Vitamins and Nutraceuticals During Pregnancy

According to the Americcan College of Obstetricians and Gynecologists (ACOG), it is advisable to take one prenatal vitamin a day. This typically includes: [1]

• Vitamin C (80 mg for ages 14-18, 85 mg for ages 19-50)
• Calcium (1300 mg for ages 14-18, 1000 mg for ages 19-50)
• Iron (27 mg)
• Iodine (220 mg)
• Choline (450 mg)
• Vitamin A (750 mg for ages 14-18, 770 mg for ages 19-50)
• Vitamin D3 (400-600 units)
• B6 (1.9 mg)
• B12 (2.6 mcg)
• Folic acid (600 mcg)

Besides those listed above, ACOG does not explicitly say whether or not it is safe to take herbal or other dietary supplements such as the ones listed in FLCCC protocols. [1] Supplements such as B1 (1.4 mg), B2 (1.4 mg), B3 (18-35mg), and zinc (11-13 mg) are recommended by the American Pregnancy Association. [2]

Magnesium supplementation during pregnancy may reduce fetal growth restriction and pre‐eclampsia and increase birthweight. [3] (See below for dosing.) The need for magnesium increases during pregnancy, and most pregnant women likely do not meet this increased need. [4] Magnesium deficiency or insufficiency during pregnancy may pose a health risk for both the mother and the newborn, with implications that may extend into adulthood of the offspring.

Safety of melatonin and other supplements listed on the FLCCC protocols in pregnant women

Safe Supplements
Vitamin C, D3, zinc, and B complex, taken within recommended daily dose, are considered safe in pregnancy since they are part of recommended prenatal vitamin supplementations.

Magnesium and Omega-3 fatty acids (mercury-free source): Safe and beneficial.
A daily dose of 300-400 mg magnesium is safe and beneficial in pregnancy. [3;4] Data derived from observational studies have found that omega-3 fatty acid consumption during pregnancy either in the diet or via supplements is associated with improved neurodevelopmental outcomes in the child. [5]

N-acetyl cysteine: NAC (600 mg daily) appears to be safe in pregnancy. [6;7]

Undetermined Supplements
Melatonin, Curcumin and Resveratrol: No evidence to support reproductive safety in humans.
Clinical evidence on melatonin use in pregnancy is scarce, and most studies have been done on animals and in vivo. Even though a few clinical studies on pregnant women show melatonin as being risk-free, when considering the extensive and not yet known effects on fetal development, it should not be used by pregnant women before further studies. [8-11]

Although the safety of Curcumin and Resveratrol have been proven with no adverse effects on reproductive performance or embryos in animal models, there is a lack of human data to demonstrate their safety and efficacy in gestational women. [12]

Spermidine. No human data is found for spermidine use during pregnancy. [13] The serum level of spermidine is increased during a normal pregnancy. [14] Without evidence showing the safety and therapeutic use of spermidine during pregnancy, spermidine should not be recommended for this population.

Supplements to Avoid
Quercetin: Should be avoided in pregnancy. No human studies have been found on quercetin. There have been a few studies done on animals and molecular docking with controversial findings, and a couple of them are concerning. [15] A study in mice suggested that prenatal quercetin exposure results in epigenetic changes and increased iron storage in the liver in adulthood. [16] In another study, prenatal exposure to quercetin was linked to increased cancer risk. [17]

Nigella sativa: Should be avoided in pregnancy. Nigella sativa should be avoided during pregnancy because it can stimulate menstruation and has been used as a contraceptive. [18;19]

