Unived VeganMomy Postnatal Multinutrient

Postpartum recovery is not just for few days. Fully recovering from pregnancy and childbirth can take months. While many women mostly feel recovered by 6-8 weeks, it may take longer than this to feel like yourself again.

Mental health: After giving birth one may feel quite emotional for a while. Experiencing ‘baby blues’, which can leave you feeling anxious, low, irritable or wanting to cry for no apparent reason is common. All these symptoms are normal and usually only last for a few days.

Pain: Experiencing pain and cramping after giving birth is seen in some women. This is because your womb (uterus) is contracting and going back to its normal size. These pains usually last for 2 or 3 days after a vaginal delivery and longer in case of tear.

Bleeding: Bleeding from your vagina after giving birth vaginally or by c-section will be quite heavy at first. This will carry on for a few weeks and will gradually turn a brownish colour and decrease until it finally stops.

Stitches: not all but some may have had stitches after tearing or an episiotomy (where the doctor or midwife makes a cut to make the opening of the vagina a bit wider) during the birth.

Breastmilk: the breasts starts producing yellow fluid called colostrum in the first few days after your baby is born. This is concentrated food, so your baby will not need a lot at each feed, but they may want to feed quite often (maybe every hour). The milk comes in after about 3 days making the breasts much fuller. The amount of milk you make will increase or decrease depending on your baby’s needs.

During lactation the maternal diet must provide sufficient energy and nutrients to meet the mother’s usual requirements, as well as the needs of the breastfed infant. It is important to take postnatal vitamins and minerals during this phase as it will help recovery and fill the gaps in nutrition for the micronutrients and trace minerals.

Just as the need for micronutrients increase during this time, the need for macronutrients like protein also increases. Thus we developed the Pre-Post Natal Protein that one must consider while pregnant or breastfeeding because along with 20g protein it also contains Calcium, Magnesium, and Choline.

DHA helps with growth and development. During pregnancy, you need DHA to help your baby’s brain and eyes develop. Adequate consumption of omega-3 fatty acids is vitally important during pregnancy as they are critical building blocks of fetal brain and retina. In fact, DHA plays major roles in the psychomotor neurodevelopment in the first months of life, when it is supplied at high amounts by breastmilk[xxi].

• RBC-phospholipid-DHA (percentage of total fatty acids by weight) was significantly higher in the DHA-supplemented group at birth and increased significantly[xxxi].
• studies that have shown the association between increase in the content of DHA in breastmilk and a better overall health status of the infant, especially in terms of visual acuity and cognitive development[xxxi].
• Cord RBC-phospholipid-DHA and head circumference were significantly higher in newborns of women assigned to DHA than to placebo[xxxi].
• Head circumference was 0.5 cm greater with the intervention[xxxi]

DHA is the most biologically active form of omega-3 fatty acids, which is primarily derived from marine sources such as seafood and algae. Fetal brain growth accelerates during the second half of pregnancy, and the rate of growth remains high during the first year of life with continued growth for the next several years. It is likely that, while breastfeeding, omega-3 requirements increase over normal to support mother and infant’s growth, particularly of the brain and eyes. Thus it is crucial to supplement Daily with DHA throughout pregnancy and lactation.

Vitamin A

In humans, vitamin A has three active forms (retinal, retinol and retinoic acid). This liposoluble micronutrient is not synthesized by the body and must be obtained through the diet. It is available from two main sources: preformed vitamin A (retinol and retinyl ester) and provitamin A (caratenoids)[i].

During pregnancy, there is an increase in the demand for vitamin A, particularly in the third quarter because of the accelerated fetal development in this phase. Adequate vitamin A levels during pregnancy are essential for the health of both the mother and the fetus. The transfer of vitamin A from mother to child occurs via the placenta during gestation and via the mammary gland during lactation (breastfeeding)[i].

While there is some indication that low doses of vitamin A supplements given to pregnant women on a daily or weekly basis, starting in the second or third trimester, can reduce the severity of decline in maternal serum retinol levels during late pregnancy and the symptoms of night blindness, current evidence indicates that vitamin A supplementation during pregnancy does not reduce the risk of illness or death in mothers or their infants[ii].

