
ascorbic acid

500 mg

1200 mg
ascorbic acid, magnesium ascorbate and calcium ascorbate

Vitamin D3

400 IU

400 IU
D2 Ergocalciferol

1000 IU

800 IU

800 IU

Vitamin E

30 IU
as d-alpha tocopheryl succinate

30 IU
as d-alpha tocopheryl succinate

50 IU
as d-alpha tocopheryl

400 IU
as d-alpha tocopheryl

400 IU
as mixed tocopherols

Vitamin K

90 mcg
K1:
phytonadione

65 mcg
K1:
phytonadione

100 mcg
K1:
phytonadione

100 mcg
K1

150 mcg
K2: menaquinone

Vitamin B-1

1700 mcg
thiamin mononitrate

10 mg
thiamin mononitrate

4 mg
thiamin hydrochloride

50 mg

100 mg
thiamin hydrochloride

Vitamin B-2 as Riboflavin

2 mg

10 mg

3.6 mg

10 mg

60 mg

Niacin

20 mg
niacinamide

20 mg
niacinamide

30 mg
niacinamide

50 mg
niacinamide

200 mg
niacinamide and inositol hexanicotinate

Vitamin B6

2.5 mg
pyridoxine hydrochloride

15 mg
pyridoxine hydrochloride

10 mg
pyridoxal-5-phosphate

50 mg
pyridoxine hydrochloride

100 mg
pyridoxine hydrochloride and pyridoxal-5-phosphate

Folate

800 mcg
folic acid

800 mcg
folic acid

1000 mcg:
500 mcg as Calcium Folinate and 500 mcg as 5-mthf

400 mcg
L-5-mthf

800 mcg
L-5-mthf

Vitamin B12

8 mcg
cyanocobalamin

25 mcg
cyanocobalamin

200 mcg:
100 mcg as adenosylcobalamin and 100 mcg as methylcobalamin

200 mcg
methylcobalamin

400 mcg
methylcobalamin

Biotin

300 mcg

300 mcg

50 mcg

300 mcg

300 mcg

Pantothenic acid (as d-calcium pantothenate)

10 mg

15 mg

16 mg

100 mg

400 mg

Calcium (as carbonate, citrate, malate)

720 mg

200 mg

200 mg

400 mg

1000 mg

Iron

45 mg

30 mg

45 mg

30 mg

0

Iodine (from kelp)

150 mcg

150 mcg

150 mcg as Potassium Iodide

225 mcg as Potassium Iodide

150 mcg

Magnesium

300 mg
oxide, citrate

100 mg
oxide

100 mg
citrate, malate

200 mg
malate

500 mg
oxide, aspartate, citrate

Zinc

15 mg
chelate

15 mg
citrate

25 mg
picolinate

25 mg

20 mg
monomethionine

Selenium (as l-selenomethionine)

25 mcg

100 mcg

50 mcg

200 mcg

200 mcg

Copper (as copper amino acid chelate)

2 mg

2 mg

2 mg
picolinate

2 mg
glycinate

2 mg

Manganese

2 mg
chelate

2 mg
citrate

5 mg
picolinate

5 mg
citrate

5 mg
chelate, gluconate, aspartate

Chromium

50 mcg
polynicotinate

120 mcg
nicotinate

100 mcg
picolinate

200 mcg
polynicotinate

200 mcg
picolinate and polynicotinate

Molybdenum (as molybdenum amino acid chelate)

75 mcg

50 mcg
picolinate

50 mcg
citrate

150 mcg

Potassium

50 mg
chelate

10 mg

90 mg
chloride

99 mg
aspartate, chloride and succinate

Choline

4 mg
bitartrate

10 mg

350 mg
choline citrate and bitartrate

Inositol

10 mg

10 mg

200 mg
Inositol, Inositol hexanicotinate

Vanadium (as vanadyl sulfate)

50 mcg

20 mcg

Boron (amino acid chelate)

1 mg

1 mg
picolinate

1 mg

2 mg

para-aminobenzoic acid

2 mg

50 mg

Citrus bioflavonoids

200 mg
raspberry leaf, dandelion root, nettle leaf, peppermint leaf

90 mg
“Gentle Prenatal Blend” Flavonoids

100 mg

DHA

50 mg
from tuna

0

Lipase (8,000 USP u /g)

“Complete Digestive Support“
24 mg, Protease, Amylase, Lipase, Cellulase

27.5 mg

Amylase (1,000,000 FCC u /g)

19 mg

Protease (5,000,000 FCC u /g)