References

1. Nutrition in Pregnancy (ACOG.org). https://www acog org/womens-health/faqs/nutrition-during-pregnancy [accessed 2022 Aug. 21]
2. Pregnancy Vitamins and Nutrients (APA). https://americanpregnancy org/healthy-pregnancy/pregnancy-health-wellness/pregnancy-vitamins-nutrients/ [ 2021 [cited 2022 Aug. 21];
3. Zarean E, Tarjan A. Effect of magnesium supplement on pregnancy outcomes: A randomized control trial. Adv Biomed Res 2017; 6:109.
4. Dalton LM, Ni’Fhloinn DM, Gaydadzhieva GT, Mazurkiewicz OM, Leeson H, Wright CP. Magnesium in pregnancy. Nutr Rev 2016; 74:549-557.
5. Coletta JM, Bell SJ, Roman AS. Omega-3 fatty acids and pregnancy. Reviews in Obstetrics and Gynecology 2010; 3:163-171.
6. Amin AF, Shaaban OM, Bediawy MA. N-acetyl cysteine for treatment of recurrent unexplained pregnancy loss. Reproductive Medicine Online 2008; 17:722-726.
7. Miller BM, Wells KK, Wells CB, Lam XT, Carney ME, Kepko DS et al. Exposure to the dietary supplement N-acetyl-L-Cysteine during pregnancy reduces cyclophosphamide teratogenesis in ICR mice. J Clin Nutr Food Sci 2018; 1:35-39.
8. Voiculescu SE, Zygouropoulos N, Zahiu CD, Zagrean AM, Davila C. Role of melatonin in embryo fetal development. Journal of Medicine and Life 2014; 7:488-492.
9. Kuhne BA, Vazquez-Aristizabal PV, Fuentes-Amell M, Pla L, Loreiro C, Gratacos E et al. Doccosahexaenoic acid and melatonin prevent impaired oligendrogenesis induced by intrauterine growth restriction (IUGR). Biomedicines 2022; 10:1205.
10. Hobson SR, Gurusinghe S, Lim R, Alers NO, Miller SL, Wallace EM. Melatonin improves endothelial function in vitro and prolongs pregnancy in women with early-onset preeclampsia. J Pineal Res 2018; 65:e12508.
11. Carloni S, Favrais G, Saliba E, Albertini MC, Chalon S. Melatonin modulates neonatal brain inflammation through endoplasmic reticulum stress, autophagy, and miR-34a/silent information regulator 1 pathway. J Pineal Res 2016; 61:370-380.
12. Sebastiani G, Navarro-Tapia E, Almeida-Toledano L, Serra-Delgado M, Paltrinieri AL. Effects of antioxidant intake on fetal development and maternal/neonatal health during pregnancy. Antioxidants 2022; 11:648.
13. Tamba RP, Moenadjat Y. Oral spermine supplementation in gestated rabbit: A study on villi height of immature intestines. Front Surg 2021; 8:721560.
14. Hussain T, Tan B, Ren W, Rahu N, Kalhoro DH, Yin Y. Exploring polyamines: Functions in embryo/fetal development. Animal Nutrition 2017; 3:7-10.
15. Zhang J, Peng Q, deng Y, Sun M, Zhao Y, Zhang W. The preventive effects of quercetin on preterm birth based on network pharmacology and bioinformatics. Reproductive Sciences 2022; 29:193-202.
16. Vanhees K, Godschalk RW, Sanders A, van Schooten FJ. Maternal quercetin intake during pregnancy results in an adapted iron homeostasis at adulthood. Toxicology 2011; 290:350-358.
17. Vanhees K, de Bock L, Godschalk RW, van Schooten FJ. Prenatal exposure to flavonoids: Implications for cancer risk. Toxicological Sciences 2011; 120:59-67.
18. Salarinia R, Rakhshandeh H, Oliace D, Ghasemi SG, Ghorbani A. Safety evaluation of Phytovagex, a pessary formulation of Nigella sativa, on pregnant rats. Avicenna J Phytomed 2016; 6:117-123.
19. Ahmad A, Husain A, Mujeeb M, Khan SA, Najmi AK, Anwar F. A review on therapeutic potential of Nigella sativa: A miracle herb. Asian Pac J Trop Biomed 2013; 3:337-352.