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DESCRIPTION
Abruptio placentae is the partial separation of the placenta (also called the afterbirth) from the wall of the uterus in the last 3 months of pregnancy. The placenta carries all nourishment and oxygen to the unborn child. If the placenta partially separates prematurely, the child's life will be endangered. Treatment depends on the severity of the separation, the condition of the fetus, and the duration of the pregnancy.
There are three classifications of placenta abruption: External Abruption (Bleeding is evident when blood is seen flowing from the vagina), Relatively Concealed Abruption (There may be blood spotting or no bleeding seen), and Concealed Abruption (Blood backed up behind the placenta and no blood is seen flowing from the vagina). All classifications are severe and can result in fetal demise and danger to the mother. Full abruption is when the entire placenta has separated from the uterus and fetal demise is almost certain unless an immediate cesarean is performed. A partial abruption is when an edge of the placenta has separated, such is seen in a placenta previa (the placenta covers the opening of the cervix either partially or fully) when cervical dilation begins and the placenta is dislodged.
Also known as Premature separation of placenta; Ablatio placentae; Abruptio placentae; Placental abruption.
FREQUENT SIGNS & SYMPTOMS
Small separation of the placenta:
- Vaginal bleeding.
- Mild pain or discomfort. Abdominal pain. Back pain.
- Unborn child remains healthy.
Large separation of the placenta:
- Heavy vaginal bleeding.
- Severe pain in the lower abdomen or back.
- Hard, tender abdomen.
- Shock (rapid heartbeat, rapid breathing, and dizziness).
- Fetal distress; heartbeat of the unborn child may be inaudible.
- Coagulopathy (disseminated intravascular coagulopathy [DIC]) - certain elements of the placenta are released into the mother's circulation causing blood clotting defects. Symptoms include nosebleed, blood in the urine, oozing from puncture sites, bleeding into the skin, round red spots on the skin.
CAUSES
It is frequently difficult to determine the exact causes of placenta abruptio. Direct causes that result in placenta abruptio are quite rare, but include injury to the abdomen from an auto accident or fall, sudden loss in uterine volume (can occur with rapid loss of amniotic fluid or the delivery of a first twin), or an abnormally short umbilical cord.
RISK INCREASES WITH
High blood pressure. Approximately 50% of placenta abruptio cases severe enough to cause fetal death are associated with high blood pressure (hypertension)
Women who smoke cigarettes.
Women over age 35.
Women who have had several pregnancies and deliveries.
A previous pregnancy with placental separation. After one prior episode there is a 10-17% recurrence; after two previous episodes the chance of recurrence exceeds 20%.
A direct blow causing trauma to the uterus.
Chronic disease, such as diabetes mellitus.
Abuse of alcohol or drugs (particularly cocaine). Drinking more than 14 alcoholic drinks per week during pregnancy. Poor nutrition. Low lying placenta (placenta previa) that partially or totally covers the cervical opening. The placenta may be partially or totally dislodged or detached when the cervix begins to dilate in late pregnancy.
The incidence of placenta abruptio, including any amount of placental separation prior to delivery, is about 1 out of 150 deliveries. The severe form, which results in fetal death, occurs in about 1 out of 500 to 750 deliveries.
PREVENTIVE MEASURES
Get early and continuous prenatal care.
Early recognition and proper management of conditions in the mother such as diabetes and high blood pressure also decrease the risk of placenta abruptio.
If pregnant, don't engage in activity more vigorous than what you were accustomed to before pregnancy.
Avoid risk factors (listed above) when possible. Maintain a positive lifestyle free of smoking, alcohol and recreational drug use (e.g., cocaine use).
Proper and adequate nutrition prior to becoming pregnant and during pregnancy will help to prevent or reduce the risk of many negative outcomes of pregnancy.
Since the cause is unknown, there is no assured way to prevent the problem.
EXPECTED OUTCOME
When the separation is less severe and with immediate medical care, the outlook for mother and fetus is good.
The mother does not usually die from this condition. Maternal death rates in various parts of the world range from 0.5-5%. Early diagnosis of the condition and adequate treatment should decrease the maternal death rate even further. Fetal death rates range from 20-35%. Upon hospital admission, no fetal heart tone is detectable in about 15% of cases.
Fetal distress appears early in the condition in approximately 50% of cases. The infants who live have a 40-50% chance of complications, which range from mild to severe. Concealed vaginal bleeding in pregnancy, excessive loss of blood resulting in shock, absence of labor, a closed cervix, and delayed diagnosis and treatment may increase the risk of maternal or fetal death.