5 mg

References and Additional Information:

Fernández-Ballart J.D: Iron Metabolism during Pregnancy. Clinical Drug Investigation, Volume 19, Supplement 1, 2000 , pp. 9-19(11)
On average, about 4.6mg of absorbed iron per day is needed during the second and third trimesters, or about 3.3mg per day more than in the nonpregnant state, to complete a full pregnancy cycle without iron deficit.
http://www.ingentaconnect.com/content/adis/cdi/2000/00000019/a00100s1/art00002

A clinical study demonstrated that HIP increased serum iron levels 23 times greater than ferrous fumarate on a milligram-per-milligram basis.
http://www.proferrin.com/wp-content/uploads/2012/09/HIP.pdf

The LEAD (Lead Education and Abatement Design) Group
Lead is released from the bone through resorption (the recycling of calcium and other minerals including lead from the bone to the bloodstream) during pregnancy, and there is strong evidence that calcium supplements reduce blood lead during this crucial period, in turn reducing lead levels in the newborn child.
and
Unfortunately calcium interferes with the absorption of iron and should not be consumed in significant quantities (more than one glass of milk or 2 slices of cheese) in conjunction with iron rich meals. Calcium can also interfere with phosphorus absorption.
http://www.lead.org.au/lanv10n2/lanv10n2-11.html

Ministry of Health Canada, Prenatal Nutrition Guidelines for Health Professionals – Iron Contributes to a Healthy Pregnancy, 2009
During pregnancy, women need more iron to support the increased maternal red blood cell mass. This supplies the growing fetus and placenta, and supports normal brain development in the fetus. In the third trimester of pregnancy, the fetus builds iron stores for the first six months of life (Fernández-Ballart, 2000).
and,
There are three main inhibitors of non-heme iron absorption in the diet: polyphenols from tea and coffee, phytate in legumes and some vegetables, unrefined rice and grains, and calcium at levels greater than 300 mg (Hallberg and Huthen, 2000).
http://www.hc-sc.gc.ca/fn-an/pubs/nutrition/iron-fer-eng.php

Leif Hallberg: Does calcium interfere with iron absorption? American Journal of Clinical Nutrition 1998
The balance of evidence thus clearly indicates that calcium in amounts present in many meals inhibits the absorption of both heme and nonheme iron.
http://ajcn.nutrition.org/content/68/1/3.full.pdf

Véronique Azaïs-Braesco and Gérard Pascal: Vitamin A in pregnancy: requirements and safety limits. American Society for Clinical Nutrition 2000
The recommendations of the World Health Organization can be summarized as follows:
During pregnancy, a daily supplement should not exceed 10 000 IU (3000 RE) and a weekly supplement should not exceed 25 000 IU (7500 RE).
and
Today, vitamin A supplementation is the most efficient way of correcting vitamin A deficiency. Its only drawback is the potential risk of teratogenesis. Interesting attempts have been made to replace vitamin A with the provitamin β-carotene, which has never been associated with any teratogenic risk.
http://ajcn.nutrition.org/content/71/5/1325s.full

Linda Houtkooper, Vanessa A. Farrell: Calcium Supplement Guidelines, University of Arizona
Dolomite, Oyster shell, and Bone Meal are naturally occuring calcium carbonate sources which may contain heavy metals, including lead. Minimizing lead intake is important for pregnant and nursing women, and children. The Food and Drug Administration (FDA) has set an upper limit for the amount of lead a calcium supplement can contain (7.5 micrograms per 1000 milligrams of calcium).
http://ag.arizona.edu/pubs/health/az1042.pdf

C Carlier et.al. A randomised controlled trial to test equivalence between retinyl palmitate and beta carotene for vitamin A deficiency. BMJ 1993;307:1106
beta carotene is therapeutically equivalent to retinyl palmitate
http://www.bmj.com/content/307/6912/1106

americanpregnancy.org
Omega-3s have been found to be essential for both neurological and early visual development of the baby. However, the standard western diet is severely deficient in these critical nutrients. This omega-3 dietary deficiency is compounded by the fact that pregnant women become depleted in omega-3s, when the fetus uses omega-3s for its nervous system development. Omega-3s are also used after birth to make breast milk. With each subsequent pregnancy, mothers are further depleted. Research has confirmed that adding EPA and DHA to the diet of pregnant women has a positive effect on visual and cognitive development of the baby. Studies have also shown that higher consumption of omega-3s may reduce the risk of allergies in infants.
Omega-3 fatty acids have positive effects on the pregnancy itself. Increased intake of EPA and DHA has been shown to prevent pre-term labor and delivery, lower the risk of pre-eclampsia and may increase birth weight. Omega-3 deficiency also increases the mother’s risk for depression. This may explain why postpartum mood disorders may become worse and begin earlier with subsequent pregnancies.
http://americanpregnancy.org/pregnancyhealth/omega3fishoil.html

