Folic Acid, Vitamin D, Calcium, Iron, DHA, how to make up for the fastest way to hold a baby?2025 Guide is here!

Did you know? The nutritional status of the first 1000 days of life has a significant impact on the health of the foetus throughout its life. These 1000 days refer to the period from the fertilised egg to the age of two years after birth, of which the most important is the foetal period.

　　Numerous research data show that organ metabolic systems do not change throughout life after they are formed during the foetal period, so nutritional interventions during the foetal period can have a very important role in the health of the life that follows.
　　In addition to heredity, if life experiences malnutrition and other factors during this period, it will not only lead to the individual’s physical and intellectual development is delayed, and increase the chances of developing obesity, diabetes, cardiovascular disease and other chronic diseases and illnesses in adulthood.
　　More frighteningly, such effects do not only affect one generation, but may even last for several generations, so nutritional supplementation during this time of pregnancy and foetal period is particularly critical.
　　How to supplement all kinds of micronutrients during preparation and pregnancy is also a major concern for all sisters, and it is also the most frequently asked question to doctors.
　　Quality of evidence and strength of recommendation
　　In order to facilitate understanding, I will first explain some common academic terms in the consensus as follows.
　　For example, the grade of evidence is divided into four levels, ABCD, the higher the level, the more reliable the evidence, for example, level A means very confident, the observation value is close to the true value, and so on.
　　The strength of the recommendation is divided into two types: 1 and 2, with strength 1 meaning that it is clear that the benefits of the intervention outweigh the disadvantages or that the disadvantages outweigh the benefits, and strength 2 meaning that the benefits and disadvantages are uncertain or that the benefits and disadvantages are comparable regardless of the quality of the evidence.
　　Then for those clinical issues that lack direct evidence, in this consensus based on the clinical experience of the experts, a recommendation based on expert consensus, i.e., good practice evidence, is formed, as indicated by GPS.
　　01 About folic acid
　　Routine genetic testing for folate metabolism and serum or erythrocyte folate concentrations are not recommended
　　Recommendation and level of evidence is GPS, note here is not recommended for all populations of folate metabolism gene testing, including our circle of sisters oh.
　　Serum or red blood cell folate concentration testing is not recommended for the general population, but it is recommended for high-risk pregnant women with a history of foetal neural tube malformations.
　　WHO recommends that women of childbearing age should have a red blood cell folate concentration of 906 nmol/L, but this test is limited to pregnant women with a history of foetal neural tube malformation.
　　Recommendations for Folic Acid Supplementation Dosage
　　For women without any risk factors, folic acid supplementation of 0.4-0.8mg per day is recommended from at least the first 3 months of pregnancy until the full 3 months of pregnancy, with a recommendation and level of evidence of 2C;
　　Women in this group may choose a multivitamin supplement containing folic acid, vitamin B12, and iron with a recommendation and level of evidence of 1B;
　　Several studies have confirmed that a daily dose of 0.8 mg of folic acid is more favourable for rapid red blood cell folate concentrations of 906 nmol/L or more.
　　For those who did not supplement or used supplements with fewer than 3 vitamins or minerals, pregnant women who supplemented with multivitamins (≥3 vitamin or mineral supplements) before and during pregnancy had a 33%, 14%, 17%, 40%, and 32% lower risk of developing offspring neural tube malformations, orofacial defects, cardiovascular defects, urinary tract defects, and limb defects, respectively.
　　So, this tells us to supplement with multivitamins when we can, which is the best option for reducing birth defects.
　　For women with a prior history of neural tube malformation pregnancies, folic acid supplementation of 4mg/day is recommended starting at least 1 month prior to gestation and continuing at least until the full 3rd trimester of gestation, with a recommendation and level of evidence of 2D given that 5mg/day can be supplemented due to the domestic dosage form.
　　For people at high risk of birth defects associated with folic acid deficiency, folic acid supplementation of 0.8-1mg/day is recommended from at least the first 3 months of pregnancy until the third month of gestation, with a recommendation and level of evidence of GPS.
　　The more controversial issue here is the genetic test suggestive of pregnant women with C677TT type of MTHFR gene, where several international academic organisations have recommended that folic acid supplementation in accordance with the standard dosage is sufficient.

