Nutrition for pregnancy and Breastfeeding, what should you take and what you shouldn't?

PM Procare does include Vitamin A, but in the form of Betacarotene, or pro Vitamin A. The reason is discussed below. Vitamin A is beneficial to pregnant and breastfeeding women for both themselves and the offspring. Vitamin A can be easily obtained from vitamin A rich food readily available in different cultures (see Tables 1 and 2 below).

Table 1: Selected animal sources of vitamin A

Food	Vitamin A (IU)*
Liver, beef, cooked, 3 ounces	27,185
Liver, chicken, cooked, 3 ounces	12,325
Milk, fortified skim, 1 cup	500
Cheese, cheddar, 1 ounc	284
Milk, whole (3.25% fat), 1 cup	249
Egg substitute, ¼ cup	226

Table 2: Selected plant sources of vitamin A (from beta-carotene)

Food	Vitamin A (IU)*
Carrot juice, canned, ½ cup	22,567
Carrots, boiled, ½ cup slices	13,418
Spinach, frozen, boiled, ½ cup	11,458
Kale, frozen, boiled, ½ cup	9,558
Carrots, 1 raw (7½ inches)	8,666
Vegetable soup, canned, chunky, ready-to-serve, 1 cup	5,820
Cantaloupe, 1 cup cubes	5,411
Spinach, raw, 1 cup	2,813
Apricots with skin, juice pack, ½ cup	2,063
Apricot nectar, canned, ½ cup	1,651
Papaya, 1 cup cubes	1,532
Mango, 1 cup sliced	1,262
Oatmeal, instant, fortified, plain, prepared with water, 1 cup	1,252
Peas, frozen, boiled, ½ cup	1,050
Tomato juice, canned, 6 ounces	819
Peaches, canned, juice pack, ½ cup halves or slices	476
Peach, 1 medium	319
Pepper, sweet, red, raw, 1 ring (3 inches diameter by ¼ inch thick)	313

Source: http://dietary-supplements.info.nih.gov/factsheets/vitamina.asp [1]
NOTE:
•    1 ounce = ~28grams
•    IU = International Units
•    For foods not listed in this table, refer to the U.S. Department of Agriculture's Nutrient Database Web site: http://www.nal.usda.gov/fnic/cgi-bin/nut_search.pl.

Vitamin A is required in low amount and there are serious side effects for overdoses of Vitamin A especially during the pregnancy and breastfeeding periods.  Health authorities also warn against serious complications if Vitamin A intake is higher than the safe intake level during this period. According to the World Organization (WHO) [2] pregnant and lactating women should follow the level as below:

Group	Mean requirement		Recommended safe in take
	(mcg RE/day)	IU	(mcg RE/day)	IU
Pregnant women	370	1232.1	800	2664
Lactating women	450	1498.5	850	2830.5

The Australian Therapeutic Goods Administration (TGA) states: “The recommended daily amount of vitamin A from all sources is 700 retinol equivalents (or 2331 IU) for women. It is important for women who are pregnant or considering becoming pregnant to consult their doctor or pharmacist before taking Vitamin A supplements. It is also mandatory that all vitamin A products contain the following warning on the packaging and product inserts: “WARNING: When taken in excess of 3000 micrograms retinol equivalents (10,000iu), vitamin A can cause birth defects. It is recommended that women who are pregnant or considering becoming pregnant to consult their doctor or pharmacist before taking vitamin A supplements.”[3]

It is very easy to exceed the limits set by the health authorities above depending on what food you eat. For e.g., according to Table 1, in 1 gram of liver or beef (cooked), there is about 323.63 IU of Vitamin A, so for 300grams (a normal meal), we would be consuming around 97,089IU of Vitamin A in one serving. That is 36 times the safe limit for pregnant women and 34 times for breastfeeding women. So pregnant and breastfeeding women need to be careful about what food they eat to avoid excess amount of Vitamin A intake. They need to consult their doctors if they wish to take Vitamin A supplements as they may already exceed the limit due to food intake.

After careful consideration, PM Procare was introduced with Beta-carotene, also known as Pro Vitamin A, the precursor to Vitamin A. Its structure consists of 2 Vitamin A molecules (in the form of retinol) linked together. Once in the body Beta-carotene will be converted to Retinol when the body requires Vitamin A. The proportion of Beta-Carotene that is converted into Vitamin A is determined by the body’s Vitamin A status. The body will not be overloaded with Vitamin A but will consume just the amount it needs. Provitamin A carotenoids such as beta-carotene are generally considered safe because they are not associated with specific adverse health effects [1]. 