High Doses of Vitamin D May Cut Pregnancy Risks: Study Shows 4,000 IU a Day of Vitamin D May Reduce Preterm Birth and Other Risks. WebMD Health News, May 4, 2010
Women who take high doses of vitamin D during pregnancy have a greatly reduced risk of complications, including gestational diabetes, preterm birth, and infection, new research suggests. Based on the findings, study researchers are recommending that pregnant women take 4,000 international units (IU) of vitamin D every day — at least 10 times the amount recommended by various health groups.
http://www.webmd.com/baby/news/20100504/high-doses-of-vitamin-d-may-cut-pregnancy-risk

Cleveland Clinic Prenatal Vitamin Recommendations
http://www.clevelandclinic.org/health/health-info/docs/2800/2801.asp?index=9754

Javert CT, Stander HJ (1943). “Plasma Vitamin C and Prothrombin Concentration in Pregnancy and in Threatened, Spontaneous, and Habitual Abortion”. Surgery, Gynecology, and Obstetrics 76: 115–122.
However, in a previous study of 79 women with threatened, previous spontaneous, or habitual abortion, Javert and Stander (1943) had 91% success with 33 patients who received vitamin C together with bioflavonoids and vitamin K (only three abortions), whereas all of the 46 patients who did not receive the vitamins aborted.

Frederick R. Klenner, M.D., F.C.C.P. : Observations On the Dose and Administration of Ascorbic Acid When Employed Beyond the Range Of A Vitamin In Human Pathology. Journal of Applied Nutrition Vol. 23, No’s 3 & 4, Winter 1971
Observations made on over 300 consecutive obstetrical cases using supplemental ascorbic acid, by mouth, convinced me that failure to use this agent in sufficient amounts in pregnancy borders on malpractice. The lowest amount of ascorbic acid used was 4 grams and the highest amount 15 grams each day. (Remember the rat-no stress manufactures equivalent “C” up to 4 grams and with stress up to 15.2 grams). Requirements were roughly 4 grams first trimester, 6 grams second trimester and 10 grams third trimester. Approximately 20 percent required 15 grams, each day, during last trimester. Eighty percent of this series received a booster injection of 10 grams, intravenously, on admission to the hospital. Hemoglobin levels were much easier to maintain. Leg cramps were less than three percent and always was associated with “getting out” of Vitamin C tablets. Striae gravidarum was seldom encountered and when it was present there existed an associated problem of too much eating and too little walking. The capacity of the skin to resist the pressure of an expanding uterus will also vary in different individuals. Labor was shorter and less painful. There were no postpartum hemorrhages. The perineum was found to be remarkably elastic and episiotomy was performed electively. Healing was always by first intention and even after 15 and 20 years following the last child the firmness of the perineum is found to be similar to that of a primigravida in those who have continued their daily supplemental vitamin C. No patient required catheterization. No toxic manifestations were demonstrated in this series. There was no cardiac stress even though 22 patients of the series had rheumatic hearts. One patient in particular was carried through two pregnancies without complications. She had been warned by her previous obstetrician that a second pregnancy would terminate with a maternal death. She received no ascorbic acid with her first pregnancy. This lady has been back teaching school for the past 10 years. She still takes 10 grams of ascorbic acid daily. Infants born under massive ascorbic acid therapy were all robust. Not a single case required resuscitation. We experienced no feeding problems. The Fultz quadruplets were in this series. They took milk nourishment on the second day. These babies were started on 50 mg ascorbic acid the first day and, of course, this was increased as time went on. Our only nursery equipment was one hospital bed, an old, used single unit hot plate and an equally old 10 quart kettle. Humidity and ascorbic acid tells this story. They are the only quadruplets that have survived in southeastern United States. Another case of which I am justly proud is one in which we delivered 10 children to one couple. All are healthy and good looking. There were no miscarriages. All are living and well. They are frequently referred to as the vitamin C kids, in fact all of the babies from this series were called “Vitamin C Babies” by the nursing personnel–they were distinctly different.
http://www.doctoryourself.com/klennerpaper.html

