Unived VeganMomy Prenatal Multinutrient – Trimesters 2 & 3

Each trimester has a unique set of milestones. In the first trimester, the fertilized egg grows into a moving fetus with eyes, ears, and working organs. In the second trimester, the baby’s features develop and its movement can be felt. In the third trimester, the fetus grows rapidly to get ready for birth.

In the second trimester, hair, including eyebrows and eyelashes, begins to grow. Development continues, allowing more movement. The fetus begins to here noise in this trimester and will grow quickly. You will be able to feel this. It will put pressure on your lungs, stomach, bladder, and kidneys. As a result of the development of taste buds and sensory neurons, your baby will be able to taste and touch during the second trimester. By the end of the second trimester, the fetus will weigh almost 2 pounds and will be about 1 foot long. By now, all of the essential organs have formed. 

There will be a lot of moving during the third trimester. You should be able to feel about 10 movements per hour. Babies begin “practicing” breathing during the third trimester by moving their diaphragm. In the final few weeks before birth, the fetus will gain a good amount of its weight. By week 33, it is in position for delivery, ideally with its head resting on the cervix. The bones harden and the skin becomes thicker. Beginning at week 35, the fetus will gain ½ – ¾ pound per week. Babies are considered to have grown to “full-term” by week 37. The baby will most often be delivered between weeks 38 and 42. Your baby will weigh an average of 7.5 pounds at birth and measure about 20-22 inches long. 

Pregnancy is a critical period during which the mothers diet must provide enough nutrients to ensure optimal fetal development as well as to sustain the mother’s physiological needs. In addition to the metabolic demands associated with the fetus’ growth, rises in blood volume, extracellular liquids, adipose tissue, and placental weight all lead to an increase in the mother’s dietary requirements.

The maternal diet must provide sufficient energy and nutrients to meet the mother’s usual requirements, as well as the needs of the growing fetus, and enable the mother to lay down stores of nutrients required for fetal development as well as for lactation.

It is important to take prenatal vitamins and minerals as it will help cover the gaps in nutrition for the micronutrients and trace minerals. Just as the need for micronutrients increase during pregnancy, the need for macronutrients like protein also increases. Thus we developed the Pre-Postnatal Protein that one must consider while pregnant or breastfeeding because along with 20g of 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.

• RBC-phospholipid-DHA (percentage of total fatty acids by weight) was significantly higher in the DHA-supplemented group at birth and increased significantly[xxvii].
• Gestational age was also 2.87 d greater, and birth weight and length were higher by 172 g and 0.7 cm, respectively[xxvii].
• Cord RBC-phospholipid-DHA and head circumference were significantly higher in newborns of women assigned to DHA than to placebo[xxvii].
• Head circumference was 0.5 cm greater with the intervention[xxvii]
• The incidence of preterm birth did not differ between the groups; however, significantly more infants in the placebo group had an early preterm birth[xxvii]
• A trend toward fewer LBW deliveries was not statistically significant (P = 0.059), but there was a significantly lower incidence of VLBW in the DHA-supplemented group (P = 0.026)[xxvii].

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, during pregnancy, omega-3 requirements increase over normal to support fetal growth, particularly of the brain and eyes. Thus it is crucial to supplement Daily with DHA throughout pregnancy.

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. 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].

Excessive or deficient vitamin A levels can both be very harmful to the fetus and lead to malformation. Thus it is very important to regulate the vitamin A levels and the form of vitamin A being supplemented. However, intake of beta-carotene was not found to be associated with congenital defects[i].

• Vitamin A is important for visual health, immune function and fetal growth and development[iii].
• 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[iii].
• Adequate vitamin A status also helps to reduce inflammation and maintain innate immunity[i].

Vitamin D

• Vitamin D is known to be involved in skeletal homeostasis during pregnancy, and severe vitamin D deficiency may lead to neonatal seizures in neonates with profound hypocalcemia[iv].
• 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[iv].
• Vitamin D is known to play an important role in bone metabolism through regulation of calcium and phosphate equilibrium[v].
• 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 women[vi].

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.