POSSIBLE COMPLICATIONS
Shock or life-threatening bleeding in the mother.
Death of unborn child and mother.
Brain damage to the unborn child.
Of the site of placental attachment starts to hemorrhage after the delivery and loss of blood cannot be controlled by other means, a hysterectomy (removal of the uterus) may become necessary. 10 to 17% of patients have abruptio placentae in a future pregnancy. TREATMENT
GENERAL MEASURES
Abruptio placentae is an emergency, but there is usually time to obtain advice by telephone and arrange safe transportation to the hospital. Panic is not helpful. If the placenta separation is slight, you may be able to return home for bed rest and close observation after examination.
Hospitalization required (except for mild cases). The mother will be carefully monitored for symptoms of shock and signs of fetal distress, which include abnormal heart rates.
Surgery to deliver the unborn child by cesarean section, or vaginal delivery (sometimes). If the fetus is very immature and there is only a small separation, the mother may be kept in the hospital for close observation and released after several days if the condition does not get worse. If the fetus is mature, vaginal delivery may be chosen if there is minimal distress to the mother and child. Otherwise, a cesarean section may be the preferred choice.
TESTS MAY INCLUDE:
Pelvic exam
CBC, may not decreased hematocrit or hemoglobin and platelets.
Prothrombin time test.
Partial thromboplastin time test.
Abdominal ultrasound.
MEDICATION
Oxytocin, a drug to induce labor, may be used if immediate delivery is necessary.
Intravenous (IV) fluids may be necessary for fluid replacement.
Blood transfusion may be necessary to replace amount of blood loss.
ACTIVITY
If you are able to remain at home, rest in bed until bleeding and other symptoms cease. Do not resume normal activities until specific instructions to do so are given to you.
Avoid sexual relations until otherwise instructed.
MoonDragon's Pregnancy Information: Bedrest Checklist
DIET
If you are resting at home, continue with your regular prenatal dietary program. See MoonDragon's Nutrition Index for helpful dietary information for proper nutrition during pregnancy.
If hospitalized, a liquid-only diet may be prescribed until it is determined that surgery is not likely. Solid food may cause risk if emergency surgery becomes necessary.
NUTRITION AND POSITIVE PREGNANCY OUTCOMES
Nearly all pregnant women can benefit from nutritional and multivitamin supplementation one year before and all during pregnancy, and throughout labor, delivery, and breast-feeding. The effects of poor nutrition during pregnancy can be seen in the increase of birth defects during times of famine. But a standard Western diet (high in fats, salt, sugar, and low in complex carbohydrates) also lacks necessary essential vitamins and minerals needed during pregnancy and breast-feeding, leading to a "compromise in an offspring's health." The appropriate diet is well-balanced and varied, and includes fresh fruits, vegetables, whole grains, legumes, beans and fish, with a limit on refined sugars, processed foods, and saturated fats. Organically grown produce, meats, and poultry are preferable, or at least carefully washed produce to remove agricultural chemicals.
In an observational study involving 76 healthy pregnant women, 78% had "one or more glaring nutritional deficiency." Another study showed an "overall apparent protective effect of pen-conceptual multivitamin use" for prevention of certain pregnancy-related illnesses and birth defects. Of especial importance are folate (folic acid) and calcium intake, since the requirement for both of these substances (one a vitamin, the other a mineral) doubles during pregnancy.
"The fetus, the neonate, and the pregnant woman have an increased requirement for folic acid and vitamin B-12, and are more likely to suffer from a deficiency of these vitamins." Nutrients such as folic acid, vitamin B-6 and B-12 all have been correlated with prevention of the more common negative pregnancy outcomes, such as spontaneous abortion, placental abruption, pre-term delivery, low infant birth weight, and neural tube defects (e.g. spina bifida and anencephaly). Supplementation with calcium, the only mineral whose requirement doubles during pregnancy, has been positively correlated with prevention of pregnancy hypertension and preeclampsia, preterm delivery, and low birth weight, as well as puerperal psychosis (postpartum depression). Magnesium supplementation has also been shown in studies to reduce the complications of pregnancy and improve the health of the infant.
NUTRITIONAL SUPPLEMENTS
FOLIC ACID (VITAMIN B-9): Folate is the only vitamin, whose requirement doubles in pregnancy. Deficiencies of folic acid have been linked in studies to low birth weight infants and neural tube defects. According to one controlled study, women at high risk (having previously given birth to babies with neural tube defects) given folate supplementation, showed a 72% protective effect compared to the placebo group. In one study, a group of pregnant women given folate supplementation gave birth to infants with increased birth weight and Apgar scores, and had a decreased incidence of fetal growth retardation and maternal infections. Other studies also showed significant prevention with supplementation. Because of firmly-established connections between deficiencies of folic acid and low birth weight infants and neural tube defects, the US Public Health Service recommends that all women of childbearing age take daily folic acid supplementation to reduce their risk of congenital birth defects.