HomeSpun – A Women’s Networking Newsletter: Home Abortion Remedy – Vitamin C
I found this recipe in a book called “A Woman’s Book of Choices: Abortion, Menstrual Extraction, RU-486” by Rebecca Chalker and Carol Downer.
The books says to take 6-10 grams of ascorbic acid a day for 5-10 days. It says specifically ascorbic acid. Don’t use vitamin C with bioflaviniods in it, because they work to prevent miscarriage. Read the label and check the ingredients, write down what to look for if you think you won’t remember when you get to the store. Tons of vitamin c products are available, look for the cheap generic brands, they are usually the ones that have pure ascorbic acid. Don’t use anything that has Rose-hips in it, they conntain bio-flaveniods which help to prevent miscarriage.
http://www.sisterzeus.com/Hsp1shlp.htm

American Academy of Pediatrics 4 May 2013
Vitamin C may head off lung problems in babies born to pregnant smokers
“Though the lung function of all babies born to smokers in our study was improved by supplemental vitamin C,” she said, “our preliminary data suggest that vitamin C appeared to help those babies at the greatest risk of harm during their development from their mother’s smoking in pregnancy.”
http://www.eurekalert.org/pub_releases/2013-05/aaop-vcm042613.php
http://www.abstracts2view.com/pas/view.php?nu=PAS13L1_1165.7

Surén P, et al.: Association between maternal use of folic acid supplements and risk of autism spectrum disorders in children. JAMA. 2013 Feb 13;309(6):570-7. doi: 10.1001/jama.2012.155925.
” Use of prenatal folic acid supplements around the time of conception was associated with a lower risk of autistic disorder in the MoBa cohort. Although these findings cannot establish causality, they do support prenatal folic acid supplementation.”
http://www.ncbi.nlm.nih.gov/pubmed/23403681

Molloy AM, et.al.: Effects of folate and vitamin B12 deficiencies during pregnancy on fetal, infant, and child development. Food Nutr Bull. 2008 Jun;29(2 Suppl):S101-11; discussion S112-5.
The role of folic acid in prevention of neural tube defects (NTD) is now established, and several studies suggest that this protection may extend to some other birth defects.In terms of maternal health, clinical vitamin B12 deficiency may be a cause of infertility or recurrent spontaneous abortion. Starting pregnancy with an inadequate vitamin B12 status may increase risk of birth defects such as NTD, and may contribute to preterm delivery, although this needs further evaluation. Furthermore, inadequate vitamin B12 status in the mother may lead to frank deficiency in the infant if sufficient fetal stores of vitamin B12 are not laid down during pregnancy or are not available in breastmilk.
http://www.ncbi.nlm.nih.gov/pubmed/18709885

Theresa O Scholl, et.al.: Vitamin E: maternal concentrations are associated with fetal growth. Am J Clin Nutr. 2006 December; 84(6): 1442–1448.
In summary, our results suggest that α-tocopherol is positively associated with fetal growth. It is plausible that circulating concentrations of α-tocopherol could be associated with some increase in fetal growth by greater blood flow and nutrient supply to the fetus.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1876684/

Howe AM, et.al.: Severe cervical dysplasia and nasal cartilage calcification following prenatal warfarin exposure. Am J Med Genet. 1997 Sep 5;71(4):391-6.
It supports the hypothesis that warfarin interferes with the prenatal growth of the cartilaginous nasal septum by inhibiting the normal formation of a vitamin K-dependent protein that prevents calcification of cartilage. The child also had severe abnormalities of the cervical vertebrae and secondary damage to the spinal cord.
http://www.ncbi.nlm.nih.gov/pubmed/9286443

Harry J McArdle and Cheryl J Ashworth: Micronutrients in fetal growth and development
-Developing teeth and bone contain two vitamin K dependent proteins; matrix gla protein, necessary to maintain growing cartilage in a noncalcified state and bone gla protein which is important for tooth mineralisation. -Maternal vitamin E deficiency may, however, be associated with pre-eclampsia and accumulation of lipid peroxidase products in vitamin E deficient mothers causes vasoconstriction and consequent pregnancy induced hypertension
http://bmb.oxfordjournals.org/content/55/3/499.full.pdf

Nature’s Way Prenatal
http://www.naturesway.com/products/Vitamins/14903-Completia-Prenatal-Multivitamin.aspx

Vital Nutrients Prenatal
http://www.vitalnutrients.net/Products/Product.aspx?ID=123

Thorne Research Prenatal
http://www.thorne.com/products/womens-health/prd~vmp.jsp

Rainbow Light Prenatal
http://www.rainbowlight.com/prenatal-vitamins-prenatal-one-multivitamin.aspx