Infants and young children need vitamin A for visual health, immune function and optimal health, growth, and development[iii]. Almost all children are born with low stores of vitamin A. During the first six months of life, mothers need to breastfeed exclusively to increase their babie’s vitamin A stores. Starting at six months of age, vitamin A must come from breastmilk, vitamin A-rich foods, and, if needed, supplements[iv].

• Exclusive breastfeeding reduces infection and vitamin A losses.
• Postpartum vitamin A supplementation of lactating women will raise breastmilk vitamin A content.
• Its deficiency can cause visual impairment in the form of night blindness and, in children, may increase the risk of illness and death from childhood infections, including measles and those causing diarrhoea[v].
• Adequate vitamin A status also helps to reduce inflammation and maintain innate immunity[i]

Vitamin D

• Vitamin D is needed to support healthy bone development and to prevent rickets, a condition that causes weak or deformed bones[vi].
• The function of vitamin D during this sensitive period, however, also may have potential effects on other systems, including immune, pancreatic, musculoskeletal and cardiovascular function, as well as neural development[vii].
• Vitamin D may influence fetal and postnatal growth through effects on calcium absorption, parathyroid hormone expression, phosphate metabolism, growth-plate function, and regulation of the insulin-like growth factor axis[viii].
• Vitamin D is known to play an important role in bone metabolism through regulation of calcium and phosphate equilibrium[ix].
• Vitamin D has important roles in calcium metabolism and in the prevention of rickets and osteomalacia; low levels of 25-hydroxyvitamin D are common in the general population and amongst pregnant or lactating women[x].

Vitamin E

Vitamin E is a fat-soluble vitamin found in many foods. One of vitamin E’s main functions is protecting cell membranes from damage – a healthy intake of vitamin E contributes to the structure of cells throughout your body.

• Alpha-tocopherol is imperative to a baby’s nervous system development, and they primarily get this from breast milk[xi].
• Vitamin E helps your body create and maintain red blood cells, healthy skin and eyes, and strengthens your natural immune system[xii],[xiii].
• As antioxidants, vitamins E and C act synergistically to help prevent oxidative stress, which is an imbalance in the amount of free radicals circulating in the body and the availability of antioxidants to counter the free radicals[xii].

Vitamin K

Vitamin K deficiency can present a serious health risk to pregnant women and their babies that may lead to haemorrhage, especially in newborns[xiv]. Vitamin K is needed to form blood clots and to stop bleeding. Babies are born with very small amounts of vitamin K stored in their bodies, which can lead to serious bleeding problems like vitamin K deficiency bleeding (VKDB). VKDB can lead to brain damage and death[xv].

• Haemorrhaging occurs due to reduced levels of prothrombin ‐ an important element of the blood dependent on vitamin K for coagulation ‐ that slows down the blood‐clotting process and may result in excessive maternal or neonatal bleeding[xiv].
• Vitamin K is also needed for healthy bone development and protein formation in the liver. This is particularly important during labour and just after you’ve given birth, when your body is recovering and starting to heal[xiv].

Vitamin C

Vitamin C does not only enhances immune system functions and reduces risk of iron-deficiency anaemia, it is also key to your baby’s physical development.

• Aids in the production of collagen, which supports normal growth, healthy tissue and wound healing.
• Supports baby’s immune system.
• Helps the fetus absorb iron and build up stores for later use

• Vitamin C also has an important role in enhancing the absorption of non-haem sources of iron[xvi].

B-Complex vitamins

The B-group vitamins are needed to help the body to use the energy-yielding nutrients (such as carbohydrates, fat and protein) for fuel. Thiamin (B1) and riboflavin (B2) are needed for the release of energy in the body’s cells. Requirements for thiamin parallel the requirements for energy and are subsequently higher for the last trimester of pregnancy

Other B-group vitamins are needed to help cells to multiply by making new DNA.