Dietary folic acid is a mixture of folates in the form of polyglutamates, which are readily destroyed by cooking. Higher levels of dietary folate intake has been shown in some cases to decrease the incidence of neural tube defects, but women hereditarily predisposed to such defects may need to take in more folic acid through supplements in order to reach optimal levels. Folic acid can be found in green leafy vegetables, nuts and whole grains, liver, watercress, parsley, and dandelion. With artificial supplementation, care must be taken, because large doses of folic acid have been associated with a decrease in zinc absorption, a mineral required for proper fetal growth and immunity, as well as maternal infection and abnormally slow fetal heart rate.
Folic acid: 600 mcg per day, RDA
Nursing: 500 mcg per day
Food sources: green leafy vegetables, nuts, whole grains, liver, watercress, parsley, dandelion.
Folic Acid (Vitamin B-9), 100% Natural, Nature's Way, 800 mcg, 100 Caps
Prenatal Multi-Vitamin & Mineral, 100% Natural & Complete, Nature's Way, 180 Caps
NIACIN (NICOTINIC ACID - VITAMIN B-3): Niacin supplementation in the first trimester has been positively correlated in studies with higher birth weight, longer length, and newborn head circumference (all signs of healthier infants). Good food sources of niacin are wheat germ, fish, and garlic. Herbal sources are burdock root and seed, dandelion, alfalfa, and parsley.
Vitamin B-3 (niacin): 17 mg per day, RDA
Nursing: 20 mg per day
Food sources: wheat germ, fish, garlic
Herbal sources: alfalfa, burdock root and seed, dandelion, parsley
NAD, Niacin, 25 mg, NOW Foods, 60 Lozenges
Prenatal Multi-Vitamin & Mineral, 100% Natural & Complete, Nature's Way, 180 Caps
RIBOFLAVIN (VITAMIN B-2): Studies show that riboflavin depletion is common during pregnancy (up to 40% less at term than non-pregnant women and men), so riboflavin supplementation is recommended to prevent metabolic disturbances. Good sources of riboflavin are watercress and brown rice. Herbal sources include rose hips, parsley, saffron, dandelion, dulse, kelp, and fenugreek.
Vitamin B-2 (riboflavin): 1.6 mg per day, RDA
Nursing: 1.8 mg per day
Food sources: watercress, brown rice.
Herbal sources: rose hips, parsley, saffron, dandelion, dulse, kelp, fenugreek
Vitamin B-2 (Riboflavin), 100% Natural, 100 mg, Nature's Way, 100 Caps
Prenatal Multi-Vitamin & Mineral, 100% Natural & Complete, Nature's Way, 180 Caps
THIAMINE (VITAMIN B-1): Direct correlation has been shown between supplementation of thiamine early in pregnancy and higher infant birth weight and size, and thiamine depletion is common during pregnancy; supplementation is recommended. Food sources are green peas, bell peppers, and sunflower seeds. Herbal sources include dandelion, alfalfa, red clover, fenugreek, raspberry leaf, and seaweeds.
Vitamin B-1 (thiamine): 1.5 mg per day, RDA
Nursing: 1.6 mg per day
Food sources: bell peppers, green peas, sunflower seeds
Herbal sources: alfalfa, dandelion, fenugreek, raspberry leaf, red clover, seaweed
Thiamine (Vitamin B-1) HCl (Hydrochloric acid), 100% Natural, 100 mg, Nature's Way, 100 Caps
Prenatal Multi-Vitamin & Mineral, 100% Natural & Complete, Nature's Way, 180 Caps
VITAMIN B-6 (PYRIDOXINE): Vitamin B-6 is "marginally deficient" in about 50% of pregnant women. Supplementation has been linked to relief of nausea and morning sickness, especially in extreme cases that include vomiting. In one experimental study, 75% of women taking Vitamin B-6 experienced complete relief from symptoms of morning sickness. Higher doses were used for treatment of first trimester morning sickness (25 to 200 mg. 3x daily), but are not recommended before delivery, as higher doses may shut off breast milk in nursing mothers, or cause the baby withdrawal seizures if commercial formula is given that does not include enough pyridoxine (B-6). However, when given during labor, Vitamin B-6 may prevent many postnatal adaptation problems by increasing the oxygen-carrying capacity of the blood.