It is recommended that pregnant women may continue to take folic acid or folic acid-containing multivitamins in the middle and late stages of pregnancy and throughout pregnancy, with a recommendation and level of evidence of 2B.
　　Twin pregnant women are recommended to take folic acid supplementation of 0.8-1mg per day starting early in pregnancy and continuing throughout pregnancy, with a recommendation and level of evidence of GPS.
　　The risk of anaemia due to folic acid deficiency in pregnant women with multiple pregnancies is eight times higher than in pregnant women with singleton pregnancies, so prolonged supplementation and higher doses are required for pregnancy.
　　Supplementation with multivitamin tablets containing 0.8-1 mg of folic acid daily from at least the first 3 months of pregnancy and throughout pregnancy is recommended for women who are overweight (BMI of 24-28) or obese (BMI ≥28) before pregnancy, recommendation and level of evidence 2C.
　　02 About iron supplements
　　It is recommended that serum ferritin be tested at the first maternity test in early pregnancy, with a recommendation and a low level of evidence of 2C
　　Some studies have shown that serum ferritin level in early pregnancy is the best marker to predict anaemia in late pregnancy.
　　Therefore, some foreign guidelines recommend that oral iron 30-60 mg/day can be used as a routine antenatal care measure in areas with high prevalence of iron deficiency anaemia.
　　It is recommended that pregnant women who are overweight or obese, should take continuous iron supplementation during pregnancy with a recommendation and level of evidence of GPS.
　　Iron supplementation of 30-60mg/day during pregnancy is recommended for twin pregnant women with a recommendation and level of evidence of 2D.
　　03 On vitamin D and calcium
　　Calcium supplementation of at least 600mg per day from mid-pregnancy until delivery is recommended with a recommendation and level of evidence of 1C;
　　For women who experience gastrointestinal distress on calcium carbonate, calcium supplements from organic calcium sources are available, recommendation and level of evidence 1B;
　　Calcium supplements with vitamin D are recommended for pregnant women who get adequate sunlight from appropriate daily outdoor activities, with a recommendation and level of evidence of GPS;
　　Here to mention again, if you do not have more outdoor activities in daily life, should you consume more vitamin D for the purpose of promoting the absorption of calcium supplements, the guideline is not mentioned here, but for many sisters outdoor activities are not sufficient.
　　It is recommended that pregnant women who are overweight or obese should take continuous supplementation of vitamin D (400U/day), calcium and many other micronutrients during pregnancy, with a recommendation and level of evidence of GPS;
　　For twin pregnant women it is recommended that vitamin D supplementation of 1000 U and calcium of 1000 to 2000 mg per day during pregnancy is recommended and the level of recommendation and evidence is GPS.
　　04 On fatty acids
　　This expert consensus very strongly recommends consuming foods rich in omega-3 fatty acids (e.g., fish and other aquatic products) 2-3 times per week during pregnancy, with a recommendation and level of evidence of 1A, which is highly recommended and recommended.
　　Pregnant women who consume too little fish take supplements containing omega-3 fatty acids or DHA.
　　In view of the possible problem of marine pollution of fish, the Italian Expert Consensus Dietary and Nutritional Requirements in Pregnancy and Lactation recommends obtaining purer DHA through algae to avoid external pollution.
　　Data from epidemiological surveys show that diets in many regions of the country are prone to inadequate intake of omega-3 fatty acids, with DHA intake decreasing in coastal, lakeshore and inland areas in that order.
　　Even in coastal areas, the average DHA intake (93.9 mg/d) is far below the recommended standard of 200 mg/d, and in some inland cities, the intake is even less than 10 mg/d.
　　For pregnant women who are not satisfied with their daily diet, an additional supplement of 200 mg of docosahexaenoic acid (DHA) per day until the end of breastfeeding may be considered, with a recommendation and level of evidence of 2D.
　　High-dose (e.g., >900 mg/d) omega-3 fatty acid supplements such as DHA are not recommended for the general pregnant population, and omega-3 fatty acid or DHA supplements from algal oil sources are recommended for pregnant women.