Supplements for Pregnancy and Postpartum

Updated September 2006:

Hold off on the flax seed oil! There is some new evidence that flax seed oil may affect estrogen levels in some people, and no one seems to know exactly what that means yet. To be on the safe side, I'd switch to fish oil (not cod liver oil--too high in Vitamin A) until we get some more definitive answers about the flax seed.

I get a lot of email asking me about supplements I recommend for pregnancy and postpartum, particularly flax seed fish oil.

Remember: I am not a doctor. I am a medical hobbyist, and I tend to err on the side of not taking anything unless it's really serious (I've been working on the same small bottle of ibuprofin for about 5 years). So that means my list of recommended supplements is not that long. I do not recommend anything that isn't generally recognized as safe, but if you have any doubts, ask your midwife or doctor what she thinks about it.

Pregnancy:

1. Your prenatal vitamin. Duh, of course. But don't freak out if you can't keep it down or just forget to take it a lot sometimes. All the research shows that it's more important to take a vitamin and/or have a balanced diet in the months before you get pregnant. The baby takes from your body's stores, so you can still have a healthy baby even if you get hyperemesis and can't keep anything down for months. But you'll have more energy and you'll recover faster from the pregnancy and delivery if you can take your vitamin somewhat regularly.

2. Flax seed oil or fish oil. Taking an Omega 3 supplement prevents or eases pregnancy constipation, which alone is enough reason to take it IME. But taking flax seed or fish oil during pregnancy can also make your baby sleep better for the first few months postpartum. (The abstract to back that up is here. Thanks, Amy.) Consumption of flax seed oil can also prevent or alleviate depression, which is the unspoken symptom of pregnancy. I don't know how great the effect of the flax seed oil is on pregnancy-specific depression. Anecdotally, I was severely depressed during my first pregnancy (no flax seed oil) and only mildly depressed during my second pregnancy (with flax seed oil). There is also evidence that supplementing with flax seed oil or fish oil can prevent some types of premature birth (scroll down to "Omega-3s for Longer Gestation".

What's the difference between flax seed oil and fish oil? I don't think there is one in terms of results. But fish oil can give you vile burps (which some people say is alleviated by taking the capsules frozen or by taking them right before bed). Personally, I don't even want to think about fish burps, so I take flax seed oil capsules. If fish oil doesn't make you burp, feel free to take that instead. The dosage is 2-3 1,000 mg capsules a day (all together or separated, however you can remember to take it).

3. Chocolate. Eat chocolate. Please, for the sake of the children. The children! (FWIW, I absolutely disagree with Nigel Denby.)

Postpartum:

1. Flax seed fish oil. If you thought it was great during pregnancy, you'll be even more impressed with what it does in the postpartum period. It continues to keep you regular (v. v. important in the first few days postpartum). It continues to prevent depression (one movement in research on post partum depression thinks that PPD is caused by a lack of Omega 3s in the maternal brain because the Omega 3s are depleted during pregnancy to go to the baby). It prevents plugged milk ducts (so does lecithin, but why not take something that will prevent plugged ducts and PPD at the same time?). It will also keep your hairy shiny and your nails strong, and keep your cholesterol low.

Ther's no official dosage, so I just stick with 3,000 mg a day. If I skip a few days, I start to feel a little blue and a little plugged-ducty.

For more info on Omega 3s and amino acids in mood disorders (depression and bi-polar disorder in particular) check out Julia Ross's excellent books The Mood Cure and The Diet Cure.

If you are here because you have post-partum depression, please talk to your partner and your health-care provider. Flax seed fish oil capsules, regular exercise, and talking to friends can prevent PPD and cure mild PPD, but if you are having thoughts that you want to hurt someone (like yourself or your baby) or that you need to run away or that you are not worthy of being a mother, you have an illness that can be treated. It is not your fault. Don't try to "fix it" yourself. Tell your partner or a friend and they will help you get help. If you can't tell anyone in your real life, email me and I'll help you find someone near you to help you. You are the perfect mother for your baby, and you have a normal, easily-treatable illness. You won't have to stop nursing to get it treated, either.

2. Lots and lots of water. It flushes the excess fluids from your system and makes the swelling go down faster. It helps your body heal. It helps you make milk. It helps prevent constipation. It prevents fatigue. Make sure there's a bottle of water at your nursing station at all times. Water Duty is a great job for someone who wants to help you during the first week or so, but doesn't know exactly what to do (like a partner or MIL who has no experience with breastfeeding). Water Duty = making sure you always have a glass/bottle of water and a one-handed snack, and holding the baby while you go to the bathroom.

3. Oatmeal. No one is exactly sure why, but oatmeal increases your milk production. A bowl or two a day should help turn you into a fine dairy cow, and it helps keep you regular.

