Nutritional assessment is a critical component of preconceptual and antepartum care.  There is evidence that periconceptual folate supplementation lowers the incidence of neural tube defects.  However, it should be stressed that vitamin/mineral supplementation does not replace a well-balanced diet and dietary counseling.  Neither does it correct poor or inadequate nutritional intake.

 

1.     The United States Public Health Service recommends that all women capable of becoming pregnant consume 0.4 mg of folic acid daily.  Many prenatal vitamin supplements contain both iron and folic acid.  Most preparations contain 0.4 mg of folic acid (folate).  These can be prescribed for once daily use.   Ideally, women of childbearing age should take folic acid supplements daily and continue until at least 8-12 weeks into the pregnancy.   If patients are not taking a prenatal vitamin, folate in a minimum dose of 0.4 mg should be prescribed and taken until 12 weeks gestation.

 

2.     Patients with a history of a previous infant with a neural tube defect or with a history of seizure disorder and on medication, should be placed on a higher dose of folate.  Ideally, these patients should begin 4 mg of folic acid 2-3 months prior to attempting conception and continue 4 mg daily until 12 weeks gestation.  After this time, a change to the lower dose would be appropriate.

 

3.     There are some patients who should be on folic acid supplementation because of medical or obstetrical problems.  These include patients with sickle cell disease, hereditary spherocytosis, or multiple gestations.  These patients should take 1mg of folic acid daily throughout the pregnancy. 

 

Note:  2 Flintstone vitamins ( or generic) are equivalent to 1 prenatal vitamin

 

 

                                                  Prepared in conjunction with the

                                                  Division of Maternal-Fetal Medicine

                                                  Duke University Medical Center

 

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                                                            Director

 

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                                                            Date

 

Vitamin/Mineral Supplementation

 

 

1.               Recommendations from a report entitled "Nutrition During Pregnancy, Weight Gain and Nutrient Supplements" published by the Institute of Medicine, National Academy Press, 1990. Pgs. 15-23.

 

2.       Folic Acid and Food Fortification:  Implication for the Primary Care Practitioner.  The Nurse Practitioner, March 1997.  Vol 22 3:105-114.

The Clinical Care Guidelines Development Committee of the Perinatal Improvement Board of Duke University Health System has developed a series of multi-disciplinary protocols to offer guidance to health care providers who are caring for pregnant women with high risk conditions.

 

These protocols are designed to assist health care providers in the management of a variety of problems that occur in pregnancy and the time of delivery. They should not be interpreted as standard of care, but instead represent only general guidelines for the care of pregnant women with high risk conditions.  We recognize that services offered by individual providers depend not only on their training, experience and institutional resources, but on the medical facts and circumstances of the specific care situation.

The protocols remain the intellectual property of the Duke University Health System.  They cannot be reproduced in whole or part without the expressed permission of the Health System.

 

These protocols are reviewed by the Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine, the Department of Pediatrics Division of Neonatology and the Department of Anesthesiology Division of Women’s Anesthesia.  Please contact Andra H. James (andra.james@duke.edu), Chair, Clinical Care Guidelines Development Committee of the Perinatal Improvement Board with ideas for additional protocols.