Vitamin B7

Biotin requirements increases during pregnancy to support the increased metabolic demand. Pregnant women with biotin deficiency may be increasing their chances of having children with birth defects. An additional intake of 5 µg/day has generally been proposed for lactating women to cover biotin losses due to breastfeeding, considering the amount of biotin that would be excreted by women breastfeeding exclusively (IOM, 1998; Afssa, 2001; WHO/FAO, 2004)

Vitamin B9

Folate is an essential nutrient that is required for DNA replication and as a substrate for a range of enzymatic reactions involved in amino acid synthesis and vitamin metabolism[xvii]. It is estimated that, globally, up to one-third of pregnant and lactating women have some degree of folate undernutrition.

Spinal tube defects: taking folate regularly preconception and during pregnancy is very important as it may help prevent birth defects of the brain and spine called neural tube defects (also called NTDs)[xvii].

Healthy DNA replication: Folate helps to form DNA and RNA and is involved in protein metabolism[xvii]. It plays a key role in breaking down homocysteine[xvii], an amino acid that can exert harmful effects in the body if it is present in high amounts. Folate is also needed to produce healthy red blood cells and is critical during periods of rapid growth.

Anemia: Also helps prevent the risk of anemia as the blood volume expands and hemoglobin concentration normally decrease slightly during pregnancy, as a normal physiological change of pregnancy[xvii].

Folate in breast milk:[xviii] Milk folate content is maintained at a level that prevents the development of folate inadequacy in exclusively breast-fed infants, but often at the expense of maternal folate stores. During lactation, folate is preferentially taken up by actively secreting mammary glands, and milk folate declines to critically low concentrations only in the case of maternal folate deficiency.

Vitamin B12

Vitamin B12 is crucial for normal cell division and differentiation, and necessary for the development and myelination of the central nervous system. Serum vitamin B12 concentrations begins to decline during pregnancy[xix]. Vitamin B12 plays a vital role in neuronal development.

• Brain development starts from conception, and pregnancy is a period of rapid growth and development for the brain. Poor vitamin B12 status in infancy is linked to poor growth and neurodevelopment[xix].
• During pregnancy, vitamin B12 is concentrated in the fetus and stored in the liver. Infants born to vitamin B12-replete mothers have stores of vitamin B12 that are adequate to sustain them for the first several months postpartum[xix],[xx].
• Maternal vitamin B12 deficiency has been associated with increased risk of common pregnancy complications, including spontaneous abortion, low birth weight, intrauterine growth restriction and neural tube defects. Children born to these women are at increased risk of developmental abnormalities and anaemia[xix].
• Early B12 supplementation helps in reduction of homocysteine levels which has shown to improve expressive language score, gross motor domain, and alliveates inflammatory responses in infants[xxi].

Minerals

Iron

Iron is required by numerous proteins that participate in many cellular functions, including oxygen transport, antioxidant defences and DNA synthesis. Iron deficiency in pregnancy has been associated with increasing perinatal morbidity and mortality and it is recommended that pregnant and lactating women increase their daily iron intake to support increased requirements[xxii].

• The fetus accumulates most of its iron during the last trimester of pregnancy, and the iron needs of the fetus are met at the expense of maternal iron stores[xvi]
• It reduces the risk of maternal anaemia and the development of iron deficiency[xxii].
• WHO recommends oral iron supplementation, either alone or in combination with folic acid, to postpartum women for 6–12 weeks following delivery for reducing the risk of anaemia[xxiii].
• The iron content of human milk appears to be homeostatically controlled by up- and down-regulation of transferrin receptors in the mammary gland[xxiv].
• Because of the considerable iron requirement for growth and the marginal supply of iron in infant diets, iron deficiency is prevalent among infants between 6 and 12 months of age.[xxiv]
• Iron requirements rise markedly around 4 to 6 months of age for red blood cells, myoglobin and stores as stores are depleted and demands for iron increase to meet needs imposed[xxiv].

Zinc

Zinc is an essential component for numerous antioxidant enzymes, metalloenzymes, zinc-binding factors and zinc transporter[xxv]. Zinc is an essential mineral known to be important for many biological functions including protein synthesis, cellular division and nucleic acid metabolism[xxvi].

