Supplements for Pregnancy and Postpartum

Updated September 2006:

Hold off on the flax seed oil! There is some new evidence that flax seed oil may affect estrogen levels in some people, and no one seems to know exactly what that means yet. To be on the safe side, I'd switch to fish oil (not cod liver oil--too high in Vitamin A) until we get some more definitive answers about the flax seed.

I get a lot of email asking me about supplements I recommend for pregnancy and postpartum, particularly flax seed fish oil.

Remember: I am not a doctor. I am a medical hobbyist, and I tend to err on the side of not taking anything unless it's really serious (I've been working on the same small bottle of ibuprofin for about 5 years). So that means my list of recommended supplements is not that long. I do not recommend anything that isn't generally recognized as safe, but if you have any doubts, ask your midwife or doctor what she thinks about it.

Pregnancy:

1. Your prenatal vitamin. Duh, of course. But don't freak out if you can't keep it down or just forget to take it a lot sometimes. All the research shows that it's more important to take a vitamin and/or have a balanced diet in the months before you get pregnant. The baby takes from your body's stores, so you can still have a healthy baby even if you get hyperemesis and can't keep anything down for months. But you'll have more energy and you'll recover faster from the pregnancy and delivery if you can take your vitamin somewhat regularly.

2. Flax seed oil or fish oil. Taking an Omega 3 supplement prevents or eases pregnancy constipation, which alone is enough reason to take it IME. But taking flax seed or fish oil during pregnancy can also make your baby sleep better for the first few months postpartum. (The abstract to back that up is here. Thanks, Amy.) Consumption of flax seed oil can also prevent or alleviate depression, which is the unspoken symptom of pregnancy. I don't know how great the effect of the flax seed oil is on pregnancy-specific depression. Anecdotally, I was severely depressed during my first pregnancy (no flax seed oil) and only mildly depressed during my second pregnancy (with flax seed oil). There is also evidence that supplementing with flax seed oil or fish oil can prevent some types of premature birth (scroll down to "Omega-3s for Longer Gestation".

What's the difference between flax seed oil and fish oil? I don't think there is one in terms of results. But fish oil can give you vile burps (which some people say is alleviated by taking the capsules frozen or by taking them right before bed). Personally, I don't even want to think about fish burps, so I take flax seed oil capsules. If fish oil doesn't make you burp, feel free to take that instead. The dosage is 2-3 1,000 mg capsules a day (all together or separated, however you can remember to take it).

3. Chocolate. Eat chocolate. Please, for the sake of the children. The children! (FWIW, I absolutely disagree with Nigel Denby.)

Postpartum:

1. Flax seed fish oil. If you thought it was great during pregnancy, you'll be even more impressed with what it does in the postpartum period. It continues to keep you regular (v. v. important in the first few days postpartum). It continues to prevent depression (one movement in research on post partum depression thinks that PPD is caused by a lack of Omega 3s in the maternal brain because the Omega 3s are depleted during pregnancy to go to the baby). It prevents plugged milk ducts (so does lecithin, but why not take something that will prevent plugged ducts and PPD at the same time?). It will also keep your hairy shiny and your nails strong, and keep your cholesterol low.

Ther's no official dosage, so I just stick with 3,000 mg a day. If I skip a few days, I start to feel a little blue and a little plugged-ducty.

For more info on Omega 3s and amino acids in mood disorders (depression and bi-polar disorder in particular) check out Julia Ross's excellent books The Mood Cure and The Diet Cure.

If you are here because you have post-partum depression, please talk to your partner and your health-care provider. Flax seed fish oil capsules, regular exercise, and talking to friends can prevent PPD and cure mild PPD, but if you are having thoughts that you want to hurt someone (like yourself or your baby) or that you need to run away or that you are not worthy of being a mother, you have an illness that can be treated. It is not your fault. Don't try to "fix it" yourself. Tell your partner or a friend and they will help you get help. If you can't tell anyone in your real life, email me and I'll help you find someone near you to help you. You are the perfect mother for your baby, and you have a normal, easily-treatable illness. You won't have to stop nursing to get it treated, either.

2. Lots and lots of water. It flushes the excess fluids from your system and makes the swelling go down faster. It helps your body heal. It helps you make milk. It helps prevent constipation. It prevents fatigue. Make sure there's a bottle of water at your nursing station at all times. Water Duty is a great job for someone who wants to help you during the first week or so, but doesn't know exactly what to do (like a partner or MIL who has no experience with breastfeeding). Water Duty = making sure you always have a glass/bottle of water and a one-handed snack, and holding the baby while you go to the bathroom.

3. Oatmeal. No one is exactly sure why, but oatmeal increases your milk production. A bowl or two a day should help turn you into a fine dairy cow, and it helps keep you regular.

4. Your prenatal vitamin. Keep taking it to rebuild your body's stores so you'll have more energy and recover faster.

5. Chocolate. Helps stabilize mood, at least for me.

If you are nursing, stay away from mint in any form and red wine for the first few weeks. They inhibit milk production, so you don't want to ingest them until your supply is well-established.

As I said, I'm low-intervention, so the list is not that long. If you only do two things today, take your flax seed fish oil capsules and eat some chocolate.