The Center for the Evaluation of Risks to Human Reproduction (CERHR) of the US Government stated:  “The FDA has recommended that pregnant women obtain vitamin A in the form of beta-carotene whenever possible (FDA Talk Paper; October 6, 1995). According to the FDA, "beta-carotene is a substance found naturally in plants, and it can be converted to vitamin A in the body. It is considerably less toxic than the pre-formed vitamin A.” [4]

As such, PM Procare provides women with the essential nutrient if their body needs it in case they do not have enough from their food sources, but does not overload the system and pose undesirable health risks.

Calcium carbonate (Chemical formula, CaCO3) consists of calcium (40%), chelated to the organic compound carbonic acid (60%). Calcium carbonate is the active component in agricultural limestone and pure calcium carbonate used for food and pharmaceutical products can be produced from a pure quarried source that is usually marble.

Calcium carbonate provides a relatively high (40%) of calcium, and is the cheapest form of calcium supplement. While most people digest calcium carbonate very well, some might develop gastrointestinal discomfort or gas [5].

Calcium Phosphate [Ca3(PO4)2 - also known as Tricalcium diphosphate] consists of 38.7% Calcium bound to Phosphorus.  It is one of the forms of Calcium that are present in human and animal bones.  Crystallized Calcium Phosphate is a major component of the Teeth. Calcium phosphate costs more than calcium carbonate. It is easily absorbed and is less likely to cause constipation and gas [5].

Absorption of calcium is the key to obtaining the body requirements, and will differentiate the different calcium forms.

The Upper Tolerable limit’s (UL) is the highest level of nutrient intake that is likely to pose no risk of adverse health effects for the majority of the general population. As the intake increases above the UL, the risk of adverse effects will also increase. The purpose of UL is to caution against excessive intake of nutrients that could lead to detrimental effects.

The Recommended Nutrient Intakes (RNIs) for folic acid as stated in WHO [2] are:

Group	RNI (mcg/day)
Pregnant women	600
Lactating women	500

400mcg of Folic acid is provided in PM Procare, because this is the level at which WHO considers to be adequate to prevent most neural tube defects. Additional amount of folic acid can be achieved from daily food intake.

Pregnant and lactating women in addition to taking folic acid supplements, they will also be obtaining folic acid through diet. Dietary sources of folic acid include leafy green vegetables (e.g. Chinese cabbage, leeks, spinach, cabbage, mugwort/common sagebrush), beef liver, beans. In addition a lot of types of foods are now fortified with folic acid due to recommendation from health authorities. These include (chicken) eggs, bread, cereal, flour etc...(Refer to Table 3 below). Breakfast cereals and flour can add significant amounts of folic acid to the diet [2]. Supplementary products with 800mcg or 1000mcg of folic acid, in addition to folic acid obtained through diet will likely result in exceeding the UL for folic acid. As mentioned previously, as the intake increases above the UL, the risk of adverse effects will increase as well.

Table 3: Selected Food Sources of Folate and Folic Acid

Food	Micrograms (mcg)
*Breakfast cereals fortified with 100% of the DV, ¾ cup	400
Beef liver, cooked, braised, 3 ounces	185
Cowpeas (black eyes), immature, cooked, boiled, ½ cup	105
*Breakfast cereals, fortified with 25% of the DV, ¾ cup	100
Spinach, frozen, cooked, boiled, ½ cup	100
Great Northern beans, boiled, ½ cup	90
Asparagus, boiled, 4 spears	85
*Rice, white, long-grain, parboiled, enriched, cooked, ½ cup	65
Vegetarian baked beans, canned, 1 cup	60
Spinach, raw, 1 cup	60
Green peas, frozen, boiled, ½ cup	50
Broccoli, chopped, frozen, cooked, ½ cup	50
*Egg noodles, cooked, enriched, ½ cup	50
Broccoli, raw, 2 spears (each 5 inches long)	45
Avocado, raw, all varieties, sliced, ½ cup sliced	45
Peanuts, all types, dry roasted, 1 ounce	40
Lettuce, Romaine, shredded, ½ cup	40
Wheat germ, crude, 2 Tablespoons	40
Tomato Juice, canned, 6 ounces	35
Orange juice, chilled, includes concentrate, ¾ cup	35
Turnip greens, frozen, cooked, boiled, ½ cup	30
Orange, all commercial varieties, fresh, 1 small	30
*Bread, white, 1 slice	25
*Bread, whole wheat, 1 slice	25
Egg, whole, raw, fresh, 1 large	25
Cantaloupe, raw, ¼ medium	25
Papaya, raw, ½ cup cubes	25
Banana, raw, 1 medium	20