• Because supplemental zinc significantly improves the weight and height gain in growing children, it was assumed that maternal zinc supplementation would improve fetal growth[xxv]
• Zinc is not transferred through breast milk to the infant, however it is important for the mother as zinc plays a central role in cell division, protein synthesis and growth[xxvii].
• It helps build immunity of the mother.
• Zinc is important for cellular growth, cellular differentiation and metabolism and deficiency limits childhood growth and decreases resistance to infections[xxvii].
• Deficiency can negatively impact pregnancy outcomes including the health of the mother and newborn infant[xxvii].

Iodine

Iodine is essential for the production of maternal and fetal thyroid hormones that regulate the development of the fetal brain and nervous system[xxviii]. A woman’s iodine requirements increase substantially during pregnancy to ensure adequate supply to the fetus[xxviii]

• Iodine is a major component of thyroid hormones and is essential for their functions, namely growth, formation and development of organs and tissues, in addition to the metabolism of glucose, proteins, lipids, calcium and phosphorus, and thermogenesis[xxix].
• Irreversible damage to a child’s normal physical growth and mental development can be attributed to maternal iodine deficiency during pregnancy, as well as iodine deficiency in early childhood[xxii].
• Insufficient iodine intake increases the risk of negative reproductive outcomes, such as perinatal and infant mortality, and intellectual impairment, the most extreme form of which is cretinism[xxviii]

Other trace minerals

Selenium

• Selenium is an important component of the body’s defense against free radical damage[xxv].
• As with zinc, selenium is an antioxidant, important in supporting immune function and reducing cellular stress[xxii].

Manganese

• Manganese is a key component of enzymes involved in the metabolism of amino acids, carbohydrates, and cholesterol, formation of cartilage, synthesis of urea and protection of cells against oxidative damage and also, plays a role in activating other enzymes[xxx].

Molybdenum

Molybdenum is required for the activation of enzymes involved in the metabolism of sulphur-containing amino acids and nitrogen containing compounds contained in DNA and RNA, production of uric acid and detoxification. Molybdenum plays a role in the synthesis of red blood cell[xxx].

[i] Bastos Maia S, et. al. “Vitamin A and Pregnancy: A Narrative Review”. Nutrients. 2019 Mar 22;11(3):681. doi: 10.3390/nu11030681. PMID: 30909386; PMCID: PMC6470929.

[ii] https://www.who.int/elena/titles/vitamina_pregnancy/en/

[iii] https://www.who.int/elena/titles/vitamina_postpartum/en/

[iv] https://rehydrate.org/breastfeed/facts-breastmilk.htm

[v] https://www.who.int/elena/titles/vitamina_pregnancy/en/

[vi] https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/diet-and-micronutrients/vitamin-d.html

[vii] Hollis, B.W., Johnson, D., Hulsey, T.C., Ebeling, M. and Wagner, C.L. (2011), Vitamin D supplementation during pregnancy: Double-blind, randomized clinical trial of safety and effectiveness. J Bone Miner Res, 26: 2341-2357. https://doi.org/10.1002/jbmr.463

[viii] Daniel E. Roth, et. al., “Vitamin D Supplementation in Pregnancy and Lactation and Infant Growth”, August 9, 2018, N Engl J Med 2018; 379:535-546 DOI: 10.1056/NEJMoa1800927

[ix] https://www.who.int/elena/titles/vitamind_supp_pregnancy/en/

[x] Moon, R.J., Davies, J.H., Cooper, C. et al. Vitamin D, and Maternal and Child Health. Calcif Tissue Int 106, 30–46 (2020). https://doi.org/10.1007/s00223-019-00560-x

[xi] https://www.nutraingredients-usa.com/Article/2017/07/28/Tocopherol-source-may-affect-breast-milk-vitamin-E-profile-says-study

[xii] https://www.who.int/elena/titles/vitaminsec-pregnancy/en/

^[xiii] “Vitamin E in Health and Disease – Interactions, Diseases and Health Aspects”, April 5th 2021 DOI: 10.5772/intechopen.97268 https://www.intechopen.com/online-first/role-of-vitamin-e-in-pregnancy