• Scientific studies have shown that an adequate intake of vitamin E during pregnancy reduces the likelihood of your baby developing asthma and respiratory issues later in life
• Vitamin E helps your body create and maintain red blood cells, healthy skin and eyes, and strengthens your natural immune system[vii],[viii].
• Is an antioxidant vitamin and helps reduce oxidative stress[vii].
• Helps reduce the risk of pre-eclampsia (gestational hypertention)[vii].
• 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[vii].

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[ix].

• 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[ix].
• 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[ix].

Vitamin C

Vitamin C does not only enhances immune system functions and reduces risk of iron-deficiency anaemia in pregnancy, 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

• Supplementation with vitamin C and vitamin E during pregnancy reduced the risk of placental abruption[x]
• Vitamin C given alone reduced the risk of preterm and term prelabour rupture of membranes (PROM), while the risk of term PROM was increased when vitamin C was provided together with vitamin E[x]
• Vitamin C also has an important role in enhancing the absorption of non-haem sources of iron[xi].

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 B6

Vitamin B6 is important for several metabolic processes, as well as development and functioning of the nervous system, primarily through the biosynthesis of neurotransmitters[xii].

• It has antiemetic properties[xii],[xiii].
• In humans, vitamin B6 deficiency leads to hyperhomocysteinaemia, which has been related to obstetric complications such as pre-eclampsia[xii],[xiii].
• . It may also account for some type of anemia during pregnancy[xii].
• It has been hypothesised that vitamin B6 deficiency may contribute to aggravation of gingivitis and oral tissue changes associated with pregnancy[xii].

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. Demands for folate increase during pregnancy because it is also required for growth and development of the fetus[xiii].

Spinal tube defects: Folate deficiency has been associated with abnormalities in both mothers (anemia, peripheral neuropathy) and fetuses (congenital abnormalities)[xiii]. Taking folic acid before and during early pregnancy can help prevent birth defects of the brain and spine called neural tube defects (also called NTDs)[xiii]. Some studies show that taking folic acid may help prevent heart defects and birth defects in your baby’s mouth (called cleft lip and palate).

Healthy DNA replication: Folate helps to form DNA and RNA and is involved in protein metabolism[xiii]. It plays a key role in breaking down homocysteine[xiii], 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, such as during pregnancy and fetal development.

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[xiii].

Vitamin B12

Because of its role in DNA synthesis, Methylcobalamin is essential for cell multiplication during pregnancy. 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[xiv].

• 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[xiv].
• 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[xiv]^,[xv].
• 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[xiv].
• 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[xvi].

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 women increase their daily iron intake to support increased requirements[xvii].

• Iron supplementation has evidence for reducing the risk of preterm birth or delivery of a low birth weight infant in settings where nutritional intake is poor and the risk of anaemia or adverse perinatal outcomes is much higher, such as in developing nations[xvii]
• It reduces the risk of maternal anaemia and the development of iron deficiency[xvii].
• Who recommends daily oral iron and folic acid supplementation with 30 mg to 60 mg of elemental iron and 400 µg (0.4 mg) folic acid, for pregnant women to prevent maternal anaemia, puerperal sepsis, low birth weight, and preterm birth[xviii].
• Iron requirements are increased during pregnancy to supply the growing fetus and placenta and for the production of increased numbers of maternal red blood cells[xi].
• 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[xi].

Zinc

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

• Zinc deficiency alters levels of hormones associated with the onset of labour, and because zinc is essential for normal immune function, deficiency may contribute to systemic and intra-uterine infections, both major causes of pre-term birth[xx].
• Lower plasma zinc concentrations could reduce placental zinc transport and the foetal zinc supply[xix].
• Because supplemental zinc significantly improves the weight and height gain in growing children, it was assumed that maternal zinc supplementation would improve foetal growth[xix].

Iodine

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

• 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[xvii].
• 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[xxi].

Other trace minerals

Copper

Copper-containing enzymes such as cytochrome play key roles in many oxidative processes and, hence, in the production of most of the energy required for metabolism. These cuproenzymes are important in the body’s defense against free radicals (e.g., superoxide dismutase in cytosol and mitochondria), in the synthesis of connective tissue, in the transport and utilization of iron, in the synthesis of norepinephrine, and in other metabolic pathways[xxii].