Local application of B-6 as a lozenge provided protection from dental cavities, which are more common during pregnancy. Supplementation may also prevent toxemia of pregnancy (preeclampsia). Food sources are wheat germ, egg yolks, peas and carrots. Pyridoxine is found in all whole grains.
Vitamin B-6 (pyridoxine): 2.2 mg per day, RDA
Nursing: 2.1 mg per day
Food sources: whole grains, wheat germ, egg yolks, peas, carrots
Vitamin B-6 (Pyridoxine), Nature's Way, 100 mg, 100 Caps
Prenatal Multi-Vitamin & Mineral, 100% Natural & Complete, Nature's Way, 180 Caps
VITAMIN B-12: The coenzyme form of vitamin B-12 is a very complex molecule containing cobalt, designated in humans as cobalamin, which is required for proper homocysteine metabolism. At least 12 different inherited inborn errors of metabolism related to cobalamin are known; low plasma vitamin B-12 levels have been shown to be an independent risk factor for neural tube defect in one study. Supplementation is recommended and may also help in prevention of anemia. Food sources are cauliflower and broccoli. Herbal sources are alfalfa, comfrey, miso, seaweeds, and catnip.
Vitamin B-12 (cobalamin): 2.2 mcg per day, RDA
Nursing: 2.6 mcg per day
Food sources: cauliflower, broccoli
Herbal sources: alfalfa, catnip, comfrey, miso, seaweed
Ultra B-12, NOW Foods, 4 oz.
Prenatal Multi-Vitamin & Mineral, 100% Natural & Complete, Nature's Way, 180 Caps
VITAMIN A: Daily doses of 40,000 units or more of vitamin A during pregnancy may be toxic, while doses lower than 10,000 units appear to be safe. A study of 22,000 pregnant women, those who consumed more than 15,000 units of vitamin A per day from food and supplements, or 10,000 units as a supplement, showed a significant increase in birth defects associated with cranialneural-crest tissue (several-fold higher incidents of birth defects). Most of these women consumed the vitamin A before the seventh week of pregnancy. Rat studies show a possible link to folic acid metabolism. Elevated levels of vitamin A in the blood have also been correlated with low birth weights.
Preterm infants have been shown to be deficient in vitamin A, which may predispose them to development of chronic lung disease. Healthy pregnant women who developed pre-eclampsia were shown to be deficient in vitamin A (but not beta-carotene). Pre-eclampsia is a potentially dangerous condition characterized by high blood pressure, swelling, and /or protein spilling into the urine. Supplementation with no more than 6,000 units of vitamin A is recommended. Do not exceed 10,000 IU daily during pregnancy. Beta-carotene, which has the same positive effects as vitamin A, has not been associated with toxicity or teratogenicity in humans or animals.
Plant sources of the nontoxic "provitamin A" beta carotene are organic fruits and vegetables, especially yellow and orange ones; for example, one sweet potato or one cup of carrot juice contains 25,000 IU of beta carotene.
Vitamin A: more than 6,000 IU daily is not recommended. Do not exceed 10,000 IU daily from all supplement sources.
Beta carotene: 10.000 IU
Food sources: yellow and orange fruits and vegetables
Herbal sources: alfalfa, cayenne, comfrey, dandelion, elderberries, lamb's quarters, seaweed
Vitamin A, 10,000 IU, 100% Natural, Nature's Way, 100 Softgels
Beta Carotene (Natural Dunaliella salina), Nature's Way, 100% Natural, 25,000 IU, 100 Softgels
Prenatal Multi-Vitamin & Mineral, 100% Natural & Complete, Nature's Way, 180 Caps
VITAMIN C: Vitamin C plays a vital role in the formation of collagen - a major protein found in connective tissue, cartilage, and bone, and is "chronically underdosed." It is essential to the nerves, healthy gums and teeth, and prevents infection. Although one study showed that women who took 5000 mg of vitamin C daily during pregnancy delivered healthy infants who developed scurvy (preg-rel. 528), this "rebound scurvy" is very rare, and the infant recovers quickly without treatment. Supplementation with vitamin C may be as effective as calcium for leg cramps during pregnancy. food sources of vitamin C are fruits (particularly citrus), green chilies, tomatoes, honey, cabbage, cucumbers, prunes. Herbal sources include elderberries, rose hips, parsley, dandelion greens, nettles, alfalfa, and cayenne.