[xiv] Kellie, Frances J. “Vitamin K supplementation during pregnancy for improving outcomes.” The Cochrane Database of Systematic Reviews vol. 2017,6 CD010920. 26 Jun. 2017, doi:10.1002/14651858.CD010920.pub2

[xv] https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/diet-and-micronutrients/vitamin-k.html

[xvi] Williamson, C.S. (2006), Nutrition in pregnancy. Nutrition Bulletin, 31: 28-59. https://doi.org/10.1111/j.1467-3010.2006.00541.x

[xvii] James A. Greenberg, et. al., “Folic Acid Supplementation and Pregnancy: More Than Just Neural Tube Defect Prevention”, Rev Obstet Gynecol. 2011;4(2):52-59 doi: 10.3909/riog0157

[xviii] Amy D Mackey, Mary Frances Picciano, Maternal folate status during extended lactation and the effect of supplemental folic acid, The American Journal of Clinical Nutrition, Volume 69, Issue 2, February 1999, Pages 285–292, https://doi.org/10.1093/ajcn/69.2.285

[xix] Chandyo RK, Ulak M, Kvestad I, et al. “The effects of vitamin B12 supplementation in pregnancy and postpartum on growth and neurodevelopment in early childhood: Study Protocol for a Randomized Placebo Controlled Trial”. BMJ Open 2017;7:e016434. doi:10.1136/ bmjopen-2017-016434

[xx] Siddiqua TJ, Ahmad SM, et. al., “Vitamin B12 supplementation during pregnancy and postpartum improves B12 status of both mothers and infants but vaccine response in mothers only: a randomized clinical trial in Bangladesh”. Eur J Nutr. 2016 Feb;55(1):281-93. doi: 10.1007/s00394-015-0845-x. Epub 2015 Feb 4. PMID: 25648738.

[xxi] Thomas, S., Thomas, T., Bosch, R.J. et al., “Effect of Maternal Vitamin B12 Supplementation on Cognitive Outcomes in South Indian Children: A Randomized Controlled Clinical Trial”. Matern Child Health J 23, 155–163 (2019). https://doi.org/10.1007/s10995-018-2605-z

[xxii] Wilson, R.L., et. al., “Vitamin and mineral supplementation in pregnancy: evidence to practice”. J Pharm Pract Res, 48: 186-192. https://doi.org/10.1002/jppr.1438

[xxiii] https://www.who.int/elena/titles/guidance_summaries/daily_iron_pregnancy/en/

[xxiv] Nancy F. Butte, et. al., “Nutrient adequacy of exclusive breastfeeding for the term infant during the first six months of life”, WHO Library Cataloguing-in-Publication Data 2001 : Geneva, Switzerland ISBN 92 4 156211 0

[xxv] Chaffee, B.W. and King, J.C. (2012), Effect of Zinc Supplementation on Pregnancy and Infant Outcomes: A Systematic Review. Paediatric and Perinatal Epidemiology, 26: 118-137. https://doi.org/10.1111/j.1365-3016.2012.01289.x

[xxvi] https://www.who.int/elena/bbc/zinc_pregnancy/en/

[xxvii] https://www.who.int/elena/titles/zinc_pregnancy/en/

[xxviii]https://www.who.int/elena/titles/bbc/iodine_pregnancy/en/

[xxix] Marangoni F, et. al., “Maternal Diet and Nutrient Requirements in Pregnancy and Breastfeeding. An Italian Consensus Document”. Nutrients. 2016; 8(10):629. https://doi.org/10.3390/nu8100629

[xxx] Khayat, Samira et al. “Minerals in Pregnancy and Lactation: A Review Article.” Journal of clinical and diagnostic research : JCDR vol. 11,9 (2017): QE01-QE05. doi:10.7860/JCDR/2017/28485.10626

[xxxi] Susan E Carlson, et. al., “DHA supplementation and pregnancy outcomes”, The American Journal of Clinical Nutrition, Volume 97, Issue 4, April 2013, Pages 808 815, https://doi.org/10.3945/ajcn.112.050021