4. Your prenatal vitamin. Keep taking it to rebuild your body's stores so you'll have more energy and recover faster.

5. Chocolate. Helps stabilize mood, at least for me.

If you are nursing, stay away from mint in any form and red wine for the first few weeks. They inhibit milk production, so you don't want to ingest them until your supply is well-established.

As I said, I'm low-intervention, so the list is not that long. If you only do two things today, take your flax seed fish oil capsules and eat some chocolate.

Comments

[janet]

"You are the perfect mother for your baby"

That one statement felt like it was meant for me. I really needed to hear that today. Thank you.
And really, even if you aren't depressed, maybe just "blue", every mother needs to hear that. It can't be said often enough.

The fact that you made sure to put that in this post is what makes you wonderful and why I have a crush on you.

[Lala]

Moxie: will you marry me?
I'm going to write these notes on index cards and hand them out to my family and friends. I have no taste for chocolate right now but with 7 weeks to go I think I can force some down.

[Lala]

See?? I'm capable of a loving, gushing comment.

[Jen (yup, another one)]

Wow! I've been on the flaxseed plan for over a month now but didn't know about the chocolate. Now that I've passed the 3-hour GTT I will gleefully add chocolate to my list!

[Kateri]

YES!!! FLax seed oil and chocolate!

[No Nym]

Beware fish oils and fish as supplements for Omega-3s. Farm raised fish are usually fed corn and as a result have lower Omega-3s than their wild caught brethren. And their wild caught brethren have higher Hg levels.

[Julie]

Hi Moxie,
Do you have a recommendation on the best place/deal to get flax seed oil? I looked on gnc.com and they had 60 capsules @400mg for 10.99--sounds like I'd have to take several a day (and it's got other stuff in it--borage oil, 200mg and microalgae oil 400mg). Is it best to get 100% flax seed?

Thanks, in advance.

[Jen P]

I took to chocolate with wild abandon after passing my glucose tests in pregnancy but I've got to argue...

That whole sleeping thing. Yeah.

I took both Flaxseed oil 1000mg and Fish Oil (Organic pricey Canadian stuff) 2000mg a day in pregnancy AND to this day...

and we're still up 9 times a night. So no one go planning on a super sleeping. It's allllllll in the temperament and/or gastric diseases.

I was advised to add in a Folic Acid vitamin 800mcg because my prenatal was very, very low in it despite being marketed as 'for pregnancy'. Especially if you have a family history of ancephaly, spina bifida (both occur in our families) and other related neural diseases.

A naturopath reccomended (pardon spelling no sleeeeeep) Sprirulina (either in capsules or powder with yoghurt) as she believed it to be a perfect supplement for anyone and I did buy some but stopped taking it as it make my Morning Sickness a nice foresty shade of green. I should start taking it again.

Lovely post Moxie.

[Moxie]

Julie, I just buy my flax seed oil capsules (plain flax seed oil caps, 1,000 mg) at Whole Foods. I think I pay maybe $7 for 180 of them.

[Jamie]

It's not insane to get your EFAs from flax meal. 1T. of flax meal weighs ~8g, approx. 3.2g of which is fat. We put it in smoothies, or occasionally sprinkle it over oatmeal.

[stephanie]

cool i like what you have to wrgiht

[Nancy]

I'm with Janet. I needed to hear that I am the perfect mother for my baby. I've heard that breastmilk is the perfect food for him from all the internets and since I've had trouble making enough and have to supplement w/ formula I sometimes feel like a failure as a mama. That one sentence really made a difference.

Thank You.

[Liz]

Your paragraph on PPD made me cry. You hit on every reason I was afraid to get help when I needed it most. I'm so glad I'm here to say Thank you.

[Katie/WannaBeMom]

The other day we picked up a bottle of flax seed oil at the store and I said to Partner, we better consult Moxie about this-- and here's our consultation.

I think I'll get some next time I am at that store! If I take it and get pregnant on this next round of IVF, maybe you can also add flax seed oil as good for pregnancy attempts...

[anon]

Two in one: make your oatmeal, then, while it's hot, sprinkle in several spoonfuls of ground flax seed meal.

[kim m]

ok...i am a nursing mother and i have been taking omaga3,6,9 supplements and a multivitamin for some time now. I recently read an article about not taking borage oil supps if nursing...but it didnt say why...can anyone answer as to why i shouldnt be doing so??

[Moxie]

Hi Kim M. Here's what I found on Kellymom.com about borage:

Use this herb with care as it is potentially toxic - if you use it, it is recommended that you ensure that it's prepared by an experienced herbalist. Borage leaves, when prepared properly, appear to be an effective galactagogue. There is at least one tincture designed for increasing milk supply that contains borage (among other things) that is commercially available .

That's right here:
http://www.kellymom.com/herbal/milksupply/herbal-rem_a.html#borage

It looks like it's a fear of improperly processed leaves that makes it a no-go for nursing.