Vitamin C: 70 mg per day, RDA
Nursing: 95 mg per day
Food sources: cabbage, cucumbers, fruits (especially citrus), green chilies, honey, tomatoes Herbal sources: alfalfa, cayenne, dandelion greens, elderberries, nettles, parsley, rose hips
Vitamin C Liquid, with Rose Hips and Bioflavonoids, Kosher, Natural Citrus Flavor, 1000 mg, 16 fl. oz., Dynamic Health
Vitamin C 1000 with Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps
Prenatal Multi-Vitamin & Mineral, 100% Natural & Complete, Nature's Way, 180 Caps
VITAMIN D: The absorption of vitamin D (as well as calcium, which vitamin D helps metabolize) is enhanced during pregnancy, and since vitamin D tends toward toxicity, supplementation should be "judicious," to prevent excessive amounts of it from spilling into the urine. Fish oil and sunshine are good sources of natural vitamin D, which benefits the development of good teeth and bones. Herbal sources of vitamin D are alfalfa and nettles; and, of course, sunshine!
Vitamin D: 10 mcg per day, RDA
Nursing: 10 mcg per day
Source: Sunshine
Food sources: fish
Herbal sources: alfalfa, nettles
Dry Vitamin D, 400 IU, Nature's Way, 100% Natural, 100 Caps
Prenatal Multi-Vitamin & Mineral, 100% Natural & Complete, Nature's Way, 180 Caps
VITAMIN E: Vitamin E status declines during pregnancy creating deficiencies, and fetal vitamin E levels are usually low. Lower plasma levels in the mother may be associated with increased risk of pre-eclampsia, as well as premature and low birth weight infants. (54) Supplementation has been shown to be effective in preventing habitual or chronic abortion. Good food sources are parsley, brown rice, and wheat germ. Herbal sources include alfalfa, rosehips, raspberry leaf, dandelion, seaweeds, and watercress (although watercress should be avoided in the first trimester).
Vitamin E: 10 mg per day, RDA
Nursing: 12 mg per day
Food sources: brown rice, parsley, wheat germ
Herbal sources: alfalfa, dandelion, raspberry leaf, rosehips, seaweed, watercress
Vitamin E, 400 IU, 100% Natural, NOW Foods, 100 Gels
Prenatal Multi-Vitamin & Mineral, 100% Natural & Complete, Nature's Way, 180 Caps
VITAMIN K: Necessary for bone metabolism, vitamin K (required by law in most states) is given to newborns in the hospital by injection in the foot immediately after birth, or a shot is given during labor, to prevent hemolytic disease in the newborn, characterized by anemia, jaundice, enlargement of the liver and spleen, and generalized edema. Naturopathic doctors recommend checking the pregnant mother's diet for vitamin K deficiency (to see if she is getting enough of the vitamin through her intake of squash and dark leafy vegetables), and adding oral supplementation of vitamin Kin the last month of pregnancy, if needed, rather than automatically giving the shots, which have been shown in some studies to link with childhood cancer.
Vitamin K (along with vitamin C) is effective in preventing the nausea and vomiting of early pregnancy, and may reduce the risk of intraventricular hemorrhage in premature infants. Some food sources are parsley and brown rice. Nettle or alfalfa leaf infusion or tea taken throughout the pregnancy will increase available vitamin K and hemoglobin in the blood; also helpful is kelp.
Vitamin K: 65 mcg per day, RDA
Nursing: 65 mcg per day
Food sources: parsley, brown rice
Herbal sources: alfalfa, nettles
Full Spectrum Vitamin K, Allergy Research Group/ Nutricology, 90 Softgels
Alfalfa, NOW Foods, 650 mg (10 Grain), 500 Tabs
Prenatal Multi-Vitamin & Mineral, 100% Natural & Complete, Nature's Way, 180 Caps
CALCIUM: Calcium is the only mineral whose requirement doubles during pregnancy. Low dietary intake is associated with pre-eclampsia, a potentially dangerous (but preventable) condition characterized by high blood pressure (hypertension), swelling, and/or protein spilling into the urine. Supplementation with calcium may reduce the risk of preterm delivery, often associated with pre-eclampsia, and may also prevent the hypertensive disorders of pregnancy. Calcium supplementation can also help to ease leg cramps during pregnancy.
Excessive levels of calcium in the body, however, can result in spillage into the urine and the increased possibility of kidney stones. Supplementation with calcium must be done with efficient forms of the mineral, such as calcium citrate or citrate/malate, which are the more absorbable forms. And attention must be paid to the relationship between calcium and other minerals, such as magnesium and zinc.