Source: http://ods.od.nih.gov/factsheets/folate.asp#h6 [6]

There is some concern that high dose folic acid might increase the risk of adverse cardiovascular outcomes and cancer. Preliminary clinical research suggests that taking doses of 800-1200 mcg/day might increase the risk of adverse cardiovascular events [7] [8]. High doses of folic acid might promote cell growth by providing large amounts of the biochemical precursors needed for cell replication. Overgrowth of cells in the vascular wall might increase the risk of occlusion [7].

There is also concern that excess folic acid intake masking the diagnosis of pernicious anaemia (often caused by Vitamin B12 deficiency), because the anaemia is corrected by high levels of folic acid [2]. This may result in the neuropathy to progress undiagnosed to a point where it is irreversible even upon treatment with Vitamin B12 [2].
Due to these concerns, it is recommended that doctors should advise their patients not to overdo it with folic acid supplements. Recommend that most adults only take the current recommended daily amount (RDA) of 400mcg/day. As for pregnant and breastfeeding women, doctor’s advice should be sought if they consider to take more than the 600mcg (for pregnancy) and 500mcg (for breastfeeding). There needs to be careful consideration of each person’s individual requirements and folic acid intake from food sources during this period.

In the US for e.g., it is considered that the variety of fortified foods available has made it easier for women of childbearing age to consume the recommended 400 mcg of folic acid per day from fortified foods and/or supplements [9]. The large numbers of fortified foods on the market, however, also raises the risk of exceeding the UL. This is especially important for anyone at risk of vitamin B12 deficiency, which can be triggered by too much folic acid. It is important for anyone who is considering taking a folic acid supplement to first consider whether their diet already includes adequate sources of dietary folate and fortified food sources of folic acid [6].

PABA (P-aminobenzoic acid), is a water soluble B-group vitamin. It is not recommended for oral intake by pregnant and lactating women due to insufficient safety data available for oral use.

Supplementation with Spirulina (a blue green algae) is not recommended during pregnancy and lactation due to insufficient safety data.

The only herb that has been studied and deemed to be safe for pregnant women is ginger (for morning sickness). No other herbs have safety data for either of the two periods.

PM Procare has been researched carefully to contain only the required nutrition that is safe from before conception, to pregnancy and breastfeeding period.

In particular it has a high level of DHA omega 3 fatty acids from Tuna oil, supported by a group of ingredients to benefits mums and her offspring in the following areas:

• A healthy fertility health and successful conception
• Delivery outcome include Longer gestation, better physical measurements at birth. Prevent neural tube defect (NTD)
• Meet with Increased demand in Mum’s body for transferring to foetus/infant
• Assist with Foetus’/Offspring’s Brain, eye, bone development and Offspring’s motor skill development
• Assist with mum’s and baby’s mental and immune health
• Beneficial to Cardiovascular health
• Help with mum’s pregnancy complication such as morning sickness relief, pre-eclampsia and recurrent miscarriage

All ingredients used in PM Procare have been sourced from quality manufacturers. These manufacturers are GMP-accredited, ensuring quality pharmaceutical grade raw ingredients. It is regulated as therapeutic (medicinal) goods in Australia and has to comply with all of stringent regulations by the Australian Therapeutic Goods Administration (TGA), one of the strictest health authorities in the world.

 

References:

1. Health, O.o.D.S.N.I.o., et al. Dietary Supplement Fact Sheet: Vitamin A and Carotenoids       Available from: http://dietary-supplements.info.nih.gov/factsheets/vitamina.asp.
2. WHO, Vitamin and mineral requirements in human nutrition. 2004: World Health Organization and Food and Agriculture Organization of the United Nations. 1-340.
3. Administration, A.T.G., Gazette notice - required advisory statements for medicine labels (RASML), D.o. Health, Editor. 2008, TG