Selenium

• Selenium is an important component of the body’s defense against free radical damage[xxii].
• As with zinc, selenium is an antioxidant, important in supporting immune function and reducing cellular stress[xvii].
• Selenium deficiency in pregnancy has been associated with miscarriage, pre-eclampsia and fetal growth restriction and selenium supplementation has beneficial effects on hypertension. Thus, the NHMRC recommends an additional 10–15 micrograms/day selenium for pregnant women[xvii].

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[xxiii].
• In women with intrauterine growth restriction infants have lower serum levels of manganese than those with normal pregnancy and therefore, manganese may play an important role in fetal growth and development[xxiii].

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[xxiii].

Chromium is a mineral that helps your body break down and store fats, carbohydrates, and protein. It also works with the hormone insulin to maintain a normal level of glucose in your body. This is especially important if you’re diabetic or become diabetic during pregnancy (gestational diabetes)[xxiv].

Chromium (along with insulin) also promotes the building of proteins in your developing baby’s growing tissues.

Coenzyme

Coenzyme Q10 (CoQ10) is a potent lipid-soluble antioxidant synthesized in the human body, which mainly plays a role in the mitochondrial bioenergetic functions.

• It was demonstrated that maternal body weight gain or fat mass gain from the second trimester to the third trimester was significantly associated with increased serum CoQ10 levels during the third trimester[xxv].
• Increases in serum CoQ10 levels during the third trimester were significantly associated with increases in birth weight[xxiv].
• It is an excellent antioxidant and Helps reduce the risk of developing preeclampsia[xxvi].

A balanced diet contains plenty of vitamins and minerals, but taking a prenatal vitamin will only assure that the nutrient intake is enough for your body and your baby’s needs. Unived’s prenatal & Postnatal vitamins and protein range is formulated with the idea that the person taking them is eating a healthy diet, therefore there is no need to consider taking additional nutrient supplements alongside. Be sure to let your doctor know so they are aware and not repeating these in your prescription.

[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] 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

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

[v] 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

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

^[vii] “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

[viii] 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

[ix] https://www.who.int/elena/titles/review_summaries/vitaminC-pregnancy/en/

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

[xi] https://www.who.int/elena/titles/vitaminb6-pregnancy/en/

[xii] Dror, D.K. and Allen, L.H. (2012), Interventions with Vitamins B6, B12 and C in Pregnancy. Paediatric and Perinatal Epidemiology, 26: 55-74. https://doi.org/10.1111/j.1365-3016.2012.01277.x

[xiii] 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

[xiv] 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

[xv] 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.

[xvi] 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

[xvii] 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

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

[xix] 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

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

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

[xxii]Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. Nutrition During Pregnancy: Part I Weight Gain: Part II Nutrient Supplements. Washington (DC): National Academies Press (US); 1990. 15, Trace Elements. Available from: https://www.ncbi.nlm.nih.gov/books/NBK235243/

[xxiii] 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

[xxiv] Jovanovic, L., Gutierrez, M. and Peterson, C.M. (1999), Chromium supplementation for women with gestational diabetes mellitus. J. Trace Elem. Exp. Med., 12: 91-97. https://doi.org/10.1002/(SICI)1520-670X(1999)12:2<91::AID-JTRA6>3.0.CO;2-X

[xxv] Haruna, M., Matsuzaki, M., Ota, E., Honda, Y., Tanizaki, T., Sekine, K., Tabata, N., Yeo, S. and Murashima, S. (2010), Positive correlation between maternal serum coenzyme Q10 levels and infant birth weight. BioFactors, 36: 312-318. https://doi.org/10.1002/biof.104

[xxvi] Teran, E., Hernandez, I., Nieto, B., Tavara, R., Ocampo, J.E. and Calle, A. (2009), Coenzyme Q10 supplementation during pregnancy reduces the risk of pre-eclampsia. International Journal of Gynecology & Obstetrics, 105: 43-45. https://doi.org/10.1016/j.ijgo.2008.11.033

[xxvii] 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