Raspberry leaf infusion contains calcium in its most absorbable form; also nettle infusions, fresh parsley, and watercress. Other food sources of calcium include milk products, (although consumption of these can lead to an allergic condition in the baby) dark green leafy vegetables, asparagus, and pumpkin seeds. Avoid bone meal or oyster shell calcium tablets, which have been found to be high in lead, mercury, cadmium, and other toxic metals.
Calcium: 1,000 mg per day if age 19-50, 1,300 mg per day if under age 18; may be able to use lower doses if using calcium citrate/malate
Nursing: same as for pregnancy
Food sources: asparagus, dairy products, dark green leafy vegetables, pumpkin seeds
Herbal sources: raspberry leaf, nettles, horsetail
Calcium Citrate / Malate Complex, Nature's Way, 500 mg, 100 Caps
Prenatal Multi-Vitamin & Mineral, 100% Natural & Complete, Nature's Way, 180 Caps
CHROMIUM, COBALT, & COPPER: These three trace minerals were positively associated in studies with higher infant birth weights, and supplementation is therefore recommended.
Chromium: 120 mcg per day, RDA
Cobalt: presumably as part of B-12, 2 mcg per day, RDA
Copper: 2 mg per day; RDA
Chromium Picolinate, NOW Foods, 200 mcg, 100 Caps
Chromium Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz.
Cobalt Ionic Mineral Supplement, Fully Absorbable, 30 +/- ppm, 16 fl. oz.
Copper Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz.
Prenatal Multi-Vitamin & Mineral, 100% Natural & Complete, Nature's Way, 180 Caps
IRON: Some researchers have concluded that iron supplementation is essential during pregnancy in order to maintain adequate maternal iron stores. But iron supplementation can exacerbate zinc depletion by blocking absorption of that mineral, so any supplementation should be warranted by tests that show a deficiency in the mother's hemoglobin, so routine iron supplementation during pregnancy is not clearly indicated.
If a woman gets sufficient iron in the first trimester of pregnancy, then studies show a definite positive association with infant birthweight and size (but not in the second and third trimesters. Good food sources are almonds, honey, beets (including greens), and high quality protein foods like egg yolks and organ meats (liver, kidney, heart). Herbs high in iron are nettles, dandelion, and alfalfa, as well as kelp.
Iron: 30 mg per day, RDA
Nursing: 15 mg per day
Food sources: almonds, beets (including greens), egg yolks, honey, organ meats (liver, kidney, heart)
Herbal sources: alfalfa, dandelion, nettles
Iron Ionic Mineral Supplement, Fully Absorbable, 20 +/- ppm, 16 fl. oz.
Alive! Whole Food Energizer, Multi-Vitamin & Mineral, w/Naturally Occurring Iron (No Iron Added), Nature's Way, 90 VCaps Prenatal Multi-Vitamin & Mineral, 100% Natural & Complete, Nature's Way, 180 Caps
MAGNESIUM: Magnesium deficiencies are associated with preeclampsia, and preterm labor. Supplementation must be in the first trimester to positively affect birthweight and size. Researchers think that magnesium may act by opposing calcium-dependent arterial vasoconstriction, and also prevent cell damage and death, making magnesium sulfate the "drug of choice" in the treatment of pre-eclampsia. In general, supplementation may reduce the complications of pregnancy and improve the health of the infant. In studies, magnesium-treated women had a 29.5% reduction in the risk of hospitalization, as well as a 37% reduction in per capita hospital days. Food sources are honey, almonds, barley, dried fruits, and potatoes. Herbs are dandelion, alfalfa, and watercress (avoid in first trimester), as well as dulse (seaweed). Magnesium-Calcium should be taken with 1 part magnesium to 2 parts Calcium (e.g., 250 mg / 500 mg)
Magnesium: 300 mg per day, RDA
Nursing: 355 mg per day
Food sources: almonds, barley, dried fruits, honey, potatoes
Herbal sources: alfalfa, dandelion, dulse
Magnesium Malate, 150 mg, 120 VCaps
Prenatal Multi-Vitamin & Mineral, 100% Natural & Complete, Nature's Way, 180 Caps
POTASSIUM: Potassium levels may be deficient in pregnancy, with lowest concentrations in women with eclampsia. Supplementation is recommended. Food sources are bananas, potatoes (especially peels), olives, bran, and green leafy vegetables. Herbs are nettles, dandelion, alfalfa, and chamomile.
