Antenatal supplements

Z36.9 + (Z29.9)

DESCRIPTION

Supplements before and during pregnancy and lactation can help to prevent, or lessen the effect of, a number of conditions or complications associated with pregnancy. Specifically:

  • Folic acid, given for at least one month before conception and during pregnancy (particularly the first 12 weeks) can help to prevent neural tube defects (abnormal development of spinal cord/brain).
  • Iron can help to prevent anaemia.
  • Calcium can help to prevent pre-eclampsia.

GENERAL MEASURES

  • Eat a balanced diet to prevent nutritional deficiency.
  • Avoid unpasteurised milk, soft cheeses, raw or undercooked meat, poultry, raw eggs and shellfish.
  • Cut down on caffeine. Reduce intake of tea. Do not drink tea within 2 hours of taking iron tablets.

MEDICINE TREATMENT

Prevention of Neural Tube Defects (NTD)

  • Folic acid, oral, 5 mg daily:
    • All women intending to become pregnant or pregnant women (first trimester of pregnancy).
    • If high risk, throughout pregnancy, i.e.:
      • on anticonvulsants - especially valproic acid and carbamazepine,
      • previous child with NTD; or
      • family history of NTD.

LoEI [17]

CAUTION
Children born to women taking valproic acid are at significant risk of birth defects (10%) and persistent developmental disorders (40%).
Valproic acid is contra-indicated and should be avoided in pregnancy and women of child-bearing potential.
LoEIII [18]

Prevention of anaemia:

During pregnancy, after delivery and during lactation:

  • Ferrous sulfate compound BPC (dried), oral, 170 mg once daily, (± 55 mg elemental iron), 12 hourly with meals.

LoEIII [19]

OR

  • Ferrous fumarate, oral, 200 mg once daily (± 65 mg elemental iron).
    • Taking iron tablets with meals decreases iron absorption, but improves tolerability. (Note: Do not take iron tablets with milk).

If daily iron is poorly tolerated (e.g. epigastric pain, nausea, vomiting and constipation), intermittent iron supplementation may be administered:

  • Ferrous sulfate compound BPC (dried), oral, 340 mg per week, (± 110 mg elemental iron), with meals.

OR

  • Ferrous fumarate, oral, 400 mg per week (± 130 mg elemental iron).
    • Taking iron tablets with meals decreases iron absorption, but improves tolerability. (Note: Do not take iron tablets with milk).

LoEI [20]

Note: Established anaemia i.e. Hb < 10 g/dL, See Anaemia .

Prevention of pre-eclampsia:
From confirmation of pregnancy:

  • Calcium, elemental, oral, 1 g daily (given as calcium carbonate), 12 hourly.
    • Although the benefit is greatest in high-risk women, consider use of this agent in all pregnant women. See Pre-eclampsia .
    • Calcium reduces iron absorption from the gastro-intestinal tract. Take supplements 4 hours apart from each other.

LoEI [21]