Food sources: bananas, bran, green leafy vegetables, olives, potatoes (especially peels)
Herbal sources: alfalfa, chamomile, dandelion, nettles
Potassium Ionic Mineral Supplement, Fully Absorbable, 340 +/- ppm, 16 fl. oz.
Prenatal Multi-Vitamin & Mineral, 100% Natural & Complete, Nature's Way, 180 Caps
ZINC: Zinc is required for proper fetal growth and immunity. Plasma zinc levels decline about 30% during pregnancy, and low zinc intake is associated with spontaneous abortion and premature delivery, as well as complications and labor abnormalities. Low zinc was also associated with the specific complication of fetal distress, and may be associated with ONS abnormalities in infants, including neural tube defects, as well as low birthweight infants and toxemia of pregnancy. Supplementation, especially if zinc levels are low, is recommended to reduce the risk of fetal and maternal complications. In one study, complications during labor (vaginal bleeding, fetal acidosis, uterine inertia) were improved. Another study showed a lower incidence of pregnancy-induced hypertension (which is associated with pre-eclampsia and preterm labor). Some food sources of zinc are oysters, beets, broccoli, wheat germ, wheat bran, fish, and lentils; and watercress (not in the first trimester).
Zinc: 15 mg per day, RDA
Food sources: beets, broccoli, fish, lentils, oysters, wheat bran and germ
Zinc Ionic Mineral Supplement, Fully Absorbable, 100 +/- ppm, 16 fl. oz.
Zinc Lozenges w/Echinacea & Vitamin C, Nature's Way, 23 mg, 60 Lozenges
Prenatal Multi-Vitamin & Mineral, 100% Natural & Complete, Nature's Way, 180 Caps
BIOFLAVONOIDS: When women who chronically abort were placed on citrus bioflavonoids daily as soon as a period was missed, many stopped aborting. One study demonstrated that previously Rh immunized mothers treated with bioflavonoids during their pregnancy delivered babies who were less erythroblastotic than expected.
Bioflavonoid Products & Information Prenatal Multi-Vitamin & Mineral, 100% Natural & Complete, Nature's Way, 180 Caps
ESSENTIAL FATTY ACIDS (EFAs): Essential fatty acids have a unique role during pregnancy because of the rapid development of new cell growth, new tissues, and new organ systems in a developing fetus. Fetal development is associated with a high EFA requirement, and this supply is dependent on the amount and availability of EFAs from the mother.
Prostaglandins are also involved in the development and clinical expression of pre-eclampsia. These prostaglandins are modulators of vascular smooth muscle tone and platelet aggregation (blood platelets sticking together). Pre-eclampsia is characterized by increased vasoconstriction, frequently associated with increased platelet aggregation, reduced uteroplacental blood flow, and premature delivery. In a placebo-controlled clinical trial, a group of pregnant women receiving a combination of evening primrose oil and fish had a significantly lower incidence of edema. Evening primrose oil has also been shown effective in preventing pregnancy-induced hypertension (associated with pre-eclampsia and preterm labor).
There is some evidence that EPO, taken both orally and vaginally can be used to promote cervical ripening. Clinically, EPO supplementation during pregnancy has been found by practitioners of natural childbirth to be an efficacious method to stimulate cervical ripening during labor, and PGE1 is known to stimulate cervical ripening and hasten the progression of labor. Although practitioners using this supplement report no adverse effects, a retrospective trial comparing the oil to no supplement did not note a difference between groups and there was a suggestion that there was an increased incidence of premature rupture of membranes, labor augmentation, and assisted vaginal delivery in the evening primrose group.
The main food sources of essential fatty acids are raw seeds and nuts or fish. Whole and ground flax seeds or the purified flax seed oil are excellent sources of the two essential oils, linoleic acid and linolenic acid. Borage oil and black current oil can be taken in capsule form as nutritional supplements.
Maternal levels of omega-3 fatty acids, especially DHA, decrease during pregnancy. EFAs are components of breast milk and maternal levels may be reduced further in nursing women. For the fetus, a deficiency of EFAs, particularly EPA and DHA, may lead to a poorly developed central nervous system. EFA deficiency may also lead to intrauterine growth retardation leading to a lower whole body weight and slower growth of the brain. Supplementation with a daily complex of essential fatty acids and fish oils during pregnancy provides vital nutrients that supply the necessary EFAs for the increased nutritional and metabolic demand throughout the nine months of gestation.
Several trials have been conducted to study the effects of fish oil supplementation on the duration of pregnancy. In one such study, fish oil was investigated for its effects on pregnancy duration, birthweight, intrauterine growth restriction and pregnancy induced hypertension: 2.7 g/day of omega-3 fatty acid supplementation was compared to an olive oil and/or no supplement. The fish oil supplemented pregnancies lasted 4 days longer and birthweight was 107 gm greater. Fish oil also appeared to be related to a reduction in the risk of preterm delivery in those women who had a previous preterm delivery. There was no effect of fish oil on intrauterine growth restriction or pregnancy induced hypertension.
Although research clearly shows that moderate EFA supplementation is beneficial and safe for pregnant women, caution should be exercised when consuming large doses. Also, there may be some caution about increased fish intake due to the mercury content. Fish like shark, swordfish, king mackerel, tilefish and tuna have higher mercury content than other fish.
Ultimate Oil, Omega-3 & Omega-6 Essential Fatty Acids, Nature's Secret, 90 Softgels
Omega 3-6-9, NOW Foods, Organic, 16 fl. oz.
COENZYME Q-10 (CoQ10): Coenzyme Q10 is a fat soluble quinone occurring in the mitochondria of every cell, whose primary biochemical action is as a cofactor in the electron transport chain on which most cellular functions rely, making it "essential for the health of virtually all human tissues and organs." Plasma levels of this enzyme rise during normal pregnancy, reaching highs of 50% above normal by the 36th week. Decreased levels have been linked in studies to spontaneous abortion and threatened abortion, particularly before 12 weeks.
CoQ10, NOW Foods, 400 mg, 60 SoftGels
METHIONINE (SAM): Methionine is a component of many proteins, serving as a source of available sulfur for synthesizing both cysteine and taurine, crucial to cellular metabolism. Supplementation with methionine in mice reduced neural tube defects by 47%, and also positively affected birthweight and size.
L-Methionine, 500 mg, Plus B-6, 10 mg, 100 Caps
PHOSPHATIDYLCHOLINE (PC): PC is a primary component of lecithin, sometimes referred to as pure lecithin, from which dietary choline is derived. Dietary choline, after absorption by the intestinal mucosa, is metabolized in the liver to choline, a critical nutrient for brain and nerve development and function. In mammals, amniotic fluid has a ten-fold greater concentration of choline than that in maternal blood and at birth, all mammals studied have plasma choline concentrations much higher than those found in adults. When rats were supplemented with choline, the spatial memory of their offspring was permanently enhanced, they showed more accurate performance on both working and reference memory components of tasks. From these studies, researchers believe that choline is critical for optimal brain development, and therefore supplementation is suggested. Lecithin, a derivative of the soy bean, is needed by the brain to function properly, and helps to break down fatty cholesterol deposits in the body. Lecithin contains phosphorus and stimulates the metabolism. Lecithin is also found in fertile eggs, soy products and, in small amounts, in all vegetables which have been vine ripened.
Lecithin Vegetarian Granules, NOW Foods, 97% Phosphatides, Identity Preserved Non-GE, 1 lb.
TAURINE: Taurine is an amino acid found widely distributed in foods of animal origin (but not milk or milk products). Taurine is biosynthesized from methionine or from cysteine during the metabolic process, and disturbances in enzymatic reactions that take place in this process can lead to mental retardation. Vegetarian mothers who consume no meat products during their pregnancy, and therefore have a low-taurine diet, as well as others on a protein, methionine, or B6 deficient diet might be at particular risk. Although dietary deficiency of taurine has not been demonstrated to impact fetal development in humans, researchers recommend that vegetarian women who intend to have children optimize dietary levels of protein and B-6, since there is no taurine present in plants and vegetables. Meat-eaters are advised to eat only organic or "free range" animals, in order to avoid the high concentrations of hormones and pesticides found in animal products raised in farm "factories."
L-Taurine, Free Form, NOW Foods, 500 mg, 100 Caps
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Source: Pregnancy and the Use of Nutritional Supplements - Women's Health Update
Townsend Letter for Doctors and Patients, Jan, 2002 by Tori Hudson
Bibliography for "Pregnancy and the Use of Nutritional Supplements - Women's Health Update"
Tori Hudson "Pregnancy and the Use of Nutritional Supplements - Women's Health Update". Townsend Letter for Doctors and Patients. Jan 2002. FindArticles.com. 14 Jul. 2007.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PRACTITIONER IF...
You have bleeding (anything more than slight spotting) during pregnancy, please have it checked out immediately by your health care provider or midwife. This is an emergency! Call 911 and get to the emergency room if you are pregnant and symptoms of placenta abruptio develop. This may rapidly become an emergency condition that threatens both the mother and the baby.
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